Tummy Time: What the Evidence Says About Motor Development

By Birth & Baby University · Last updated: October 2026 · 7 min read

Tummy time is one of the most repeated pieces of newborn advice, and one of the most resisted by newborns. Parents are told it builds strength, prevents flat heads and supports development, yet many babies protest, and some parents worry that they are doing it wrong or that it conflicts with “back to sleep.” Postpartum doulas are often asked to demonstrate it. The evidence is better for some claimed benefits than others, and recommended amounts differ between organizations. This article summarizes what the American Academy of Pediatrics (AAP), the World Health Organization (WHO) and the research say about tummy time, and where the research is thinner than the confidence of the advice.

Key takeaways

Quick answer: tummy time means supervised play on the stomach while the baby is awake, and it is distinct from sleep position, which should always be on the back. A systematic review found it positively associated with gross motor development and with prevention of brachycephaly (a flattened back of the head), while associations with plagiocephaly, walking, sitting and social and cognitive domains were indeterminate. Most studies were observational, and recommendations about amounts differ.

• The AAP recommends starting tummy time the day the baby gets home from the hospital with 2 to 3 sessions of 3 to 5 minutes, increasing gradually to 15 to 30 minutes a day by 7 weeks.
• WHO’s 2019 guidelines recommend that infants not yet mobile have at least 30 minutes in the prone position spread throughout the day while awake.
• A systematic review of 16 articles with 4,237 participants found tummy time positively associated with gross motor and total development and reduced BMI z-score and brachycephaly, with indeterminate associations for plagiocephaly, walking, standing and sitting and no association for fine motor development and communication.
• Tummy time is supervised awake play, and the AAP is clear that babies must always sleep on their backs.

What the research says

What organizations recommend. The AAP’s page Back to Sleep, Tummy to Play (updated September 2026) describes tummy time as for awake, closely supervised babies. It says to start the day the baby comes home with 2 to 3 sessions of 3 to 5 minutes a day, to increase gradually as the baby shows enjoyment, and to work up to 15 to 30 minutes a day by 7 weeks. It suggests doing it after a diaper change or a nap, putting a toy or yourself within reach, or lying on your back with the baby on your chest. For parents worried about a flat spot, it says a flat spot can develop but usually rounds out as the baby sits up, and recommends alternating the end of the crib the baby’s feet face, varying positions when awake and limiting time in swings, bouncy chairs and car seats. WHO’s 2019 guidance on physical activity, sedentary behavior and sleep for children under 5 says infants should be physically active several times a day, particularly through interactive floor-based play, including at least 30 minutes in the prone position spread through the day while awake for those not yet mobile, and should not be restrained for more than 1 hour at a time. The AAP and WHO figures differ, with the AAP building up to 15 to 30 minutes by 7 weeks and WHO stating at least 30 minutes across the day, and neither is based on a trial of different doses.

What the evidence shows. Hewitt, Kerr, Stanley and Okely’s 2020 systematic review in Pediatrics examined the association of tummy time with infant health outcomes in healthy infants 0 to 12 months. It included 16 articles with 4,237 participants from 8 countries. Tummy time was positively associated with gross motor and total development, a reduction in BMI z-score, prevention of brachycephaly, and the ability to move while prone, supine, crawling and rolling. The association was indeterminate for social and cognitive domains, plagiocephaly, walking, standing and sitting, and absent for fine motor development and communication. The authors note most studies were observational and lacked the robustness of randomized trials, with high selection and performance bias. Smaller trials add to this picture. In a randomized trial of 30 healthy infants aged 0 to 6 months by Lameky and colleagues (2026), supervised tummy time three times daily for two weeks improved gross motor scores in both a playmat group and a mattress group, with a slightly greater improvement on the playmat (mean difference 0.20, 95% confidence interval 0.01 to 0.39). A randomized trial in preterm infants in a low-income setting (Sampaio and colleagues, 2024) had 31 infants enrolled and 18 complete the assessments, and found higher Bayley-III motor composite scores in the group asked to do at least 20 minutes of tummy time daily after two and four months of corrected age, but no difference in the prone head-elevation angle. Both trials are small and short, and the second lost 31% of its participants.

What this means for doulas

• Keep tummy time and sleep position separate. Awake, supervised tummy time is encouraged. Sleep is always on the back, including naps, according to the AAP. A baby who falls asleep during tummy time should be moved to a back sleep position.
• Start small. The AAP suggests 3 to 5 minutes, a few times a day, from the first days. Some babies fuss, and short, frequent sessions are suggested.
• Be honest about the evidence. The motor benefit has support from observational data and small trials. “It helps flat spots” is less certain: the review found prevention of brachycephaly but indeterminate findings on plagiocephaly.
• Offer ways to make it work. Chest-to-chest tummy time, a toy within reach and getting down at the baby’s level are the AAP’s suggestions.
• Refer concerns. A head that looks persistently misshapen, a baby who cannot lift or turn the head, or motor asymmetry should be mentioned to the pediatric provider. See Understanding Developmental Milestones Without Creating Unnecessary Parental Anxiety.

Putting the evidence into practice

1. Demonstrate once. Place the baby on a firm, flat surface on the floor, get down at their level, and keep them in view. Watch for tiring, spit-up, or sleepiness and stop.
2. Link it to routines. After diaper changes or naps, as the AAP suggests.
3. Use alternatives when a baby protests. Tummy time on a parent’s chest or lap counts as a start, and the AAP describes the chest-to-chest version.
4. Vary positions through the day. Reduce long periods in seats and swings, as the AAP and WHO both suggest.
5. Remind parents of safe sleep. See Safe Sleep Recommendations: What Every Postpartum Doula Must Know.

Limits and uncertainty

Most of the evidence is observational, from small studies, and cannot show that tummy time causes better motor development, since active babies may get more tummy time or parents of such babies may report more of it. The trials are small and short, one in preterm infants with considerable dropout and the other with a two-week intervention and a screening test. No studies were found comparing different doses of tummy time or establishing the minimum useful amount, so recommended amounts are best seen as guidance. This article draws on the AAP and WHO pages and the abstracts of the research. This article does not review evidence on helmets or repositioning therapy for head shape, torticollis, or equipment such as positioning supports.

The bottom line

Supervised tummy time is a low-risk daily habit with modest evidence for gross motor benefit and for preventing a flattened back of the head, and recommended amounts vary between the AAP and WHO. It should never replace the rule that babies sleep on their backs. A doula can help families begin gently, make it enjoyable, avoid overpromising and flag concerns about head shape or movement to the pediatric provider.

Birth & Baby University’s For Doulas page sets out its postpartum doula training, recertification and mentorship for doulas who support families with newborn care and development. Confirm that any program meets your certifier’s, employer’s or state’s requirements before you enroll.

This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work. For concerns about a baby’s health, contact a pediatric provider or emergency services.

Sources and further reading

• American Academy of Pediatrics. Back to Sleep, Tummy to Play: Give Your Baby a Safe, Strong Start (HealthyChildren.org, updated September 2026). Read the source
• World Health Organization. To grow up healthy, children need to sit less and play more (news release on the 2019 guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age, 24 April 2019). Read the source
• Hewitt L, et al. Tummy time and infant health outcomes: a systematic review. Pediatrics (2020). Read the source
• Lameky VY, et al. Effectiveness of tummy time exercise using playmat versus mattress on gross motor development in infants aged 0-6 months: a randomized controlled trial. Journal of Pediatric Nursing (2026). Read the source
• Sampaio SSS, et al. Cognitive and motor improvement by tummy time practice in preemies from low-income settings: a randomized clinical trial. Frontiers in Psychology (2024). Read the source

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