Q&A: Tummy time—when do I start? How do I do it?

According to the American Academy of Pediatrics (AAP), the safest position for your baby for sleeping is on her back. This recommendation was put into effect in 1994 and as a result, the incidence of Sudden infant death syndrome (SIDS) has decreased by as much as 40 percent.

With babies spending more time on their backs, pediatricians have noted an increase in cranial asymmetry, or misshapen heads. Babies' skulls are still somewhat soft, and constant back positioning with no break can sometimes cause a flattening effect on the back of the head.

Tummy time literally gets babies off their backs. It provides a break for the occipital area, or back of their heads, and gives babies a chance to strengthen their neck muscles to prepare them for crawling. It also helps them to get ready to push up, roll over, sit up, and eventually stand.

The Benefits of Tummy Time
Tummy time helps with both fine and gross motor development:

• Once on their tummies, babies tend to kick and flail, working their large motor muscles. Later, rolling onto their tummies will help babies strengthen neck and leg muscles.
• Babies on their tummies tend to grasp at a parent's shirt or blanket, encouraging fine motor development.

What Tummy Time Looks Like
There are multiple forms of tummy time:

• Hold Baby on your chest while you're reclined or lying flat.
• Place Baby on a firm, safe surface, such as a blanket on the floor.
• Hold Baby on your forearms (as opposed to a traditional cradle hold).
• As your baby gains more head control, try using a nursing pillow or blanket to prop her up on her tummy.
• Try using an exercise ball to help make it more fun: Place Baby on her tummy on top of the ball. While supporting her with your hand on her back or bottom, gently roll the ball lightly forward and backward.

It helps for you to lie down on your tummy and interact with Baby. Talk to, play with, and be silly with your child! A common tummy time problem is that Baby becomes frustrated with being simply placed on a blanket on the floor. So instead, make faces, sing songs, play with toys—you'll have more fun and this will keep Baby from getting fidgety. If you have older children, make sure the baby is safe from getting stepped on by a busy sibling!

If Baby falls asleep during tummy time, do not leave him unattended on his tummy: Place him on his back to continue sleeping.

How Much Tummy Time and When
The current recommendation for time on the tummy is approximately 30 minutes a day, either all at once or broken up into short segments ranging from a few minutes to longer.

Engage Baby in tummy time when she's content and alert. It is important not to insist on it if she's fussy: Forcing the issue will cause Baby to negatively associate this tummy time with being unhappy. Try again later when Baby is calm and willing.

Monitoring Baby's Tummy Time Progress
Some pediatricians have seen slight delays in typical motor milestones due to the change from tummy sleeping to back sleeping. Today's average baby will learn to:

• sit and roll over (from tummy to back and back to tummy) between 4 and 7 months
• crawl between 8 and 12 months
• walk around 11 and 13 months

Notice there is a wide range of several months for each milestone. This means you shouldn't compare your child's growth to another child's development. If you have concerns, talk to your little one's pediatrician.

During regular check-ups, your pediatrician will examine Baby's head. If he notes any flattening, he will determine if adjustments need to be made to how you are regularly positioning your baby . Occasionally some babies will have to wear a helmet to help reshape the head if there is significant flattening. If you have concerns or questions, talk to your baby's doctor. (Read more about the importance of tummy time for Baby's developing head.)