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. [1] [2] [3]
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 decreased by 50% since the Safe to Sleep campaign started in 1994, [4] 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. [2] 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.
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. [5] [6] When babies experience tummy time in their waking hours, they are provided with opportunities to strengthen their neck [7] and trunk muscles. [5] Positioning the infant on their stomach while awake will not impact the amount of slow wave sleep [8] [9] [10] [11] [12] since tummy time only occurs when an infant is awake.
Furthermore, tummy time provides infants with opportunities for cognitive and communicative development through interactive play with their supervisor. [13] [14]
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. [1] 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. [15] 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. [1] Babies who are unaccustomed to frequent tummy time sessions may cry or show noncompliance when it is first introduced, [16] however enjoyment may be increased by providing stimulating objects during sessions, such as preferred toys and videos. [17]
Tummy time may also be used to stabilize the neck in torticollis, [18] and to address hypertonia associated with Down syndrome. [19]
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, [5] [6] [13] [14] regardless of these effects, it is essential that infants are placed to sleep on their back due to the risk of SIDS.
Sudden infant death syndrome (SIDS), sometimes known as cot death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep. Typically death occurs between the hours of midnight and 9:00 a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths.
Brachycephaly is the shape of a skull shorter than average in its species. It is perceived as a cosmetically desirable trait in some domesticated dog and cat breeds, notably the pug and Persian, and can be normal or abnormal in other animal species.
Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion of the skull. A mild and widespread form is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods.
Torticollis, also known as wry neck, is a painful, dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus, meaning "twisted", and collum, meaning "neck".
Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old, generally caused by blunt trauma, vigorous shaking, or a combination of both. SBS is the leading cause of fatal head injuries in children under two, with a risk of death of about 25%. The most common symptoms include retinal bleeds, multiple fractures of the long bones, and subdural hematomas.
The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of policy statements, ranging from advocacy issues to practice recommendations.
Opsoclonus myoclonus syndrome (OMS), also known as opsoclonus-myoclonus-ataxia (OMA), is a rare neurological disorder of unknown cause which appears to be the result of an autoimmune process involving the nervous system. It is an extremely rare condition, affecting as few as 1 in 10,000,000 people per year. It affects 2 to 3% of children with neuroblastoma and has been reported to occur with celiac disease and diseases of neurologic and autonomic dysfunction.
A pacifier is a rubber, plastic, or silicone nipple substitute given to an infant or toddler to suckle upon between feedings to quiet its distress by satisfying the need to suck when it does not need to eat. Pacifiers normally have three parts: an elongated teat, a handle, and a mouth shield which prevents the child from swallowing or choking on it.
Swaddling is an ancient practice of wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favour in the 17th century.
Necrotizing enterocolitis (NEC) is a devastating intestinal disease that affects premature or very low birth weight infants. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, multi-organ failure, and even death.
Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Other symptoms may include excess sleepiness or poor feeding. Complications may include seizures, cerebral palsy, or kernicterus.
The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.
The red reflex refers to the reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope. It is important to note that the red reflex may be absent or poorly visible in people with dark eyes, and may even appear yellow in Asians or green/blue in Africans.
The Safe to Sleep campaign, formerly known as the Back to Sleep campaign, is an initiative backed by the US National Institute of Child Health and Human Development (NICHD) at the US National Institutes of Health to encourage parents to have their infants sleep on their backs to reduce the risk of Sudden Infant Death Syndrome, or SIDS. The target age group of the campaign is 0–1 years of age, because this is when babies are at the greatest risk of experiencing SIDS. Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%. However, there has been a rise in infant sleep-related suffocation events. Consequently, the campaign has broadened its goal to focus on safe sleep conditions and further preventative measures.
Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.
Sleep training is a set of parental intervention techniques with the end goal of increasing nightly sleep in infants and young children, addressing “sleep concerns”, and decreasing nightime signalling. Although the diagnostic criteria for sleep issues in infants is rare and limited, sleep training is usually approached by parent(s) or caregivers self identifying supposed sleep issues.
Sudden unexplained death in childhood (SUDC) is the death of a child over the age of 12 months which remains unexplained after a thorough investigation and autopsy. There has not been enough research to identify risk factors, common characteristics, or prevention strategies for SUDC.
Gerhard Jorch is a German pediatrician. He is Professor for general pediatrics and neonatology at the Otto-von-Guericke University of Magdeburg and director of the University children's hospital.
Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.
Infant sleep is an act of sleeping by an infant or a newborn. It differs significantly from sleep during adulthood. Unlike in adults, sleep early in infancy initially does not follow a circadian rhythm. Infant sleep also appears to have two main modes - active, associated with movement, and quiet, associated with stillness - exhibiting distinct neurological firing patterns. Sleep duration is also shorter. As the infant ages, sleep begins to follow a Circadian rhythm and sleep duration increases. Infants nap frequently. Infants are also particularly vulnerable during sleep; they are prone to suffocation and SIDS. As a result, "safe" sleep techniques have been the subject of several public health campaigns. Infant sleep practices vary widely between cultures and over history; historically infants would sleep on the ground with their parents. In many modern cultures, infants sleep in a variety of types of infant beds or share a bed with parents. Infant sleep disturbance is common, and even normal infant sleep patterns can cause considerable disruption to parents' sleep.
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