Monday, November 24, 2008

Why Tummy Time for Preemies - Part 1

Why Tummy Time?
Vickie Dakin PT

Have you ever heard your baby needs more tummy time? Probably much more than you want, especially if your child is premature ( a preemie). Why is it so important and what difference does it make? In my 30+ years as a pediatric physical therapist, I have recommended tummy time to hundreds of parents. However, before we discuss tummy time, let’s first talk about babies initial developmental hurtles.

In a typical full term newborn, the challenge for the baby is to move from a compressed ball like position into a fully extended position. Development generally goes from the head down and the first step is to achieve an upright head position against gravity. Once this is achieved, the head starts to turn to either side and the head gets higher off the surface. Pretty soon the arms are involved and the baby starts pushing up on their elbows and shifting from side to side. With each new developmental skill, the extension moves farther down the spine. The next step is pushing up on extended (straight) arms and getting the chest off the surface. Rolling is next and by the time a full term baby is 6 months old they have complete extension in their spine, their hips are fully extended and their shoulders are strong and stable. All of this can happen naturally, as long as the baby gets enough tummy time. But this window is brief, so it’s important to pay attention to tummy time early.

These days all too many full term babies are not getting enough tummy time. As a result, their development is at best choppy. But what about preemies? As you have seen with your babies, preemies generally appear weaker than their full term counterparts. They can and usually are weaker but more importantly, they are missing something called “physiological flexion”. Physiological flexion is that balled up position that full term babies have and it acts as a protection for them against gravity. This physiological flexion provides a structural support that allows the full term baby to move against gravity without collapsing into the surface. Think of it as a coiled spring, like the one you might find in an ink pen. If you hold it in your fingers at one end, you can push or pull it back and forth or right and left with ease. Release it, and boing, it jumps right back to vertical. Well, a full term baby is a lot like that spring. Baby can move his limbs in different directions via his muscles (against gravity) but the phenomenon of physiological flexion pulls him back to the curled position on its own. With effort (again, against gravity) baby moves away from the curl, but returns to his comfy balled up place with ease. For a preemie, it is different. He not only has to battle to move his limbs, but he has no naturally occurring curled position to return to. This missing physiological flexion causes much of the difficulty that premature babies have in early developmental skills. You may have noticed that babies in the NICU, unless they are well supported, tend to be stretched out with their arms and legs extended away from their body. This “flattened” position does not provide any leverage for the baby to move against gravity. Of course the earlier and the smaller the baby the more difficult it is to move against gravity.

Our challenge is to support the premature baby while helping them to build up enough strength to move against gravity. If you just placed a preemie on their tummy and did not support them, it would not help their development and it could make them feel even more helpless. That is where tummy time with a twist comes in. We will help the preemie get to the point where they can take on their own tummy time development and progress like their full term counterparts.

Before we move on, let’s talk about why preemies dislike tummy time.
1. Babies who spent a lot of time in the NICU are used to seeing a lot of action and tend to get bored easily. Preemies are nosy and want to see what’s going on. It is hard to see from your tummy
2. For many, tummy time is new and seems hard at first. The more premature they are the harder it will be because of the lack of physiological flexion
3. A babies sense of time is different from ours and they think they will be on their tummy “forever”

Important facts for parents:
1. Tummy time does not physically “hurt” your baby
2. Tummy time is the single most important activity for your baby and it will make the most difference for them over time
3. For the best possible outcome, 90 minutes of tummy time or more per day is the goal. It may take awhile to build up to 90 minutes. Consistency is the key.

In the next article we will begin the “how to” section to make tummy time fun and functional for you and your baby.

Homework: Practice getting your baby to stop crying if only for a few seconds before you pick him up. This is especially important while you are working on tummy time. We will discuss why in our next article.