The truth about tummy time

As mothers and fathers, we all want what is best for our baby.  In this day and age it is hard to always know exactly what that is.  When it comes to SIDS, Back to Sleep and tummy time, there are a few key things you need to know.  As a Pediatric Physical Therapist and mother of three, I have spent the last 11 years observing certain trends in the field with the way we now care for our infants.  This new way of thinking is directly related to the concerns parents have about SIDS and the recommendation for back to sleep.  It is important to realize how difficult it is to dramatically change one aspect of child care without having an impact on other areas.  This effect is currently being seen with the fear of SIDS, the Back to Sleep campaign and the advent of car seats, bouncers and other confining apparatuses. 

     It is vital to fully explain what SIDS is.  Sudden Infant Death Syndrome is a diagnosis given to infants who die unexpectedly in the first year of life with no known cause.  It is, therefore, not a disease process like cancer, but a lack of a known cause.  This diagnosis is given after three important requirements are met.  First, a complete autopsy must be performed to rule out possible causes of death.  Second, a death scene investigation must be performed to explore what circumstances surrounded the event.  Lastly, a complete review of the child’s and the family’s medical history is performed to rule out any genetic or other medical possibilities for the unexpected death.   If the cause is still not identified, a SIDS diagnosis is given to represent “We don’t know what the cause of death is.”  The current rate of SIDS is 0.5 in 1000 live births in the United States making it the third leading diagnosis of infant mortality. 

     In the early 1990’s, the Back to Sleep campaign initiated placing babies on their backs to sleep.  The preliminary data indicated that the program was successful.  What people remember most is “back to sleep”, but do not implement the other recommendations of the program.   With the diagnosis of suffocation quadrupling in the last two decades, a safe sleeping environment should be in the forefront of every parent’s mind.  In 2012, the National Institute of Health has launched an enhanced form of this program to continue the push to keep babies safe during sleep.  The new campaign is called Safe to Sleep and focuses on ALL sleep related deaths, not just SIDS.  The emphasis of the program is a safe sleeping environment for all infants. 

     A safe sleeping environment is one devoid of soft items like stuffed animals, pillows, thick, plush blankets or any other soft item that pose a suffocation risk.  It is one in which an infant sleeps alone in a crib or bassinet without other children or other adults.  An infant must not share an adult bed with an adult or with other children, especially other children.  Adult mattresses are too plush and soft for an infant to move around on due to insufficient muscle strength.  Co-sleeping with an adult or with other children poses the threat of overlay, entrapment and ultimately suffocation.  Along with the soft sleeping surface, couches and recliners must be added to the list for the same reasons of entrapment and suffocation.  Review boards are also finding apparatuses like swings, bouncers and u-shaped pillows dangerous to use without supervision.  Remember, suffocation and SIDS are NOT the same thing. 

     One area that has dramatically changed since the Back to Sleep campaign is the excessive use of car seats as a permanent residing place for infants.  Not only are car seats unfavorable to the development of an infant, they also contribute to rising diagnoses like torticollis (shortened neck muscles) and plagiocephaly (flattened spots on the head).  Car seats confine infants contributing to developmental delay and sensory integration issues as well.  What is more, a baby cannot develop proper muscle strength and integrate reflexes if he or she spends copious amounts of time strapped in a car seat or other similar device like a bouncer, or swing.  Car seats should be used only in the car.  It is not to say you cannot use these items at all, your baby just shouldn’t spend most of his or her time confined in one.  The best position for infant development is lying down exploring the world against gravity.  This can be done in a play yard or on the floor in a safe place.  Paramount to development is lying on the stomach.  Tummy time is essential for the development of the muscles that will eventually allow your baby to crawl and walk.  There is no time limit you should aim for during the day as you cannot give a baby too much opportunity for development in different positions.  Start small and build up the time each day.  As the baby becomes more comfortable, he or she will actually prefer to be on the stomach because it is a very functional position for movement. 

For more information on SIDS, the Back to Sleep campaign, Car Seats and more, visit or or follow on Twitter and Facebook @abouttummytime

For more information about the Safe to Sleep Campaign, visit

Stephanie Pruitt is a Pediatric Physical Therapist at the National Institute of Health Safe to Sleep Champion