By Sally Fryer Dietz, PT, DPT, CLC, CST-D

Placing babies on their tummies for brief periods while they are awake and supervised—referred to as tummy time—is an important way to help babies strengthen their neck, shoulder, and arm muscles, and improve both motor skills and bilateral coordination. 

Tummy time is what helps prepare a developing baby to crawl—an important foundational milestone for learning and motor skill progression. Unfortunately, with infants spending less time on their tummies, crawling can be delayed, shortened, or even absent. In my experience as a physical therapist and developmental specialist, it is to the child’s benefit to crawl; I would much rather see a late walker than an early walker because the late walker who crawls will almost certainly have better bilateral coordination. 

Some parents and guardians make the mistake of avoiding tummy time because the baby fusses in that position. Today, many babies spend far too much time in car seats, baby carriers, or baby swings, or some other kind of container that keeps them supported. And remember, though swaddling provides important warmth and security in a newborn’s transition from the womb to the world, it should be limited to the first few weeks of life, not months. 

Rather, let your child discover how to move their body and shift to new positions. A typically developing child needs sensory input on both sides of their body—the tummy and the back—in order to develop adequate postural strength and control, and a good foundation for bilateral coordination.

Bilateral Coordination

Bilateral coordination refers to the ability to move both sides of the body at the same time in a coordinated, controlled, and organized manner. Examples include doing jumping jacks, holding a piece of paper with one hand while writing with the other, clapping games (eg, pat-a-cake), or catching/dribbling a ball with two hands. 

Well-developed bilateral coordination indicates that both sides of the brain are sharing information and communicating effectively.  

When babies cry or fuss as they are placed on their stomachs, parents often think it’s because their child simply “doesn’t like it,” so they avoid it even more. Tummy time can be hard for some, yes, but it is an important developmental experience. In small children—as in some grown-ups—frustration is not a bad thing; after all, it can help drive development and test strengths, and ultimately overcome weakness.

The American Academy of Pediatrics recommends that a newborn—whether born prematurely or at term—be placed on their back for sleeping to help prevent sudden infant death syndrome (SIDS). While this guideline has been very effective in reducing the incidence of SIDS, we now see many more children than we once did who have misshapen heads—a condition called “plagiocephaly.” Fortunately, when caught early enough, plagiocephaly can be treated with interventions including physical therapy and CranioSacral Therapy (CST). 

Why Children Crawling on Hands and Knees is Important

Crawling is an accomplishment you should be sure to savor because it is remarkably sophisticated, nurturing, and a vital neurological catalyst that supports the foundation of future development by stimulating millions of neurons to grow together into complex pathways. Because of this, children who skip the crawling stage may not have as solid of a sensory-motor foundation that higher skills are dependent upon

In fact, research shows that crawling increases hand-eye coordination, fine and gross motor skills (refined and large movements), balance, and overall strength. In the long term, the development of these skills helps prepare the brain and body for more advanced skills such as reading, writing, and creative problem-solving. 

While it’s true that a baby does not need to crawl in order to walk, it absolutely does need to develop the muscle strength and four-limb coordination that crawling so wonderfully provides in order to skillfully perform tasks requiring refined fine-motor skills later. 

So—long story short—don’t be in a hurry for your child to walk.

Craniosacral Therapy

CranioSacral therapy—a gentle, non-invasive, manual therapy technique—is frequently used to relieve pain, tension, and body dysfunction, as well as to improve motor coordination, developmental progress, neuromuscular function, and overall health. 

This gentle and yet highly effective modality was developed by John E Upledger, DO, OMM, beginning in the 1970s. As a highly innovative osteopathic physician, Upledger demonstrated extensive clinical successes and pioneered research at Michigan State University and the Upledger Institute in Florida over the course of four decades. 

Since its inception, over 100,000 practitioners have been trained worldwide, and CST’s benefits continue to be documented through research and confirmed every day by the patients who have received this treatment. 

While controversial in its early years of use, CST has found its way into mainstream medicine as more and more physicians, therapists, and patients around the world have experienced it firsthand—and have recommended it to others.

CranioSacral Therapy played an important role in preparing formerly conjoined twins from Egypt for their world-renowned separation surgery in October 2003—performed in Dallas by a team of fifty physicians and led by Kenneth Salyer, MD, one of the world’s foremost reconstructive plastic surgeons.

Several CranioSacral therapists were part of that team, and it was our job to work with the two boys, who were joined at the top of their skulls, to prepare their bodies and internal systems for a surgery that would be enormously physically challenging for them—even if everything went according to plan.

Initially, the boys were extremely sensitive to movement, and when one moved, the other was instantly affected—often in a way the other did not like—and the movement that was possible was obviously very limited. For a year, we worked several times each week to help the boys gain weight, strength, and muscle tone, and even to learn how to eat and walk. 

Several of us would hold one boy upside down as the other gained experience standing on his own two legs. Little by little, their tolerance to this activity improved and they were able to take their first steps, preparing each for walking independently after their surgery.

Physical and occupational therapy were vital parts of our overall regimen along with the CST, which helped their autonomic nervous systems to relax and be more receptive to all the other therapeutic inputs, boosting their physical gains.

Upledger himself came to Dallas to be part of the CranioSacral team and we were able to take the boys to the Upledger Institute in Florida as well. The children thrived, and by the time the separation surgery—which lasted thirty-three hours—was finally performed, they were ready. 

The surgery was an overwhelming success in the end. Like everyone on our very large team, we were all delighted by what we had collectively accomplished. Salyer, the twins, and the story of their successful separation surgery and treatment were all featured on numerous shows, including Dateline and The Oprah Winfrey Show, as well as on The Discovery Channel, receiving media attention from around the world. It was an extraordinary experience and a wonderful opportunity to demonstrate what an invaluable complementary tool CranioSacral Therapy can be, even in the most extreme situations.

Today the twins are in their twenties living in their two separate, healthy bodies with their family in Egypt, their lives are forever changed through the miracle of modern medicine, incredible surgeons, and CranioSacral Therapy.

In terms of safety, the extremely light touch involved in the application of CST makes it a safe approach for everyone, even the most fragile of patients, including children, infants, newborns, frail elderly, and injured individuals such as those recovering from a concussion.

Tummy Time with Tonic Labyrinthine Reflex 

Tummy time, along with Tonic Labyrinthine Reflex (TLR)—a primitive, involuntary movement pattern in infants—helps to provide the baby with a means to master head and neck control as well as learn about gravity outside of the womb. There are two forms of the TLR: one occurs when the baby bends their head forward while on the tummy. In this position, the arms, legs, and torso fold forward into what we know as the “fetal position.” The second form occurs when the baby tilts their head backward. In this position, the whole body straightens and extends.  

These two actions set the body up to be in good alignment so that balance, visual tracking, auditory processing, and organized muscle tone contributing to adequate bilateral coordination can all be optimized. 

On the other hand, when this reflex is not fully integrated, we see challenges with balance and coordination, stiff jerky movements, toe walking, or W-sitting. All these foundational skills, when not fully developed, can lead to trouble paying attention, following directions, and challenges in motor planning. 

Bonding and Attachment for Healthy Development

In addition to practices such as tummy time and crawling, simply watching and interacting with your baby, capturing their gaze, and eliciting intermittent smiles is important for not only developing a strong, bonded attachment but also driving sensory motor development. 

Encourage your child by looking for opportunities to capture their gaze, allowing them to imitate your expression or follow your face from side to side. When you hold your baby to feed them—whether from a breast or a bottle—they are at the perfect distance from your face to be able to engage it visually. 

Nothing’s more stimulating to a newborn than your face, so forego all the toys and digital devices intended to help capture your baby’s attention—you’ve got the very best tool with you all the time. 

When it comes to digital devices, minimum use is key. In fact, the American Academy of Pediatrics has even come out with a recommendation that children under the age of two not be exposed to any technology at all. 

I recently saw an advertisement for a potty-training seat with a mounted electronic tablet. It was being marketed to busy parents who liked the idea of turning potty training over to a computer software application that purportedly would both instruct and entertain their child—a scary concept if you think about having an electronic device in lieu of a parent teaching their child. 

I also regularly see dozens of parents and babysitters pushing babies in strollers while talking on their phones as they make their way down the street, rather than pointing out the colors of different trees in the ground and airplanes in the sky. And you know yourself how many kids in restaurants are commonly handed their parents’ phones or tablets to keep them quiet at the table. 

There is nothing better for a young child than direct interaction with a parent or another person, whether it is at the dinner table, on a walk, or over a potty chair. Person-to-person connections are critically important in every child’s development. 

Entertain your child with peek-a-boo and pat-a-cake instead of lights and sounds on a bright screen. Make funny faces with your infant child; play airplane games. Tummy time, crawling, playing, and discovering are essential elements of your child’s journey.

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Sally Fryer Dietz, PT, DPT, CLC, CST-D, is a highly esteemed Doctor of Physical Therapy, developmental specialist, sensory integration expert, lactation counselor, and Upledger CranioSacral Therapy Diplomate and presenter. With unmatched dedication to therapeutic pediatrics, and as a devoted mother to two boys with distinct learning styles, she has touched the lives of thousands of children and their families, helping them lead healthier, happier lives. Her innovative therapy methods have garnered international acclaim, making her a true pioneer in her field. Residing in Dallas, Texas, Dietz continues to advocate for the potential within every child to succeed naturally.

Well Being Journal adapted the above excerpt from Sensory Processing Solutions: Drug-Free Therapies to Realize Your Child’s Potential by Sally Fryer Dietz, PT, DPT, CLC, CST-D © 2023 and reprinted with permission of Healing Arts Press.