Sunday, February 1, 2009

Why Tummy Time for Preemies - Part 3

Why Tummy Time for Preemies?
Part 3
Vickie Dakin PT

Welcome to Part 3 of why tummy time for preemies. I hope you took the time to do the homework from Part 2. Let’s review the homework.

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 is usually a nice surprise.

By now you know your babies adjusted age and are ready for the next step. Why is the adjusted age important for tummy time? The reason is that tummy time changes and evolves as the baby grows and develops. Knowing your babies’ adjusted age will give you a clear place to start.

Getting an early start. As we discussed in Part 1, the easiest way to be successful in tummy time is to start right away. In fact, if the NICU is not working on tummy time, you can ask them about it. There may be medical reasons for limiting tummy time, but ask to find out.

There is one more thing to mention before we talk specifics, the surface. The surface where tummy time is done is very important. Ideally the surface is firm with some give. A closed cell foam mat can be very helpful, especially for preemies because it stays “neutral warm” where vinyl, etc. can get rather chilly. Please do not use comforters, they are too soft and slippery for the baby to get any traction. If you have questions about surfaces or other tummy time questions, please contact me at

General Guidelines:

Below 0 to 1 month adjusted: This is a period of supportive positioning and gentle encouragement. Our goal during this period is to recreate how a full term newborn infant looks. Position your baby with their arms flexed and tucked into their body and their legs flexed up under them. Use towels, blankets or special equipment like Bendies to help your baby maintain the position. Start with short periods of time up to 5 minutes initially. Great activities during this period are patting the babies back while talking softly or singly soothingly to them. The goal during this period is to have the baby start lifting his head from the surface and beginning to turn their head from side to side.

1-2 Months Adjusted: During this period in a full term baby, there is less flexion (tucked in positioning). The baby is pushing up on their elbows, but the shoulders are still in front of the shoulders. For preemies, allow the legs to be away from the body. You may need to support the arms under the baby, but do not place the elbows directly under the shoulders. Encourage the baby to lift their head and turn it from side to side. Toys with bright colors and sounds like rattles are good toys to use at this time. Use simple toys without loud sounds. One technique that works well is to use a rolled up blanket or towel. Roll it tightly to the size that it fits under the arms and across the chest for support, but it allows the elbows to be on the surface. The towel takes some of the weight off and allows the baby to stay longer on their tummy before tiring.

3 months adjusted: At 3 months a full term baby is starting to push up on extended (straight) arms briefly. The shoulders are now aligned over the elbows and the baby is much more active. This is the time to start encouraging the preemie much more. Place them on their elbows on their tummy (prone on elbows) or (if they can) encourage them to push themselves up. Blow bubbles, sing songs, use toys with lights and sounds to increase the amount of time they tolerate prone (tummy) lying. Remember, preemies get bored quickly without stimulation. Once they can stay up on their elbows for 5-10 minutes, help them push up on extended arms (prone on extended arms). They will only do this for a few seconds at first.

4-5 months adjusted: At this time a full term baby is getting quite active. Rolling occurs by the end of this period. The baby also starts something called pivoting in prone, which is staying on the tummy but turning their body in a circle. This is important because by turning their bodies in a circle, they are learning all the motions they need to crawl on their bellies and later creep on all fours. During this time continue to encourage the prone on elbows and prone on extended arms. While they are on their tummy, encourage them to follow a toy just out of reach. Help them as little as possible, but allow them to get the toy. Keep working on this skill until they can go all the way around in a circle in both directions. This may take several months to fully achieve.

6 months adjusted: Six months is an exciting time. The baby can sit briefly once placed in sitting. ( They will not get into sitting by themselves until 9-10 months adjusted.) They will also get themselves into all 4’s and rock. This skill is very important, but can be difficult at first for preemies. Help them get into all 4’s and support them as much as necessary. Assist them to rock forward and backward. I like to sing/chant “giddy-up Johnny, giddy-up” or something similar to help them get the rhythm of the activity. This activity is difficult, so just rock 3-4 times at a time and stop. Keep practicing this activity until you see them do it without your help. Although it looks like they will creep in all 4’s soon after learning this skill, it usually takes until they are 9-10 months adjusted to be able to creep in quadruped.

By 6 months adjusted the work of “tummy time” is over. All the muscle are fully stretched, activated and strengthened. The shoulder blades are stable which makes using the arms more effective. The ribcage has moved down in the chest and stabilized allowing breathing to be more efficient and effective, which is especially important for preemies. With the basics of tummy time mastered, the baby is ready to take on the challenges of mobility. Congratulations mom and dad. Without you we’d have never made it. Oh yes, and to the little one, “Good Job!”

But please remember, every baby is different and preemies can be especially challenging. If you have specific questions about your preemie, contact me at