Infant Development - It's more basic than you might think

Here's the scoop on Tummy Time and all those baby contraptions.......

Tummy Time - It's important, but do you really know why?
If you've become a new parent in the last several years then you've heard the term "Tummy Time."  But there's always this big question of what tummy time really is, the importance of it, and how to do it. 
Tummy time is essentially giving infants plenty of opportunities every day to play on their tummies in order to build strength in the neck, torso, and arms for the development of motor skills, such as looking up, turning the head, pushing up, rolling, crawling, and so on.  The whole reason for the campaign was in response to a major increase in the number of infants with plagiocephaly (or head flattening) and delayed motor skills, which was a result of the Back to Sleep campaign started by the American Academy of Pediatrics in 1992 in order to decrease SIDS.  Up until this point babies had been sleeping on their tummies, getting their tummy time naturally. Also, the market for baby contraptions, to make life easier for parents of course, hadn't started booming yet and parents just did with their infants what their parents had done with them which was to lay the baby on a blanket on the floor to play when the baby was awake and not being carried. It sounds simple and yet all this time to play on the floor is exaclty what babies need in order to develop their muscles and motor skills.  No new baby contraption is going to do that for them better than good old fashioned playing on the floor. 

An Overview of Typical Infant Development and How To Do Tummy Time
First, let's explore the normal pattern of motor skill development of an infant before we discuss how to mess with it. In utero, a fetus is in fexion (i.e. the fetal postion) and after birth their bodies still want to be in this position for a while. They feel safe and secure like this, hence the swaddling. But infants need to develop their muscles, and especially their extensor muscles after having been in flexion for so long. When you see a baby on their hands and knees with head up, this baby is using the extensor muscles in their neck and arms. So to get to this important milestone (i.e. crawling on hands and knees) infants have to go through a developmental progression, building upon new skills, and it looks like this:
* An infant first needs to practice lifting their head and holding it up while laying on their tummy (from birth)
* Gradually, strength is built up and the infant can hold their head up for longer and turn it side to side around 1 month
* Then they begin to push up on their forearms around 2 months
* Around 3 months babies then push up on their hands to lift the whole chest off the ground
* Between 3 to 4 months of age babies start to roll one way and then a month later they're rolling both ways
* Babies then coordinate these abilities to log roll as an effective means of getting what and where they want
* Combat crawling then begins around 6 or 7 months (pulling themselves along the floor with their arms)
* Rocking on hands and knees comes next and eventually crawling on hands and knees occurs sometime between 8 and 10 months; and from a developmental standpoint crawling on hands and knees is extremely important!
But none of this happens without plenty of opportunities to practice. Athletes don't spontaneously become good at a sport; they have to practice to build their skills and the same is true for every baby. When babies are spending hours lying on their backs in a crib and then the majority of their awake time in carseats, infant seats, swings, and other contraptions they are not getting the opportunities to build up strength and work on their motor skills. This is why tummy time is so essential and why your baby's pediatrician is always asking "are you doing tummy time?" The problem is that doctors don't always have the time to explain HOW to do tummy time and what happens if you don't. So here's a quick overview of

How To Do Tummy Time:
* Place your baby on their tummy on a flat, safe surface: in a crib, on a blanket on the floor, on top of your chest if you're lying down, or hold the baby face down position in your arms (like an airplane)
* Provide some interesting toys to attract your baby's attention and to get him/her to look up: mirror (Sassy makes a great mirror for tummy time and to hang in the crib), soft colorful toys, musical toys (but not too loud or over-stimulating), your face at the baby's eye level, and talk or sing to your baby
* Start out with a goal of 5-10 minutes and keep increasing the time as your baby tolerates it - as they get older and stronger babies will prefer to play on their tummies and can do so for 20 minutes or more at a time. Newborns may love this position and may even fall asleep. To make it easier you can roll up a hand towel and place it under your baby's chest below the armpits.
* Remember: this is hard work for babies and it is new to them - most don't start off liking tummy time because it takes a lot of effort (think: doing 100 situps a couple of weeks after giving birth). And I know no one wants to see their baby cry, especially first time moms, but I promise you that this is not hurting them, it's just that it's not fun for babies for the first couple of months. And when they really start crying and throwing their heads back because they're so mad at having to work this hard they are actually building up the most muscle then. So don't be afraid to go 30 seconds or so past this point of screaming (not whimpering) before you give your baby a break and a cuddle and then do this again a couple more times. Eventually your baby will build enough strength to play on his/her tummy for longer without hating it, but it can take a couple of months.
* Start doing tummy time a few times a day as soon as you get home from the hospital and then do it EVERYDAY. It doesn't always have to be in the same way; see the first bullet for different ways of getting tummy time in.  Doing it on your chest is sometimes how parents feel most comfortable doing tummy time with infants.
* Try to work doing tummy time several times a day into your routine (ex: for 15 min before every feeding or before nap times and bed time).  But it's also more simple than that - most times you are about to put your baby down so that you can have your hands free, put him on a blanket on the floor instead of in the infant seat; when you're holding your baby, hold her tummy-down in your arms for a little while so that she can try to look up to see things around her; when you and your baby are playing, put him in different horizontal positions so he's working on getting his head up (airplane, tummy-down over your legs with his head off to the side, etc).
* Keep the floor space safe: young infants are pretty immobile, but keep them safe from pets and siblings; older babies who begin rolling, combat crawling, and crawling on hands and knees should be kept safe from stairs, unsecured cupboards and drawers, unstable furniture, and choking hazards.

What's with all the Baby Contraptions? Are they good for babies?

 Todays parents, myself included, are being seduced by the fancy new baby contraptions that are advertized as essential for survival:  The carseat carrier (so you never have to take your baby out of the carseat for an entire 2 hour errand fest or dinner at a restaurant), the singing/vibrating/rocking/visually entertaining infant seats, the bumbo, infant swing, exersaucer, jumping contraptions, slings, infant carriers, co-sleepers...................  These are not all bad (the bumbo and johnny jump ups are the only two that should really be avoided), some are even great (like the slings and infant carriers) and the others are definitely a life saver and fine for your baby's development when used appropriately. But are these things really essential and what impact do they have on infant development?  And how are they interfering with tummy time?

Do they have an effect on development? And how necessary are they really?
The slings and infant carriers meant for wearing your baby (baby bjorn, ergo baby, etc) are great - they keep your baby in a fetal position and close to your body which is great for bonding.  As babies get bigger they can start to move their head around while in the carrier and work on head control in a safe and supported way.  These are also a much better option for transporting your baby during errands instead of keeping your baby in the carseat and using a carseat carrier the entire time.

The infant seats and swings are convenient for parents because it gives us a chance to have both hands free (even though after having a baby having the use of two hands at the same time almost feels a little like cheating), but they really do nothing to enhance the development of our children.  Although as long as babies aren't spending greater than 20-30 minutes at a time a couple times a day in these things (alternated with tummy time of course) then it's not going to impact their development.  The movement can also be calming for most babies and infant seats can be helpful to work on things like visual tracking skills, reaching, and bringing the two hands together.  But just keep in mind that extended periods of combined time spent in seats, swings, and carseats can increase areas of preferrential head flattening, especially for babies who do all of their sleeping on their backs. 

Tummy time mats and play gyms can be great for entertaining babies on the floor and encouraging them to engage in tummy time for longer, but be careful of what you're buying.  Don't buy items that are TOO over-stimulating with lots of bright colors, patterns, musical features, and obnoxious attachments.  Contrasting colors with a couple of patterns and simple attachments are best.  Look for tummy time mats with mirrors or visual toys that can be attached vertically so that it encourages the baby to look up instead of down.  Look for play gyms that have attachments/mirrors on the mat as well as hanging ones so that babies can use it to play on their backs as well as their tummies.

Bumbos - hmmmm... where to begin on bumbos.  Strictly from a developmental perspective I don't think that they are that great: they don't encourage a proper sitting position, they don't teach a baby to sit up independently, and can be dangerous if used inappropriately (i.e. unsupervised, on high surfaces, for extended periods of time, or with babies who are too young to have the necessary head and trunk control to use it).  When in the hands of a parent who uses it responsibly I think they don't pose an issue, but when used inappropriately I think bumbos have the potential to be a problem.  I did have one for my second child, but it wasn't used all that much; he wanted to be moving around on the floor anyway.  So bottom line is that they really aren't necessary (unless you have multiples you are trying to keep track of) and for all babies the floor is a much better (and cheaper) option.
Exersaucers are fine when used appropriately and for short periods of time.  Babies can be put in exersaucers starting when they have very good head control and good trunk control but may not be sitting independently yet (meaning they can sit up on their own when someone is supporting their hips) and can bare weight on their legs when someone holds them in a standing position - so basically around 5 months, depending on the baby.  The exersaucer needs to be positioned correctly: the legs should be low enough that the baby's feet are touching the bottom when sitting in the seat, but should be high enough that the baby can not stand up and lift his/her bottom up off the seat.

Johnny Jump Ups (or other jumping contraptions) are NOT good.  Walkers, which are no longer made, would be in this category as well (and exersaucers that are used incorrectly could also be added).  The reason being that these contraptions put babies in positions where they are putting too much weight and too much force on their developing joints before their bodies are really ready for it.  When babies get to the stage where they can bounce on their own while standing and holding on to furniture, and the bouncing is of their own accord, not enhanced by shocks, then it is developmentally appropriate.

Bottom Line - Keep It Simple

The great thing about development is that if you give your baby opportunities to move and explore, the developmental progression will occur naturally.  And unfortunately you can really mess with your baby's development by limiting these opportunities to build skills. So, the bottom line is that the floor is the best place for a baby to play and develop strength and motor skills (basically their only job besides eating, pooping, and bonding with caretakers).  Other than the baby items we discussed that are good, babies do not need all of these other contraptions in order to grow and develop; they've been doing it for centuries without them. In fact, some of these contraptions inhibit movement and keep babies just sitting passively (not good for development).  Plus, the floor is free and these baby contraptions are not. Limit the baby's sedentary time in baby contraptions; he/she should be spending more awake time moving, playing on the floor, or being held by a caretaker than not. Also, limit the use of things that passively entertain your baby (like TV and baby videos). You are your baby's best source of entertainment. So, keep it basic and allow your baby to do his/her job: move and interact with you!

**If you feel that your baby is not meeting developmental skills on time then you should speak with the pediatrician or seek a consult with a pediatric occupational therapist because early intervention is extremely important for helping a baby with a developmental delay catch up as quickly as possible and for preventing other developmental issues.**

I encourage readers to post comments about their own experiences with tummy time and any tips for other parents.