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.

Check Out Your Toys Carefully

The other day I was shopping in Wal-mart. I spent some time in the baby aisle checking out the baby rattles. They had a large selection and the prices ranged from $1.96 to 6.96 per rattle. Most of them were too large for a new baby or premature baby, but the one thing I noticed that really surprised me was a warning that was on most of the packages. The warning was DO NOT SUBMERGE IN WATER. That was a real surprise. Is that safe for a baby that puts everything in their mouth?How do you adequately clean such a rattle?

Read those labels.

How much Tummy Time is enough?

This question about tummy time has been asked a lot, but now there is an answer. A study was presented at the NDTA 2008 National Conference which revealed that the minimum amount of tummy time was one and one half hours a day ( 1 1/2 ). More time is better but 1 and 1/2 hours spread out during the day was the minimum amount that made a difference. For best results, start tummy time as soon as your baby gets home from the hospital. There will be less protests from the baby and the benefits will start right away. This is important for all babies but especially for preemies and babies with other issues at birth.

It's great to finally have an answer to the question, "How much tummy time does my baby need?"

Vickie PT

Arching, What Does It Mean and How to Help

Does your baby arch their body when upset? It's not unusual, but it can be scary. In very young and early babies arching is a sign of an immature nervous system. We are all born with a set of reflexes that help us fight gravity. With preemies, because of their early arrival, their muscle are weak and they have a hard time moving against gravity. Those reflexes allow them to "cheat" and they can use the reflexes to move. Unfortunately, the reflexes only allow certain movements and one of them is arching. The reflex starts at the head and neck, so the best way to minimize it is to curl your baby into a ball. It often helps to rock the baby and hold them against your body so that they relax. The strongest position for the reflex is supine (back lying). Sidelying is a wonderful position if you can place them against a firm, cushioned surface. Sidelying also helps them get their hands to midline which is soothing to them.

I hope this information has been helpful. Please contact me if you have questions or would like to hear about other topics.

Vickie PT

The Hidden Danger of Baby Chairs

There are some wonderful baby chairs available on the market. The chairs allow even a young baby to sit fully supported in a nearly vertical position. Very often a mom can sit with her child in the chair right by her feet, so that she can touch the child or sooth them if they get fussy. How could these comfortable chairs cause any problems for a baby?

There are 2 major issues. The first is that the baby is so well supported that they do not need to use their own muscles to hold themselves up. The second problem is that when a baby is sitting in a chair, they are missing out on floor time, where development really happens. Floor time, especially tummy time, is critical for a baby to develop their motor skills.

My suggestion for the use of baby chairs is to minimize their use to 15 to 20 minutes at a time. Another idea is to use the chairs is during low energy periods for the baby, such as, when they are tired or not feeling well. Save high energy times for floor time.

I would love to hear any feedback from parents and therapists, pro and con on baby chairs and any other related topics.

Thank you,

Vickie

An Open Invitation To Parents

My name is Vickie Dakin. I have been NDT trained and a specialist working with babies for years. I have been a physical therapist for 30 years and have worked with hundreds of children and their families. Because of this extensive experience, I look at development from a different perspective. I created this blog to share my knowledge about babies and development with parents and other therapists and to encourage others to share what they know.

I am available to answer questions. I will be writing articles on various topics with the emphasis on babies and children from 0-3 years old. I personally invite you to share your thoughts with me as we grow together.