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Wednesday, March 30, 2016

Importance of Tummy Time by Trisha Roberts

What is the big deal about “Tummy Time”?

 There is such a Buzz about that term—what does it mean and why are childcare professionals so adamant about it?

Crawling is Important for Many Reasons
Crawl, Baby, Crawl!

Tummy Time Builds Head Control and Strength
Prone on Extended Arms Position
Prone Positioning is Important to Development
Prone on Elbows Position

 The American Academy of Pediatrics started to encourage parents in 1994 to put their babies to sleep on their backs to help reduce the incidence of Sudden Infant Death Syndrome (SIDS).  “Back to Sleep” Campaigns have helped reduce the occurrence of SIDS, but therapists have seen an increase in children who do not like to be on their tummy at all!  Sometimes parents hear, “back” and block out the part, “to sleep”.

  • When a child is awake, they need to be placed on their tummy in order to develop extension through their body, leading to head and trunk control and the gross motor skills for crawling.  When a child gets to a prone on elbows position or prone on extended arms position, they experience weight bearing through their shoulder girdle.  This weight bearing facilitates the development of the shoulder joint leading to proximal stability.  If a child does not develop good proximal control (control at the center of the body), they do not have the stability and control they need at the distal end of their extremities, in this case their wrist, hands and fingers.  So a child who is not bearing weight consistently through their shoulders will have a more difficult time with fine motor skills like holding their bottle, holding and passing a toy from hand to hand, feeding themselves, and eventually coloring and writing.When a child gets into an all fours position (hands and knees), the same thing occurs at the hip joint—the muscles around the joint ‘firm up’ and prepare the hip to perform its task of stabilizing the pelvis and lower extremity. 

Crawling Builds Shoulder and Hips Strength
Crawling Develops Proximal Stability
  • If children are not placed in prone (on their tummies), they don’t develop good core control and they will be delayed in their crawling skills or not crawl at all.  Why is this a big deal?  I have had mothers say to me in a proud way, “My baby never crawled—they went straight to walking!”  Well, this is not really a thing to celebrate!  Crawling is a very important part of development.  It develops core strength and control as well as the control of the hips and shoulders, as previously discussed.  But it also develops eye acuity—when a child crawls they look down in front at their hands and then up and out to where they want to crawl.  This allows the eyes to develop the ability to perform close-up work and then adjust to focusing at a distance, which are skills necessary for classroom work.

Crawling Develops many skills
Looking Up and Out

  • Crawling is also a skill that requires the use of arms and legs together as well as the coordination of the left and right sides (bilateral coordination) of the body.  The right side of our body is controlled by the left hemisphere of our brain, and conversely, the left side of our body is controlled by the right side of the brain; reciprocal movement (alternating sides) is extremely important to develop the skills for walking and coordination. When we perform activities like crawling, we are using both sides of our brain.  A baby develops connections in the brain in the Corpus Callosum that allow this coordinated control of both hemispheres. These connections serve that child for their entire life!  In fact, more connections are formed in the first year of life than at any other time in a person’s life. When a child doesn’t crawl, less connections are formed; non-crawling children are often clumsy and uncoordinated, even as adults.  They have more difficulty with left-right skills, like writing, reading, and most sports, as almost all sports require the coordination of both sides of the body and crossing mid-line.
  • When a baby is on their tummy, they are getting sensory input through their entire ventral surface (front side)—their skin is in contact with the floor and they are taking in information and learning about their world. Tile is hard and cold.  Carpet is soft and giving. A blanket will bunch up and form a lump under their tummy.
    Tummy Time Sensory Input
    Great Sensory Experiences in Crawling
  • Babies who are frequently placed in an infant seat, baby carrier, car seat, bouncer, Exersaucer, walker, etc. do not develop the same skills as readily as a child who is allowed to move freely on the floor.  Many parents think that it is better for their children to have all of these ‘great’ pieces of equipment to use, but the opposite is true.  As a therapist, I often refer to these children as “Container Babies”—kids who are moved from one type of restricted seating system to another and not allowed time to move and explore with their whole bodies.  I have visited Daycare Centers that use walkers and Exersaucers on a regular basis to help “protect” from more active toddlers or aggressive kids or control children and “keep them from getting into trouble”. Children certainly need to be protected and kept from harm, but confinement in a ‘container’ is not the way to achieve this!
  • Frequently parents or daycare workers will point to all of the wonderful toys and gadgets attached to a seat or saucer and say, “See—they have all kinds of great things to play with.” Or “Look—my 4-month old is standing!”  These are not good things!  Playing with a toy is wonderful, but when a child is only allowed to play with a toy in a restricted, confined space, they are not getting the full benefit of play.  When a child is placed in a walker or Exersaucer at an early age, they tend to develop increased extension through their trunk and lower extremities and frequently rise up on their toes, which can lead to poor muscle tone and oftentimes, to toe walking. Children don’t develop good control of their “core” musculature when constantly supported in a walker or saucer.  I am not saying that you should never use a walker or an exersaucer, but the time in these devices should be restricted to no more than 10 or 15 minutes at a time once or twice a day.  I have seen children placed in an Exersaucer in front of a TV screen for hours at a time!  This is NOT good!
In my next Blog, I will focus on:


Author:  Trisha Roberts

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  1. Wow! I didn't know that crawling was so important. My daughter used a walker when she was young, not exclusively, but she didn't crawl much. I must say that today, even as an adult, she is still somewhat uncoordinated. Maybe there is a correlation. Good thoughts to ponder.

  2. As a Physical Therapist, I wish all of my parents of new babies would read this! Nicely explained!