Research: 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.
This study seeks to determine whether motor outcomes of an exercise intervention beginning at 2 months corrected age (CA) in children with periventricular brain injury (PBI) are correlated with fractional anisotropy (FA) measures derived from diffusion tensor imaging (DTI) at 12 months CA.

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.
This study found that the Functional Independence Measure for Children (WeeFIM instrument) and severity of disability were the best predictors of amount of assistance ratings provided by parents and teachers.

Radecki RT, Gaebler-Spira D. Deep vein thrombosis in the disabled pediatric population. Arch of Phys Med and Rehabil. 1994; 75(3): 248-250.
This study seeks to study the incidence of deep vein thrombosis (DVT) in the disabled pediatric population and examines  the incidence in patients younger than 18 years of age who were in a rehabilitation center.

Younes M, Aubrin CE, Robitaille M, Sarwark JF, Labelle H. SYounes 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.s. Journal of Pediatric Orthopaedics. 2007; 27(7): 775-781.
This study is presented to document and analyze 3-dimensional (3-D) surgical correction goals for AIS as determined by a sample of experienced spine surgeons.