Newborns

American Academy of Pediatrics

Back to Sleep, Tummy to Play

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What are the 2 most important things to remember about safe sleep practices?

  • Back to sleep. Healthy babies are safest when sleeping on their back at nighttime and during naps. Side sleeping is not as safe as back sleeping and is not advised.

  • Tummy to play. Tummy time is for babies who are awake and being watched. Babies need tummy time to develop strong muscles.

Here is information from the American Academy of Pediatrics for parents and caregivers about doing tummy time with babies and creating a safe sleep environment for them.

How much tummy time should babies have?

Play and interact with babies while they are awake and on their tummy 2 to 3 times each day for a short time (3–5 minutes), increasing the amount of tummy time as babies show they enjoy it. Work up to 15 to 30 minutes each day by 7 weeks. A great time to do this is when babies finish a diaper change or wake up from a nap. Tummy time prepares babies for being able to slide on their belly and crawl. As babies grow older and stronger, they need more time on their tummy to build their own strength. Start from the first day home from the hospital.

What if babies do not like being on their tummy?

Some babies may not like the tummy time position at first. Place yourself or a toy within reach for them to play with. Eventually, babies will enjoy tummy time and begin to enjoy play in this position.

Does sleeping on their back cause babies to have a flat head?

Parents and caregivers often worry about babies developing a flat spot on the back of their head because of sleeping on their back. Although it is possible for babies to develop a flat spot on their head, it usually rounds out as they grow older and sit up. Here are ways to reduce the risk of babies developing a flat spot.

  • Alternate which end of the crib you place the baby's feet. Babies naturally turn toward light or objects indifferent positions, which lessens the pressure on one particular spot on their head.

  • When babies are awake, vary their position. Limit time spent in freestanding swings, bouncy chairs, and car safety seats. All these items add pressure on the back of the baby's head.

  • Spend time holding babies in your arms and watching them play on the floor, both on their tummy and on their back.

  • Breastfed babies typically change breasts during feeding; if the baby is bottle-fed, switch the side that they feed on during feeding.

How can I exercise babies during tummy time?

There are many ways to play with babies during tummy time.

  • Place yourself or a toy just out of the baby's reach during playtime to get them to reach for you or the toy.

  • Place toys in a circle around the baby. Reaching to different points in the circle allows them to develop the appropriate muscles to roll over, scoot on their belly, and crawl.

  • Lie on your back, and place the baby on your chest. The baby will lift their head and use their arms to try to see your face.

  • While keeping watch, have a young child play with the baby while on their tummy. Young children can get down on the floor easily. They generally have energy for playing with babies, may really enjoy their role as the "big kid," and are likely to have fun themselves.

How do I create a safe sleep environment?

Here is what parents and caregivers can do to create a safe sleep environment for babies.

  • Always place babies on their back to sleep, even for short naps.

  • Place babies on a firm, non-inclined, flat sleep surface that meets current safety standards. For more information about crib safety standards, visit the US Consumer Product Safety Commission website (www.cpsc.gov).

  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation from the baby's sleep area.

  • Make sure the baby's head and face remain uncovered during sleep.

  • Place the baby within a smoke-free environment.

  • Do not let babies get too hot. Keep the room where babies sleep at a comfortable temperature. In general, dress babies in no more than one extra layer than you would wear. Babies may be too hot if they are sweating or if their chest feels hot. Dressing babies with layers of clothing is safer than using blankets to keep them warm. Wearable blankets, like a sleeping sack, or warm sleeper clothing can also be used. If you use a wearable blanket, make sure it is the right size for the baby and it doesn't cover their head. Do not use weighted blankets or weighted clothing. Do not place hats on babies when indoors except in the first hours after birth or in the neonatal intensive care unit.

  • If you are working in a family child care home or center, create a written safe sleep policy to ensure that staff and families understand and practice back to sleep and other safe sleep practices in child care, like those to reduce the risk of sudden infant death syndrome (SIDS) or suffocation. If you are a parent with a child in out-of-home child care, advocate for the creation of a safe sleep policy.

For More Information

American Academy of Pediatrics

www.aap.org and

www.HealthyChildren.org/Safesleep

Centers for Disease Control and Prevention

www.cdc.gov/sids

CJ First Candle

https://firstcandle.org

National Institute of Child Health and Human

Development Safe to Sleep Campaign

www.nichd.nih.gov/sids

National Resource Center for Health and Safety in Child Care and Early Education (Search for "sleep.")

https://nrckids.org/

Disclaimer

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.