Course:KIN355/2020 Projects/Tummy Time
Tummy Time
Defining the Concept and Its Importance
Tummy time refers to the act of placing an infant on their stomachs while awake on the floor under adult supervision (Hewitt, Kerr, Stanley, & Okely, 2020; Wen, Baur, Simpson, Rissel, & Flood, 2011). Tummy time is considered a form of physical activity recommended for all infants, 6 months and younger (Hewitt et al., 2020). Studies show that tummy time has a significant positive effect on gross motor development (Dudek-Shriber, & Zelamy, 2007; Majnemer & Barr, 2005; Monson, Deitz, & Kartin, 2003; Russell, Kriel, Joubert, & Gloosen, 2009; Salis, Silverman, & Gatty, 2002); therefore, it is included increasingly in national movement initiatives around the world such as in Australia, Canada, South Africa, and the United Kingdom; as well as from professional organizations (National Academy of Medicine, American Academy of Pediatrics), including the World Health Organization (Hewitt et al., 2020). Specifically, it is recommended that infants less than 6 months of age are provided tummy time daily for 30 minutes across a 24-hour period for healthy growth and motor development (Hewitt et al., 2020).
The emphasis on tummy time largely results from contemporary medical recommendations that place infants in the supine position to sleep. While the supine sleeping position is recommended for decreasing the risk of Sudden Infant Death Syndrome (SIDS), it is associated with increased delays in motor milestone acquisition (such as rolling and sitting) (e.g., Davis, Moon, Sachs, & Ottolini, 1998; Jantz & Blosser, & Fruechtung, 1997). In addition, the supine sleeping position is associated with a rise in the presentation of deformational plagiocephaly, which refers to the development of a flat spot, usually on the posterolateral aspect of an infant’s head ranging from mild to severe (e.g., ipsilateral forehead bulging or asymmetry in the ear/eye positioning) (Wittmeier & Mulder, 2017). As such, tummy time is a critically important physical activity strategy as it relates to gross motor development and head growth in infancy.
Role in Childhood Development and Contemporary Considerations
For the last 30 years, the recommendation from various health and medical organizations (e.g., the World Health Association, American Academy of Pediatrics) has been to place infants in the supine position (on the back) to sleep (American Academy of Pediatrics, 1992). The ‘Back to Sleep’ campaign recommended strongly sleeping in the supine because of the increased risk of SIDS that is associated with sleeping in the prone position; wherein, sleeping in the supine position is thought to decrease the risk of SIDS (American Academy of Pediatrics, 1992). For example, reports suggest that the “Back to Sleep’ campaign resulted in a 40% decrease in the incidence of SIDS in the United States (Willinger et al., 1998). While the incidence of SIDs decreases in supine sleepers, sleeping in the supine position can result in delayed acquisition of motor milestones (Davis, Moon, Sachs, & Ottolini, 1998; Jantz & Blosser, & Fruechtung, 1997). This is thought to occur because of negative effects of supine sleeping on muscle tone (Monterosso, Kristjanson, & Cole, 2002). As such, tummy time has become an important contemporary physical activity strategy in infancy to stimulate motor development (Hewitt, Stanley, & Okely, 2017). Tummy time stimulates the infant to practice lifting their head, lifting their torso off the ground and turning their head, as well moving the legs and pushing their torso up using their arms. Therefore, tummy time provides the opportunity to build muscular strength in the neck, shoulder, and trunk muscles. Building muscular strength is important for reaching such motor milestones as lifting the head, rolling the body (e.g., front to back), learning to sit upright, and encouraging the emergence of the rudimentary skills of crawling and creeping (Hewitt, Stanley, & Okely, 2017). Given the positive effects on gross motor development, the ‘Back to Sleep’ slogan is paired with the slogan, “Prone to Play” (American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005; Task Force on Infant Positioning & SIDS, 1996).
Despite the importance of tummy time, it has been reported that only about 30% of parents and 75% of child care educators adhere to tummy time recommendations (Gross et al., 2017; Hewitt et al., 2018). It is unclear as to the reasons behind reported adherence rates; however, there is some literature that would suggest some caregivers may be unaware of tummy time recommendations (Yin et al., 2014) suggesting the need for more effective caregiver education (Zachry & Kitzmann, 2011). While some caregivers may be familiar with ‘back to sleep’ recommendations, they may not be aware of ‘prone to play’ recommendations and the impact of a lack of tummy time on motor development (Felzer-Kim, Erickson, Adkins, & Hauck, 2020; Zachry & Kitzmann, 2011). Another reason for low adherence rates by parents may be that it is not uncommon for parents to report that their infant, especially when young, does not enjoy tummy time. An infant may become distressed or noncompliant (e.g., cry), squirm, appear frustrated, or even attempt to roll off of their stomachs (Kadey & Roane, 2012). Observing and experiencing this type of behaviour may increase a caregivers’ reluctance to place a child in tummy time (Kadey & Roane, 2012). However, it is important to persistent (Ricard & Metz, 2014); as infants get older and gain increased strength, tummy time practices improve (Hewitt, Stanley, & Okely, 2017). Further, the earlier that tummy time prone positioning is introduced the more tolerant of the position the infant becomes later on (Jennings et al., 2005).
Various strategies have been suggested to promote tummy time and appropriate infant behaviour. For example, caregivers can start with a few minutes at a time and gradually progress in duration until reaching 30 minutes a day across a 24-hour period (Hewitt, Stanley, & Okely, 2017). To achieve tummy time recommendations, it has also been suggested to break down major milestone achievements (e.g., rolling, sitting unassisted) into smaller achievements such as celebrating the capability for the infant to lift their head off the ground or moving their arms/legs while prone. Other suggestions have been to place stimulating toys in the infant’s field of view (Graham, 2006, Kadey & Roane, 2012). In fact, literature shows that wakeful prone bouts of tummy time last longer when there are objects in the environment versus the bare floor (Guidetti et al., 2017).
Practical Applications
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Summary
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References
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