August 21, 2018


Babies need more than tummy time to strengthen necks and prevent flat heads.

File 20180815 2894 1un5fq3.jpg?ixlib=rb 1.1

Tummy time is important for strengthening infants’ necks, but it’s not all they need.
from www.shutterstock.com

Elizabeth Williams, University of Melbourne and Mary Galea, University of Melbourne

Supervised, awake tummy time is recommended to facilitate a baby’s development and minimise flat head syndrome.

But some babies don’t like tummy time, and will kick up an almighty fuss to let you know.

Luckily, tummy time is not all you can do to get your baby moving.

What is flat head syndrome?

Flat head syndrome, or “plagiocephaly”, occurs when the baby’s soft skull can mould and cause a flat spot at the back of the head, or a bulge at the forehead. This is due to gradual pressure on the back of the head from the baby lying on that spot as the head grows rapidly.

Plagiocephaly is surprisingly common, affecting 46.6% of infants at 7-12 weeks and 50% at six months. One study found 80% of infants were considered normal by five years of age.

In more severe cases, the baby may be prescribed an orthotic helmet; but this is controversial and parents have reported problems such as child stress and high costs. In 2014, a randomised controlled trial discouraged the use of helmets, but the same year a study reported 95% improvement in asymmetry with helmet therapy.

Studies have shown three-year-olds with plagiocephaly had statistically significant delays in cognitive, language and adaptive behaviours. Another study of three to five year-old children found postural changes and poor balance compared to children without flat head syndrome.

A systematic review of flat head syndrome and developmental delay concluded flat head may be a marker of developmental needs requiring early intervention.

Just tummy time isn’t enough

Supervised tummy time, or rolling the child onto their stomach, has long been recommended, although currently there are no national guidelines regarding the frequency and duration of tummy time an infant should receive.

Tummy time helps strengthen babies’ necks. It gets them off the back of their heads where flatness can occur and leads to strengthening of the extensors (straightening muscles) in the back of the neck, which hold the head up when babies are on their stomachs.

Some research found tummy time alone is not enough to prevent flat heads. In addition to tummy time, parents should encourage “face time” to strengthen the muscles at the front of the neck to enable baby to move their head while on their back.

Face time is challenging for the baby as it requires the flexor (curling up) muscles to coordinate the head to lift it forward towards you, and against gravity.

Face time can be done when baby is awake by supporting them in front of you “face to face” and engaging them with direct eye contact. If they are happy and settled they will follow your eyes to the side and, if you keep eye contact, turn their head to see you.

Even newborns will be able to move their heads from side to side to keep your eye contact.
from www.shutterstock.com

Previous studies have shown reduced plagiocephaly rates when parents prepared the environment to allow free and spontaneous movement (such as placing the baby on a mat when they’re awake), when infants spent less time in carriers, and when parents were aware of the infant’s head position. This research adds specific advice for active head movement that can become part of daily activities.

Head control fact sheet (detail) – Royal Children’s Hospital

Both tummy time and face time can be started from birth. Tummy time can be face time as well if you lie down with them on your stomach. When they can hold their head up themselves in tummy time they can go on a mat with some toys for short sessions.

If they’re upset, get down and play with them to see if they settle, otherwise you need to pick a better time when they are active and awake.

What parents should know

It’s important to follow safe sleeping advice, which specifies a baby should sleep on their back. Along with this, parents should interact with their baby as in the above illustrations and know:

  • even newborn babies can move their head to each side by following their parents’ eye contact or their voice and they should be encouraged to do so
  • from birth, babies need both tummy time and face time when they are awake and happy
  • baby’s head should be supported until they can hold it themselves.

The Conversation

The best way to encourage babies to be more active is to play with them, provide tummy time and engage face to face with eye contact, smiles and talking, from birth.

Elizabeth Williams, PhD Candidate, University of Melbourne and Mary Galea, Academic Director, Australian Rehabilitation Research Centre, Royal Melbourne Hospital,Professorial Fellow, Department of Medicine (Royal Melbourne Hospital), University of Melbourne

This article was originally published on The Conversation. Read the original article.

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  • A friend’s son hated tummy time as a small baby but now at 18 months old still occasionally rolls over onto his stomach with his legs up under him like in the diagram. She put her older son in the middle of their queen size bed one day while she was drying him after bathing him. As soon as she finished drying his back he rolled from his tummy onto his back. His Mum got such a shock she though she had imagined it the first time he did it. He was only 2 months old when he did it.


  • My youngest had quite severely plagiocephaly, because while laying on her back she always turned her head to the left. Her neck became stiff and it was as if it was on lock. This needed correction and we had physiotherapy for about a year. It’s all good now :)


  • The first child is always the hardest for tummy time, but once there are other children the head is swivelling all the time to stay in touch with their siblings.


  • Of course they do. Like any human, we don’t lie in one position for months at a time.


  • They just want to see the world around them.. Mum tells me I preferred tummy time and have been reasonably lucky.


  • Mine hates tummy time so we always did it being held.


  • We do tummy time almost from birth (on mum or dads chest) in addition to face time and rotated sleeping positions to help keep bubs head rounded and symmetrical. The stronger those neck muscles are the better.


  • My son loved tummy time and we also held him on our chest to encourage him to use his neck


  • My baby hates tummy time when she was smaller, so we did adjusted ‘tummy time’ by laying her on our chests or sitting her upright in front of us.


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