Tummy time reduces infant flat head and other ailments

Changing how the baby breathes, or just imparting sensations to different parts of the body can make a huge difference.

Tummy time reduces infant flat head and other ailments

During a recent initial assessment session, pediatric physical therapist Tonya Onstad at Sanford Health in Bemidji, Minnesota, saw a 3-month-old infant who was very stiff and did not want to move his body into different positions.

“He was very upset, very resistant and cried through our whole first session,” Onstad recalled.

Working with the infant’s mother, Onstad offered a few position changes and suggestions on how to coax the child into accepting those alterations.

“We started mom with some very gentle things to do, but the key is to be really consistent with them,” Onstad said.

Mom followed Onstad’s suggestions and, one week later, brought the infant in for another session. And the difference was amazing.

“He’s already turning easier, he tolerated stretches much better. He’s sleeping through the night already,” Onstad said. “Just changing things a little bit can be very impactful. Changing how the baby breathes, or just imparting sensations to different parts of the body can make a huge difference.”

Those subtle but effective changes are instruments in the “tummy time” toolbox and can help a child develop the muscles in the neck and shoulder, and the muscles babies need to roll, sit and crawl. Tummy time also aids in the development of motor skills such as working with their hands.

“Tummy time strengthens many of the proximal muscles, including the shoulder, the core and the hip muscles,” Onstad said. “As those muscles strengthen, baby is able to use the elbows, push up on extended arms and lift the legs. All of these things will prepare them to hold themselves up against gravity while in the ‘hands and knees’ position and, eventually, in the standing position.

“Babies are inherently lazy and sometimes are just stuck in their little ways so the least bit of resistance may keep them from going (to the next step in their development),” Onstad continued. “But if you can push them through a little bit, they can move out of that little bit of resistance and, suddenly, the rest of their development picks back up and, ‘BOOM’, off they go.”


Many babies born in the Bemidji area are in desperate need of extensive tummy time because they are born with a condition called torticollis.

“Torticollis, basically, is a diagnosis that defines that a baby has a preference to hold the head in one direction instead of going both ways,” Onstad said. “If we took the statistics of all the babies born in Bemidji, maybe four of every 100 might have torticollis. But torticollis seems very common to me because there are only two pediatric physical therapists at Sanford Bemidji, and any baby in the area coming to see a pediatric PT will see one of us.

“In my professional life and field, torticollis seems to be very common and seems to be increasing.”

Infants who have developed torticollis have special needs, but Onstad’s initial assessment also targets the caregivers.

“My initial evaluation measures range of motion and identifies where the problem areas are. Then I take the time to teach the caregivers about the proper stretches to do and the various tummy time and positioning activities,” she said. “It is important to educate the caregivers that tummy time, which is simply positioning baby so gravity is at their back, starts on day one.”

Different positions

There are a variety of positions to use while holding, feeding and playing with a baby that can become part of the tummy time experience and can prevent the baby from being on its back.

“The only place a baby should be on its back is for sleeping,” Onstad said. “The rest of the time of development should be tummy time. But if baby is not tolerating tummy time, there likely is an underlying reason behind that and that could warrant a question to your doctor and a physical therapy evaluation.”

Sanford Children’s Therapy offers these tummy time tips:

  • It is safest to have your baby on their tummy when the child is awake and you are with the infant.
  • Time on the floor will benefit your baby much more than using a car seat, infant carrier, swing, walker, Exersaucer, or Johnny Jumper for their awake play time.
  • Your baby will like being on the tummy better if you are down on the floor with the child.
  • Putting toys in front of your baby will help your baby lift the head and stay on the tummy longer.
  • If your baby is unable to lift his/her head away from the ground, a rolled up towel underneath the infant’s chest and arms can help prop the child for some time on the tummy.


Too much time resting on the same side of the head can also lead to plagiocephaly, as the constant pressure can result in flattening or asymmetry.

“A baby’s little head is very malleable, it is just a piece of Play-Doh, and if they lay on the right or left side all of the time, that side of the head can become flat,” Onstad said. “That condition is known as plagiocephaly.”

The skull bones were specifically designed to line up in a specific way, and a major flat spot can result in many problems. Down the road, plagiocephaly can cause spinal issues or impact the position of the ears, which can result in infections or hearing and ear canal issues. It can also affect the vision, as even a couple of degrees difference in the position of the eyes can have a negative impact. Misalignment of the jaw and related dental issues could also occur.


“If we can’t change the head shape back to a fairly symmetrical shape by getting baby moving better and off the flat side of the head, then we may go with a cranial remolding orthosis, which most people would just call a helmet,” Onstad said. “We don’t helmet babies because we want everybody to have beautiful round heads. It is not done for cosmetic reasons. Rather, we do it for medical purposes.”

The quicker the need for a helmet is determined, the better the result will be.

“A baby can’t go into a helmet until the head reaches a certain circumference, and we try to wait and see if proper positioning will work before we consider a helmet,” Onstad said. “But if it doesn’t work, we talk about using a helmet when the age is appropriate. We like to fit helmets somewhere between 5 and 7 months. That’s when the head experiences the most growth and the fastest change.”

If parents or caregivers suspect that an infant is experiencing torticollis or plagiocephaly, Onstad suggests discussing things with their pediatrician or family practice physician.

“If there might be an issue, the physician will refer you to me and we can do an evaluation,” Onstad said. “There is no problem with coming to me for an initial evaluation versus the wait-and-see. If there is a problem (and if the caregiver waits too long), now all of a sudden we are beyond where we want to be and the problem is going to be harder to fix.”

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Posted In Children's, Health Information