Going Home - Your Baby's Development
Positioning and playtime activities
Positioning and Playtime 0-3 months
When your baby is starting to have some alert times showing you they are ready for play and interaction you can try some of the positions and activities below for playtime. It is good for your baby’s sensory and motor development to experience lots of different positions when they are awake but when your baby sleeps they must always sleep on their backs (see section on ‘safe sleep’ )
Activities for ‘awake’ time to develop movement and play skills 0-3 months .
- The following are activities that you can begin to introduce to your baby as you notice them having more quiet alert, awake times. At the start when you bring your baby home you may find they sleep a lot and are not ready for long interactive play times.
- The best time to do this is when they are awake and calm in a quiet relaxed place.
- Always follow their cues and body language if they need a rest or sleep or are telling you they need time out or sleep.
- Do not be disappointed if your baby is not able for much interaction at the start. Remember, they will change and grow quickly over the next few weeks.
‘Tummy Time’ is about lying your baby on their tummy to exercise and develop head and body control. ‘Tummy Moments are several short moments throughout the day (1-2 minutes) where you give your baby the opportunity to spend awake, active time on their tummy.
Preterm babies will be used to doing lots of skin to skin time on your chest for snuggles and sleeps. As your baby becomes more alert you can encourage them to spend awake times where they are doing short periods lying tummy down alert and awake on your chest as you sit or lie reclined. Remember to have your hands cupped around their shoulders and close to support their head. At the start they might only have short Tummy Moments but practising this several times throughout the day will help your baby develop head control so they will enjoy moving to Tummy Time when they are bigger.
Remember, tummy time is awake time, never let your baby sleep while on their tummy. Tummy Moments are short periods of about 1-2 minutes done regularly throughout the day in the first few weeks after bringing your baby home. Start with your baby on your chest. As they get bigger and stronger you can try other positions listed below.
Your baby can do ‘Tummy Moments’:
- On your chest or tummy while you lie reclined
- On your knees
- On a therapy ball
- On a firm mat on the floor
- Over a ‘Tummy Time’ roll toy or rolled up blanket
- ‘Tiger in tree hold’ or tummy down carrying along your arm.
Enjoying 'tummy time'
How to do ‘Tummy Time’ on the floor.
- Place your baby on their tummy for exercise or playtime.
- Always supervise your baby while on their tummy.
- Look at your baby’s face to see that their breathing is comfortable. Check your baby’s breathing throughout ‘Tummy Time’.
- Position your baby’s forearms or elbows under or slightly in front of their shoulders, so that they can lean through them to help lift their head.
- Cup your hands around their shoulders to give some support if they need.
- Place your hand on their hips if they are struggling.
- Use gentle massage on their shoulder or neck to encourage them to lift their head.
- Use your voice (Especially singsong tones)
- Use a toy, which has nice colours, or makes a noise (music or shakers). Be aware and watch your baby for their reactions in case this stimulation might be too much for them to deal with. If so, focus only on the tummy moment exercise.
- As your baby gets better at lifting their head while on their tummy, increase their ‘Tummy Time’ experiences.
- Roughly, by the time your baby is 3 months corrected they should be spending about 30 minutes in total ‘Tummy Time’ every day.
As your baby grows, they will begin to enjoy spending more and more awake time on their tummy for play and development. You will notice they can lift their head higher for longer while propping themselves on their arms and look around, and maybe even start to reach for toys placed close by.
‘Tummy Time’ is especially important for babies who have low tone, reflux or plagiocephaly
Ideas for play during ‘Tummy Time’
- Place a rattle in your baby’s hand or help them to explore or touch different toys and textures (try using little teddies, rattles, or textured sensory toys)
- Use a mirror placed close by so they can look at their face.
- Lie in front of them, so they can see you and ‘talk’ to you. If your baby is one of twins or triplets, let them face their twin or triplet so that they can ‘play’ together.
If you are concerned about any of the above or if your baby struggles with tummy time, have a chat with your baby’s physiotherapist.
Side-lying – laying your baby on their side
This is a nice position to promote your baby’s development, their head is supported and can see their hands as they naturally come to midline in this position.
- Side-lying can be done on your lap or on the floor or even as a carrying position providing you and your baby are comfortable.
- Use a roll placed behind your baby to give them support and stop them from rolling out of position and place your hand on their hip to support them.
- Alternate the sides to which your baby lies.
- This is not a position for sleeping.
- They can bring their hands together or to their mouth to self soothe or just to learn about their hands and faces
- As your baby begins to play and explore more you can give them toys to reach, or just lie close to them and let them watch and reach for your face.
Supine-lying is when your baby is lying on their back.
Laying your baby on their back while on your lap
- Get yourself into a comfortable position, on a sofa or a seat. You may find it helpful to place a small box under your feet so your knees are raised higher than your hips (a toddler step is perfect height for this).
- Lay your baby on your lap. Help them to rest their legs in a clmfy tucked up position or let them rest on your tummy.
- Help your baby to bring their hands and head into a midline position.
Playtime on the floor
Laying your baby on their back while on the floor
- Lay your baby on their back on to the floor.
- Your baby may need some positioning rolls or supports initially to help them to control their posture and to learn to move well when playing in this position.
- Your physiotherapist will advise if this is necessary.
Remember these positioning supports are for awake time only, remove them for sleeping time.
Activities to do with your baby while in a supine position to help develop the following skills:
Fine motor (hand) and reaching skills
These skills help your baby to:
- Learn to bring their hands to their face or their hand-to-hand on their chest.
- Help and guide your baby’s hand to reach for toys (a play arch or dangling toys are useful for this).
- Learn to grasp by placing small toys in their hands or let them hold your fingers (grasping)).
- Develop sensory skills by using different shapes and textures of objects to help learning through sight, touch, taste, smell, hearing, posture and movement.
Try the following to develop your baby’s:
- Looking (visual) skills – hold toys or baby books for your baby to look at.
- Social skills – talk, coo and mimic facial expressions for your baby.
- Self-comforting skills – help your baby to bring their hands to their mouth to learn to comfort himself.
- Sitting is a good position for your baby to help and encourage them to look around and interact with their environment.
- Adjust the angle of the seat so they can sit supported and comfortably with their head in the middle position, without slumping to the side or forward.
- As your baby gets bigger they can play while sitting on a ‘V’ cushion or while sitting supported with their back to you, or between your legs on the on the floor.
- Your baby’s physiotherapist or occupational therapist can show you how to use positioning supports if appropriate
- It is not recommended to let babies sleep in a sitting position, for example, in car seats or bouncers.
Tips to help prevent positional plagiocephaly (Flat/ Misshapen head)
- Alternate the side to which your baby turns their head each time you are laying them down.
- Do not place pillows, rolls, or moulded mattresses into the cot or under your baby’s head while they are sleeping. These are dangerous and can increase the risk of sudden infant death syndrome.
- Practice lots of tummy time and other developmental activities to help your baby develop head control and strong neck and shoulder muscles.
- If you are concerned talk to your baby’s doctor or physiotherapist.
Equipment to limit /avoid
- Baby bouncers and bouncer seats: These can cause your baby to do a lot of bouncing and pushing backwards. This can over strengthen some of your baby’s muscles and lead to muscle imbalances. For example, this may make it more difficult for your baby to use their arms to reach forward and can encourage them to stand on tiptoe.
- Jumpers or door jumpers: While many babies love to stand and bounce, which is a normal part of development, spending time in jumpers teaches babies to stand on their toes and can cause stiffening of the ankles. It also stops them from strengthening their tummy (core) and hip muscles.
- Walkers and entertainers: These do not help babies to learn to walk better. They can lead to delays in walking independently or poor walking patterns.
- Pillows: Pillows are dangerous for babies. No pillow reduces the risk of positional plagiocephaly.
Toys for preterm babies
The best toy for your baby in the early days is you. They do not need lots of toys or equipment. As your baby develops, they may enjoy short exposures to the following:
- Baby books designed with large contrasting patterns (often in black white red) may help to encourage vision and focus.
- Small toys like rattles are excellent for encouraging reaching, grasping and mouthing skills.
- Toys of different texture, feel and weights
- Balls of different sizes are very useful for grasping and exploring, and later for reaching and encouraging movement.