Tummy time

File:Tummy time.jpg

Tummy time is a colloquialism for placing infants in the prone position while awake and supervised to encourage development of the neck and trunk muscles and prevent skull deformations.{{Cite web|title=Babies Need Tummy Time!|url=https://safetosleep.nichd.nih.gov/safesleepbasics/tummytime|last=|first=|date=|website=Safe to Sleep, US Department of Health and Human Services, National Institutes of Health|archive-url=|archive-date=|access-date=April 30, 2020}}{{cite journal |doi=10.1542/peds.2011-2220 |title=Prevention and Management of Positional Skull Deformities in Infants |year=2011 |last1=Laughlin |first1=J. |last2=Luerssen |first2=T. G. |last3=Dias |first3=M. S. |journal=Pediatrics |volume=128 |issue=6 |pages=1236–41 |pmid=22123884 |author4=Committee On Practice Ambulatory Medicine|doi-access=free }}{{cite web |url=http://losangeles.cbslocal.com/2013/04/30/doctor-finds-success-in-treating-infants-with-flat-head-syndrome/ |title=Doctor Finds Success In Treating Infants With Flat-Head Syndrome |publisher=CBS Los Angeles |accessdate=November 11, 2013 |date=April 30, 2013}}

In 1992, the American Academy of Pediatrics recommended babies sleep on their backs to prevent sudden infant death syndrome (SIDS). Although the rate of SIDS has decreased by 50% since the Safe to Sleep campaign started in 1994,{{cite web |title=Back to Sleep Public Education Campaign |url=http://www.nichd.nih.gov/sids/ |publisher=National Institute of Child Health and Human Development |date=March 23, 2010}} an unintended consequence was that babies missed out on the twelve or so hours they used to spend in the prone position while asleep, and there was a sharp increase in plagiocephaly (flat head syndrome) in infants. Along with tummy time, rotating the direction infants lie in their cribs as well as avoiding too much time in car seats, carriers, and bouncers are behaviors recommended to alleviate the associated risks of infants sleeping in a supine position.

Impact on development

Infants put to sleep in the supine position have been found to reach motor developmental milestones (e.g. crawling, rolling, and sitting) at a slower rate compared to infants who sleep in the prone position.{{cite journal |doi=10.1017/S0012162205000733 |title=Influence of supine sleep positioning on early motor milestone acquisition |year=2005 |last1=Majnemer |first1=Annette |last2=Barr |first2=Ronald G |journal=Developmental Medicine & Child Neurology |volume=47 |issue=6 |pages=370–6; discussion 364 |doi-broken-date=25 March 2025 |pmid=15934485}}{{cite journal |doi=10.1542/peds.102.5.1135 |title=Effects of Sleep Position on Infant Motor Development |year=1998 |last1=Davis |first1=B. E. |last2=Moon |first2=R. Y. |last3=Sachs |first3=H. C. |last4=Ottolini |first4=M. C. |s2cid=18553504 |journal=Pediatrics |volume=102 |issue=5 |pages=1135–40 |pmid=9794945}} When babies experience tummy time in their waking hours, they are provided with opportunities to strengthen their neck{{Cite web|last=Geyer|first=Hilda|title=How to ensure your baby's neck muscles are strong|url=https://www.news24.com/parent/baby/development/a-strong-neck-20080806|access-date=2021-03-19|website=Parent|language=en-US}} and trunk muscles. Positioning the infant on their stomach while awake will not impact the amount of slow wave sleep{{cite journal |pmid=9646378 |year=1998 |last1=Myers |first1=MM |last2=Fifer |first2=WP |last3=Schaeffer |first3=L |last4=Sahni |first4=R |last5=Ohira-Kist |first5=K |last6=Stark |first6=RI |last7=Schulze |first7=KF |title=Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants |volume=21 |issue=4 |pages=343–9 |journal=Sleep}}{{cite journal |doi=10.1203/00006450-200209000-00016 |title=Quality of Diet, Body Position, and Time after Feeding Influence Behavioral States in Low Birth Weight Infants |year=2002 |last1=Sahni |first1=Rakesh |last2=Saluja |first2=Deepak |last3=Schulze |first3=Karl F |last4=Kashyap |first4=Sudha |last5=Ohira-Kist |first5=Kiyoko |last6=Fifer |first6=William P |last7=Myers |first7=Michael M |journal=Pediatric Research |volume=52 |issue=3 |pages=399–404 |pmid=12193675|doi-access=free }}{{cite journal |doi=10.1016/S0022-3476(73)80017-4 |title=Psychophysiologic effects in the neonate of prone versus supine placement |year=1973 |last1=Brackbill |first1=Yvonne |last2=Douthitt |first2=Thomas C. |last3=West |first3=Helen |journal=The Journal of Pediatrics |volume=82 |pages=82–4 |pmid=4681872 |issue=1}}{{cite journal |doi=10.1016/S0387-7604(12)80020-9 |title=Effects of prone and supine position on heart rate, respiratory rate and motor activity in fullterm newborn infants |year=1991 |last1=Amemiya |first1=Fumiaki |last2=Vos |first2=Johan E |last3=Prechtl |first3=Heinz FR |s2cid=4763777 |journal=Brain and Development |volume=13 |issue=3 |pages=148–54 |pmid=1928606}}{{cite journal |vauthors=Kahn A, Rebuffat E, Sottiaux M, Dufour D, Cadranel S, Reiterer F |title=Arousals induced by proximal esophageal reflux in infants |journal=Sleep |volume=14 |issue=1 |pages=39–42 |date=February 1991 |pmid=1811318}} since tummy time only occurs when an infant is awake.

Not only does tummy time improve and strengthen and infants muscle, it also aids in improving neural connections. The ability for the brain to form new neural connections through experiences and verbal interactions is called plasticity. When an infant is laying supine, they are only able to see what is above them. However, when an infant is laying in a prone position, they are able to use their neck and trunk muscles to take in their surroundings. This allows an infant to form neural connections in relation to their environment, the communication between themselves and their caregivers, and even the learning toys in front of them. While improving muscular support and brain stimulation, tummy time allows an infant to reach their developmental milestones.{{Cite journal |last1=Dumuids-Vernet |first1=Marie-Victorine |last2=Provasi |first2=Joëlle |last3=Anderson |first3=David Ian |last4=Barbu-Roth |first4=Marianne |date=2022-04-28 |title=Effects of Early Motor Interventions on Gross Motor and Locomotor Development for Infants at-Risk of Motor Delay: A Systematic Review |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.877345 |doi-access=free |issn=2296-2360 |pmc=9096078 |pmid=35573941}}

Furthermore, tummy time provides infants with opportunities for cognitive and communicative development through interactive play with their supervisor.{{cite journal|last1=Dewey|first1=C.|last2=Fleming|first2=P.|last3=Golding|first3=J.|last4=The Alspac Study Team|year=1998|title=Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months|journal=Pediatrics|volume=101|issue=1|pages=e5|doi=10.1542/peds.101.1.e5|pmid=9417169|doi-access=free}}{{Cite journal|last1=Martiniuk|first1=Alexandra L. C.|last2=Vujovich-Dunn|first2=Cassandra|last3=Park|first3=Miles|last4=Yu|first4=William|last5=Lucas|first5=Barbara R.|date=2017-01-01|title=Plagiocephaly and Developmental Delay|journal=Journal of Developmental & Behavioral Pediatrics|volume=38|issue=1|pages=67–78|doi=10.1097/dbp.0000000000000376|pmid=28009719|s2cid=39477708|issn=0196-206X|hdl=1959.4/unsworks_43153|url=https://unsworks.unsw.edu.au/bitstreams/1fa34015-4e67-48ba-abf2-ce418e25738d/download |hdl-access=free}}

Meeting with a Physical Therapist can benefit an infant with developmental disabilities by working on tummy time in the office and engaging the guardians so the exercises can be replicated at home. Tactics such as proper head positioning or the use of a toy for entertainment within reach can improve strength, stability, and an increase in neural connections. Safe play with guardians allows the infant to progress in their developmental milestones, eventually resulting in independent sitting, standing, and walking.{{Cite journal |last1=Dumuids-Vernet |first1=Marie-Victorine |last2=Provasi |first2=Joëlle |last3=Anderson |first3=David Ian |last4=Barbu-Roth |first4=Marianne |date=2022-04-28 |title=Effects of Early Motor Interventions on Gross Motor and Locomotor Development for Infants at-Risk of Motor Delay: A Systematic Review |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.877345 |doi-access=free |issn=2296-2360 |pmc=9096078 |pmid=35573941}}

Implementation

Tummy time is recommended to be practiced from birth, first in short sessions of three to five minutes, two to three times a day. As babies grow more receptive towards the sessions, they can be extended and performed more frequently. The World Health Organization advises that infants under one year of age who are not yet mobile should experience tummy time for at least 30 minutes per day across sessions.{{Cite web|title=To grow up healthy, children need to sit less and play more|url=https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more|last=|first=|date=April 24, 2019|website=World Health Organization|archive-url=|archive-date=|access-date=}} Supervision by a parent or caregiver is important during tummy time so that the infant's position can be monitored and to encourage social interaction. Babies who are unaccustomed to frequent tummy time sessions may cry or show noncompliance when it is first introduced,{{Cite journal|last=Graham|first=John M.|s2cid=45672124|date=2006-03-01|title=Tummy Time is Important|journal=Clinical Pediatrics|volume=45|issue=2|pages=119–121|doi=10.1177/000992280604500202|pmid=16528431|issn=0009-9228}} however enjoyment may be increased by providing stimulating objects during sessions, such as preferred toys and videos.{{Cite book|last=Kadey, Heather J Roane, Henry S|title=EFFECTS OF ACCESS TO A STIMULATING OBJECT ON INFANT BEHAVIOR DURING TUMMY TIME|date=2012|publisher=The Society for the Experimental Analysis of Behavior|oclc=810682892}}

Tummy time may also be used to stabilize the neck in torticollis,{{Cite journal|last1=Kaplan|first1=Sandra L.|last2=Coulter|first2=Colleen|last3=Sargent|first3=Barbara|s2cid=52909510|date=2018-10-01|title=Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy|journal=Pediatric Physical Therapy|volume=30|issue=4|pages=240–290|doi=10.1097/PEP.0000000000000544|issn=1538-005X|pmid=30277962|pmc=8568067 }} and to address hypertonia associated with Down syndrome.{{Cite journal|last1=Boutot|first1=E. Amanda|last2=DiGangi|first2=Samuel A.|date=2018-02-23|title=Effects of Activation of Preferred Stimulus on Tummy Time Behavior of an Infant with Down Syndrome and Associated Hypotonia|journal=Behavior Analysis in Practice|volume=11|issue=2|pages=144–147|doi=10.1007/s40617-018-0212-5|issn=1998-1929|pmc=5959811|pmid=29868339}}

Infants with these developmental disabilities often present with decreased muscle tone in their upper and lower extremities. An early intervention of tummy time, beginning at 2-4 months, has shown to have greatest effects on motor development. Especially in infants with Down Syndrome or CP, their bodies are weak and may be unable to perform the typical milestone tasks. If tummy time is implemented early, motor skills will improve, allowing a better performance in sitting up independently, progressing to standing up and eventually walking.{{Cite journal |last1=Dumuids-Vernet |first1=Marie-Victorine |last2=Provasi |first2=Joëlle |last3=Anderson |first3=David Ian |last4=Barbu-Roth |first4=Marianne |date=2022-04-28 |title=Effects of Early Motor Interventions on Gross Motor and Locomotor Development for Infants at-Risk of Motor Delay: A Systematic Review |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.877345 |doi-access=free |issn=2296-2360 |pmc=9096078 |pmid=35573941}}

In society today, the use of technology is advancing not only for social use, but also for healthcare. The use of early intervention Physical Therapy such as tummy time in infants is crucial for their development. However, it is not also easy. First time parents may feel uneasy or anxious to put their baby in a prone position, especially with the stigma that babies do not like the tummy time position. To put those first time parents at ease, they can use their phone or computer to meet with their pediatrician to ensure that their baby and the environment is safe. Mobile phones are widely accessible and is a great tool that can be used to communicate with the primary care doctor. {{Cite journal |last1=Ekambareshwar |first1=Mahalakshmi |last2=Ekambareshwar |first2=Swathi |last3=Mihrshahi |first3=Seema |last4=Wen |first4=Li Ming |last5=Baur |first5=Louise A. |last6=Laws |first6=Rachel |last7=Taki |first7=Sarah |last8=Rissel |first8=Chris |date=December 2021 |title=Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review |journal=International Journal of Behavioral Nutrition and Physical Activity |language=en |volume=18 |issue=1 |page=10 |doi=10.1186/s12966-020-01074-8 |doi-access=free |issn=1479-5868 |pmc=7796572 |pmid=33422066}}

Although sleeping in the supine position without sufficient tummy time may change the physical appearance of the head through plagiocephaly and consequently promote developmental delays, regardless of these effects, it is essential that infants are placed to sleep on their back, because of the risk of SIDS.

Tummy time

Impact on development

Implementation

See also

References

Further reading