This week I interviewed Michelle Emanuel, an Occupational Therapist and Craniosacral Therapist, who teaches her trademarked TummyTime! Program to parents and other professionals (bodyworkers, lactation consultants, doulas, educators, etc) which is where I first learned this approach, including the Polyvagal Theory. As many families have questions about tummy time with their baby, I thought I would let Michelle address these directly. Here are her answers to the most common questions I hear from families.
You are a body worker and OT, and obviously passionate about tummy time. What is significant to you about this practice?
After working with many babies as an Occupational therapist, I began looking for additional ways to help babies that were referred to me for head preference/torticollis/neck tightness, facial asymmetry, head flattening (plagiocephaly/brachycephaly), postural problems, gastrointestinal disturbances/colic/reflux, difficulty soothing, sensory processing challenges, decreased breastfeeding skills, and other challenges.
I learned a vast array of bodywork modalities including, but not limited to, craniosacral therapy, reflexology, all different types of baby massage, healing touch, etc, however, I realized that although these wonderful modalities were helpful the vast majority of positive change was the baby in tummy time moving themselves, wiggling, turning their head, pushing up with the arms and learning to roll themselves around. Knowing that parents were really the best person to support their baby, I became passionate about equipping parents with the tools and skills needed for tummy time.
The majority of the TummyTime! program is run in groups, facilitated by a professional who demonstrates while parents engage with their babies. Another aspect that that makes me passionate is that this method fully includes the baby’s perspective into the process, and the emphasis is on social interaction, happiness and comfort in this sometimes challenging, yet important position.
Is it all about flat heads? For many parents that isn’t quite enough motivation to work super hard to make tummy time fit in.
No, tummy time is not all about flat heads! Tummy time is important for tongue function, oral skills, sensory development, postural and head control, learning about and exploring the environment, play, gastrointestinal issues (passing gas, pooping, burping, reflux, gastric motility), neurological development, strengthening, and much more!
However, flat heads do play a significant part in why intentional tummy time is important in a Back to Sleep culture. Prior to the Back to Sleep, babies were spending roughly 10-14 hours per day sleeping on their tummies. Currently, many babies spend less than 5-10 minutes in a day on their tummy (outside of being held). Flat heads, or plagiocephaly/brachycephaly, are often caused from laying on one side of the head during sleep, for prolonged periods of time. Tummy time offsets the time babies spend lying on the back of their heads during sleep.
Another contributor to flat heads is sleeping semi upright in infant seats, swings, rock n play or other devices. We have a “container lifestyle”, with baby going from lying flat on the back during sleep, to the swing, to the carseat, to the bouncy seat, and even to being held reclined for feeding.
Tummy time can be really easy to fit into most lifestyles, for example, at each diaper change baby can be rolled to his or her tummy for a minute, which adds up over 8 to 10 diaper changes a day! Also, consider babywearing, laid back nursing, on your lap, over your arm, skin to skin, on a Boppy, on a physioball, etc.
Engaging in tummy time on the floor encourages babies to unfold and extend, which is opposite of their intrauterine, flexed position. Some babies have structural issues from intrauterine lie/ movement restriction, medicalized births, tethered oral tissues, and the use of baby seats and containers that restrict baby's freedom of active movements. Tummy time encourages the active movements which ameliorate these barriers.
We know research says Tummy Time is beneficial for babies. What do you believe is the biggest benefit in practicing tummy time?
This is a great question and difficult to answer simply, but I’ll give it a try. For me, tummy time is about being with baby in a way that is contributing to his or her natural method of developing, transitioning from a flexed, womb-like position to an extended, opened up position. Equally important is connecting with a parent and experiencing the sensory awareness of extra-uterine life and the influences of gravity which tummy time provides. If our babies were sleeping on their tummies, perhaps the need for intentional tummy time would be much less, but for now, in a Back to Sleep culture, tummy time is a vital part of baby’s neurologic and neurosensory development.
In the first months of life, babies use reflexes to move, push up, lift and turn the head, etc, however to do this babies need to work against gravity and this is where tummy time is vital. More than half of all babies have a head turning preference to one side and the best way to ensure that baby turns head to the other side (important for all of development) is to make sure baby is in the best position to do this, which is tummy time. But in the end, its really about mom/dad and baby beginning to play together at the current stage of development.
Parents say, “My baby hates tummy time.” How do you help babies overcome this?
I hear this all the time, from first time clients and from my colleagues who work with parents and babies. This statement, “my baby hates tummy time” is meaningful to me, because it clues me in that something is going on which makes baby uncomfortable, whether it’s neck tension, torticollis/plagiocephaly, mid-line restrictions of the tongue such as tongue tie/lip tie, or lack of safe and slow experiences in this position. Babies deserve to find comfort in all positions, on their back, their sides and especially tummy time, and if they are not comfortable, this means that baby would benefit from tummy time therapy.
The TummyTime! method is about much more than just putting a baby on his or her tummy, the method utilizes key concepts from the Polyvagal Theory, which ensures that baby is well regulated, calm and organized during all activities. It helps parents fully understand the vast implications of eye contact, facial expressions, breathing and interacting on the level of satisfaction and comfort babies get in tummy time. The whole program is dedicated to helping baby LOVE tummy time experiences and I always see this result! Tummy time is time that baby spends with parent on the floor for connection and play.
- How does Tummy Time help babies with reflux? Don’t babies spit up more in tummy time?
This answer has not been proven by medical evidence, however, here is my theory. Reflux is the backward flow of stomach contents into the esophagus and sometimes the mouth and beyond. Reflux happens secondary to inadequate sphincter control (valves that shut off the top of the stomach and top of the esophagus) due to immature nervous systems. In order for these valves to operate properly, they need pressure or the weight of the baby’s body while laying in tummy time to achieve adequate control from the brain over these sphincters. We know that the “tone” or strength of the sphincter is decreased when baby lays on their back, therefore prolonged exposure to back lying can increase reflux.
There is a difference between ‘physiologic reflux’ which is common in babies and gastroesophageal reflux disease (GERD) which is a popular term these days. Most babies actually don’t have an “acid” problem, they have poor sphincter control and decreased peristalsis (the squeezing action of the esophagus and intestines to keep breastmilk flowing in the correct direction). Therefore treating a baby with medications is not always helpful (although sometimes it can be).
Many pediatricians will tell parents that babies “grow out of reflux”, but what they actually mean is that the baby strengthens, grows, matures and moves their body, which then more effectively keeps the contents of their gastrointestinal track in the right place and flowing in the right direction.
Yes, sometimes, especially initially babies will spit up a little during tummy time, a tiny amount usually and this will discontinue as the baby’s body is challenged perfectly well to work properly in tummy time.
Additionally, many babies pass gas, poop easier and burp more effectively when in the tummy time position. Of course, babies who have failure to thrive should be monitored closely for volume loss, but for the most part, intermittent reflux in tummy time is worth helping babies improve their tummy function.
- How much time are we aiming for per day? Per session?
For me, it’s really about the quality of the tummy time experience, rather than the quantity. What I have learned from teaching TummyTime!™ for almost ten years is that when a baby engages well and enjoys the experience for short periods of time, they will eventually engage in longer periods of time. So instead of focusing on time, I focus on helping baby enjoy the position and feel the comfort of it, eventually they stay in tummy time for longer periods of time.
A couple of Occupational Therapists completed and published a research study that compared two groups of babies, one group spent 30 minutes minimum of tummy time per day and the other group did not, the tummy time group scored higher on developmental assessments, so perhaps 30 minutes in a good goal per day; most helpful if broken up into mini sessions throughout the day.
- Doesn’t babywearing count as tummy time? Does tummy time have to be a flat surface?
Yes! Babywearing is a form of tummy time, however, it doesn't replace the need or benefit of getting down on the floor with baby for play and connection. Babywearing is excellent for babies for a wide variety of reasons--and so is tummy time experiences on the floor with a parent. Both activities are similar in that the parent and baby are intimately involved in an activity together. However, modern babywearing typically doesn't mimic indigenous babywearing, which provided a lot of squatting for extended periods of time, bending over, and other high activity levels. Babywearing allows a baby to feel postural sway and movements in a vertical manner to gravity, tummy time on the floor allows baby to engage and feel these movements in a horizontal manner to gravity. Both are needed for optimal developmental experiences.
Babywearing is a great support on many levels for babies, however, for babies who have a head turning preference to one side (torticollis), head flattening (plagiocephaly) or have other soft tissue restrictions, tension through the neck, shoulders or anywhere in the body, will especially benefit from the structure and open space of the floor during tummy time to work out these problems.
Although babywearing supports and enhances postural and head control, babies need to be belly down to the earth in order for all of the natural postural reflexes to be optimally stimulated and integrated into smooth volitional movements and eventually for crawling.
So bottom line? Do BOTH, babywearing and intentional tummy time on the floor. Baby loves both.
- Where can parents go to get more information on helping their babies?
I’m a big advocate for connecting moms and babies in community groups, which is why the TummyTime! program is typically run in classes or groups where moms learn a lot from each other. I’m also a proponent of connecting moms with baby bodyworkers who are local to them. A baby bodyworker is someone who is specially trained to use hands-on skills to help baby with alignment, symmetry, comfort in the body, releasing tension, and promoting optimal movement, connection and interactional skills. A baby bodyworker will be able to work with parents to help baby get comfortable and enjoy tummy time.
Here are some websites that may be of interest:
www.pathways.com (this has a lot of helpful resources for both parents and professionals)
- Is there further training is available for people who work with babies (doulas, nannies, newborn care specialists, Bodyworkers, lactation consultants, etc)?
There are many opportunities; I have events in the planning phase for Orlando, Portland (September/October), Kripalu (December 6-9), and North Carolina. I’ll also can go where I’m invited anywhere an organizer can gather 10-12 people or more.
I offer several trainings including:
- 2 day TummyTime!™ Clinical application of the Polyvagal Theory application for Babies
- 2 day Cranial Nerves for Newborns and Precrawling babies: a practical and functional approach to treating the tongue, postural asymmetries (including torticollis/plagiocephaly) and breastfeeding
- 1 day class specific to Torticollis and Plagiocephaly, which can be added to the TummyTime!™ training for a total of three days
Michelle Emanuel lives in Cincinnati, OH and is the mother to three wonderful children, who taught her all about tummy time. You can contact her with questions here: EmanuelOT@yahoo.com.