Tummy Time: What You Need To Know with Dr. Matthew Badgett

Podcast Transcript

Molly Shroades:

Hi and thanks for joining us for this episode of the Health Essentials Podcast. My name is Molly Shroades and I'll be your host. It can be so exciting when you bring home your little one, but you might find yourself falling into a cycle of feeding, changing diapers and getting them off to sleep. You might wonder, when are we going to get to do something together? While you might be a ways off from playing a round of catch or doing an art project together, one activity that's on the horizon is tummy time. Today we're joined by pediatrician, Matthew Badgett to talk about what tummy time is and the purpose of it. Thank you so much for joining us today, Dr. Badgett.

Matthew Badgett:

Thank you for having me.

Molly Shroades:

So, let's just dive right in by talking a little bit about what tummy time is.

Matthew Badgett:

Well, it's as simple as tummy time is putting a baby or infant on their tummy for short periods of time every day to help train them. A little bit more long-winded of an answer is back when they realized that babies sleeping on their stomachs was increasing the risk of SIDS and we started having babies always sleep on their backs, back in the early 90s. Doctors started realizing there was a lot more plagiocephaly, which is weird shaped heads and then torticollis, which is neck getting kinked to one side in infants and that they weren't necessarily learning to crawl or roll over as quickly. And we realized that although we would always place babies on their tummies, with the Back to Sleep campaign, parents were completely avoiding tummy time.

              And we realized that that was meaning they were missing the chance to develop. They were missing the chance to give their skull pressure. They were missing the chance to turn their head in different ways. And so, it was creating a developmental issue and that some of the kids weren't developing motor skills as quickly when we weren't specifically talking about and advocating for tummy time. So, in the later 90s, we started putting in more specific guidelines and recommendations on how to do tummy time, what the advantages are. And there's been some research since that has shown that, sure enough, tummy time is going to lead to gaining milestones, like crawling, rolling over a little bit earlier. There's not even in the long run does it really help? But in the short run, it definitely helps the babies develop better. And more importantly, it is an early chance for interaction and play with your baby, which is a really important bonding activity.

Molly Shroades:

Yeah. That's interesting. I hadn't thought of it in terms of, by putting them on their backs for sleeping, that you were taking away that time on their stomach.

Matthew Badgett:

Yeah. And I think the early campaign, parents really got afraid of stomach sleeping to the point they avoided all stomach activities. Death rates dropped, which is the No. 1 concern. But, we also realized that we weren't giving the kids the appropriate developmental opportunity with tummy time that is different than sleeping and should be supervised.

Molly Shroades:

Awesome. So, OK, let's talk a little bit about what's happening to a baby's body when they're on their tummy. Let's talk a little bit about the purpose of tummy time.

Matthew Badgett:

Yeah. I mean, obviously, you're flipping them over. And the babies, especially in the beginning, they're going to spend almost all their time on their back. And so, it's forcing them to kind of flip their world upside down a little bit. Early on, they're not going to be able to do a lot. So, it's just going to be lifting the head up in order to lift it off the ground so they can look around. And that's actually really tiring for a newborn. They can't do it for very long. So, that's why we need to observe them. As they develop more, they'll have their arms out. They'll push. So, they'll start doing kind of a cobra pose or working on pushups and things like that. And in the long run, it's going to give them opportunities to look around more, try to move more, start to grab things, roll over, eventually crawl. And so, it's really training them for early motor skills that we're trying to get them to acquire.

Molly Shroades:

Yeah, awesome. I'm glad you brought up that they don't really do a lot in the beginning, because I think parents are always so excited, right? They're like, "Oh, I get to do something with my baby!" And then they lay them on the floor and realize that very little happens. Can you talk a little bit about for each age and stage kind of in those early days what you should expect to happen when you lay a baby on their tummy?

Matthew Badgett:

Yeah. So, the AAP recommends that we can do it as soon as the baby comes home. The problem is a lot of babies really can't lift their heads very much, if at all. And if they can, not very long. And so, really just putting them on their stomachs and making sure that their face isn't in the ground. And so, some recommendations are actually rolling up a small towel to prop up their chest, so their face isn't pushing down. But in the beginning, they're really just going to sit there. And they might cry. They might hate it. And be ready for that, because this is what a lot of parents say is that, "My baby hates tummy time." Some babies love it. Some babies hate it. To some degree, you kind of want to tough it out, make them suffer through it a little bit, challenge them, because it's going to push them to learn some skills earlier.

              But if your baby despises it, don't put them out there for 15 minutes. In the beginning, when they first come home, we're only looking for three to five minutes maybe. And if your baby really despises it, even one to two minutes is OK, just enough to challenge them. But even though they might hate it and might start crying, they're really not able to move their arms and push up with their arms. They're not able to roll over. So, they're really just sitting there. And especially when they first come home, they really haven't mastered just great eye contact. They can't see very well, because they're really nearsighted. So, they'll kind of respond to sound, but they're not even doing a great job of fixating on you if you're three feet away and trying to talk with them. But that's OK. That's really OK.

              As they get older, they're going to develop better head control. They can keep their head up longer. They might not need that towel to prop them up. They might be able to push up with their arms in the first couple months. And especially, one of the first things parents will notice is that their vision will get better, so they will start fixating on you, on making eye contact, maybe kind of interacting more with you when they're on tummy time. In the long run, somewhere in the four to six-month age, they might start to develop rolling over, both stomach to back and back to stomach. And that's really where they can start playing more. They'll also start to get the ability to push up more with their arms and be a lot more independent.

              And then, you can start introducing things like toys for them to grab. You can really start playing with them, because they just have a little bit more core strength. And they're a little bit more interactive. And then, in the later stages of that first year, six months to a year, everyone develops differently, but they're going to start play crawling or crawling, which is always a dangerous thing, because then they develop the ability to move and you have to watch that. And eventually, they'll use it as this kind of practice walking, where they'll try to crawl, push up and see what happens. And so, tummy time kind of slowly transitions into crawling, walking, play time as they develop. And it's kind of just an earlier introduction to it.

Molly Shroades:

No, that's interesting. One thing I'm wondering about is how early should you start this?

Matthew Badgett:

Yeah, like I said before, the American Academy of Pediatrics says, "You can start it as soon as they go home." So, those first couple days. However, babies should never be left alone face down, even if they're propped up. And that's the real concern, is that tummy time needs to be supervised. And so, you can't just put your baby on their tummy and set a timer and a walk away. You really need to keep an eye on them, because if they slip for whatever reason, or their face is down and they lack the ability, because they're too tired to lift their head up, they might not actually be able to breathe. And so, that's the real concern. So, you do need to be careful and you need to be observational. But, challenging them early on, this is something that is beneficial.

Molly Shroades:

Awesome. Now, one thing I kind of wanted to dive into that you mentioned, and I connected with, for sure, is when baby hates it, how as a parent to deal with that, because I think you try to put them down. You think you're doing a great job. And they're just screaming the whole time. What do you kind of tell parents to do to help get through that?

Matthew Badgett:

It can be hard. And some babies are nonnegotiable. Well, all babies are nonnegotiable. But, some of them eventually decide they're OK with it. But, shorter time periods instead of the three to five minutes that we should be pushing for, maybe just one to two. Once the baby's a little bit older, you can make more of games of it. But especially in those first month or two, they're really not going to be... If they're angry, they're just not interested. And you can push through it a little bit, but I wouldn't try to torture your baby, have them on their stomach for 10 minutes, because they don't like it. Just do really short periods of time. Try to interact with them as best they can. Figure out if it's kind of mood dependent.

              So, one recommendation is you should probably not right after a feed and after a diaper change, because their stomach's a little bit lower, so there's less pressure and they're less likely to spit up. But figure out if there's periods of the day where they're just more open to it. If they wake up after a nap, do they just have more energy and they're just more willing to entertain it? Or if you put them in tummy time when they're hungry, they're going to be extra irritable, because not only are they doing something that they don't like, you're also not feeding them. And so, you kind of have to figure out your baby's personality and when in the day, and when in their cycles, that they're going to be most open to it. But, sometimes still, they hate it.

Molly Shroades:

So, it probably shouldn't be a stressful activity.

Matthew Badgett:

No. No, it should not.

Molly Shroades:

Gotcha. Great, great. Yeah. That's definitely, I think first time parents, in particular, can get very anxious. They want to do everything right.

Matthew Badgett:

Yeah. And I think you always have to be careful, because the guidelines exist for a reason, but every baby has their own personality, their own likes and dislikes. And we can't fit them all into this very kind of overly sterile box that you should follow perfectly. It's hard to. And just being open to some flexibility is important and realizing that your baby's not going to like everything that the guidelines say that you need to do with your baby.

Molly Shroades:

Oh, that's such great advice for parents, because they want to check those boxes, for sure. Now, let's talk a little bit more about those kind of milestone developments, because that was really fascinating. You were talking about how it kind of transitions each step. So, when you're doing tummy time and you're going to start transitioning into crawling and walking, can you talk a little bit more about kind of how those muscles have been developing and how that's kind of helping getting them moving?

Matthew Badgett:

Yeah. So, when you think about crawling, for us it's, I mean, we probably don't crawl very much anymore. But, it's intuitive. We don't have to really think about it. But, in order to crawl, you have to be able to move the arms up and push down and pull forward. So you have to push into the ground and pull. And there's a lot of movement here. And so the first activity on that is really just being able to push and keep your body up with your arms. And so, tummy time is really going to develop that. You also need a decent amount of core to help stabilize during crawling. And then also using the legs, lifting the legs up kind of like a frog position and pushing down. And that also, the babies are just especially in the kind of three to nine-month area, they're going to be moving the legs and trying to pretend to crawl.

              And sometimes they can't figure out how to do it, because their core's not strong enough. So, their legs are, but because their core's not tight enough, they're still kind of dragging their stomach on the ground and not getting anywhere. And so just being on their stomach and figuring out how to slowly push their entire body off is going to help them develop a stronger core and do that. And just this repetitive activity is going to just make their muscles stronger, improve their nervous system, which really is the big challenge. It's not just the muscles. The nerves aren't connected well enough to figure it out.

              And also, as they get a little bit older, their curiosity is going to increase and their vision is going to increase. So they're going to see an object over there. They're going to be interested. Or they're going to see a sibling, or a parent that's calling their name. And so, they're going to be driven to try to get in that direction. And so, it's just that the continuous muscle training, but also the interactions during tummy time, that's going to help kids get ready to crawl.

Molly Shroades:

Yeah, it's kind of interesting thinking of tummy time almost as a baby workout.

Matthew Badgett:

Yeah. And it really is. I've made some comments that it's funny that during tummy time, babies will do a lot of yoga poses. There's just these named poses that we do with these exercises. And it's just what they did in their first year of life. And so it's just kind of interesting that these are these things that stretch and strengthen and improve the nervous system to get them ready to move in order to succeed later on in life.

Molly Shroades:

We talked a little bit about figuring out timing here. Should parents set a timer every time that they're doing it to kind of keep track of how long this is lasting each session?

Matthew Badgett:

Not necessarily. Some parents just like timers and that's OK. And the recommendations are three to five minutes, two to three times a day, pushing up to 20 or more minutes a day. And once they're a little bit older, once they're crawling, they're going to be on their tummies and crawling around for long periods of time every day. And so, once they get into the later half of that first year, they'll definitely be more longer. But, I don't necessarily like the idea of timers, because once again, it's that check-boxing that parents get really stressed out by. And so, if you're the type of parent who just finds check-boxing useful just to keep yourself organized, that's great.

              But if you're stressing out and judging yourself about not reaching metrics, and you feel like you're a bad parent, the timer's really going to be hurting you, because tummy time also shouldn't be stressful for you to hit your metrics. This is also time that you should be playing with your baby. And so, by putting the baby on their stomach, it's also time for you to remind you like, hey, it's just not about feeding, and peeing, and pooping, and sleeping. This is actually a time, that like, "Hey, I'm going to kind of play with my baby." And so, it should be a fun activity for you, too. And if really trying to hit these metrics and trying that 5-minute mark or that 20-minute a day mark is really making your day worse, don't do it.

Molly Shroades:

Absolutely. Now, let's dive into a little more about that play part of it and the enjoyment part of it. What are some things that parents can do to kind of promote the fun of tummy time for both them and baby?

Matthew Badgett:

Like I said, in the beginning, don't expect a lot and they'll slowly develop skills and improve. But, in the beginning you put them on your tummy and you're just two feet in front of them calling their name, smiling and waving so they make eye contact. And they'll figure out a social smile. They'll get their coos in. Later on, they'll start to giggle. And so that stuff. As they get a little bit stronger, you can find objects they like. You can put a toy out of their reach and they can try to grab it. You could try to have them track something, so you can just use your hands and move it around. And so, when their heads are up, they're moving their heads around. And you can get toys and stuff.

              But in the end, I think the most valuable is, it's that interaction, that playing. This is another chance if you have an older sibling, through the baby you, or a relative, or another kid, they can play with them. Obviously, keep an eye on them. But, just interacting with and waving. Another thing that you can do is that some parents will do tummy time on the parent's tummy with the parents laying back and the baby on top of them. So, it's a chance for physical bonding, but also the baby's on their tummy and that that'll make it more interactive, and you can talk with them, and all that stuff.

Molly Shroades:

Oh, cool. I didn't think of that as counting. I always thought it had to be on the floor, checking these... Well, of course, I say checking boxes. Figures!

Matthew Badgett:

But if it's tummy to tummy, it's still tummy time, so.

Molly Shroades:

Awesome. Now, I feel like I know the answer to this one, but there are a lot of products out there that promote like, "Oh, this will make tummy time fun," like, mirrors, and water pads, and fancy mats. Do you need any of that or are those just kind of playful bonuses?

Matthew Badgett:

They're playful bonuses. You don't need any of it. What really matters at the end of the day is just letting your baby experience it, and having healthy human interaction during tummy time, are going to be the most important tools. The toys certainly help and entertain them. But, babies are also entertained by small, simple things. And especially early on, in the first couple months, the toys, they're probably going to have almost no interest in. But later on, they might be more interested in it, might play with it more. Just make sure that the toys you're getting for are actually certified, safe and that they're recommended for the age group that you're providing. Because some of them are going to have small objects that could be dangerous and things like that. So, make sure you're actually getting infant safe toys.

Molly Shroades:

Gotcha. Yeah, there's all those things out there that are super cute, but it's like, do you need a padded tummy time mat versus a blanket on the floor or the floor?

Matthew Badgett:

Yeah, yeah, a floor. And as a pediatrician, some of the toys or things that I see parents bring, I'm like, "I did not know that existed in reality. That seems like it might be OK. I don't know if I would spend that money on that. But, if your kid really likes it, go for it." But yeah, like you said, a blanket or the floor. Make sure it's clean. But, a firm, harder surface is going to be better. Kind of like we were talking before with back to sleep. Don't put them on a pillow for tummy time. Don't put them on a couch that they can roll off of, or just get smothered in. You want something flat and firm. And that obviously, keep an eye on them. But hardwood is OK. Carpet's OK. A blanket on those things are OK.

              It really doesn't have to be anything fancy, especially in the beginning when the baby's not moving very much and isn't super interactive, you don't need a cool baby play area, with the gates and all this other stuff. It can be very Spartan and simple.

Molly Shroades:

Absolutely. Now, one thing I'm wondering as we talk about this is with all this activity, baby can get tired. What happens if baby falls asleep during tummy time? Should you wake them up and flip them over or just watch them carefully?

Matthew Badgett:

I wouldn't say you need to wake them up, because when a baby sleeps you should count that as a blessing. But, I would try to gently and quietly roll them back onto their back and let them sleep on their back. If you can get them to their crib, that's great. Let's say that your baby, as soon as you pick the baby up, they're going to be fighting, if they seem comfortable and warm, they can sleep on the blanket, on the floor, as long as you're keeping an eye on them. But, I would definitely get them off their stomach. But then, if the baby's sleeping, just take that as a victory.

Molly Shroades:

Awesome. Yeah. Oh, never move a sleeping baby if you can and help it, right?

Matthew Badgett:

Yeah.

Molly Shroades:

So, I want to kind of talk a little bit more about kind of working this into your regular schedule, making sure as a parent that you're trying to fit in tummy time, if it's working, and if baby likes it. How should you kind of integrate this into your normal life?

Matthew Badgett:

It's a complex question, because everyone's schedules are different. Some parents have it easy. The baby goes to daycare. And the daycare's like, "They hit all three check marks for tummy time today, so you're good to go." And you're like, "Great, I don't have to do anything tonight." You still should. But, other times it's like, where are you going to build into your schedule? And then here's the hard part is it's you're really held hostage to the baby's schedule. And when you finally figure out a system, they're going to change their schedule.

              So, that makes it tricky. But, figure out when in the baby's cycle, like I said, the one recommendation that I always see is after diaper change. So, the baby empties its stomach, but still awake. Can you play with it then? Depending on what your day looks like, if you're busy, maybe try to get one done in the morning, one around lunchtime, one in the evening. But, it really depends on your schedule. So, it's hard to say. There's no universal truth.

              The one thing that I would probably recommend against is, if we're trying to get our babies to sleep more at night, if it's time that we want to sleep, we should probably not do tummy time, because that's going to get the baby up and moving and get switched onto a more nocturnal rhythm. But, everybody's schedule's different and every baby's schedule's different. And so really, you need to figure out what is going to align up with you guys.

Molly Shroades:

Yeah, it seems like this is a really good bonding opportunity for you to kind of work in with your child.

Matthew Badgett:

Mm-hmm (affirmative).

Molly Shroades:

Awesome. Now, just as we wrap up today, I am wondering about any words of wisdom you can pass along to parents who maybe are getting frustrated with tummy time, or they're trying to figure out how exactly to make this work with their child that hates it. Any words of wisdom you can pass along for us?

Matthew Badgett:

Yeah, first of all, step back. Tummy time, I mean, has kind of always existed, but as a very prescribed concept is relatively new. I think 1996 or 1998 was when it was put forth in the guidelines. And other cultures do no baby time. And great news, their babies grow up. Their babies walk. Their babies talk. They're completely normal. So, if you do no tummy time, your baby will probably still be OK. So, if it doesn't work out, it doesn't work out. Babies are pretty resilient. And so, it not always going to work out. And don't judge yourself, because even if you're getting a little bit in, it's going to help them to develop quicker.

              But, we really lack the long-term research that five years out, are kids doing better if they did tummy time or not? Are they better at soccer when they're five if they did tummy time? We don't have that research. It's hard to do. And some research that we have tried to do shows that it doesn't make a huge difference in the long run. In the short run, it really does. And so it helps get those things rolling. But, if you're struggling, don't judge yourself. Accept that your baby is opinionated and work within those boundaries to do as much as you can. But, accept that we're finite in what we can do as parents and that we just need to make sure, first and foremost, that our babies are safe, in a good place and they're developing.

              And whether or not that involves tummy time for 15 to 20 minutes a couple times a day, or you get one to two-minute sessions and that's all you can manage, that's all good, because generally speaking, babies will keep growing. And maybe because you didn't do tummy time, your baby doesn't crawl until 10 months instead of eight. But, that's OK. Don't grade yourself on these report cards and check boxes, because although they're helpful, sometimes they can kind of shame us a little bit too much.

Molly Shroades:

Yeah, just do your best, right?

Matthew Badgett:

Yeah. Yeah.

Molly Shroades:

Awesome. Well, hey, thank you so much for joining us today and sharing your insights.

Matthew Badgett:

Thank you.

Molly Shroades:

To learn more, visit ClevelandClinicChildrens.org.

Audio:

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