1. Make “tummy-time” fun and interactive
Developing a Parent Education Program
for Infant Prone Positioning
Shelby Gordon, SPT, Kristin Lemenager, SPT, Molly Peterson, SPT, Jan McElroy, PT, PhD
Background/Hypothesis
Participants/Methods
Prone to
Play
The National Institute of Health initiated the “back to sleep” campaign in 1992, due to the rise in sudden infant death syndrome (SIDS), urging parents to put their sleeping infants in the supine position. Since the initiation of the back to sleep campaign, there has been an increase in:
1. Positional plagiocephaly (PP), a condition in which an infant’s head develops an abnormally flattened appearance (increasing from less than one percent of infants to twenty percent of infants aged two months).3
2. Torticollis, a condition which is characterized by lateral flexion of the head to one side and cervical rotation to the opposite side.1
3. Delayed gross motor development
Prone positioning during waking hours, even in small increments, may offset the risk of developing PP, torticollis, and delayed gross motor development.6 Infants are often unhappy in prone; however, early prone positioning, using a variety of positions in small increments, may lead to an increased tolerance of “tummy-time.”
Pediatric health professionals are in an excellent position to inform and educate new and expecting parents about the importance of prone positioning, “tummy-time.”
We hypothesize that early additional education to parents on the importance of prone positioning will lead to an increase in prone positioning play during infant awake hours and a subsequent decrease in plagiocephaly, torticollis, and developmental delay diagnoses.
The study cohort will consist of typically developing infants who will be recruited at their 2 week post birth follow up appointments with their pediatricians. Infants and their families will be divided into three groups. Group 1 will receive prone to play information at 3 weeks, group 2 will receive it at 3 months, and group 3 will receive it at 6 months.
Parents will receive an educational video and an informational handout regarding the importance of “tummy time.” Participants’ gross motor development will be tracked using the Alberta Infant Motor Scale (AIMS) at 3, 6, 9, and 12 months or until they reach independent walking. Our goal is to provide parents with information that will make “tummy time” enjoyable for the infant and parent.
The purpose of this project was to develop an informational video to educate parents to on prone to play and on the use of alternative prone positions for infants at 3 weeks, 3 months, and 6 months of age. Preparatory steps for the study included a literature search, survey development, and IRB preparation. This research study will evaluate the gross motor skills and time spent in prone to play of infants whose parents received additional prone positioning information compared to parents who received a standard packet of information from the hospital and/or their pediatricians.
Tummy time is more than just laying flat on the ground!
2 weeks
prone on chest
6 months
football carry
Make “tummy-time” fun and interactive
Parents, family, or siblings are the most interesting to infants
Get in infant’s line of sight
Use bright, interesting toys
Emphasis is on PLAY!
Outcome Measures
Clinical Relevance
The Alberta Infant Motor Scale (AIMS)
The AIMS is a norm-referenced outcome measure used for infants 0-18 months or walking age. The test takes about minutes to complete.
The AIMS will be administered at months 3, 6, 9, and walking age
Prone to play time and pleasure surveys
Parents will also complete surveys at 3, 6, 9, months and walking age. Surveys will provide data on the amount of time infants spend in prone to play at each age and how well the child tolerates the prone position.
Prone positioning helps infants to develop strength in the neck, back, and shoulder muscles necessary for head control, independent sitting , and overall gross motor development.3
Plagiocephaly is estimated to have increased fivefold since 19924
It is estimated that 1 out of every 60 infants will be diagnosed with plagiocephaly4
Parents can make tummy time more of a priority and more enjoyable for their infants when given early information and education. An improved balance between back to sleep and prone to play will contribute to increased time spent in prone and a decrease in infants who develop conditions such as developmental delay, positional plagiocephaly, and torticollis.
References:
Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther. 2013;25(4):
Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Valkama AM. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. Eur J Pediatr. 2015;174(9):
Kuo YL, Liao HF, Chen PC, Hsieh WS, Hwang AW. The influence of wakeful prone positioning on motor development during early life. Journal of Developmental and Behavioral Pediatrics. 2008;29:367–376.
McKinney CM, Cunningham ML, Holt VL, Leroux B, Starr JR. Characteristics of 2733 cases diagnosed with deformational plagiocephaly and changes in risk factors over time. Cleft Palate Craniofac J. 2008;45(2):208–216.
Biggs WS. Diagnosis and management of positional head deformity. Am Fam Physician. 2003;67:1953–1956.
Jones, M. W. (2004). Supine and prone infant positioning: A winning combination. Journal of Perinatal Education, 13, 10–20.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #T73MC00022, Missouri LEND. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.