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THE VENTRAL SURFACE: TUMMY TIMETM AS A THERAPEUTIC STRATEGY IN TONGUE-TIED INFANTS

The ventral surface refers to the front half of the body. Tummy time means being on the ventral surface or being on your belly.

When babies are not given an appropriate amount of tummy time, what are the issues we see? Babies with a tongue tie have a midline defect, often demonstrating a wide variety of issues, which can affect the breastfeeding relationship. These babies can also have asymmetries, restricted movement and inhibited reflexes. We want to elongate the anterior (front plane) myofascial body, in contrast to gestational physiologic flexion leading to soft tissue contractures. In other words, when babies are in the womb, they are curled forward in a ball. Some babies can be born with restrictions and imbalances potentially resulting in a host of issues.

What are the advantages of tummy time and elongating the anterior aspect of the body? It resolves torticollis, which is a twisted neck and can happen due to positioning in the womb or after a difficult childbirth. Every single baby has a head preference, which leads to head turning problems. Head turning issues impact breastfeeding abilities and cause compensatory strategies to arise. Tummy time is the best position for baby to engage in head turning. Interestingly, torticollis is often linked to tongue tie and lip tie and is very often a cause of breastfeeding problems, latch problems even without tongue or lip tie. Midline defects and asymmetries that cause compensatory defects are addressed often times through tummy time.

Tummy time promotes optimal jaw growth and function. Babies experience rapid growth in the first 6 months of life. Most babies are born with a small jaw and tummy time provides optimal forces for bone growth. Jaw mobility and function has much to do with breastfeeding success and has a positive effect on sinuses and ears.

If baby is comfortable in their own body, they will breastfeed better. Tummy work will optimize sensory input and all of the sensory systems (touch, space, movement, body awareness) work together for successful breastfeeding. When the nursing dyad is functioning properly, sensory input provides information to the nervous system and should be calming and containing for baby. It can reveal sensory sensitivities and promotes baby’s comfort and range of breastfeeding abilities. They need to be belly down to the earth for optimal reflex activity.

This offsets time babies spend on the dorsal surface.

Modern culture makes it difficult to implement tummy time and is thought of as the container lifestyle. For example: Car seats (gravity is loading down on baby and is the leading cause of scoliosis), Back to Sleep 1992/2011, Safe Sleep 2014, Bumbo, caregiving activities (diaper/ bath, etc.), being held in arms and even breastfeeding. When taking baby out of a car seat, do tummy time right after to re-establish balance.

Tummy time is easy to implement because it’s free and available at home, empowers parents, allows parents to connect with their baby, is a natural developmental expectation and engages and optimizes the social engagement system. It also helps the baby to integrate bodywork changes and helps those changes to last longer. Tummy time provides daily, consistent practice but bodywork happens less regularly. Babies need bodywork for dysregulation of soft tissue restrictions, which inhibit function.

Posture affects everything and is an integral part of development. Feeding baby is a postural event, a primary activity of daily living and a whole body process. Feeding promotes development of articulations around the thoracic cage and vertebral column and sets a foundation for lifetime postural habits.

Tummy time promotes optimal head shape and helps resolve head flattening.

It promotes GI function, impacts rib cage, diaphragm, psoas and the pelvic floor. It allows for easier burping, passing gas, pooping and optimizes pressure induced through body weight and gravity. Vagal tone can also be optimized, which translates into how well the vagus nerve can calm down the heart rate in a calming manner to deal with situations.

How do we “dose” tummy time? It’s really about quality not quantity and we want it to be enjoyable for baby. We need to be consistent as baby learns to adapt. It should also be implemented before and after a revision and even tummy time if no revision is indicated.

How do you accomplish Tummy time?

Start baby on the back

Engage baby-eye contact, cooing, facial expressivity, talking, stimulated vagus nerve

Mom rolls baby to side first and pauses

Then roll to tummy

Mom/ dad becomes observer (opens chest and pulls shoulder girdle back) if arm is stuck give baby a chance to pull arm out,

Make changes as requested by baby, baby will tell you what they need

Baby communicates readiness to transition, tucks arm in and rolls slowly back to belly

Pick baby up and plug in heart to heart

Repeat when baby has taken a deep sigh and feels safe and connected

Alternative tummy time positions:

On a lap, ball, over an arm, on parent’s chest, propped on boppy or wedge, and baby wearing, but the goal is a flat surface. The gold standard is to live on the parent’s chest for first 10-14 days of life. After 10-14 days, place a blanket on the floor with parent (bidirectional/ reciprocal interaction) and begin with a few minutes a day, working up to 30 minutes by 6 months of age.

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