The Infant “Guppy” Stretch

Rachel Heidling, OTR/L — October 14th, 2024

The “guppy” stretches the front of the neck, chest, and shoulders. It promotes tongue mobility, improves feeding skills, and increases tummy time success!

What’s the “guppy” all about?

The "guppy" stretch was popularized by Dr. Linda Blanchard, a pediatric physical therapist. It is designed to help improve neck and tongue mobility in infants, particularly for those with issues related to breastfeeding or oral function. The stretch encourages extension of the neck and promotes better motor development.

For the most traditional “guppy” stretch, start with baby laying on a safe, flat surface, on their back. Ensure they are comfortable and relaxed. Gently lift the infant’s head and tilt it back slightly, encouraging them to look up/behind them. Your other hand holds the infant’s shoulders or chest down to stabilize. A full guppy stretch opens all neck rolls as the neck goes into it’s full range of extension (the last picture on this blog post has the best example).

Which babies benefit & when is it safe to try?

Babies with difficulty opening the neck OR who have had more than 2 hours of “container time” in a day will particularly benefit from this stretch. However, all babies can benefit from this stretch to promote moving out of physiological flexion. The state of physiological flexion is a natural position where arms and legs are curled up close to the body, commonly referred to as a baby who is curled up in the “fetal position”. Encouraging infants to move out of this position is important for developing strength, improving posture, sensory exploration, and reaching motor milestone.

Signs of difficulty opening the neck include: tension, a head tilt or side preference, deep neck rolls, and/or difficulty breastfeeding.

You can technically start with a modified stretch from Day 1! Although, let’s be honest, that first week is such a blur of cuddling, feeding and sleeping you’re likely past Day 1 and now is also perfectly good time to start!

How long to hold the stretch?

Perform the stretch for a few seconds at a time, gradually increasing as the infant becomes more comfortable. Aim to incorporate the stretch into daily routines, but always pay attention to the infant’s cues and comfort level. If they’re happy/relaxed then many can tolerate for 2-3 minutes (some babies like even longer!). If they’re crunching or really guarded/tight, they’re not getting the benefit of the stretch, so stop and try again later.

Reverse Tummy Time

I like to refer to the “guppy’ as “reverse tummy time”. In both an ideal “guppy” pose and optimal tummy time, baby opens their neck, bringing chin away from the chest. However, babies lift up their head to open their neck during tummy time and rest their head back to open the neck for the “guppy”. The “guppy” is a much easier position to assume, since it works with gravity and does not require neck/shoulder/back strength. Both the “guppy” and tummy time help baby move out of physiological flexion.

If you pair the guppy stretch with tummy time, then baby can strengthen their newfound range of motion immediately after stretching it. So here’s the catchy rhyme: “Lengthen (aka stretch out with the guppy) THEN strengthen (tummy time)!
Tummy time is surprisingly beneficial for all — I would be willing to bet you and I would benefit from the guppy stretch as well!

Ways to modify?

The “guppy” is a highly versatile stretch, meaning there are many modified versions you can try. For example, a newborn can easily be stretched in your arms. With a small infant, hold them with one hand supporting the neck and their back/trunk and bottom/hips resting along that same forearm. Your other hand can then hold the back of their head and gently guide it backwards to open the neck. The guppy can be complete with a boppy pillow (pictured above), across your lap with head laying on the floor or couch (see below), over your bent knees (pictured to the left), using a couch pillow or cushion, or with a yoga ball or a peanut ball.

A deeper stretch with feeding benefits!

As the head is extended, encourage your little to stick out their tongue. This can be done by gently stimulating the tongue, making playful sounds, or sticking out your own tongue for them to copy. Engaging the tongue provides a deeper stretch because the root of the tongue is connected to the hyoid bone, a small, U-shaped bone located in the neck. The hyoid bone provides support and stability for the tongue. An infant requires tongue mobility to successfully draw milk from a breast of bottle. Further stretch is also achieved by stabilizing the baby’s shoulders or chest during the hold.

Try it for yourself:

Light neck stretch: lift your chin up and away from your chest.

Deeper neck with tongue engagement: (1) Suction your tongue to the roof of your mouth. (2) With your tongue suctioned, lift your chin away from your chest. Do you feel the difference?!

Wait, will baby get a head rush?

The stretch is more about opening the neck and less about them being inverted so they don’t get a head rush. Think about how you could lie flat on you back and change the tilt of your chin without getting a head rush/being inverted and yet your neck really opens up! Some providers teach a more exaggerated “full hang” neck stretch. In this case, infants are fully inverted. If your baby is positioned with their head lower than their heart/body, then the stretch should be done for a shorter period, and while watching baby very closely.

Most importantly!

Avoid forcing any movements; the stretch should be gentle and enjoyable! Please consult with a pediatric developmental therapist (physical or occupational therapist) or your child’s primary healthcare provider for personalized guidance, if there are specific concerns regarding your infant’s development.

Transform Your Baby's Tummy Time Experience

Is your little one fussing, crying, or completely refusing tummy time? You're not alone. Many parents struggle with this essential developmental activity, but there's good news - it doesn't have to be a battle. The guppy stretch technique is one piece of the puzzle that helps babies become more comfortable and confident during tummy time sessions.

What Parents Are Saying: "Before Rachel showed me easy steps to do tummy time, my baby only tolerated a few min of tummy time once a day. After my session with her, my baby loves tummy time and can stay longer and we do it 3-4 times a day now. She also taught me stretches to relieve tense muscles to help tummy time. My baby is a happier baby now b/c we have fun during tummy time!" - Recky M., mom of 2-month-old

Ready for peaceful, productive tummy time? Book your FREE 15-minute phone consultation with Rachel, our pediatric occupational therapist specializing in infant development. During this no-obligation call, she'll listen to your tummy time challenges, share initial insights, and determine if a comprehensive 1:1 Virtual Consultation would help your baby thrive.

Rachel has successfully guided many families through tummy time challenges, providing effective virtual guidance that works with your schedule and in your home environment. You don’t have to let tummy time tensions continue — your baby can make steady improvements with personalized guidance!