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Pathways Awareness - For Parents - Tummy Time - Tummy Time Research

Tummy Time Research

Pathways aims to serve as a catalyst in promoting Tummy Time related research in order to elucidate potential risk factors associated with lack of Tummy Time. We invite you to explore the studies and articles linked below. Watch for new research articles and links to be added as they become available.

Infant Motor Development & Tummy Time

Abbott AL, Bartlett DJ. Infant motor development and equipment use in the home. Child: Care Health & Development. 2001; 27: 295–306.

This study concluded “parental education with respect to moderate use of equipment and provision with adequate floor time (tummy time) to practice and experiment with motor abilities might be required to enhance motor outcomes of vulnerable infants.”

American Physical Therapy Association. Lack of time on tummy shown to hinder achievement of developmental milestones, say physical therapists. News Release. 2008; August 6, 2008.

In the national survey of 400 pediatric physical and occupational therapists, two-thirds of those surveyed say they’ve seen an increase in early motor delays in infants over the past six years. Those physical therapists who saw an increase in motor delays said that the lack of “tummy time,” or the amount of time infants spend lying on their stomachs while awake, is the number one contributor to the escalation in cases.

Bartlett DJ, Kneale Fanning JE. Relationships of equipment use and play positions to motor development at eight months corrected age of infants born preterm. Pediatric Physical Therapy. 2003; 15: 8–15.

In this study researchers examined the relationships between the use of infant equipment, play positions, and motor development in high risk, premature infants. Through parent reports the researchers determine that therapists should consider the use of infant equipment and specific play positions to enhance motor development and discuss ways to develop early motor skills with parents

Berger SE, Nuzzo K. Older siblings influence younger siblings' motor development. Infant & Child Development. 2008; 17(6): 607-615.

In one of the first attempts to study the effects of an older sibling on the onset of motor milestones, this study begins to document the interaction between social and motor development and introduces a new set of questions. It is noted that parents set aside special ‘tummy time’ so that infants have the opportunity to get used to being on the floor and to strengthen the muscles they will need to crawl.

Davis BE, Moon RY, Sachs HC, Ottolini MC . Effects of sleep position on infant motor development. Pediatrics. 1998; 102(5): 1135-1140.

The purpose of this study was to determine the relationship between sleep position and the age of achieving specific motor milestones in the first year of life. Results of the study indicated that the average ages of attaining rolling from tummy to back, sitting supported, crawling, and pulling to stand were significantly earlier in the infants who slept on their tummy than infants who slept on their back.

Hotelling BA. Tools for teaching - newborn capabilities: parent teaching is a necessity. The Journal of Perinatal Education. 2004; 13(4): 43-49.

This column states that infants need tummy time for general upper body strengthening. Parents learn that the best time for tummy time is when the infant is awake and supervised.

Jantz JW, Blosser CD, Fruechuting LA. A motor milestone change noted with a change in sleep position. Archive of Pediatric and Adolescent Medicine. 1997; 151:565-568.

This was the first study to investigate the relationship between change of sleep position and early motor development. At 4 and 6 months of age, 257 infants were studied to determine whether the recommended change in sleep position was having an impact on their motor development. Their results indicated that the 4 month old infants who slept on their back or side were less likely to roll over than tummy sleepers.

Majnemer A, Barr RG. Association between sleep position and early motor development. The Journal of Pediatrics. 2006; 149:623-29.

To compare motor development among infants using different sleep positions, Canadian researchers studied 4 and 6 month olds who had been sleeping on their backs or on their tummy. Researchers found that at 4 months, motor scores were lower in the group that slept on their backs, and by 6 months, the differences increased, with motor delays documented in 22% of babies sleeping on their backs. At 15 months, the back sleep position continued to be linked to delayed motor performance. Researchers concluded that the rate at which an infant develops motor skills seems to be influenced by factors such as the positions they adopt during sleep and awake time. While sleeping on their backs may somewhat delay the rate at which infants reach certain milestones, daily tummy time while the infant is awake tends to overcome some of the delays linked to sleeping on their back.

Monson RM, Deitz J, Kartin D. The relationship between awake positioning and motor performance among infants who slept supine. Pediatric Physical Therapy. 2003; 15, 196–203.

The purpose of this study was to examine the relationship between gross motor development and whether an infant was placed on their tummy during awake time at 6 months of age in infants who slept on their backs. This study specifically examined the relationship between gross motor development and whether an infant was placed on their tummy during awake time instead of on their back. The study makes a final point that physical and occupational therapists should educate parents about the need for supervised tummy time in early infancy.

Msall ME. Measuring outcomes after extreme prematurity with the Bayley-III Scales of infant and toddler development: a cautionary tale from Australia. Archive of Pediatric and Adolescent Medicine. 2010; 164(4):391-393.

Pin T, Eldridge B and Galea MP. A review of the effects of sleep position, play position and equipment use on motor development of infants. Development Medicine and Child Neurology. 2007; 49:858-867.

The review concluded that healthy infants, born at term, who spent time on their tummy when awake, achieved developmental milestones significantly earlier than those who did not or who spent limited time in prone when awake in the first 6 months of life.

Ratliff-Schaub K, Hunt CE, Crowell D, Golub H, Smok-Pearsall S, Palmer P, Schafer S, Bak S, Canteu-Kiser J, O’Bell R; CHIME Study Group. Relationship between infant sleep position and motor development in preterm infants. Journal of Developmental & Behavioral Pediatrics. 2001; 22: 293–299.

This study determined whether motor development varies among sleep position preferences in premature infants. The results of this study revealed that preterm infants whose sleep position was on their back had better performance on the item tested while the infant was on their back (rolling from supine to side), but fewer percentages of these infants received credit on the items tested while they were on their tummy (such as maintaining head at certain degree and lower head with control).

Salls, JS, Silverman LN, Gatty CM. The relationship of infant sleep and play positioning to motor milestone achievement. American Journal of Occupational Therapy. 2002; 56:577-580.

This study included 22 full-term infants recruited from well-baby visits at 2, 4, and 6 months of age. A questionnaire was given to the caregivers to gather demographic information, primary sleep position, and estimated amount of awake time on the tummy every day. The results of this study found that infants spent very little time on their tummy during the wakeful hours before 4 months of age. Some delay in the development of antigravity neck extension was found at 2 months of age, but no differences were found at later ages.

Sarwark JF, Aubin CE. Growth considerations of the immature spine. The Journal of Bone and Joint Surgery. 2007; 89:8-13.

Stein MT. Infants need daily “tummy time” for early motor development. . Journal Watch Pediatrics and Adolescent Medicine. 2007; .

Researchers in Canada compared motor skills in healthy white infants at either 4 or 6 months of age. Two standardized tests were used to evaluate infant motor function, and parents recorded infant positioning while awake. At 4 months, infants in the back sleeping group had lower motor scores and were significantly less likely than tummy sleepers to achieve prone extension on their arms. At 6 months, differences in motor development between the back and tummy sleeping infants increased significantly; 22% of infants sleeping on their backs had gross motor delays and also were less likely than tummy sleepers to sit and roll. Among back sleepers, more time spent on the tummy while awake was positively correlated with better motor performance.

Back to Sleep Campaign & Tummy Time

American Academy of Pediatrics Policy Statement. Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005; 116(5):1245-55.

The American Academy of Pediatrics’ (AAP) policy statement encourages tummy time when the infant is awake and observed as a means to enhance motor development. Additionally, the AAP includes a recommendation to avoid having the infant spend too much time in car-seat carriers and ‘bouncers,’ in which pressure is applied to the occiput.

American Academy of Pediatrics: Task Force on Infant Positioning and SIDS. Positioning and sudden infant death syndrome (SIDS): Update. Pediatrics. 1996; 98(6), 1216-1218.

This American Academy of Pediatrics update states: “A certain amount of “tummy time,” while the infant is awake and observed, is recommended for developmental reasons and to help prevent flat spots on the occiput.”

American Academy of Pediatrics: Task Force on Infant Sleep Position and SIDS. Changing concepts of sudden infant death syndrome: Implications for infant sleeping environment and sleep position. Pediatrics. 2000; 105(3), 650-656.

The American Academy of Pediatrics recognized “A certain amount of tummy time while the infant is awake and observed is recommended for developmental reasons…”

Davis BE, Moon RY, Sachs HC, Ottolini MC . Effects of sleep position on infant motor development. Pediatrics. 1998; 102(5): 1135-1140.

The purpose of this study was to determine the relationship between sleep position and the age of achieving specific motor milestones in the first year of life. Results of the study indicated that the average ages of attaining rolling from tummy to back, sitting supported, crawling, and pulling to stand were significantly earlier in the infants who slept on their tummy than infants who slept on their back.

Dewey C, Fleming P, Golding J. Does the supine sleeping position have any adverse effects on the child?: II. Development in the first 18 months. Pediatrics. 1998; 101: e5-12.

Evidence in this study suggests that putting infants to sleep on their backs results in a reduced developmental score at 6 months of age. However, this disadvantage appears to be short-term. Weighing this against the adverse health effects demonstrated with the back sleeping position, researchers in this study concluded that the results should not change the message of the Back to Sleep Campaign.

Koren A, Reece SM, Kahn-D'angelo L, Medeiros D. Parental information and behaviors and provider practices related to tummy time and back to sleep. Journal of Pediatric Health Care. 2010; 24(4):222-30.

Outcomes of this study suggest that with the implementation of Back to Sleep guidelines there has been a lack of clarity and education for both parents and providers about the importance of tummy time when young infants are awake. 90% of the mothers in this study reported receiving information about positioning the infant while asleep. However, only 55% mothers postpartum and 26% at 2 months after birth received information regarding infant positioning during awake time. Providers reported barriers such as lack of time and confusing guidelines to tummy time education.

Madhavan S, Campbell SK, Campise-Luther R, Gaebler-Spira D, Zawacki L, Clark A, Boynewicz K, Kale D, Bulanda M, Yu J, Sui Y, Zhou XJ. Correlation between fractional anisotropy and motor outcomes in one-year-old infants with periventricular brain injury. Journal of Magnetic Resonance Imaging. 2014; 39(4):949-57.

Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Ziviani J, Granger CV, Braun S. Functional assessment and care of children with neurodevelopmental disabilities. American Journal of Physical Medicine and Rehabilitation. 2000; 72(2):114-123.

Radecki RT, Gaebler-Spira D. Deep vein thrombosis in the disabled pediatric population. Arch of Phys Med and Rehabil. 1994; 75(3):248-250.

Younes M, Aubrin CE, Robitaille M, Sarwark JF, Labelle H. Scoliosis correction objectives in adolescent idiopathic scoliosis. Journal of Pediatric Orthopaedics. 2007; 27(7):775-781.

Plagiocephaly, Torticollis & Tummy Time

Girolami G, Shiratori T, Aruin A. Anticipatory postural adjustments in children with typical motor development. Experimental Brain Research. 2010; 205:153-165.

Horowitz LJ, Oosterveld WJ, Adrichem R. Effectiveness of sensory integration therapy on smooth pursuits and organization time in children. Pediatrie und Grenzgebiet. 1993; 31(5):331–344.

After months of SI therapy focused on eye movement, tracking and learning time for children with SI issues, this study recorded significant reduction in impaired eye movement as well as time to complete organizational activities.

Hurley DS, Sukal-Moulton T, Msall ME, Gaebler-Spira D, Krosschell KJ, Dewald JP. The cerebral palsy research registry: Development and progress toward national collaboration in the United States. J Child Neurol. 2011; 26(12):1534-1541.

Hutchison L, Thompson J, Mitchell E. Determinants of nonsynostotic plagiocephaly: A case-control study. Pediatrics. 2003; 112(4): 316-322.

This study concluded that early identification of a favored head orientation, which may indicate the presence of neck muscle dysfunction, may help prevent the development or further development of nonsynostotic plagiocephaly in infants. The study also notes that plagiocephaly may be prevented by varying the head position when putting the infant down to sleep and by giving supervised tummy time when awake.

Kane AA, Mitchell LE, Craven KP, Marsh JL. Observations on a recent increase in plagiocephaly without synostosis. Pediatrics. 1996; 97:877-885.

As a result of the recent increase in reported cases of plagiocephaly without synostosis (PWS), researchers in this study compared patterns of PWS referrals and referrals for another head deformity called synostotic plagiocephaly over a 16-year study period at a center specializing in head and facial deformities.

Kennedy E, Majnemer A, Farmer JP, Barr RG, Platt RW. Motor development of infants with positional plagiocephaly. Physical & Occupational Therapy in Pediatrics. 2009; 29(3)222-35.

The purpose of this study was to compare motor development between infants with positional plagiocephaly and matched peers without positional plagiocephaly. Also, researchers examined differences in infant positioning practices when asleep and awake between the two groups. The study found that motor development was associated with amount of time spent on the tummy while awake for both groups of infants. Infants with positional plagiocephaly who spent less time on their tummies while awake had lower motor scores when compared with their matched pairs.

Persing J, James H, Swanson J, Kattwinkel J. Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery & Section on Neurological Surgery. Prevention and management of positional skull deformities in infants. Pediatrics. 2003; 112(1), 199-202.

This report provides guidelines for the prevention, diagnosis, and management of positional plagiocephaly in healthy infants. Pediatricians are advised to properly diagnose skull deformities, educate parents on methods of positional plagiocephaly prevention such as tummy time, initiate appropriate management, and make referrals to a therapist when necessary.

Renske M van Wijk, Leo A van Vlimmeren, Catharina G M Groothuis-Oudshoorn, Catharina P B Van der Ploeg, Maarten J IJzerman. Helmet therapy in infants with positional skull deformation: randomised controlled trial. BMJ. 2014; .

The objective of the study was to determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months. The change score for both plagiocephaly and brachycephaly was equal between the helmet therapy and natural course groups. Full recovery was achieved in 10 of 39 (26%) participants in the helmet therapy group and 9 of 40 (23%) participants in the natural course group. All parents reported one or more side effects. The study concluded that based on the equal effectiveness of helmet therapy and skull deformation following its natural course, high prevalence of side effects, and high costs associated with helmet therapy, the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation is not recommended.

van Vlimmeren L, van der Graaf Y, Boere-Boonekamp M, L’Hoir M, Helders P, Engelbert R. Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference: A randomized controlled trial. Archive of Pediatric and Adolescent Medicine. 2008; 162:712-718.

After studying the effect of pediatric physical therapy on positional and deformational plagiocephaly, researchers found that a 4-month standardized pediatric physical therapy program to treat positional plagiocephaly significantly reduced the prevalence of severe deformational plagiocephaly compared with usual care.