Sunday, December 28, 2008

Tummy Time for Preemies Part 2

Why Tummy Time for Preemies?
Part 2
Vickie Dakin PT

Welcome to Part 2 of “Why tummy time for preemies”. I hope you had the opportunity to do the homework from Part 1. Let’s review the homework.

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.

This exercise may be the hardest, but most effective activity you do with your baby. Why is that? First of all, let’s think about premature babies who have spent time in the NICU. To survive the NICU, they have to be tough and they have to find ways of getting us to meet their needs. As a result of this extremely significant need, (it’s a survival skill, really) they can become experts at controlling and calling the shots. Crying is one of the skills that allowed them to survive, but there is just one problem, they do not know everything they need. But they do know what they do (or do not) want. Unfortunately, their wants and their needs are not always the same and that’s why they need us. Crying is the best and most effective skill in their arsenal and this bit of knowledge they learn very quickly. As parents, therapists and caregivers, we do not like to hear them cry. True, the sound is unpleasant, but most importantly it’s frightening. This is especially true with preemies because we worry about burning calories, throwing up, discomfort, breathing issues, and many other things that are some what less worrisome with full term infants. Our first inclination then, is to immediately pick them up and ask “why” later. Before long, the baby has us trained to pick them up at the first cry. In many cases picking them up does not create a problem, but with tummy time, it can be disastrous. Before we go on, let me remind you of a few important facts:

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.

You as caregiver know how important tummy time is and that your child needs it. Your baby doesn’t. Often when they cry it is just communication such as “What am I doing here; I didn’t ask for this” or “This is boring; get me out of here”. I am not asking you to ignore your babies cry. I am asking that you find a way to separate the connection between tummy time and being picked up. If you fail to make this disconnect, then baby will “learn” that to avoid tummy time, he need only cry. Remember, as we discussed earlier, babies can’t distinguish very well between what they need and what they want.

These are a few ideas that have worked for me and many parents:

• Try distraction; use toys, music, talking, other children to distract the baby either so they can stay a while longer or so you can pick them up when they are not crying.
• Pat their back and talk soothingly to them
• When nothing else works, roll them onto their side (preferable) or to their back. Try again to stop the crying. Then after at least 1 minute, pick them up even if they are still crying. The change in position has broken the link between crying and being picked up.

These techniques really work. If you can get everyone who interacts with your baby to follow the same rules consistently, the worst will be over in 2 weeks. Once the baby realizes the benefits of tummy time, they will enjoy it.

One word of advice, don’t try letting them cry for long periods of time. Preemies can outlast us, they are that tough. Eventually, you will pick them up and they will have just learned they just have to cry longer to get their way. Besides, our goal is to get them to like tummy time.

There is one more thing we need to discuss before we get to the “how to” of tummy time and that is age. With preemies, they have 3 ages, an actual age, a gestational age and an adjusted age. The gestational age is how many weeks was your baby in the womb before they were born. The adjusted age is how early your baby was compared to a baby born at 40 weeks gestation. To find your child’s adjusted age subtract their gestational age from 40. For example, if your baby was born at 28 weeks gestation, subtract 28 from 40 which leaves 12 weeks. Divide by 4 and get 3 months early.

Why is this important? If your baby is 3 months early, it is not fair to expect your child to perform 6 month old skills at 6 months of adjusted age. As a general rule, a baby’s age is adjusted for the first 2 years of life. In other words, a 9 month old baby who was 3 months early would be expected to act like a 6 month old baby. A premature baby “catches up” and by 2 years their skills are generally like a full term 2 year old. Often the area of gross motor development is the slowest to catch up and that is the area most greatly influenced by tummy time.

Now that we have the necessary background information, our next installment will start the real work.

Homework: Think about why this idea of adjusted age is important in tummy time. Figure out your babies’ adjusted age and see how your baby compares to other babies at that adjusted age. It’s usually a nice surprise.


Tessa Lou said...

Thank you so much for providing a resource. We are having a hard time finding adequate information to reference where Jasper should be. He was 8weeks early and in NICU for 5 weeks. Now that he is 6 months old our Pedi just recommended PT. I fear that we are behind. Can you recommend any books that would help us?

Vickie Dakin, PT said...

Dear Tessa Lou,
Thank you for you kind comment. There are a few books and the easiest way to find them is to search on Amazon. It is hard to find good motor books on preemies. It is great to get PT though and they will help a lot. Remember you want to subtract 2 months from his actual age and base your expectations on his adjusted age. Tummy time is probably the best thing you can do for your son right now. The goal is to work up to 90 minutes a day.

Anonymous said...

Hi , I am surprise to know that it needs to be at least 90 minutes tummy time... does the baby needs to be awake the whole 90 minutes.. My baby is 32weeks and 5 days when she was born.. I think she likes tummy time, but she always fall asleep after 10 minutes. so i pick her up again and sleep her on her back..

Vickie Dakin, PT said...

That was a good question. Your baby is still not full term. 90 minutes is the time you work up to. At 32 weeks they will sleep a lot. Encourage as much tummy time as you can when the baby is awake. Its great that she likes it. Good luck.

Vickie PT

Anonymous said...

thank you so much for the information you gave. This is really helpful. I had a preemie daugther, now she's 4mos. old. She's only 31weeks when i delivered her and not confined in NICU. The doctors had to observe her for 1 week together with the full term babies and after that we took her home. And i thank God that she's healthy and strong. sometimes i worry too much eventhough they say to expect some delays on her development. Can't help myself not to worry. At four months she can hold her up and likes to watch tv. she likes to be held on a sitting position. is it ok that whenever i hold her hands she's pulling herself up?

physical therapist schools said...

I just wanted to add a comment here to mention thanks for you very nice ideas. Blogs are troublesome to run and time consuming thus I appreciate when I see well written material. Your time isn’t going to waste with your posts. Thanks so much and stick with it No doubt you will definitely reach your goals! have a great day!

Physical Therapy Ho-Ho-Kus said...

I will do the beneficial exercise with my baby. I think the exercise will increase him body strength. Thank you so much for sharing the informative article.