Tummy Time, Containers, & Freedom of Movement: Rethinking Infant-Directed Gross Motor Development

Derrick Toups, MEd

In 1994, the American Academy of Pediatrics (AAP) introduced the “Back to Sleep” campaign and recommended parents place infants to sleep on their backs, an intervention that reduced sudden infant death syndrome (SIDS) by 40% (Hewitt et al., 2020). However, infants began showing increased rates of head-shape abnormalities and later achievement of physical milestones, ostensibly caused by spending more time on their backs and less time on their stomachs. The medical community thus recommended tummy time, placing infants in the prone (belly down) position for at least 30 minutes a day.

Tummy time is now standard pediatric advice. A 2020 meta-analysis found that tummy time was positively correlated with gross motor development and with decreased brachycephaly (Hewitt et al., 2020). While research clearly shows the benefits of tummy time, it does not consider all aspects of this practice. Early childhood professionals should be familiar with research-based recommendations and also critically assess why they are implemented. The Educaring approach invites us to more deeply consider why we implement tummy time.

What is the Educaring approach?

The Educaring approach, rooted in the work of Hungarian pediatrician Emmi Pikler, was introduced to the United States by Magda Gerber through the organization Resources for Infant Educarers (RIE). RIE promotes respectful infant caregiving practices and unassisted gross motor development, which refers to giving infants freedom of movement so they naturally develop the strength and coordination needed to get into and out of prone, sitting, and standing positions on their own, rather than adults placing them into these positions. According to Magda Gerber (2002), the ultimate goal of the Educaring philosophy is to nurture an “authentic” child who feels “secure, autonomous, and competent.” Gerber’s view that “babies should not be taught because it usually interferes with learning” aligns with the constructivist theories of Dewey and Piaget: learning and development are not isolated to biology alone but encompass self-exploration and interaction with the environment.

Pikler (1978) focused on observing and documenting the optimal physical development of infants, urging caregivers to offer babies the opportunity to independently move according to their “inherent ability.” When allowed to discover their own movements on their own timelines, Pikler argued that infants experience physical development that occurs more naturally and thus move with better coordination and greater bodily awareness. This exploration becomes a process through which infants discover both the process of learning and how to use their bodies. This claim, as much pedagogical as developmental, is echoed by Gerber in her book Dear Parent: “You have to respect and trust a healthy, normal baby’s inborn capacities, his natural desire to learn.”  

Is Earlier Milestone Achievement Better?

The research supporting tummy time is clear. Longitudinal studies in the Hewitt et al. meta-analysis found a difference in gross motor development between prone and non-prone infants, including earlier rolling, crawling, unsupported sitting, and pulling to stand, and other studies found that infants who experienced more tummy time achieved milestones earlier. But this research invites a more nuanced question: does it matter if gross motor milestones are achieved earlier? While later milestone achievement can indicate atypical development, developmental timelines vary by child (Zubler et al., 2022). Earlier milestone achievement does not necessarily produce better developmental outcomes. The speed of developmental milestone acquisition and the quality of development are not the same thing.

What do Tummy Time and Containers Have in Common?

Placing infants into positions they cannot independently achieve is not limited to tummy time. “Containers,” such as bouncers, swings, high chairs, jumpers, pillows, and baby carriers, force children into positions that limit their spontaneous motor activity and that they may not have the strength or coordination to sustain. Research indicates that forced container positioning can cause developmental delays, decreased muscle strength, and poor coordination (Michalska et al., 2023). Core to Educaring is enabling, not restricting, infants’ opportunities for natural motor development.

Rather than focusing on whether tummy time or containers are good or bad, the more important question is: do infants have genuine freedom of movement throughout the day? A child who is free to explore without adult-initiated or container-assisted positioning experiences a different developmental environment than a child propped in a bouncer or highchair throughout the day. The Educaring approach argues for maximizing freedom, minimizing constraint, and trusting the infant’s capacity to learn how to move her body.

What does this Mean for Early Childhood Educators?

I am not arguing against the AAP’s recommendations for tummy time. Rather, I am extending an invitation to think more deeply about why we make certain decisions for babies and cautioning against substituting adult teaching for infant agency and learning. For early childhood educators, this means prioritizing freedom of movement over container time, challenging the impulse to place infants into prone, sitting, or standing positions before they can sustain those independently. This also means creating “yes spaces” in you your classrooms and carefully observing each infant, as Pikler and Gerber encouraged, in order to better understand each child’s natural rhythms and innate strengths. Finally, this means recognizing that each child’s development will unfold on its own timeline and may be different from peers. And this means celebrating, as Pikler put it, “the quality of the movement rather than the age at which the movement is acquired.”

Pikler (1994) and Gerber believed that a healthy infant raised in a stable and respectful relationship has the ability to learn to roll over, sit, and walk without being taught. How might we reflect in our practice the idea that infants are capable of doing more than we may give them credit for? What might we learn from infants who are given room to move, explore, and develop on their own terms?

Derrick Toups teaches education and child development courses at Tulane and multiple Louisiana community colleges and is a PhD student at LSU. He can be contacted at derricktoups@gmail.com. 

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References

Gerber, M. (2002). Dear parent: Caring for infants with respect (2nd ed.). Resources for Infant Educarers.

Hewitt, L., Kerr, E., Stanley, R. M., & Okely, A. D. (2020). Tummy time and infant health outcomes: A systematic review. Pediatrics, 145(6), 1–27.

Michalska, A., Połatyńska, K., Gładyś-Jakubczyk, A., Kędzierski, S., & Pogorzelska, J. (2023). Container baby syndrome – has infant equipment overuse an impact on motor skill development? Pediatria Polska, 98(1), 66–69.

Pikler, E. (1978). Unfolding of infants' natural gross motor development. In Terminology of basic body postures and movements. Resources for Infant Educarers.

Pikler, E. (1994). Pikler Bulletin #14: Sensory Awareness. Sensory Awareness Foundation.

Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J.K., Pajek, J. A.,

Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P.H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics 149(3), e2021052138. https://doi.org/10.1542/peds.2021-052138

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