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


Anonymous said...

As a fellow PT, I have to admit I haven't spent much time working with kids until recently becoming a parent.

I'm really enjoying your posts. Please keep them coming.

Vickie Dakin, PT said...

Thank you so much. It is great to have a peer enjoy my contribution. How old is your little one?

Jen said...

I had a preemie at 31w6d. I was not told of the importance of tummy time at the hospital, nor has my baby's pediatrician asked me about it yet. BTW, my little one is now 4 months old. I have another child and at 2 months (my baby boy's current adjusted age) she was able to lift her head and shoulders off the floor for several minutes at a time. My boy cannot do that; he cannot even lift his forehead off the floor.
Anytime I try tummy time with him (on the floor with a thin blanket under him), he pushes his face into the blanket and curls toward the floor. Sometimes I can get him to turn his head to the side, but before long it's back in the floor.
I have tried to help him lift it to show him what it feels like. I can be on the floor in front of him, sing songs, show him toys, etc., but he just doesn't seem able to figure it out.
Any suggestions?

Vickie Dakin, PT said...

Thank you for your comment. I am trying to get the word out about how important tummy time is. One thing you might try is to roll up a towel tightly and place it under his arms and across his chest. The towel roll should be big enough to give him some support but small enough so that his elbows are on the floor. Tuck his elbows under his body and give him something to look at. This may be a good starting position for him.

Please let me know how it works.


Jen said...

Thank you so much for the suggestions--I will try it today and let you know how it goes!

Anonymous said...

My son was born at 35 w 5d, he is now 7 1/2 months adjusted. But I am having a hard time with him on his tummy. Sadly, I admit I didn't realize the need for tummy time and when he hated it so much I would only do it for 5 or 10 minutes a day. Now I know better, so I will put him on his tummy often but he almost immediatly rolls over on to his back. I can never get him to stay on his tummy for any length of time. He is no where near crawling at this point, though he can sit for very long periods of time on his own. Do you have any suggestions of what I can do to get him to stay on his tummy?

Jen said...

Thank for the tips, Vickie! He's lifting his head off the floor now and sometimes his chest too. Glad I caught it when I did!

Vickie Dakin, PT said...

Thst is great news. Keep up the good work and give me updates from time to time.

Grumpy said...

Awesome, awesome blog.

I have a 6 week old (31 weeker - who adjusted is not here yet! LOL! 3 more weeks!) We've been home from the hospital for a week and a day and are already doing tummy time according to her hospital PT. (they did tummy time there.) We're doing skin to skin at the moment, but she is on her tummy on my chest and during her awake times she is lifting her head to check things out, no different than my other 2.

Having had reluctant tummy timer, full term baby who never did crawl (she's 8 yrs now) I'm always seeking ways to make sure the rest of my kids do crawl! LOL! (though her scooting was cute!) and also trying to give my Preemie a good physical start.

For reluctant ones, that are still young, our hospital PT suggested try "Tummy Time On You!" Basically put the baby on your chest while you sit upright and encourage them to look around. As they raise their head more, increase your recline over weeks until you are lying on your back and they are pushing up! Then transition to the bed (a kind of ledge if you will) so they can still look and play with you! Then gradually transition to the floor and play there too.

Anonymous said...

My 30 weeker is doing great at 8 months adjusted. But, he doesn't push up on extended arms, he stays on his elbows. And he commando crawls. Because of this, he is also can't get into the sitting position, although he's been sitting independently since 5 months adjusted. He occassionally gets up on his knees, but stays down on his elbows.

tinkerile said...

hi i have a 25wkr now she is 2months adgusted..yes i can admit i didnt do tummy time since she seemed to hate it we did tummy time on husband belly and she seemed to do great there but when we put her on her belly she cries and cries and now she wont turn her head to the left she wont pick up her head she will stay lookin to her left i try picking up her head to show her but dosent seem to get it..she is not interested on toys what so ever please help what am i doing wrong i tried the boppy pillow all she does there is slide down and with the other pillow that is much smaller she just cries ....PLEASE HELP

Dimitra said...

Dear Vickie,
Congratulations on your blog. The tummy time information and guidelines is the best material on premature babies I have seen on the web. Thank you so much, it is great to come across people who actually care to transfer their knowledge to others.
I'm looking forward to seeing you keep up the blog!

Unknown said...

I'm with Melissa. My daughter can roll from her tummy to her back and it's hard to keep her on her tummy now. She also only rolls in one direction, pushing off w her left hand.

iamarogers said...

I am just reading this now and the articles have been so helpful. My little one was born at 36 weeks. She is on the verge of being full term, but I need to stop and remember that she was not full term. Thanks for the suggestions. So helpful!

Unknown said...

Is this blog still active? I have 1 year old daughter, we are having terapy since she was 3 months old, but still there is thumb in left hand, even when she crawls it is close to the pointer not nicely wide fist like it is on her right hand... I am working with her but it is very hard now as she grows... said...

I am not sure if you check this but I need more advice. I do tummy time everyday with my LO born 36 weeks and she falls aslp she cries also no big deal I know the importance she knows I am there thats all that matter she moves herself towards me she is now 4 weeks adjusted age is newborn due date was yesterday.,,,what to do about her falling aslp in the middle of tummy time?

psychotherapy techniques said...

i love your article, it gave me a lot of information specially for a new born baby..they need to adjust specially to the surroundings,we should also be careful with our voice cause they easily get frightened..

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