The Tummy Time Controversy

As you may know by now, sleep position is a very important issue for me and I write about it quite often. When I recently came across this article in Slate magazine, I just had to comment. The gist of the article is that since the start of the back to sleep campaign in 1992, the rate of SIDS (sudden infant death syndrome) has been cut 50%. But there seems to be a downside: Parents are being overly cautious and not allowing enough tummy time when their children are awake. As a result, it’s been suggested that motor skill development such as lifting the head or rolling over, has been significantly delayed.

The arguments in this article are plausible, but a more immediate issue that’s completely being ignored is the fact then when babies are forced to sleep on their backs, by definition, you’re preventing them from staying in deep sleep. The thinking is that supine sleep allows infants to wake up easier if they ever obstruct. There are tomes of data that show that lack of deep sleep can have significant detrimental effects on your memory consolidation, affect, executive functioning, and motor skills. Imagine what can happen if you force this on an infant’s developing brain. It’s no wonder there’s been an epidemic of pediatric developmental, behavioral, and medical problems in the past few decades. It’s even been suggested that the incidence of  autism spiked just after the back to sleep campaign was implemented.

Honestly, I don’t know what the right answer is. I’m not saying that we should place all our infants on their stomachs. However, this is an important issue that needs to be discussed, even if it means that the medical profession has to admit this was not the best thing to do.

What’s your opinion on this issue? How well was your baby able to sleep on his or her back?


Please note: I reserve the right to delete comments that are offensive or off-topic.

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6 thoughts on “The Tummy Time Controversy

  1. Dr. Park,
    Thank you for bringing this important controversy to this board. I stumbled upon this article by visiting Dr. Krakow’s site. Unfortunately, with any new treatment, there, many times, is little consideration paid to the holistic implications involved. I agree that there could be detrimental effects with supine sleep. We, as medical professionals, must continue to teach “theory” to patients and not insult our patients’ intelligence. Simply telling new parents to sleep their baby in the supine, without noting that it is a theory, is irresponsible, and “dumbs down” the process. Thank you for the opportunity to comment and thank you for the article.

  2. My now 12 yo son was a champion sleeper as an infant, and he slept exclusively on his back for a very long time.

    But as you mention in your post, this resulted in minimal tummy time, as he *hated* being on this tummy and cried in distress whenever I placed him on his tummy. While he didn’t roll over, sit up unassisted, crawl, or walk “late” in any sense that indicated developmental problems, he achieved those milestones somewhat later than most of the other babies in our “play group”. But he was also a “fast gainer” the first 6-7 months (breastfed exclusively), and I think he needed more time to develop enough strength to manage those skills compared to his lighter peers.

    But his skull, while not very flat in the back like some back-sleeping babies I’ve seen, was slightly flattened to one side for a while, from the way he lay/leaned toward one side and sucked his thumb. It was most noticeable to me when I looked at his image in a mirror. Once he could sit up and support his head and upper body weight, the skull flattening and asymmetry mostly corrected itself over time, though even 12 years later I can still see slight traces of the flat area and asymmetry if his hair is cut very short and I look closely. Dr. Hang, his orthodontist, also noted the asymmetry.

  3. Parents are really in a dilemna here. I had 8 years between children, so the “custom” went from no tummy but maybe prop your child on her side, to back sleeping only.

    I could see that my kids startled more easily and slept less soundly on their backs. Once I laid my infant down in her crib on her back, went across the hall to toilet, and through the open door saw her spit up and start to choke on her spit up. She could NOT clear her own airway.

    I didn’t really like putting my kids on their backs But there is another factor at work. The “what if”. What if I let my baby sleep on her tummy or side and she died of SIDS? The guilt would be too much to survive. So I put them on their backs anyway, despite my best instincts not to. I did make time to put them on their tummies to play and even have closely supervised naps. And when they learned to turn themselves over, I didn’t feel the need to prop them so they couldn’t turn. Somehow they survived my neglect and live happy, healthy lives.

    It’s going to be very hard to find a parent willing to go against the current recommendations for back sleeping, because that “what if” looms large.

  4. Janknitz,

    You’re absolutely right. All parents are in a dilemma, including myself. An increased risk of SIDS vs. a risk of developmental disorders. Just like every medical recommendation or medications with good intentions, there are always unexpected consequences.

  5. The idea that babies need always to sleep on their backs is stupid. I have two kids and thank goodness I was never told such nonsense. I, however, had enough sense to change their sleeping positions to different sides and i certainly placed them on their tummies. I have seen kids under a year with helmuts on to help “correct” their defect of a flat head. Never have I been so disillusioned with the bullying tactics of the AAP who endorse this nonsense. SIDS is much more related to overfeeding of formula leading to baby’s becoming overweight and also overfed and then put to sleep, smoking in the household near to the baby, overheated, and toys in the crib, and throw in the unknowns. Breastfeeding decreases the incidence of SIDS for obvious reasons which I’m not going to state because I as so tired of the stupidity related to this topic.
    SIDS for sure is not related to the time honored tradition of eons of babies sleeping on their tummys. If a baby normally on his back, watch and see what he does normally when he learns to turn over. He turns to his tummy and cuddles up and sleeps very well. Teaching new, impressionable parents if they don’t do something their babies will die is disgusting, perverted, and someone is laughing all the way to the bank. Probably the AAP who has countless members who know better and are dumbed down by this act of fraud.

  6. It took a bit of searching on the internet to find anything that suggested that there might be some controversy around sleep position. Most of what I read would create fear in any parent. All my children are adult/near adults and were kept almost exclusively on their tummies their first three months. My pediatrician was of the firm belief that my job as a parent was to build a secure child and for an infant the most secure position they can be in is on their stomach. It is also the position in which they have the most control. From birth they are able to move about in their crib on their own. They were also good sleepers. Though they have turned out to be phenomenal adults, I wonder how they survived their first three months based on all the articles promoting “Back to Sleep.”

    I have wondered, as I have observed the “back to sleep” movement if part of the issue isn’t market driven as suggested by Margaret. I’ve also wondered if part of the reason the incidence of SIDS has gone down is because parents are much more aware of the possibility and are more careful in watching their children. Some of my younger friends even have video cameras installed in their children’s bedrooms. I don’t see any studies that look at the relationship between the lowered rate of SIDS and parental awareness. It would be interesting to know if there are some out there.