Tummy time

Last updated
An infant lying on his stomach. Tummy time.jpg
An infant lying on his stomach.

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]

Contents

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, [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.

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. [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]

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. [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, because of the risk of SIDS.

See also

Related Research Articles

<span class="mw-page-title-main">SIDS</span> Sudden unexplained death of a child who is less than one year of age

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.

<span class="mw-page-title-main">Brachycephaly</span> Short, broad head

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.

<span class="mw-page-title-main">Plagiocephaly</span> Skull malformation such that one side is flattened

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.

<span class="mw-page-title-main">Torticollis</span> Abnormal, asymmetrical head or neck position

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 Latin tortus 'twisted' and collum 'neck'.

<span class="mw-page-title-main">Shaken baby syndrome</span> Medical condition

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.

<span class="mw-page-title-main">Pacifier</span> Rubber, plastic or silicone nipple for infants or toddlers to suck upon

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.

<span class="mw-page-title-main">Swaddling</span> Practice of wrapping infants so as to restrict movement

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.

<span class="mw-page-title-main">Neonatal jaundice</span> Medical condition

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.

<span class="mw-page-title-main">Supine position</span> Lying horizontally with the face and torso facing up

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.

<span class="mw-page-title-main">Safe to Sleep</span> Public health initiative to promote safe sleeping positions for babies

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.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

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.

Neonatal withdrawal or neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) is a withdrawal syndrome of infants, caused by the cessation of the administration of licit or illicit drugs. Tolerance, dependence, and withdrawal may occur as a result of repeated administration of drugs or even after short-term high-dose use—for example, during mechanical ventilation in intensive care units. There are two types of NAS: prenatal and postnatal. Prenatal NAS is caused by discontinuation of drugs taken by the pregnant mother, while postnatal NAS is caused by discontinuation of drugs directly to the infant.

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 parents or caregivers self identifying supposed sleep issues.

<span class="mw-page-title-main">Gerhard Jorch</span> German pediatrician (born 1951)

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.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

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.

<span class="mw-page-title-main">Infant sleep</span>

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.

References

  1. 1 2 3 "Babies Need Tummy Time!". Safe to Sleep, US Department of Health and Human Services, National Institutes of Health. Retrieved April 30, 2020.
  2. 1 2 Laughlin, J.; Luerssen, T. G.; Dias, M. S.; Committee On Practice Ambulatory Medicine (2011). "Prevention and Management of Positional Skull Deformities in Infants". Pediatrics. 128 (6): 1236–41. doi: 10.1542/peds.2011-2220 . PMID   22123884.
  3. "Doctor Finds Success In Treating Infants With Flat-Head Syndrome". CBS Los Angeles. April 30, 2013. Retrieved November 11, 2013.
  4. "Back to Sleep Public Education Campaign". National Institute of Child Health and Human Development. March 23, 2010.
  5. 1 2 3 Majnemer, Annette; Barr, Ronald G (2005). "Influence of supine sleep positioning on early motor milestone acquisition". Developmental Medicine & Child Neurology. 47 (6): 370–6, discussion 364. doi:10.1017/S0012162205000733. PMID   15934485.
  6. 1 2 Davis, B. E.; Moon, R. Y.; Sachs, H. C.; Ottolini, M. C. (1998). "Effects of Sleep Position on Infant Motor Development". Pediatrics. 102 (5): 1135–40. doi:10.1542/peds.102.5.1135. PMID   9794945. S2CID   18553504.
  7. Geyer, Hilda. "How to ensure your baby's neck muscles are strong". Parent. Retrieved 2021-03-19.
  8. Myers, MM; Fifer, WP; Schaeffer, L; Sahni, R; Ohira-Kist, K; Stark, RI; Schulze, KF (1998). "Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants". Sleep. 21 (4): 343–9. PMID   9646378.
  9. Sahni, Rakesh; Saluja, Deepak; Schulze, Karl F; Kashyap, Sudha; Ohira-Kist, Kiyoko; Fifer, William P; Myers, Michael M (2002). "Quality of Diet, Body Position, and Time after Feeding Influence Behavioral States in Low Birth Weight Infants". Pediatric Research. 52 (3): 399–404. doi: 10.1203/00006450-200209000-00016 . PMID   12193675.
  10. Brackbill, Yvonne; Douthitt, Thomas C.; West, Helen (1973). "Psychophysiologic effects in the neonate of prone versus supine placement". The Journal of Pediatrics. 82 (1): 82–4. doi:10.1016/S0022-3476(73)80017-4. PMID   4681872.
  11. Amemiya, Fumiaki; Vos, Johan E; Prechtl, Heinz FR (1991). "Effects of prone and supine position on heart rate, respiratory rate and motor activity in fullterm newborn infants". Brain and Development. 13 (3): 148–54. doi:10.1016/S0387-7604(12)80020-9. PMID   1928606. S2CID   4763777.
  12. Kahn A, Rebuffat E, Sottiaux M, Dufour D, Cadranel S, Reiterer F (February 1991). "Arousals induced by proximal esophageal reflux in infants". Sleep. 14 (1): 39–42. PMID   1811318.
  13. 1 2 Dewey, C.; Fleming, P.; Golding, J.; The Alspac Study Team (1998). "Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months". Pediatrics. 101 (1): e5. doi: 10.1542/peds.101.1.e5 . PMID   9417169.
  14. 1 2 Martiniuk, Alexandra L. C.; Vujovich-Dunn, Cassandra; Park, Miles; Yu, William; Lucas, Barbara R. (2017-01-01). "Plagiocephaly and Developmental Delay". Journal of Developmental & Behavioral Pediatrics. 38 (1): 67–78. doi:10.1097/dbp.0000000000000376. hdl: 1959.4/unsworks_43153 . ISSN   0196-206X. PMID   28009719. S2CID   39477708.
  15. "To grow up healthy, children need to sit less and play more". World Health Organization. April 24, 2019.
  16. Graham, John M. (2006-03-01). "Tummy Time is Important". Clinical Pediatrics. 45 (2): 119–121. doi:10.1177/000992280604500202. ISSN   0009-9228. PMID   16528431. S2CID   45672124.
  17. Kadey, Heather J Roane, Henry S (2012). EFFECTS OF ACCESS TO A STIMULATING OBJECT ON INFANT BEHAVIOR DURING TUMMY TIME. The Society for the Experimental Analysis of Behavior. OCLC   810682892.{{cite book}}: CS1 maint: multiple names: authors list (link)
  18. Kaplan, Sandra L.; Coulter, Colleen; Sargent, Barbara (2018-10-01). "Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy". Pediatric Physical Therapy. 30 (4): 240–290. doi:10.1097/PEP.0000000000000544. ISSN   1538-005X. PMC   8568067 . PMID   30277962. S2CID   52909510.
  19. Boutot, E. Amanda; DiGangi, Samuel A. (2018-02-23). "Effects of Activation of Preferred Stimulus on Tummy Time Behavior of an Infant with Down Syndrome and Associated Hypotonia". Behavior Analysis in Practice. 11 (2): 144–147. doi:10.1007/s40617-018-0212-5. ISSN   1998-1929. PMC   5959811 . PMID   29868339.

Further reading