Tummy time

{{short description|Colloquialism related to child-rearing}} {{distinguish|Timmy Time}} thumb|right|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.<ref name=":0">{{Cite web|title=Babies Need Tummy Time!|url=https://safetosleep.nichd.nih.gov/reduce-risk/tummy-time|last=|first=|date=|website=Safe to Sleep, US Department of Health and Human Services, National Institutes of Health|access-date=April 30, 2020}}</ref><ref name="Pediatrics 128">{{cite journal |doi=10.1542/peds.2011-2220 |title=Prevention and Management of Positional Skull Deformities in Infants |year=2011 |last1=Laughlin |first1=J. |last2=Luerssen |first2=T. G. |last3=Dias |first3=M. S. |journal=Pediatrics |volume=128 |issue=6 |pages=1236–41 |pmid=22123884 |author4=Committee On Practice Ambulatory Medicine|doi-access=free }}</ref><ref>{{cite web |url=http://losangeles.cbslocal.com/2013/04/30/doctor-finds-success-in-treating-infants-with-flat-head-syndrome/ |title=Doctor Finds Success In Treating Infants With Flat-Head Syndrome |publisher=CBS Los Angeles |accessdate=November 11, 2013 |date=April 30, 2013}}</ref>

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,<ref>{{cite web |title=Back to Sleep Public Education Campaign |url=http://www.nichd.nih.gov/sids/ |archive-url=https://web.archive.org/web/20000815063215/http://www.nichd.nih.gov/sids/ |url-status=dead |archive-date=August 15, 2000 |publisher=National Institute of Child Health and Human Development |date=March 23, 2010}}</ref> 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.<ref name="Pediatrics 128"/> 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.<ref name=Majnemer05>{{cite journal |doi=10.1017/S0012162205000733 |title=Influence of supine sleep positioning on early motor milestone acquisition |year=2005 |last1=Majnemer |first1=Annette |last2=Barr |first2=Ronald G |journal=Developmental Medicine & Child Neurology |volume=47 |issue=6 |pages=370–376; discussion 364 |pmid=15934485}}</ref><ref name= Davis98>{{cite journal |doi=10.1542/peds.102.5.1135 |title=Effects of Sleep Position on Infant Motor Development |year=1998 |last1=Davis |first1=B. E. |last2=Moon |first2=R. Y. |last3=Sachs |first3=H. C. |last4=Ottolini |first4=M. C. |s2cid=18553504 |journal=Pediatrics |volume=102 |issue=5 |pages=1135–1140 |pmid=9794945}}</ref> A 2017 systematic review found a significant positive correlation between supervised tummy time and the timely achievement of gross motor milestones, particularly when practiced for more than 15 minutes daily by two months of age.<ref>{{Cite journal |last=Hewitt |first=Lyndel |last2=Stanley |first2=Rebecca M. |last3=Okely |first3=Anthony D. |date=2017-11-01 |title=Correlates of tummy time in infants aged 0-12 months old: A systematic review |url=https://pubmed.ncbi.nlm.nih.gov/29096238 |journal=Infant Behavior & Development |volume=49 |pages=310–321 |doi=10.1016/j.infbeh.2017.10.001 |issn=1879-0453 |pmid=29096238}}</ref> When babies experience tummy time in their waking hours, they are provided with opportunities to strengthen their neck<ref>{{Cite web|last=Geyer|first=Hilda|title=How to ensure your baby's neck muscles are strong|url=https://www.news24.com/parent/baby/development/a-strong-neck-20080806|access-date=2021-03-19|website=Parent|language=en-US}}</ref> and trunk muscles.<ref name="Majnemer05" /> Positioning the infant on their stomach while awake will not impact the amount of slow wave sleep<ref name="Myers98">{{cite journal |pmid=9646378 |year=1998 |last1=Myers |first1=M. M. |last2=Fifer |first2=W. P. |last3=Schaeffer |first3=L |last4=Sahni |first4=R. |last5=Ohira-Kist |first5=K. |last6=Stark |first6=R. I. |last7=Schulze |first7=K. F. |title=Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants |volume=21 |issue=4 |pages=343–349 |journal=Sleep}}</ref><ref name="Sahni02">{{cite journal |doi=10.1203/00006450-200209000-00016 |title=Quality of Diet, Body Position, and Time after Feeding Influence Behavioral States in Low Birth Weight Infants |year=2002 |last1=Sahni |first1=Rakesh |last2=Saluja |first2=Deepak |last3=Schulze |first3=Karl F. |last4=Kashyap |first4=Sudha |last5=Ohira-Kist |first5=Kiyoko |last6=Fifer |first6=William P. |last7=Myers |first7=Michael M |journal=Pediatric Research |volume=52 |issue=3 |pages=399–404 |pmid=12193675|doi-access=free }}</ref><ref name="Brackbill73">{{cite journal |doi=10.1016/S0022-3476(73)80017-4 |title=Psychophysiologic effects in the neonate of prone versus supine placement |year=1973 |last1=Brackbill |first1=Yvonne |last2=Douthitt |first2=Thomas C. |last3=West |first3=Helen |journal=The Journal of Pediatrics |volume=82 |pages=82–84 |pmid=4681872 |issue=1}}</ref><ref name="Amemiya91">{{cite journal |doi=10.1016/S0387-7604(12)80020-9 |title=Effects of prone and supine position on heart rate, respiratory rate and motor activity in fullterm newborn infants |year=1991 |last1=Amemiya |first1=Fumiaki |last2=Vos |first2=Johan E. |last3=Prechtl |first3=Heinz F. R. |s2cid=4763777 |journal=Brain and Development |volume=13 |issue=3 |pages=148–154 |pmid=1928606}}</ref><ref name="Kahn91">{{cite journal |vauthors=Kahn A, Rebuffat E, Sottiaux M, Dufour D, Cadranel S, Reiterer F |title=Arousals induced by proximal esophageal reflux in infants |journal=Sleep |volume=14 |issue=1 |pages=39–42 |date=February 1991 |pmid=1811318}}</ref> since tummy time only occurs when an infant is awake.

Not only does tummy time improve and strengthen an infant’s muscles, but it also aids in improving neural connections. The brain's ability to form new neural connections through experiences and verbal interactions is called plasticity. When an infant lies supine, they are only able to see what is above them. However, when an infant is lying in a prone position, they can use their neck and trunk muscles to take in their surroundings. This allows an infant to form neural connections in relation to their environment, the communication with their caregivers, and even the learning toys in front of them. While improving muscular support and brain stimulation, tummy time allows an infant to reach their developmental milestones.<ref>{{Cite journal |last1=Dumuids-Vernet |first1=Marie-Victorine |last2=Provasi |first2=Joëlle |last3=Anderson |first3=David Ian |last4=Barbu-Roth |first4=Marianne |date=2022-04-28 |title=Effects of Early Motor Interventions on Gross Motor and Locomotor Development for Infants at-Risk of Motor Delay: A Systematic Review |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.877345 |doi-access=free |issn=2296-2360 |pmc=9096078 |pmid=35573941}}</ref>

Furthermore, tummy time provides infants with opportunities for cognitive and communicative development through interactive play with their supervisor.<ref name="Dewey98">{{cite journal|last1=Dewey|first1=C.|last2=Fleming|first2=P.|last3=Golding|first3=J.|last4=The Alspac Study Team|year=1998|title=Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months|journal=Pediatrics|volume=101|issue=1|pages=e5|doi=10.1542/peds.101.1.e5|pmid=9417169|doi-access=free}}</ref><ref name=":1">{{Cite journal |last1=Martiniuk |first1=Alexandra L. C. |author-link=Alexandra Martiniuk |last2=Vujovich-Dunn |first2=Cassandra |last3=Park |first3=Miles |last4=Yu |first4=William |last5=Lucas |first5=Barbara R. |date=2017-01-01 |title=Plagiocephaly and Developmental Delay |url=https://unsworks.unsw.edu.au/bitstreams/1fa34015-4e67-48ba-abf2-ce418e25738d/download |journal=Journal of Developmental & Behavioral Pediatrics |volume=38 |issue=1 |pages=67–78 |doi=10.1097/dbp.0000000000000376 |hdl=1959.4/unsworks_43153 |issn=0196-206X |pmid=28009719 |s2cid=39477708 |hdl-access=free}}</ref>

Meeting with a physical therapist can benefit an infant with developmental disabilities by working on tummy time in the office and engaging the guardians so the exercises can be replicated at home. Tactics such as proper head positioning or the use of a toy for entertainment within reach can improve strength, stability, and increase neural connections. Safe play with guardians allows the infant to progress in their developmental milestones, eventually resulting in independent sitting, standing, and walking.<ref>{{Cite journal |last1=Dumuids-Vernet |first1=Marie-Victorine |last2=Provasi |first2=Joëlle |last3=Anderson |first3=David Ian |last4=Barbu-Roth |first4=Marianne |date=2022-04-28 |title=Effects of Early Motor Interventions on Gross Motor and Locomotor Development for Infants at-Risk of Motor Delay: A Systematic Review |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.877345 |doi-access=free |issn=2296-2360 |pmc=9096078 |pmid=35573941}}</ref>

== 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.<ref name=":0" /> 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.<ref>{{Cite web|title=To grow up healthy, children need to sit less and play more|url=https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more|last=|first=|date=April 24, 2019|website=World Health Organization|access-date=}}</ref> 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.<ref name=":0" /> Babies who are unaccustomed to frequent tummy time sessions may cry or show noncompliance when it is first introduced.<ref>{{Cite journal|last=Graham|first=John M.|s2cid=45672124|date=2006-03-01|title=Tummy Time is Important|journal=Clinical Pediatrics|volume=45|issue=2|pages=119–121|doi=10.1177/000992280604500202|pmid=16528431|issn=0009-9228}}</ref> Research suggests that while factors like infant age and time spent in the bath can increase duration, maternal concerns regarding infant distress remain a primary barrier to consistent practice.<ref>{{Cite journal |last=Hewitt |first=Lyndel |last2=Stanley |first2=Rebecca M. |last3=Okely |first3=Anthony D. |date=November 2017 |title=Correlates of tummy time in infants aged 0–12 months old: A systematic review |url=https://pubmed.ncbi.nlm.nih.gov/29096238 |journal=Infant Behavior & Development |volume=49 |pages=310–321 |doi=10.1016/j.infbeh.2017.10.001 |issn=1879-0453 |pmid=29096238}}</ref> However, enjoyment may be increased by providing stimulating objects during sessions, such as preferred toys and videos.<ref>{{Cite book|last1=Kadey |first1=Heather J. |last2=Roane |first2=Henry S. |title=Effects of access to a stimulating object on infant behavior during tummy time|date=2012|publisher=The Society for the Experimental Analysis of Behavior|oclc=810682892}}</ref>

Tummy time may also be used to stabilize the neck in torticollis,<ref>{{Cite journal|last1=Kaplan|first1=Sandra L.|last2=Coulter|first2=Colleen|last3=Sargent|first3=Barbara|s2cid=52909510|date=2018-10-01|title=Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy|journal=Pediatric Physical Therapy|volume=30|issue=4|pages=240–290|doi=10.1097/PEP.0000000000000544|issn=1538-005X|pmid=30277962|pmc=8568067 }}</ref> and to address hypertonia associated with Down syndrome.<ref>{{Cite journal|last1=Boutot|first1=E. Amanda|last2=DiGangi|first2=Samuel A.|date=2018-02-23|title=Effects of Activation of Preferred Stimulus on Tummy Time Behavior of an Infant with Down Syndrome and Associated Hypotonia|journal=Behavior Analysis in Practice|volume=11|issue=2|pages=144–147|doi=10.1007/s40617-018-0212-5|issn=1998-1929|pmc=5959811|pmid=29868339}}</ref>

Infants with these developmental disabilities often present with decreased muscle tone in their upper and lower extremities. An early intervention of tummy time, beginning at 2–4 months, has been shown to have the greatest effects on motor development. Especially in infants with Down Syndrome or CP, their bodies are weak and may be unable to perform the typical milestone tasks. If tummy time is implemented early, motor skills will improve, allowing a better performance in sitting up independently, progressing to standing up, and eventually walking.<ref>{{Cite journal |last1=Dumuids-Vernet |first1=Marie-Victorine |last2=Provasi |first2=Joëlle |last3=Anderson |first3=David Ian |last4=Barbu-Roth |first4=Marianne |date=2022-04-28 |title=Effects of Early Motor Interventions on Gross Motor and Locomotor Development for Infants at-Risk of Motor Delay: A Systematic Review |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.877345 |doi-access=free |issn=2296-2360 |pmc=9096078 |pmid=35573941}}</ref>

In society today, technology is advancing not only for social use but also for healthcare. The use of early interventions, such as tummy time in infants, is crucial for their development. However, it is not easy. First-time parents may feel uneasy or anxious about placing their baby in a prone position, especially given the stigma that babies do not like tummy time. To put those first-time parents at ease, they can use their phone or computer to meet with their pediatrician to ensure that their baby and the environment are safe. Mobile phones are widely available and a great tool that can be used to communicate with the primary care doctor.<ref>{{Cite journal |last1=Ekambareshwar |first1=Mahalakshmi |last2=Ekambareshwar |first2=Swathi |last3=Mihrshahi |first3=Seema |last4=Wen |first4=Li Ming |last5=Baur |first5=Louise A. |last6=Laws |first6=Rachel |last7=Taki |first7=Sarah |last8=Rissel |first8=Chris |date=December 2021 |title=Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review |journal=International Journal of Behavioral Nutrition and Physical Activity |language=en |volume=18 |issue=1 |page=10 |doi=10.1186/s12966-020-01074-8 |doi-access=free |issn=1479-5868 |pmc=7796572 |pmid=33422066}}</ref>

Although sleeping in the supine position (on the baby's back) without sufficient tummy time may change the physical appearance of the head through plagiocephaly and consequently promote developmental delays,<ref name="Majnemer05" /><ref name="Davis98" /><ref name="Dewey98" /><ref name=":1" /> regardless of these effects, it is essential that infants are placed to sleep on their back, because of the risk of SIDS.

== References == {{reflist}}

==Further reading== *{{cite journal |doi=10.1016/j.jpeds.2004.10.017 |title=Deformational brachycephaly in supine-sleeping infants |year=2005 |last1=Graham |first1=John M. |last2=Kreutzman |first2=Jeannie |last3=Earl |first3=Dawn |last4=Halberg |first4=Andy |last5=Samayoa |first5=Carlos |last6=Guo |first6=Xiuqing |journal=The Journal of Pediatrics |volume=146 |issue=2 |pages=253–7 |pmid=15689919|doi-access=free }} *{{cite journal |doi=10.1016/j.jpeds.2006.06.043 |title=Asymmetric heads and failure to climb stairs |year=2006 |last1=Kemp |first1=James S. |journal=The Journal of Pediatrics |volume=149 |issue=5 |pages=594–5 |pmid=17095324}} *{{cite news |first=Jane |last=Elliott |publisher=BBC News |title=Babies need 'tummy time' to develop |url=https://news.bbc.co.uk/2/hi/health/5128144.stm |date=1 July 2006 |access-date=2007-06-21}} *{{cite journal |doi=10.1016/S0031-398X(08)70506-X |title=Tummy Time Key to Prevent Delays |year=2008 |last1=Gardner |first1=H. Garry |last2=Sarwark |first2=John F. |journal=Pediatric News |volume=42 |issue=10 |pages=24}}

Category:Pediatrics