Tummy Time Positions: Alternatives for a Fussy Baby or One With Reflux

Parent reclining on a sofa with an awake baby doing chest-to-chest tummy time, a plain beige play mat on the floor nearby

Tummy time advice usually shows a baby lying flat on the floor, head up, smiling. If your baby screams the moment their tummy touches the floor, or spits up every time you try, that picture can feel far away. Flat on the floor is only one of many tummy time positions, though, and several others are easier for fussy babies and babies with reflux.

The Royal Children's Hospital (RCH) in Melbourne lists a set of positions that it says may help if your baby does not like being directly on their tummy or has colic or reflux. Below we cover how to do each one and who it tends to suit. For timing and daily totals, see our tummy time by age guide. For general tips on a baby who protests, see Baby Hates Tummy Time? 9 Things to Try.

This is general information, not medical advice. Please ask your pediatrician what is right for your baby, especially if your baby was born early or has a health condition.

Ground rules for every position

  • Awake and supervised. The American Academy of Pediatrics (AAP) says tummy time is for babies who are awake and closely supervised. The RCH says not to leave your baby alone in any tummy time position.
  • Wide awake yourself. The NHS says chest-to-chest tummy time is only for when you are wide awake and unlikely to fall asleep.
  • Sleepy means stop. If your baby gets drowsy, the CDC advises placing them on their back in a safe sleep area: a firm mattress with no blankets, pillows, bumper pads or toys.

Why the angle matters

A young baby's head is heavy. The RCH says the more upright your baby is when they are on their tummy, the easier it will be for them. A pediatric physiotherapist from Alberta Health Services puts it another way: it is easier for a baby to hold their head up for longer when their shoulders start off higher than their hips.

Think of the positions below as a ladder: more upright is easier, flatter is harder. Most babies move down it as they get stronger, and mixing positions through the day is fine.

Tummy time positions, from most upright to flattest

1. The "burping position"

A family leaflet from the physiotherapy team at Royal Aberdeen Children's Hospital (NHS Grampian) says the burping position counts as tummy time: your baby leans forward with their chest supported. In their words, if your baby is leaning forward, even just a little, that is tummy time. It is a gentle option for the upright time the AAP suggests after feeds.

2. Chest to chest, reclined

Sit with your back supported on a sofa or chair and lay your baby tummy-down on your chest. The AAP notes that your baby will lift their head and use their arms to try to see your face. The Alberta physiotherapist suggests leaning further back as your baby gets stronger. The RCH names chest positions among the more upright options for babies with reflux.

3. Across your lap, then over your leg

Sit on a chair or on the floor and lay your baby across your thighs, tummy down, with a hand on their back or hips. The NHS Grampian leaflet suggests raising one knee under your baby's chest so they are not lying so flat. Once your baby is 2 to 3 months or older, the Alberta physiotherapist suggests placing them so their arms are at the edge of your leg, so they can reach down and practice holding themselves up.

Later, sitting on the floor with your baby's chest over your leg can also stop a new roller from flipping straight onto their back, she notes. She adds that this position may be more comfortable for babies with reflux.

4. The tummy-down carry

Hold your baby face down along your forearm, supporting their head when they are young. The RCH lists "baby over your arm," and the NHS Grampian leaflet notes that even if your baby is not completely facing the floor, it is still tummy time. The Alberta physiotherapist suggests carrying over both the right and the left arm so your baby looks both ways.

5. Over a rolled towel

Place a small rolled towel or blanket under your baby's chest, arms forward over the roll. The RCH, NICHD and the NHS all describe this. The Alberta physiotherapist suggests making the roll smaller as your baby gets stronger, and keeping a hand on their hips if needed so the hips stay lower than the shoulders.

6. Starting from side-lying

For babies with reflux, the Alberta physiotherapist suggests starting on the floor with your baby on their left side, which she says is often a more comfortable position for babies with reflux, then rolling them onto their tummy after a few minutes. Stay right beside your baby the whole time.

Important: side-lying is for awake, supervised play only. For sleep, the AAP says the side position is just as dangerous as the stomach position, and that even babies with gastroesophageal reflux disease (GERD) should sleep flat on their backs.

7. Flat on the floor, with company

The RCH's last position is "on the play mat, lots of play." Lie down face to face, sing, talk and use a baby-safe mirror. The Alberta physiotherapist says floor tummy time is the best position for building strength because your baby has the most freedom to move, so aim for some every day, even briefly.

Timing tummy time around feeds when your baby has reflux

The AAP calls babies with mild reflux "happy spitters" and says reflux usually starts at about 2 to 3 weeks, peaks between 4 and 5 months and goes away by 9 to 12 months for most full-term babies. The RCH says that if your baby has reflux, you can and should continue with tummy time. What changes is timing:

  • Wait after a feed. The RCH suggests leaving 20 to 30 minutes after a feed. The AAP suggests limiting active play for about 20 to 30 minutes after meals.
  • Or go before a feed. Pregnancy, Birth and Baby (Australia) and the Alberta physiotherapist both suggest trying tummy time before feeding.
  • Use upright time after feeds. The AAP suggests keeping your baby upright for about the first half hour after feeding, with close supervision.

These positions make tummy time more doable. They are not a treatment for reflux or colic. Feeding changes and medicines are decisions for your pediatrician.

A sample day for a fussy baby

The Alberta physiotherapist says doing tummy time more often is sometimes easier than doing it for longer, and suggests trying it every time you change a diaper, even for 30 seconds at first. She also notes that grunting is OK because your baby is working hard, but if they are crying and cannot be distracted, change position. A day might look like this:

  • After diaper changes: a minute across your lap.
  • After a nap, before a feed: chest to chest on the sofa.
  • Mid-morning: side-lying, then a minute over a rolled towel, face to face.
  • Late afternoon: a tummy-down carry around the kitchen.
  • After a feed: a burping-position cuddle.

Keep a floor spot ready

Alberta Health Services suggests keeping simple tummy time spots ready: a blanket on the floor, a few toys or a small mirror, and a small towel to roll up. Keep the spot flat and clear of cords and small toys.

If you would like a dedicated spot, the GRHomera Playmat has a coral fleece surface, non-slip backing and a total thickness of about 1.3 in (3.3 cm), in Beige or Dark Grey. The 50 x 50 in square suits a compact corner, and our Playmat Size Guide compares all three sizes. Use it when your baby is awake and you are right there.

When to call your pediatrician

The AAP suggests contacting your pediatrician if your baby refuses to feed or cries and arches during feeds, has blood or a greenish color in spit-up, spits up more often or more forcefully, has a swollen or hard belly, wheezes or coughs, or does not seem to be gaining weight. The NHS lists green or yellow vomit, projectile vomiting, blood in poo and a baby who will not stop crying and is very distressed as reasons for urgent advice.

For tummy time itself, the RCH suggests seeking advice if your baby is not improving after 6 to 8 weeks of age, feels very stiff or very floppy, strongly prefers turning their head to one side or is not moving both sides of their body the same.

FAQ

Does chest-to-chest count as tummy time?

Yes. The AAP and the NHS both describe lying your baby on your chest as tummy time. Only do it when you are wide awake.

Should I still do tummy time if my baby has reflux?

The RCH says yes. Try more upright positions, such as on your chest or over your legs, and leave 20 to 30 minutes after a feed. Ask your pediatrician what suits your baby.

Can my baby sleep on their side because of reflux?

No. The AAP says even babies with GERD should sleep flat on their backs, and the side position is as dangerous as the stomach for sleep. Side-lying is for awake, supervised play only.

Sources

— The GRHomera team