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Q:

I have read some of the articles about tummy time, finding them mostly to say that babies need "ample" or "sufficient" time, or "frequent" placements on stomachs.............any rules of thumb or guidelines as to how much time is adequate for the average healthy baby?

A:

The average, healthy baby will gradually build up their skill, endurance and preference for tummy positioning in accordance with the frequency that they are positioned on their tummy. That is, the more often the tummy position is used for play, the more strength, control and comfort that will be achieved. A good rule of thumb is to place your baby on his/her tummy to play after he/she is rested, fed, diapered and ready for a bit of a challenge. This could be 3 to 4 times a day. Give your baby interesting things to do while on his/her tummy and make the experience playful and entertaining. This will keep him on his tummy longer. Reposition him when his tolerance is up. Let him rest then return him to his tummy with something new to do. You will find that his tolerance/endurance for tummy play will increase naturally as he becomes stronger. Always make sure tummy time is fun, comfortable and supervised. Don’t let him fall asleep while on his tummy.

Q:

My son was diagnosed with torticollis at age 5 weeks (he's almost 7 weeks now) and I need some ideas to strengthen his neck muscles.

A:

Your situation is a very common one now that baby's are sleeping on their backs or sides. I am guessing that since your son was diagnosed with torticollis that your physician has recommended physical therapy to address that issue. Torticollis is a specific medical condition compared to simple muscle tightness related to a frequently used head position when sleeping or in the car seat.

To improve his neck strength, try these ideas:
Place him tummy down on your chest when you are reclined and support his arms under his chest so that he can work on lifting his head to look at you. Then move your face slowly side to side to encourage him to move his head and follow you. Place a small roll under his chest when he is laying on his tummy to give him a little extra support, put one or two toys in front of him to get his attention. Give him these experiences when he is rested, happy and ready to work a little. Make this fun and give him a rest when he starts to fuss then return him to his tummy when he is ready. Only use tummy positioning when he is awake and supervised. When he is laying on his back, encourage him to turn his head to the other side, put toys and stimulation on the side he doesn't tend to look towards, hold him in different positions then where his head tends to go, alternate his position in the crib or changing table, support his head with a curved head support or small roll on the tight side when in sitting equipment so that it doesn't tilt to either side.

Try to avoid long periods of time in supported sitting equipment (more than 15 to 20 minutes) except when in a car seat in the car. Give your baby a variety of positions during the day to enrich his experiences and strengthen all muscle groups.

Q:

I’ve noticed that my 2 ½ month old daughter has a flat area on the right side of her head and when she is on her back, she likes to look towards the right side of her more than the left. Is there something I can do now to make her head more rounded? Will she always have a flat side of her head?

A:

A flattening on one side of the head can be a side effect of the back sleeping position and use of positioning equipment such as car seats, strollers, and infant seats. These positions often put more pressure on one side of the head when a baby is young because they don’t have the neck strength or need to turn their head to the other side. As one head position is used more than others, the flattening and perhaps tight neck muscles on one side with weak muscles on the other make it more difficult to turn to the other side.

Here are some suggestions:

Place your baby on her tummy to play while you are watching as often as possible. This relieves the pressure on the flattened side of the head. Use other equipment than seats for positioning and carrying her such as a front pack or sling. Encourage head turning to the other side with toys or other stimulation when she is lying on her back or in sitting equipment. Prop her with a small rolled up blanket behind her back in a side lying position to the nonpreferred side when awake and supervised. After she falls asleep at night, gently turn her head to the other side.

Your baby’s head shape may improve after following the above suggestions. Be sure to contact your physician about your concerns.

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