Article

The Influence of Wakeful Prone Positioning on Motor Development During the Early Life

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The "Prone to Play" campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket. Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months. The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes. Wakeful prone positioning promotes prone-specific motor milestones in early infancy. "Prone to play for a certain amount of time in an interactive and supervised environment" might be advocated.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Corroborating partially with these results, in Taiwan, Kuo et al. (2008) followed 288 infants and found that rolling and crawling acquisitions at the age of four to 24 months occurred significantly early in the group that practiced TT [26]. Kuo et al. and Dudek-Shriber and Zelazny (2007), in a study conducted with 100 infants at the age of four months, observed an association between time in prone and skill gains in supine, prone, and seated positions, suggesting that TT enables motor skill development and weight unloading patterns in all positions [26,27] Furthermore, head lifting is also increased in children practicing TT [28], while parental participation and interaction with toys may enhance child tolerance to the method, allowing more time in prone and greater cervical muscle activation [15]. ...
... Corroborating partially with these results, in Taiwan, Kuo et al. (2008) followed 288 infants and found that rolling and crawling acquisitions at the age of four to 24 months occurred significantly early in the group that practiced TT [26]. Kuo et al. and Dudek-Shriber and Zelazny (2007), in a study conducted with 100 infants at the age of four months, observed an association between time in prone and skill gains in supine, prone, and seated positions, suggesting that TT enables motor skill development and weight unloading patterns in all positions [26,27] Furthermore, head lifting is also increased in children practicing TT [28], while parental participation and interaction with toys may enhance child tolerance to the method, allowing more time in prone and greater cervical muscle activation [15]. ...
... Corroborating partially with these results, in Taiwan, Kuo et al. (2008) followed 288 infants and found that rolling and crawling acquisitions at the age of four to 24 months occurred significantly early in the group that practiced TT [26]. Kuo et al. and Dudek-Shriber and Zelazny (2007), in a study conducted with 100 infants at the age of four months, observed an association between time in prone and skill gains in supine, prone, and seated positions, suggesting that TT enables motor skill development and weight unloading patterns in all positions [26,27] Furthermore, head lifting is also increased in children practicing TT [28], while parental participation and interaction with toys may enhance child tolerance to the method, allowing more time in prone and greater cervical muscle activation [15]. ...
Article
Full-text available
Research Article | Open Access Volume 2023 | Article ID 4153523 | https://doi.org/10.1155/2023/4153523 Show citation “I Am Afraid of Positioning my Baby in Prone”: Beliefs and Knowledge about Tummy Time Practice Bianca Fernandes Vasconcelos e Silva ,1Sabrinne Suelen Santos Sampaio ,2Julia Raffin Moura ,3Cléa Emanuela Barreto de Medeiros ,4Carolina Daniel de Lima-Alvarez ,2Camila Rocha Simão ,2Ingrid Guerra Azevedo ,5and Silvana Alves Pereira 3 Show more Academic Editor: Samuel Menahem Published19 Apr 2023 Abstract Objective. To identify beliefs and knowledge about tummy time (TT) practice and its repercussions on motor development. Methods. Longitudinal study carried out with parents/caregivers of infants older than 30 days of life. Two assessments were performed. A structured interview was conducted, while the babies were between one and six months old to identify beliefs, knowledge about TT, and the motor milestone achievement expected for the age. At six to 12 months, the risk of motor development delay was tracked using the survey of well-being of young infant questionnaire (SWYC). Results. 41 families responded to the SWYC questionnaire (21 were allocated to the TT group). 31.70% reported that it was not important to put the infants in a prone position while awake, and 70.70% said they are afraid their babies would become breathless when positioned in a prone position. 85.70% of infants from the TT group showed typical development, while 55% of the control group showed atypical development for their age (). Only three infants from the control group were at risk of delayed motor development (). Conclusions. Most of the families feel insecure about proning their babies and fear breathlessness when positioned. Acquisition of motor milestones prevailed in the TT group, suggesting an association between TT practice and motor milestone achievement.
... The 39 studies included 15,537 participants across 15 countries. Eighteen studies had a longitudinal design [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] and 21 studies an experimental design of which 11 were randomized [34-36, 38-41, 43, 44, 46, 47]. The study duration varied between 12 months and 8 years for longitudinal studies and between 18 days and 24 months for experimental studies. ...
... Sample sizes varied between 16 and 4253 children and the percentage of girls between 23 and 69%. Six studies were conducted in children younger than 12 months [24,25,31,38,43,54], two studies in children between one and 3 years [19,20], and 31 studies in children between three and 5 years [16-18, 21-23, 26-30, 32-37, 39-42, 44-53]. In 46% of the studies, physical activity was assessed using an objective measurement instrument (e.g. by accelerometer or heart [16,24,30,33,36,37,42]. ...
... Nine out of 39 studies were rated as high methodological quality [18,20,21,23,27,28,[31][32][33], eight studies were rated as moderate quality [16,17,19,22,[24][25][26]29] and 22 studies were rated as weak methodological quality [30,. Figure 2 displays a summary of the methodological quality across included studies per outcome. ...
Article
Full-text available
Background Early childhood is a critical period for growth and development, yet the association with physical activity during this important period is unknown. The aim of this review is to critically summarize the evidence on the prospective associations between physical activity and health and development in children aged < 5 years. Methods A systematic search in three electronic databases (Pubmed, PsycINFO, and Sportdiscus) was conducted to identify prospective studies examining the associations between physical activity (all types; specified by quantity) and health indicators (body composition, cardiometabolic health, bone health and risks/harm) or development (motor, cognitive and social-emotional development) in young children (mean age < 5 years at baseline). Two independent researchers assessed the methodological quality using the ‘Quality Assessment Tool for Quantitative Studies’ (EPHPP). This tool covers eight quality criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop-outs, intervention integrity and data-analysis. Results Thirty-nine studies, predominantly conducted in preschoolers (ages 3–5 years), were included of which nine were rated as high methodological quality. There was moderate evidence for a positive association between physical activity and motor ( n = 11 studies) and cognitive development ( n = 10 studies) based on consistent findings from studies having low-to-moderate methodological quality. There was insufficient evidence for an association between physical activity and body composition ( n = 15 studies), cardiometabolic health indicators ( n = 7 studies), social-emotional development ( n = 2 studies) and bone health ( n = 2 studies) based on inconsistent findings from studies having weak-to-high methodological quality. Conclusions There is a need for more high-quality research in order to determine the dose-response relationship between physical activity and health and development in early childhood. Special attention should be paid to studies in children below the age of 3 years.
... Additionally, the association of tummy time with other infant health outcomes, such as adiposity, psychosocial health, cognitive development, fitness, and cardiometabolic health, is currently unknown because current evidence regarding tummy time interventions is focused primarily on motor development and head shape. [21][22][23] A previous review investigating the effect of tummy time on other infant health outcomes has been conducted. 24 However, to be included in this systematic review, the minimum sample size was 100 participants for observational studies. ...
... As such, only 2 studies were found relating to tummy time. One study revealed a positive effect on motor development, 23 and the other study revealed a protective effect against deformational plagiocephaly. 25 Some of the health benefits that may be present in other smaller studies may be a decrease in BMI in older children, fine motor skill development, cardiovascular fitness, bone mineral density, and a reduction in other head-shape abnormalities such as brachycephaly. ...
... Parents were asked to record or describe the amount of time their infant spent in tummy time (hours or minutes per day) in 8 studies, to report the number of times per day spent in tummy time in 7 studies, to report the number of experiences spent in a prone position when awake in 3 studies, to outline their infant's preferred position in which to be awake and play in 2 studies, to identify the age at which the infant started tummy time in 2 studies, and to report their infant's ability to move while prone in 1 study. Motor development was assessed as the health outcome of interest in 12 studies, 3,8,9,23,34,36,[39][40][41] head shape in 3 studies, 25,35,37 BMI in 1 study, 36 and cognition in 1 study. 38 The most common assessments for motor development were the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scale, which were each used in 5 studies. ...
Article
Context: The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation. Objective: To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes. Data sources: Electronic databases were searched between June 2018 and April 2019. Study selection: Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms). Data extraction: Two reviewers independently extracted data and assessed their quality. Results: Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication. Limitations: Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present. Conclusions: These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.
... Prone position was favourably associated with motor development (gross motor development but not fine motor development in 1 study) in 3 studies [97][98][99]. ...
... In the longitudinal study, higher duration of prone positioning at 4 months of age was favourably associated with the earlier achievement of several developmental milestones and gross motor development at 6 months but not at 24 months of age [97]. However, no significant differences were observed in fine motor development [97]. ...
... In the longitudinal study, higher duration of prone positioning at 4 months of age was favourably associated with the earlier achievement of several developmental milestones and gross motor development at 6 months but not at 24 months of age [97]. However, no significant differences were observed in fine motor development [97]. In separate analyses, no significant differences in motor development at 6 and 24 months of age were observed between infants who had, versus had not, experienced prone position at 4 months of age [97]. ...
Article
Full-text available
Background: Given the rapid development during the early years (0-4 years), an understanding of the health implications of physical activity is needed. The purpose of this systematic review was to examine the relationships between objectively and subjectively measured physical activity and health indicators in the early years. Methods: Electronic databases were originally searched in April, 2016. Included studies needed to be peer-reviewed, written in English or French, and meet a priori study criteria. The population was apparently healthy children aged 1 month to 59.99 months/4.99 years. The intervention/exposure was objectively and subjectively measured physical activity. The comparator was various volumes, durations, frequencies, patterns, types, and intensities of physical activity. The outcomes were health indicators ranked as critical (adiposity, motor development, psychosocial health, cognitive development, fitness) and important (bone and skeletal health, cardiometabolic health, and risks/harm). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator by each study design. Results: Ninety-six studies representing 71,291 unique participants from 36 countries were included. Physical activity interventions were consistently (>60% of studies) associated with improved motor and cognitive development, and psychosocial and cardiometabolic health. Across observational studies, physical activity was consistently associated with favourable motor development, fitness, and bone and skeletal health. For intensity, light- and moderate-intensity physical activity were not consistently associated with any health indicators, whereas moderate- to vigorous-intensity, vigorous-intensity, and total physical activity were consistently favourably associated with multiple health indicators. Across study designs, consistent favourable associations with health indicators were observed for a variety of types of physical activity, including active play, aerobic, dance, prone position (infants; ≤1 year), and structured/organized. Apart from ≥30 min/day of the prone position for infants, the most favourable frequency and duration of physical activity was unclear. However, more physical activity appeared better for health. Evidence ranged from “very low” to “high” quality. Conclusions: Specific types of physical activity, total physical activity, and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators. The majority of evidence was in preschool-aged children (3-4 years). Findings will inform evidence-based guidelines.
... Known as "tummy time" (28) this recommendation has remained constant as one of the few recommendations for promoting infant PA (29). Tummy time is supported by several studies showing delayed gross motor development in infants who did not meet the recommended time spent in prone position (30,31). This delay in motor development may contribute to accelerated infant weight gain by limiting the amount of PA ( Figure 1) (32,33). ...
... However, recent promising data has shown that higher levels of infant PA measured by ankle-worn accelerometers are associated with lower central adiposity (35). Data are lacking regarding associations between tummy time and infant unrestricted movement with other outcomes such as muscle strength and bone health (29,31,36). ...
Article
Full-text available
In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.
... It has led to avoidance of the prone position also during wakeful time. The consequences of such conduct are an increased rate of deformational plagiocephaly and gross motor delays, which have been confirmed in many studies [9][10][11][12][13][14][15][16]. Thus, the AAP has tried to solve the problem. ...
... Prolonged pressure on the occipital area can lead to deformative plagiocephaly, asymmetrical facial features, or brachycephaly. Long-term consequences such as decreased muscle strength, poor coordination, attention deficit hyperactivity disorder (ADHD), increased weight, or obesity may occur [2,[9][10][11][12][13][14][15]. According to the WHO, infants under one year of age should not be restrained for more than one hour at a time [18]. ...
... Current advice is focused on "tummy-time", or prone play, from birth. This has been shown to promote only prone-specific motor milestones (Kuo et al., 2008), and appears to neglect antigravity head control development, such as in supine atlanto-occipital flexion (chin tuck), lifting or achieving pull to sit, an accepted test of head control. Despite little being known about the early development of head control, it is evident that from birth the head actively helps to direct gaze (Bertenthal & Von Hofsten, 1998), and this could provide potential direction for better infant plagiocephaly advice. ...
... There is lack of clarity about dosage and when to implement it (Martiniuk et al., 2016;Koren et al., 2010;Mawji et al., 2014). The tummy-time recommendation is considered plausible (Mawji et al., 2014) in its simplicity but only promotes prone motor skills (Kuo et al., 2008). The latest updated recommendations for safe sleeping (AAP, 2016) state that tummy-time promotes head control and upper body strength and supine-to-prone rolling (AAP, 2016;Mawji et al., 2014;Dube & Flake, 2003) as well as decreasing prolonged pressure on one area of the skull in supine. ...
Article
It is three decades since it was recommended that infants sleep on the back to reduce risk of sudden unexpected infant death (SUID). The SUID prevention program is known as "back to sleep" or "safe sleeping", and this initiative is not questioned. Sleeping on the back is associated with, but not the cause of, the development of infant positional plagiocephaly, also known as deformational or a non-synostotic misshapen head when the skull sutures are open, not fused. This paper provides a synthesis of the history and impact of positional plagiocephaly. It includes a scoping review of plagiocephaly prevention facilitating motor development and reveals few articles on primary prevention which aims to prevent it developing in the first place. It is concerning that preschool-aged children with a history of infant plagiocephaly continued to receive lower developmental scores, particularly in motor development, than unaffected controls, and this may be a marker of developmental delay. Tummy-time (prone) for play is the mainstay of plagiocephaly prevention advice to minimize development of plagiocephaly and to facilitate infant motor development, particularly head control. While tummy-time has shown benefit for infant development, there is limited evidence of its effectiveness in preventing plagiocephaly and some evidence that it promotes only prone-specific motor skills. Most of the published literature is concerned with treatment post-diagnosis, in the form of reviews, or clinical notes. There is a plethora of opinion articles reinforcing tummy-time from birth for plagiocephaly prevention. The review shows that there are gaps in advice for early infant development of head control. An accepted test of head control in infants is "pull to sit" from supine which demonstrates antigravity strength of the neck flexors and coordination of the head and neck when the infant is drawn to sit from supine. This motor skill was cited as achievable by 4 months in the earliest paper on plagiocephaly in 1996. Physical therapists and others should revisit the mechanism of early infant head control development against gravity, particularly antigravity head, neck and trunk coordinated flexion movement in supine, as there has been little attention to early facilitation of this motor skill as a plagiocephaly prevention strategy. This may be achieved by considering "face time" as well as tummy time for primary prevention of plagiocephaly.
... For instance, in previous systematic reviews examining tummy time with health indicators in infants [1,9], only one study examined dose-response relationships between tummy time and motor development [10]. Other studies included in the reviews examined differences in motor development across two different categories of tummy time duration (e.g., < 30 min/day and ≥ 30 min/day) but did not specifically examine dose-response relationships [11][12][13]. Additionally, research examining relationships between tummy time and other developmental domains is scarce, and none have examined dose-response relationships [1,9]. ...
... Tummy time is likely important for gross motor development because prone positioning can enhance muscle strength (e.g., head, neck, and trunk) and promote spinal development [22]. In turn, this physical development allows infants to acquire gross motor skills such as head control, reaching, and crawling [11,23]. Moreover, our findings indicate that a linear dose-response relationship between tummy time and gross motor development may exist at 4 and 6 months. ...
Article
Full-text available
This study aimed to examine change in tummy time patterns and preferences in the first 6 months of life, as well as dose–response relationships between tummy time duration and development at 2, 4, and 6 months. Participants were parents of infants from the Early Movers project in Edmonton, Canada (baseline: n = 411). At 2, 4, and 6 months, infant tummy time duration and preference (i.e., 1 = really likes to 5 = really dislikes) and development (i.e., Ages & Stages Questionnaire (ASQ-3) communication, fine motor, gross motor, problem-solving, personal-social) were measured by a parental questionnaire. In a subsample (n = 127), tummy time patterns (i.e., bout frequency, mean and median bout length) were measured using a 3-day time-use diary. Tummy time bout frequency, bout length, and preference significantly increased over time. Linear dose–response relationships between tummy time duration and development outcomes were observed at 4 (gross motor) and 6 months (all development outcomes). Moreover, at 2 months, 30–44 min/day of tummy time was associated with a higher total development score (vs. < 15 min/day; B = 11.14; 95%CI: 1.60, 20.68). At 6 months, 61–120 min/day (vs. < 30 min/day; B = 27.12; 95%CI: 11.93, 42.32) and > 120 min/day (vs. < 30 min/day; B = 33.80; 95%CI: 18.90, 48.70) of tummy time were associated with higher total development scores. Differences in threshold doses between some developmental outcomes were observed. Conclusion: In the first 6 months of life, increases were observed in tummy time preference as well as tummy time bout frequent and length. This finding may explain why the optimal amount of tummy time needed for more advanced development appeared to increase with age. What is Known: • Tummy time is a type of physical activity in infancy. International and national guidelines recommend at least 30 minutes of tummy time per day for infants who are not yet mobile. What is New: • In the first six months of life, preference for tummy time as well as tummy time bout frequency and length increased. • Tummy time duration had dose-response associations with several development outcomes, and the optimal amount of tummy time needed for more advanced development appeared to increase with age.
... The onset time of attainment of motor milestones in infancy can be influenced by both physiological and environmental factors (1). The World Health Organization (WHO) developed normal age ranges for the achievement of motor milestones among healthy children (2), which parents and healthcare professionals can use as benchmarks to flag children at risk of developmental delays or help identify late achievers. ...
... We included a range of child, family, and maternal health characteristics as potential confounders according to the literature ( Table 1): (1). Child characteristics included the child's age, sex, child body mass index (BMI), righthandedness, eyesight, gestational weeks, birth weight. ...
Article
Full-text available
Background Successful self-feeding reflects the readiness of early motor development and environmental impacts, and the onset of self-feeding as a developmental milestone might be a predictor of subsequent motor development in children. In this study, we explored the association between the onset of self-feeding and childhood risk of Developmental Coordination Disorder in children from one-child and two-child families. Methods We conducted a data-linkage prospective cohort study from 38 kindergartens in 6 cities in China. A total of 11,727 preschoolers aged 3–6 years old were included in the final analysis and were assessed with the Movement Assessment Battery for Children-second edition (MABC-2) Test. The information on early self-feeding onset was obtained from parents. The mixed and multi-level logistic models utilizing a random intercept were used to investigate the associations between the onset time of self-feeding and subsequent motor performance. Results The results showed that, compared with those beginning self-feeding at or younger than 12 months of age, children starting self-feeding at 13–24, 25–36, and later than 36 months, showed a decrease in their total MABC-2 scores of 2.181, 3.026, and 3.874, respectively; and had an increased risk of suspected DCD by 36.0, 101.6, 102.6%, respectively; they also had 30.2, 46.6, 71.2% increased prevalence of at risk of suspected DCD, when adjusting for both child and family characteristics (each p < 0.05). Significant associations were observed in fine motor, gross motor, and balance subtests (each p < 0.05) in groups with a delayed onset of self-feeding. However, the strength of the associations was mitigated in the fine motor and balance subtests in children with a sibling. Conclusion The delayed onset time of self-feeding acts as an early behavioral marker for later childhood motor impairment. Moreover, children with a sibling may benefit from additional interaction and their motor developmental pattern may be affected by the presence of a sibling.
... For infants who are not yet mobile (e.g., crawling), an important type of physical activity is supervised time on the tummy or in the prone position while awake [3]. In the previously mentioned physical activity systematic review [3], only three studies were found examining the association between tummy time and development in infants [5][6][7]. Though all three studies reported an association between more tummy time and more advanced motor development, these studies had limitations [3], including the use of a cross-sectional design [5,6], convenience samples [6], questionnaires with unknown psychometric properties [5][6][7], and unadjusted analyses [6]. Another systematic review specifically focusing on infant tummy time and health indicators, with a smaller sample size criterion for observational studies (≥30 participants), was conducted after the release of the Canadian guidelines [8]. ...
... In the previously mentioned physical activity systematic review [3], only three studies were found examining the association between tummy time and development in infants [5][6][7]. Though all three studies reported an association between more tummy time and more advanced motor development, these studies had limitations [3], including the use of a cross-sectional design [5,6], convenience samples [6], questionnaires with unknown psychometric properties [5][6][7], and unadjusted analyses [6]. Another systematic review specifically focusing on infant tummy time and health indicators, with a smaller sample size criterion for observational studies (≥30 participants), was conducted after the release of the Canadian guidelines [8]. ...
Article
Full-text available
Background This study aimed to address methodological limitations of the evidence that informed national and international movement behaviour guidelines for the early years. Specifically, the primary objective was to examine the longitudinal associations of infant physical activity (i.e., tummy time) and sedentary behaviour (i.e., back time, screen time, reading time, restrained time) with gross motor development. Secondary and tertiary objectives were to examine longitudinal associations of: (1) infant physical activity and sedentary behaviour with communication, fine motor, personal-social, and problem solving development, and (2) sleep time with primary and secondary outcomes. Methods Participants were 411 parents and their infants from the Early Movers project in Edmonton, Canada. Physical activity, sedentary behaviour, and sleep were measured with a parental questionnaire and the Ages & Stages Questionnaire (ASQ-3) developmental screening tool was administered at 2, 4, and 6 months. Parents reported the dates six major gross motor milestones (i.e., independent sitting, crawling, assisted standing, assisted walking, independent standing, independent walking) were acquired in the first 18 months of life according to World Health Organization criteria. In a subsample (n = 125), gross motor development was assessed using the Alberta Infant Motor Scale (AIMS) at 6 months. Results Higher tummy time across time points was significantly associated with higher ASQ-3 gross motor and personal-social development scores over time, higher total AIMS scores at 6 months, and earlier acquisition of all gross motor milestones. Higher reading time across time points was significantly associated with higher ASQ-3 fine motor, gross motor, personal-social, and total development scores over time. In contrast, higher back time across time points was significantly associated with lower total AIMS scores at 6 months and the later acquisition of assisted standing, assisted walking, and independent walking. Similarly, higher restrained time across time points was significantly associated with a later acquisition of supported walking. Conclusions Tummy time was consistently longitudinally associated with more advanced gross motor development and reading with more advanced total development. Whereas, some detrimental associations were observed for back and restrained time. Findings support the promotion of tummy time and certain sedentary behaviours (i.e., reading) in young infants to enhance overall development.
... It has undergone rapid expansion all around the world [66,[93][94][95][96]. It is usually a noncompetitive activity where participants move spontaneously through and over whatever landscape appears in front of them, utilising the body's naturals aptitude to either run, jump, climb, or complete quadrupedal movement [97,98]. Quadrupedal movement is the use all four limbs for walking or running, and if completed effectively, it should result in a smooth, graceful movement over the ground, allowing for quick changes in direction. ...
... As a vigorous, varied, and aesthetic form of self-exploration, parkour is arguably an activity that schools should consider to meet their needs and those of the National Curriculum for Physical Education. In contrast to many other physical activities or sports, in that the training and skill development by the participant is undertaken by experimentation and self-discovery, rather than teacher or coach leading [66,96,97]. Furthermore, an attractive feature of parkour is the practicing of uploading videos, frequently referred to as samplers, which is an opportunity publish their unique accomplishments on various social media platforms, which is particularly popular with a teenage audience. ...
Article
Full-text available
High quality Physical Education should instigate and support all learners to develop into a lifelong participant in a way which upkeeps their own health, fitness, and well-being. There are, however, an ever-increasing number of children who drop out of participating in physical activities at the earliest opportunity, leading to an increase in sedentary lifestyles and a rise in childhood obesity. It is evidence such as this which indicates Physical Education, specifically in England, is not currently appropriate for all and requires change. To attempt to make the subject a more positive experience for all and to inspire lifelong involvement, varying the curriculum and including alternative activities for pupils might tap into useful wider cultures. This paper discusses the emergence of alternative sports, the challenges and synergies of implementation, and focuses on what could work and why.
... This includes at least 30 min in a prone position (tummy time) spread throughout the day while they are awake and supervised [1]. Benefits of tummy time include improved motor development [2] and a reduced likelihood of deformational plagiocephaly [3]. These recommendations also form part of the 24-h Movement Guidelines for Australia, Canada, South Africa, and the UK [4][5][6][7]. ...
... Based on previous studies [11,12], feasibility will be assessed against the following: (1) more than 30 participants to be screened and recruited, (2) 80% of participants would be retained, and (3) 70% of objectively measured physical activity (tummy time) would be successfully collected at baseline and follow-up. Acceptability will be assessed against these parameters: (1) 100% of the planned sessions would be implemented, (2) there would be a minimum 80% attendance and 80% use of WhatsApp® overall, and (3) more than 80% of the intervention participants would report the intervention to be acceptable and useful based on parent survey. ...
Article
Full-text available
Background: The World Health Organization recommends 30 min of tummy time daily for improved motor development and reduced likelihood of plagiocephaly. As only 30% of infants meet this recommendation, parents require strategies and support to increase this proportion. Methods: The aim of this study was to determine the feasibility, acceptability, and potential efficacy of a group intervention to promote tummy time. The design is a cluster randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Five groups of healthy infants (N = 35, baseline mean (SD) age 5.9 (2.8) weeks) and their mothers attending local mother’s groups (Australia) were randomly allocated to the intervention or control group. The intervention group received group tummy time classes in addition to usual care. The control group received usual care with their child and family health nurse. Primary outcomes were intervention feasibility and acceptability. Secondary outcomes were tummy time duration (accelerometry), adherence to physical activity guidelines, head shape, and motor development. Measures were taken at baseline, post-intervention, and when infants were 6 months of age. Analyses were by linear mixed models and Cohen’s d statistic. Results: Recruitment, retention, and collection of objective data met feasibility targets. Acceptability was also met with intervention mothers reporting the information, goal planning, and handouts significantly more useful and relevant than control group mothers (p < 0.01). Moderate effect sizes were also found at post-intervention for tummy time duration, adherence to physical activity guidelines and infant ability in prone and supine favoring the intervention group (intervention infants had a mean of 30 min and 30% adherence to guidelines (95% CI 0 to 60.6 min) compared to the control infants who had a mean of 16.6 min and 13% adherence to the guidelines (95% CI 0 to 42.1 min, Cohen’s d = 0.5). Limitations were the small sample size, 4-week intervention, limited accelerometer use, and a homogenous sample of participants. Conclusion: Group tummy time classes delivered in a mother’s group setting were shown to be feasible and acceptable. A larger randomized controlled trial is warranted. Trial registration: ANZCTR, ACTRN12617001298303p. Registered 11 September 2017 Keywords: Tummy time, Infant, Objective, Accelerometer, Group, Physical activity, WhatsApp®
... The contents of these variations observed in this study have however, yet to be analyzed. In recent years, it has been reported that activity in the prone position termed "Tummy Time" is important for infant development and head shape [23][24][25] . Tummy time, defined as an infant being placed on their stomach whilst awake and supervised, provides an opportunity for the infant to stimulate and enhance their motor development 23) . ...
... In recent years, it has been reported that activity in the prone position termed "Tummy Time" is important for infant development and head shape [23][24][25] . Tummy time, defined as an infant being placed on their stomach whilst awake and supervised, provides an opportunity for the infant to stimulate and enhance their motor development 23) . Evidence is also accumulating that early implementation of tummy time is effective in reducing motor delay in young infants with Down syndrome 26) . ...
Article
Full-text available
[Purpose] The purpose of this longitudinal study was to investigate the diversity in infant crawling and examine the quantitative regularity in crawling variations necessary for the acquisition of walking in infants with typical development. [Participants and Methods] Infants with no neurological or orthopedic problems participated in this study. Using Internet Protocol (IP) cameras, crawling was simultaneously filmed from six different angles. Filming was continued until the acquisition of independent walking. The crawling movement in the video was coded. We considered the number of different completed codes as the number of variations and examined the cumulative number during the filming period in each participant. [Results] Nineteen infants completed the study. The pattern of change in the cumulative number of variations with increasing age (in days) varied between cases. Although the cumulative number of crawling variations at the time of acquisition of independent walking was inconsistent, it was negatively correlated with the crawling start age (in days). [Conclusion] Diversity exists in infant crawling. Infants who start crawling at a younger age tend to express more variation, whereas infants who start crawling when older tend to express less variation.
... Supine lying early in life has also been linked to idiopathic infantile scoliosis (Mau, 1981). Conversely, prone positioning during infants' awake time correlates to proper motor development (Dudek-Shriber and Zelazny, 2007;Kuo et al., 2008), extensor mus-cle development (Russell DC, Kriel H, 2009), and cranial asymmetry prevention (Zachry et al., 2017). To help infants develop neck and head control, pediatricians advise parents to initiate supervised tummy time (i.e. ...
... Awake time positioning indicated that the infants in our study received, on average, only 12.4% prone time, compared to 43.1% time lying supine on the floor or in a supine-lying containment device (15.4% in swings, car seats and strollers, and 27.7% lying on their back), and 43.5% time in active carry (34.4% in caregiver's arms or lap, and 9.1% in baby carrier). The 12.4% daily prone time in infants' awake time, especially since 54.5% (12/22) infants reported 10% or lower daily prone time, is concerning since associations between insufficient daily prone time and delayed motor development (Dudek-Shriber and Zelazny, 2007;Kuo et al., 2008), cranial asymmetry (Zachry et al., 2017), and extensor muscle development (Russell DC, Kriel H, 2009) have been consistently reported in developmental literature. Our survey findings are comparable to a recent survey study by Franchak et al. who quantified the frequency of daily infant positioning during awake time in 95 infants less than 1 year old (Franchak, 2018). ...
Article
Infant positioning in daily life, particularly in relation to active neck and back muscles, may affect spinal development, psychosocial progression, and motor milestone achievement. Yet the impact of infant body position on muscle activity is unknown. The objective of this study was to evaluate neck and back muscle activity of healthy infants in common positions and baby devices. Healthy full-term infants (n=22, 2-6 months) participated in this experimental study. Daily sleep and positioning were reported by caregivers. Cervical paraspinal and erector spinae muscle activity was measured using surface electromyography (EMG) in five positions: lying prone, lying supine, held in-arms, held in a baby carrier, and buckled into a car seat. Mean filtered EMG signal and time that muscles were active were calculated. Paired t-tests were used to compare positions to the prone condition. Caregivers reported that infants spent 12% of daily awake time prone, 43% in supine-lying baby gear, and 44% held in-arms or upright in a baby carrier. Infants exhibited highest erector spinae activity when prone, and lowest cervical paraspinal muscle activity in the car seat. No differences were found between in-arms carrying and babywearing. This first evaluation of the muscle activity of healthy infants supports the importance of prone time in infants’ early spinal development because it promotes neck and back muscle activity. Carrying babies in-arms or in baby carriers may also be beneficial to neck muscle development, while prolonged time spent in car seats or containment devices may be detrimental to spinal development.
... At the neurocardiac follow-up clinic of Montreal's Sainte-Justine University Hospital Center, we have observed that a significant proportion of babies with congenital heart disease are unable to acquire an optimal position in prone at 4 months, which may be due to a lack of early prone positioning owing to frequent hospitalizations, surgeries, pain, and parental apprehension. 1,7,10,11,16,17 However, the implications of prone vs supine positioning on the long-term motor development of infants remain unclear. Several studies of typically developing infants highlight the importance of the prone position on the acquisition of later motor milestones. ...
... Accordingly, multiple studies document a higher risk of motor delay in healthy babies with a reduced experience in prone. 16,17 Hence, we speculate that an intervention prior to the 4-month visit at the clinic may have been even more beneficial as professionals could have educated the families as to the importance of early and frequent positioning in prone during wake times, while respecting the baby's tolerance. Moreover, our study did not systematically collect data on the time spent in prone during waking hours prior to the acquisition of walking, which is also a limitation. ...
Article
Infants with congenital heart disease are at risk of impaired neurodevelopment, which frequently manifests as motor delay during their first years of life. This delay is multifactorial in origin and environmental factors, such as a limited experience in prone, may play a role. In this study, we evaluated the motor development of a prospective cohort of 71 infants (37 males) with congenital heart disease at 4 months of age using the Alberta Infant Motor Scales (AIMS). We used regression analyses to determine whether the 4-month AIMS scores predict the ability to walk by 18 months. The influence of demographic and clinical variables was also assessed. Fifty-one infants (71.8%) were able to maintain the prone prop position (AIMS score of ≥3 in prone) at 4 months. Of those, 47 (92.2%) were able to walk by 18 months compared to only 12/20 (60%) of those who did not maintain the position. Higher AIMS scores were predictive of a greater likelihood of walking by 18 months (P < .001), with the scores in prone having a higher predictive ability compared to those in other positions (Exp(B) 15.2 vs 4.0). Shorter hospital stays and female gender were also associated with an earlier onset of walking. In conclusion, our study demonstrates that early ventral performance in infants with congenital heart disease impacts the age of acquisition of walking and could be used to guide referral to rehabilitation.
... 4 Although active prone positioning during sleep has been strongly discouraged since the 1990s due to its significant risk for sudden infant death syndrome, active prone positioning while awake has been reported to counteract the effects of supine sleeping on motor development. [5][6][7][8][9][10][11][12] This suggests that the inability to maintain the prone position on extended arms might be an early indicator of subsequent problems in motor development. ...
... 24 The former is in accordance with the positive effect of active positioning on later development. 11,12,33 The latter could strengthen infants' body trunks and also increase the chance of vertically viewing the surroundings. Playing together with the infant is an important element because the developmental deviation of the non-prone infants was widely spread across various areas. ...
Article
Full-text available
Background During routine health screenings, pediatricians may note that some infants cannot maintain the prone position with an extended arm support at 6 months. However, little is known regarding the development of full‐term infants with this developmental deviation. We investigated the developmental course of infants exhibiting this characteristic. Methods We included 2020 full‐term infants from a regional center for the Japan Environment and Children's Study. Their development was measured using the Ages and Stages Questionnaire, Third Edition, at 0.5, 1, 1.5, 2, 2.5, and 3 years. The children were grouped according to their ability to stay prone on extended arms at 6 months, and their development was compared. Results The questionnaire revealed that 1625 infants could stay prone on extended arms and 179 could not. We excluded 212 infants who could stay prone on extended arms only sometimes, and four did not respond. In the Gross Motor domain, significant difference in questionnaire scores was observed between the “could” and “could‐not” groups at 6 months (Hedges’ g 1.83) and persisted until 3 years (Hedges’ g 0.33). Significant differences were also observed in the Communication, Fine Motor, Problem Solving, and Personal–Social domains at 6 months (Hedges’ g 0.20‐0.58) and persisted until 1, 2, 2, and 1.5 years, respectively (Hedges’ g 0.21‐0.25). Conclusions Infants who cannot maintain the prone position on extended arms lag behind those who can, although the effect sizes become relatively small after 1.5 years of age. Early interventions may be considered if delays are problematic or persistent. This article is protected by copyright. All rights reserved.
... Entretanto, pesquisas internacionais da área do desenvolvimento infantil alertam para o fato de que após as recomendações da posição de supino para dormir, muitos pais não têm deixado seus filhos deitados em prono, nem mesmo durante o dia, favorecendo um atraso no desenvolvimento motor destas crianças [5][6][7][8] . Ressalta-se que o desenvolvimento motor nos primeiros anos de vida é importante não apenas para o repertório de movimentação da criança, mas também porque influencia em aquisições nos demais domínios do desenvolvimento infantil, como o cognitivo e a linguagem 9,10 . ...
... Desta forma, foi possível perceber uma variação sobre a idade de iniciar a orientação aos pais sobre o decúbito ventral quando o lactente está acordado. Ressalta-se, no entanto, que a maioria dos estudos que indicam o benefício da posição de prono no desenvolvimento motor iniciam com bebês ainda nos primeiros meses de vida 5,6,8,[18][19][20] . ...
Article
Full-text available
Introdução: O desenvolvimento infantil é uma temática de interesse pediátrico multidisciplinar sendo importante saber qual a percepção de diferentes profissionais envolvidos, considerando que intervenções e orientações por vezes, são necessárias. Objetivo: verificar a percepção, conhecimento e prática de pediatras quanto ao posicionamento do lactente e o seu desenvolvimento motor. Método: Estudo qualitativo, do tipo estudo de caso, realizado em uma cidade no interior de Minas Gerais, Brasil. Para a seleção dos participantes da pesquisa utilizou-se a técnica de “amostragem por variedade de tipo”, seis pediatras participaram do estudo respondendo uma entrevista individual e semiestruturada, no período de setembro a dezembro de 2014. Os dados foram analisados por “análise de conteúdo” e foram identificadas quatro categorias: orientação quanto ao decúbito do lactente para dormir; percepção do desenvolvimento motor de lactentes após campanha de “supino para dormir”; conhecimento e práticas sobre o desenvolvimento motor dos lactentes; prescrição de prono para o lactente enquanto acordado. Resultados: Alguns pediatras recomendam o supino e outros o decúbito lateral para dormir, a última posição principalmente em casos de refluxo gastresofágico. Indicam o prono quando acordado principalmente para o desenvolvimento do controle cervical e as orientações em relação ao prono foram variadas. Conclusões: Os pediatras entrevistados contraindicam o prono, mas principalmente recomendam o decúbito lateral, seguido de supino para dormir. Eles não perceberam, em sua prática clínica, atraso do desenvolvimento motor dos lactentes em decorrência da recomendação de supino para dormir, pelo contrário, consideram as crianças cada vez mais adiantadas em seus marcos do desenvolvimento.
... Tummy time is believed to build muscle, which may facilitate gross motor milestones. 25,26 Higher motor performance has been associated with frequent tummy time and lower performance with frequent sitting in devices. 27 Earlier motor development may be related to future physical activity, specifically a greater frequency and variety of sports participation. ...
... 28 Infants not placed regularly in prone or with short duration of prone positioning demonstrated lower motor development scores 29 and the delayed milestones, such as rolling over and crawling. 25,30 Frequent spontaneous kicking, likely increased during unrestrained floor time, has been associated with early walking. 31 Longitudinal studies focused on movement quality are needed to understand the long-term effects on development. ...
Article
Objective: To describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families. Methods: This study was a randomized controlled trial (n = 533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving "Starting Early," with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement-restricting devices). Health literacy was assessed using the Newest Vital Sign. Results: Four hundred fifty-six mothers completed 3-month assessments. Infant activity results were: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported ≥1 h/d in movement-restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44-3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14-2.49) compared to controls. No difference in the time spent in movement-restricting devices was found. Conclusions: Tummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.
... In response, parents were advised to give infants "tummy time" when they are awake. More time in a prone position each day predicts earlier onset ages for prone skills (Dudek-Shriber & Zelazy, 2007;Kuo, Liao, Chen, Hsieh, & Hwang, 2008). Even something as seemingly mundane as a diaper exerts effects on motor development. ...
Article
Full-text available
In reviewing work on motor development, we aim to interest readers from every area of developmental science. How so? Rather than writing a boutique chapter geared toward researchers who specialize in motor development, we use research on motor development to address central concepts and methodological issues that have challenged developmental scientists for centuries. We argue that the study of motor development can yield fresh insights into processes of learning and development. Motor behavior can take the lead in developmental research and partner with work in seemingly disparate domains by considering developmental phenomena as embodied in the reality of children’s growing bodies, embedded in the prac- tical exigencies of a physical environment, intimately involved in social interactions, and reflective of cultural influences. Our strategy is to focus on 10 general developmental issues that are broadly relevant to developmental science and aptly illustrated with examples drawn from research on motor development. The issues are loosely organized into framing sections on embodied movement, embedded action, and enculturated interaction.
... Mehrere Studien deuten darauf hin, dass eine regelmäßige Bauchlage beim wachen Säugling unter Beobachtung hilft, einem lagebedingten Plagiozephalus vorzubeugenund diemotorischeEntwicklung zu fördern [22][23][24][25][26]. ...
Article
The dramatic decrease in the rates of sudden infant death syndrome (SIDS) seen in recent years has largely occurred through the dissemination of advice on a safe sleeping environment for infants. This advice, however, needs updating at regular intervals. The pediatric working group of the German Sleep Society has therefore updated its guideline on SIDS prevention, now issuing the following recommendations, which should be made available to all parents of infants: 1. Place your baby on its back to sleep using a firm and horizontal surface; 2. During the day, and only as long as your baby is awake and you can observe it, you should place your baby regularly on its stomach for short periods of time; 3. Avoid overheating: during the night a room temperature of 18 °C is optimal; 4. Instead of a blanket we recommend using a sleeping bag of an age-appropriate size; if you do not want to use a sleeping bag, make sure that your baby’s head cannot slip under the blanket by placing it in the bed so that the feet are touching the footboard; 5. Refrain from using pillows, furs, “nests,” padded baby bumpers and larger stuffed animals that your baby could use to cover itself; 6. Do not swaddle your baby for sleep; 7. Let your baby sleep in your room but in its own crib; 8. Ensure a smoke-free environment for your child during and after pregnancy; 9. Breastfeed for the 1st year of life, ideally for at least 4–6 months; 10. Offer your baby a pacifier at bedtime (once breastfeeding has been firmly established).These recommendations also apply to the period immediately after birth: if your baby is lying on your breast make sure that it always has a clear airway.
... Improving an infant's motor development requires adult involvement, as they must implement daily activities to promote motor development. For example, the parents may place an infant on his/her stomach [15,17,18], as this strengthens the infant's muscles for motor milestones such as controlling the head, reaching, crawling, and pulling him/herself up [15]. However, previous research suggests that parents may be unaware of recommendations for encouraging movement and motor development [19,20]. ...
Article
Full-text available
Unlabelled: Poor motor skills are associated with several factors that might delay children's development. Therefore, early programs to promote a child's motor development are essential. Within the first year of life, parents have a critical role in promoting their infant's motor development. However, little research has explored parent-directed programs that promote infant development in a Scandinavian context. This study aimed to evaluate the effectiveness of a parent-directed program to improve infant motor development. Methods: Parents of infants received a parent-directed program that included guidance from health visitors on ways to promote motor development, videos with motor development activities and a bag with related materials. Two municipalities in Denmark took part in the study (one intervention, one control). Health visitors in both municipalities measured the infants' age-appropriate motor skills once when the infants were between 9-11 months of age. A logistic regression model was used to analyze the data. Results: No difference was detected in motor development over time in the two municipalities regarding the proportion of children with age-appropriate motor skills. Conclusions: A parent-directed program in which parents were guided to play and encourage motor development with their infant showed no effect on infants' age-appropriate motor skills at 9-11 months.
... [19][20][21] Mehrere Studien deuten darauf hin, dass eine regelmäßige Bauchlage beim wachen Säugling unter Beobachtung hilft, einem lagebedingten Plagiocephalus vorzubeugen und die motorische Entwicklung zu fördern. [22][23][24][25][26] Verfahren zur Konsensbildung ...
Chapter
Full-text available
Die Häufigkeit des Plötzlichen Säuglingstodes (SIDS, sudden infant death syndrome) hat in Deutschland zwischen 1991 und 2020 um 93% abgenommen, in absoluten Zahlen ist ein Rückgang von 1285 auf 84 Fälle pro Jahr registriert worden. Mit der aktuellen S1-Leitlinie der Arbeitsgruppe Pädiatrie der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) werden praxisbezogene evidenzbasierte Hinweise zur SIDS-Prävention vorgelegt, die allen Eltern zugänglich gemacht werden sollten, um noch weniger Todesfälle als bisher beklagen zu müssen. 13 Autorinnen und Autoren aus 5 Fachgesellschaften und einer Elterninitiative votieren dafür, dieses Anliegen auch weiterhin zu unterstützen.
... 43,53 Tummy time can positively affect global development (i.e. improvement in multiple developmental domains), 73 especially gross motor development, 74 body mass index and also in preventing development of brachycephaly. 75,76 It is safe to start infants on tummy time soon after birth and aim to build up from a few minutes at a time to accumulate at least 30 min spread throughout the day. ...
Article
Full-text available
Background Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.
... 43,53 Tummy time can positively affect global development (i.e. improvement in multiple developmental domains), 73 especially gross motor development, 74 body mass index and also in preventing development of brachycephaly. 75,76 It is safe to start infants on tummy time soon after birth and aim to build up from a few minutes at a time to accumulate at least 30 min spread throughout the day. ...
Article
Full-text available
Background Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia–Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children. Method Representatives from 19 Asia–Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework. Findings These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance. Interpretation Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia–Pacific region. Funding Funded by Integrated platform for research in advancing metabolic health outcomes of women and children
... Activities and exercises for the young child require adult involvement, as they must implement daily activities to promote the children's motor development. For example, the caregiver may place a young child on his/her stomach to promote motor development [18,21,22], as this strengthens the infant's muscles for motor milestones, such as controlling the head, reaching, crawling and pulling him/herself up [18], and tummy time is associated with motor development [23]. WHO also recommends that young children participate in daily activities that promote the child's motor development, such as tummy time, rolling and crawling, in open and safe play areas where infants can participate in free movements with appropriate toys, such as rattles and balls [24]. ...
Article
Full-text available
In the first year of life, the child’s caregivers, including parents and daycare staff, play an essential role, as they are responsible for implementing daily activities to promote the motor development of young children. However, what does the research show about interventions to promote the motor development of 0–36-month-olds carried out by the child’s caregivers, and what are the caregivers’ experiences and attitudes hereof? This scoping review aims to provide an overview of the published studies to derive an overall interpretation. A systematic search was conducted in five scientific databases, resulting in 10,219 articles, of which 9 met the inclusion criteria. The results indicate that providing early intervention to 0–36-month-old children, in which the caregivers carry out the activities, promotes the young child’s motor development. Furthermore, the interventions increase the caregivers’ interest and motivation to promote the young child’s motor development, which is essential in maintaining the behaviour after the end of the interventions. Supervision and guidance provided for the child’s caregivers concerning knowledge and skills about age-appropriate behaviours and facilitation of their child’s motor development increases the caregivers’ self-confidence, interest, and motivation.
... Burcu Aykanat Girgin et al. (2017) in particular found that the ESL position was more effective than the semi-elevated supine (ESU) position during feeding routines with preterm infants [40]. The physical therapist and physiologist encouraged parents to play with their children in a prone position, because a limited time spent in this position appears to cause developmental delays in infants [41,42]. In general, time spent in a variety of positions is important for infant motor development [43]. ...
Article
Full-text available
The diagnosis of neurobehavioral problems in very preterm neonates helps with planning and applying proper and direct therapeutic interventions. (1) Background: The aim of this study was to determine the direct impact of neurobehavior on the sucking reflex and eating abilities of neonates. (2) Methods: We assessed 18 preterm neonates twice hospitalized at the Gynecology and Obstetrics Clinical Hospital through the use of the Neonatal Behavioral Assessment Scale (NBAS). (3) Results: We found that that a neonate’s sucking ability positively correlated with the activity level item from the motor system cluster of the NBAS. (4) Conclusions: Neurobehavior should be closely assessed in very preterm neonates. Firstly, because assessments can detect fundamental problems and help a practitioner plan for early intervention. Secondly, the education of parents regarding the neurobehavior of their child can help in the facilitation of feeding skills and the planning of early rehabilitation.
... It can be carried out at many different times throughout the day. It does not have to be limited to placing the infant on the floor but can be carried out while holding, carrying, and even dressing a baby which comes in agreement with Kuo et al. [14] who stated that parents should be informed that initial exposure to prone positioning can be implemented in a variety of ways, such as placing the baby on a caregiver's chest when the caregiver is in a reclined position, placing baby on the caregiver's lap, holding and carrying the infant in a prone position, and burping the baby in a prone position on the caregiver's lap. So, in the study group, there were significant differences within measures (t= 13.152, P= 0.000). ...
Article
Full-text available
Background: Cerebral palsy (CP), a heterogeneous disorder of gross motor development, is one of the most important causes of disability influencing children. Objective: To detect the influence of prone positioning on gross motor development in children with spastic diplegic cerebral palsy. Methods: Forty-two spastic diplegic CP children of both genders participated in this study. They were randomly chosen from the Medical Centre of Faculty of Physical Therapy, Modern University for Technology and Information, Cairo, Egypt. Their ages ranged from 12 to 18 months, with partial control of head and trunk according to gross motor function measure (GMFM), and mild spasticity (grade 1, 1+ according to Modified Ashworth scale(. Children were randomly assigned into control group, received selected physical therapy program based on the neurodevelopmental principles for 60 minutes, and study group received the selected physical therapy program in addition to a designed prone and quadruped exercise for 30 minutes. Treatment procedures conducted three times/week for three successive months. Results: The in-between comparison of GMFM showed no significant differences in the pre-measures while there were significant differences in the post-measures (t= 1.322, P= 0.194, t= 6.397, and P= 0.000, respectively). Conclusion: The results of this study revealed that prone position training program was effective in improving the gross motor skills in children with spastic diplegia.
... 2). Prone positioning for play, known as "tummy time," has been associated with normative gross-motor development (e.g., Dudek-Shriber & Zelazny, 2007;Kuo et al., 2008;Salls et al., 2002), as the prone position strengthens the muscles that infants need for milestones such as controlling their heads, reaching, crawling, and pulling up (Zachry & Kitzmann, 2011). Lack of tummy time can result in the development of muscle conditions and cranial deformities, such as positional plagiocephaly (asymmetry or flattening of the head) and associated torticollis (difficulty in turning head in certain directions due to tightening of muscles). ...
Article
The American Academy of Pediatrics (AAP) recommends that infants spend supervised time in the prone (tummy) position to foster motor development and prevent cranial deformities. However, infants may not tolerate the position, and consequently, caregivers may avoid placing their infants in the prone position. The AAP recommends that caregivers provide toys or interaction during tummy time. We evaluated the individual and combined effects of a play mat and experimenter interaction on negative vocalizations and head elevation during tummy time-positive effects were limited. Next, we evaluated a parent-led intervention wherein mothers interacted with their infants, using a toy, while lying chest-to-chest. This intervention was associated with a reduction in negative vocalizations and an increase in head elevation for the majority of infants. Additionally, mothers rated the effectiveness of the parent-led intervention more favorably than the experimenter-led intervention, suggesting the effects of the parent-led intervention were also socially valid.
... Tummy time provides infants with supervised time spent on their stomachs in the prone position and has demonstrated positive effects on infant physical and behavioral development. [29][30][31] A recent review of correlates of tummy time reviewed 15 studies from seven countries; not surprisingly, tummy time was higher when parents and other caregivers prioritized time for infants to spend on the floor in the prone position. 32 Another recent study assessed ECE provider adherence to tummy time and other infant physical activity recommendations in Australia, Canada, and the United States. ...
Article
Full-text available
Background: State policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018. Methods: We reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemar's tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period. Results: From 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; p = 0.006). We did not observe any other significant difference between 2013 and 2018 regulations. Conclusions: Despite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.
... Contudo, como o tempo de permanência na posição acordado em prono se associou positivamente com todos os subescores da AIMS, assim como com o percentil e escore total, esta postura demonstra ser importante para o desenvolvimento do lactente. Estudos anteriores também encontraram efeito positivo do posicionamento em prono sobre o desenvolvimento motor ( KUO et al., 2008;LOBO;GALLOWAY, 2012;MONSON;DEITZ;KARTIN, 2003). ...
Article
Full-text available
Introduction: The acquisition of motor skills depends on factors such as environment and experience. It follows that the motor development may be influenced by the positioning of infants during the first months of life. Objective: To verify the relation between prone, supine and sitting positioning time and motor development up to six months old. Method: Were evaluated 92 infants at term, of both genders, divided into three groups according to the corresponding bimester of chronological age (1st bimester, n = 30; 2nd bimester, n = 30; 3rd bimester, n = 32). To verify the time spent in each position during the awake and sleeping periods, a timeline corresponding to 24 hours was developed. Each one-hour period could be filled with a positioning option. Motor development was assessed by Alberta Infant Motor Scale. The Shapiro-Wilk test was used to verify the normality of data distribution. The Spearman correlation test was used to verify the association between the variables. Results: There was a positive association between motor development and the sleeping time and awake time in prone and sitting postures; and negative with the sleeping time and awake time in supine. Conclusion: The time spent in prone and sitting can be considered as positive for motor development. The time that the infant remains supine can negatively influence the motor development. It is suggested that intervention through guidance to parents and caregivers is important. Infants should be stimulated on different postures so that the acquisition of motor abilities occurs properly.
... Parents may need to be more clearly informed that the "back to Sleep" and "prone to play" messages advocated by AAP are complementary rather than contradictory. Interestingly, a longitudinal cohort study revealed that prone time only influenced early motor milestones (including crawling and sitting) and did not influence first steps (Kuo, Liao, Chen, Hsieh, & Hwang, 2008). This finding is consistent with our finding that the shared environment was significant for earlier milestones but not for walking. ...
Article
Full-text available
Purpose: Variability in the timing of infant developmental milestones is poorly understood. We used a twin analysis to estimate genetic and environmental influences on motor development and activity levels in infancy. Method: Data were from the Gemini Study, a twin birth cohort of 2,402 families with 10 twins born in the United Kingdom in 2007. Parents reported motor activity level for each of the twins at age 3 months using the Revised Infant Behavior Rating Scale and reported the ages atwhich they first sat unsupported, crawled, and walked unaided. Results: Activity level at 3 months and ages when first sitting and crawling were about equally influenced by the shared family environment (45%–54%) and genes (45%–48%). Genetic influences dominated for age when children took their first independent 15 steps (84%). Conclusion: Aspects of the shared family environment appear to be important influences on motor activity levels and early milestones, although the timing of walking may have a stronger genetic influence. Further research to identify the specific environmental and genetic factors that promote early activity may be important for longer-term health outcomes.
... This finding supported earlier work done in infants with TD noting a positive influence of tummy time on achieving skills such as rolling back to tummy and sitting, but not on walking. 24,31,32 Tummy time is an appropriate activity for young infants, infants who do not have a large repertoire of skills. It follows that tummy time will be most impactful during early infancy when motor competencies are emerging. ...
Article
Purpose: This study compared differences in motor development in infants with Down syndrome beginning a tummy time intervention before 11 weeks of age and after 11 weeks of age. Methods: Nineteen infants with Down syndrome participated in tummy time until they could independently transition in and out of sitting. Motor development was assessed monthly using the Bayley III Motor Scales and compared between the groups. Results: A difference in motor development between early and late groups is apparent 1, 2, and 3 months following intervention initiation. Conclusion: Early implemented tummy time was effective in reducing motor delay in young infants with Down syndrome and is a prudent first step in intervention.
Article
This pilot study sought to determine the feasibility of quantifying sensory processing, postural control, motor skill development and participation in daily life in children with idiopathic toe walking (ITW) compared to children without ITW. A nonrandomized, prospective case-control design was employed. Twenty participants were recruited. Computerized weight bearing and postural control data was successfully collected. Differences were found in forefoot/rearfoot weight bearing, balance, sensory-motor abilities and parent reported participation challenges. Sensory processing results were inconclusive. Findings can inform standardized assessment and treatment of ITW.
Article
Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths has remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report.
Article
Every year in the United States, approimately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
Article
Full-text available
Introduction Given the importance of tummy time and the low levels of tummy time reported globally, there is a need for high-quality intervention strategies to promote tummy time. This study describes the protocol of a randomised controlled trial that aims to determine the effectiveness of a multicomponent intervention delivered in postnatal mothers’ groups in increasing infant tummy time. Methods and analysis A randomised controlled trial will be conducted. Eligible participants will be mothers and their infants attending postnatal mothers’ groups (New South Wales, Australia). Participants will be randomised to participate in either (1) infant tummy time intervention group (practice, education, WhatsApp) plus usual care; or (2) usual care group. Randomisation process and outcome assessors will be blinded. The intervention will comprise an online education and practice session (60 min) and 4 weeks of WhatsApp messaging (standardised, three times per week). Usual care will be attendance at a mothers group once per week for 3 weeks for information and support for ad hoc mother craft activities (standard practice provided by early childhood nurses for this local health district). The primary outcome will be the amount of infant tummy time using the GENEActiv accelerometer and a questionnaire (post intervention). The accelerometer will be worn on the right hip secured by an elastic belt around the waist. Wear and non-wear time will be classified using temperature and z-axis cut points as per previous research. This protocol paper presents the scientific background and proposed methods of the randomised controlled trial. Findings will inform the design of practically based strategies to inform clinicians, educators and parents about infant physical activity. Ethics and dissemination The University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee approved the study (2020/ETH02970). Dissemination plan is publication, staff training and conference presentations. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12621000575831; Pre-results.
Article
This paper describes the application of an integrated theoretical framework that consists of behavioral change models to plan preventative educational programs and target interventions to facilitate parent implementation of tummy time (prone positioning) to promote infant development and prevent flattening of the infant’s skull. A qualitative study design was used to explore tummy time barriers and facilitators and to gain an in-depth understanding of the behaviors that influence tummy time implementation. Twenty-three parent participants completed an open-ended survey designed to gain information on parental perspectives related to tummy time. Data were analyzed using thematic analysis. Physical Capability of the infant and Psychological Capability of the parent, Physical and Social Opportunity, Reflective Motivation, Automatic Motivation, Emotion, Memory, Attention, & Decision Processes, Skills, Environmental Context & Resources, Social Influences, Beliefs about Consequences, Beliefs about Capabilities, and Knowledge are components to target during intervention. Occupational therapists and other healthcare providers can use the comprehensive behavioral change models described in this paper to develop evidence-informed, theory-based interventions to promote parental implementation of tummy time.
Article
Full-text available
Introducción: El gateo representa la primera forma de locomoción autónoma. Se han mencionado las implicaciones de la adquisición del gateo para lograr la marcha independiente y el control motor en el niño, pero son pocos los estudios relacionados con el gateo y sus efectos en el niño de alto riesgo biológico. Por eso se intentó conocer la relación entre la adquisición del gateo y la marcha independiente en una población de niños nacidos de alto riesgo en un programa de seguimiento pediátrico. Material y métodos: Estudio observacional, retrospectivo y descriptivo de una cohorte de niños de alto riesgo que acuden al seguimiento pediátrico, en el cual se revisó el periodo de adquisición del patrón de gateo y la marcha independiente. Resultados: Se integraron cuatro grupos: gateo normal, gateo limítrofe, gateo con retraso y gateo nulo. Se estudió a 558 lactantes; los grupos se integraron con gateo normal, 238 niños; gateo limítrofe, 96 lactantes; retraso en la adquisición del gateo, 207 niños; y gateo nulo, 17 niños. Por género, las niñas gatean mejor, con peso y edad gestacional mayores y predominio en los gateadores. La escala de Bayley señala mejores puntuaciones para los gateadores. En los niños con gateo normal, la marcha independiente se adquirió en el periodo normal a diferencia del grupo con retraso en el gateo en el cual la marcha independiente apareció con retraso. Conclusiones: En este estudio se identificó una relación entre la edad de inicio del gateo con la edad de adquisición de la marcha independiente, con mejor evolución en los niños gateadores.
Article
The aim of this cross-sectional study was to evaluate the feasibility, construct validity, and reliability of a smart garment to characterize parent-child positioning practices in infants less than six months old. The smart garment (Get Around Garment, GG) was developed through feedback from seven infants and their parents. The final system was then tested with sixteen infants (M = 3.1 ± 1.1 months) assessed in their homes during one visit that consisted of a: 1) Structured Play Assessment (2.5 min): infant was placed in each of five positions (prone, supine, reclined/inclined, and upright) for 30 s, 2) Free Play Assessment (40−60 min): parents were asked to engage in typical daily activities, and 3) second Structured Play Assessment. Infants’ body position was both coded from video and identified from sensor data using a custom program. Feasibility was measured by data from a Daily Wearing Log and Garment Perception Questionnaire. Validity was evaluated by comparing the coding and sensor data. Reliability was measured by comparing the sensor data between the two Structured Play Assessments. The GG was considered feasible for use. The smart wearable system showed high levels of accuracy for classifying body position secondby- second and when comparing cumulative duration across time. Reliability of the smart garment was excellent. Young infants spent more time in supine and supported upright positions relative to prone, reclined, or inclined positions. The results suggest that accelerometers can be integrated into garments in a manner that is feasible to provide accurate and consistent data about positioning practices of parents with young infants. Monitoring early positioning practices is important because these practices impact future motor and cognitive developmental trajectories.
Article
Full-text available
Previous studies have shown that the use of a baby-walker during the first year after birth of a baby, when the motor skill is most significantly developed, may affect the subsequent development of the child. However, since trends in use of other infant equipment have not been investigated, it is not clear what kind of infant equipment is used at each stage of the infantile development. The present study was usage survey of infant equipment, including those other than baby-walkers, for newborns and infants during their first year of life. The survey was conducted by means of a questionnaire targeting 612 infants in Hyogo, Okayama, and Tottori prefectures in Japan, resulting in 307 valid responses, which have revealed their usage of infant equipment. Some items of infant equipment that are used for a longer time than baby-walkers may restrict infant. While the infant equipment increases the safety of the lives of infants, our data suggests the possibility that those devices may also limit their self-directed, which is important for gross motor development.
Chapter
Full-text available
RESUMO: Objetivo: Esse estudo avaliou a influência da posição prono nas aquisições posturais de bebês entre o primeiro e quarto mês de vida. Métodos: Estudo descritivo, observacional, de caráter comparativo e associativo, com abordagem transversal, no qual participaram 92 bebês, entre um e quatro meses, inexperientes na postura prono (IPP), provenientes UBS’s das cidades de Caxias do Sul e Porto Alegre. O grupo de bebês foi avaliado com a Alberta Infant Motor Scale, em prono (21 itens), supino (9 itens), sentado (12 itens) e em pé (16 itens) e comparados aos valores das curvas nacionais. Foi utilizada estatística descritiva e teste t one sample (p≤0,05). Resultados: Os bebês avaliados, tanto no geral quanto nas faixas etárias ficaram abaixo do percentil nacional, havendo um predomínio de bebês (53,5%) com suspeita de atraso no desenvolvimento. Os grupos de bebês com idade de um e quatro meses demonstram maiores déficits motores, apresentando, respectivamente, 18,2% e 23,5% dos bebês com atraso no desenvolvimento. Comparando com as curvas nacionais, o grupo IPP está significativamente abaixo da média de desempenho motor no primeiro mês de vida (p=0,004).Conclusão: O estudo demonstra que a inexperiência em prono tem influencia negativa no desenvolvimento motor. Sugere-se a realização de pesquisas longitudinais para avaliar a influência do prono com desenvolvimento no decorrer dos anos, determinando quando esta pratica maternal passa a ser determinante nas aquisições futuras das crianças.
Article
This longitudinal study investigated monthly motor development and physical activity (PA) of infants with and without Down syndrome. Gross and fine motor skills (Bayley Scales of Infant Development-III) and PA (accelerometer) were assessed in 35 infants at eight time points during infancy. A multivariate mixed model identified time points when motor scores diverged between the groups. In infants with Down syndrome, bivariate correlations between monthly PA and motor changes were calculated, and multivariate analysis of variance probed the influence of early PA on motor-skill timing. Results indicate that differences in gross and fine motor skills first emerge at 2 and 4 months, respectively. In infants with Down syndrome, gross motor and PA changes between 4 and 6 months were positively correlated. Infants more active than the mean at 2 or 3 months achieved several prone and sitting skills earlier. These results highlight the adaptability of early infancy and the importance of early intervention.
Article
Sedentary activity occupies a substantial amount of time during early childhood, with these habits influenced by changing trends in screen time for very young children. Among school-aged children, motor ability is inversely related to sedentary activity. However, the concept of sedentary activity is rarely investigated in toddlers, and thus little is known concerning its relationship with motor development during this rapidly changing and early period of life. Among two groups of toddlers, aged 18 months (N = 26) and aged 24 months (N = 16), this study investigated cross-sectional correlations of motor development (Bayley Scales of Infant Development—III) with daily sedentary activity (accelerometers). In both groups, gross motor ability, but not fine motor ability, was inversely correlated with time spent in sedentary activity. At 18 months, gross motor raw scores inversely correlated significantly with time in sedentary activity (r = −.533, p < .001) but fine motor raw scores did not (r = .182, p = .441). Also, at 24 months, gross motor raw scores inversely correlated with time in sedentary activity (r = −.563, p = .029), while fine motor raw scores did not (r = −.112, p = .425). These findings add important missing knowledge to the empirical literature regarding sedentary activity in toddlers and its relationship to emerging motor development. Future work might investigate best practices for measuring sedentary activity in this age-group and mechanisms behind its relationship with gross motor skills.
Article
Introduction: This exploratory study investigated the infant time spent in tummy time (TT) in relation to body mass index z score (BMI-z), weight gain, and motor development in infants from birth to 4 months. Method: Mothers and their infants were telephone surveyed at 2 and 4 months. Mother demographics; TT; feeding practices; and infant length, and height, and development were collected each time. Results: Results from Cochran-Mantel-Haenszel and single logistic regression showed a significant association between development, level of BMI-z, and time spent in TT at 2 months of age (p < .0001). The threshold model showed there was a decline in BMI-z at 4 months as daily time in TT increases past the threshold value of approximately 12 minutes per day. Mother education and TT at 2 months were significant predictors of BMI-z at 4 months. Discussion: Study outcomes suggest that infant positioning and time in TT promote infant motor development and may moderate rapid infant weight gain.
Article
Full-text available
Background Early childhood is a critical time for establishing physical activity and sedentary behaviours. Identifying modifiable predictors of physical activity and sedentary behaviours in the early life stages can inform the development of early intervention programs. The aim of this study was to identify modifiable predictors of outdoor play (a proxy of physical activity) and screen-time in 2- to 5-year-olds. MethodsA longitudinal data analysis was conducted using 5-year follow-up data from the Healthy Beginnings Trial undertaken in Sydney, Australia from 2007 to 2013. A total of 667 pregnant women were recruited for the study. Information on mothers’ demographics, physical activity, screen-time, knowledge of child development, and awareness of childhood obesity during pregnancy (at baseline); children’s tummy time (a colloquial term describing the time when a baby is placed on his or her stomach while awake and supervised) at 6 months old and screen-time at 1 year old was collected via interviews with participating mothers as potential modifiable predictors. Main outcomes were children’s outdoor playtime and screen-time at ages 2, 3.5, and 5 years. Mixed linear and logistic regression models were built to determine these modifiable predictors. ResultsMothers’ screen-time during pregnancy (β = 2.1, 95 % CI 0.17–4.12; P = 0.030) and children’s daily screen-time at age 1 year (β = 15.2, 95 % CI 7.28–23.11; P < 0.0001) predicted children’s daily screen-time across ages 2 to 5 years after controlling for confounding factors. Practising tummy time daily (β = 13.4, 95 % CI 1.26–25.52; P = 0.030), mother’s physical activity level (β = 3.9, 95 % CI 0.46–7.28; P = 0.026), and having been informed about playing with child at baseline (β = 11.6, 95 % CI 1.56–21.54; P = 0.023) predicted children’s outdoor playtime across ages 2 to 5 years. Conclusions Mothers played an important role in their children’s outdoor play and screen-time in the first years of live. Children’s early exposure to screen devices could be associated with their later screen-time. Early interventions to improve young children’s physical activity and sedentary behaviour should focus on improving pregnant women’s physical activity, awareness of playing with their child, reducing their own screen-time as well as practicing daily tummy time for infants after giving birth. Trial registrationThe Healthy Beginnings Trial is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459). Registered 13 March 2007. Prospectively registered.
Article
The purpose of this article is to discuss the growing problem of very early onset of obesity occurring before two years of age and to review infant motor development, physical activity, and effective pediatric disability motor interventions that may offer potential strategies to help reduce this growing problem earlier in life. Based on the review of physical activity interventions used with infants with a disability, we will propose strategies to consider to program early physical activity exposures into nondisabled young infants who are at risk for obesity. These proposed physical activity strategies will need to be combined with successful public health approaches to reducing early onset of obesity during infancy. Lucas (1991) conceived the term programming referring to permanent or extended effects of an environmental exposure occurring during a sensitive developmental period. In this paper, we propose that a very sensitive period for early onset of obesity is the first six months of postnatal life. If innovative strategies to increase the frequency of daily exposures to physical activity in young infants can be identified, these strategies could be combined with current public health approaches to preventing obesity in women before, during, and following pregnancy. Given the complexity of the obesity problem, no single strategy for prevention should be expected to be very successful.
Article
Full-text available
This study compared the health-related quality of life (HRQOL) of mothers using different infant feeding methods. We used the Medical Outcomes Study 36-item Short-Form (SF-36) to measure the HRQOL of 1,747 mothers and used the scores to look for associations with infant feeding methods (not breastfeeding, breastfeeding for <1 month, breastfeeding 1-5 months, and still breastfeeding at the 6th month). The mothers were chosen via a stratified sampling from the Taiwan national birth registration data between November and December 2003. HRQOL and breastfeeding duration were positively associated. Of the eight unadjusted domain scores of the SF-36, general health perception and mental health were significantly different among these four different infant feeding groups (P < 0.05). After controlling for potential confounding factors, mothers who breastfed for 6 months or longer had a higher HRQOL score than the other mothers. In addition, their physical functioning, general health perception and mental health scores were higher than those of mothers who did not breastfeed (P < 0.05). Mother's family income and parity and child's health status were also associated with mother's quality of life. Compared to the other mothers, mothers who breastfed for six moths or longer had better HRQOL. However, the limitation that this study was cross-sectional in design should be considered and further studies are needed.
Book
A Dynamic Systems Approach to the Development of Cognition and Action presents a comprehensive and detailed theory of early human development based on the principles of dynamic systems theory. Beginning with their own research in motor, perceptual, and cognitive development, Thelen and Smith raise fundamental questions about prevailing assumptions in the field. They propose a new theory of the development of cognition and action, unifying recent advances in dynamic systems theory with current research in neuroscience and neural development. In particular, they show how by processes of exploration and selection, multimodal experiences form the bases for self-organizing perception-action categories. Thelen and Smith offer a radical alternative to current cognitive theory, both in their emphasis on dynamic representation and in their focus on processes of change. Among the first attempt to apply complexity theory to psychology, they suggest reinterpretations of several classic issues in early cognitive development. The book is divided into three sections. The first discusses the nature of developmental processes in general terms, the second covers dynamic principles in process and mechanism, and the third looks at how a dynamic theory can be applied to enduring puzzles of development. Cognitive Psychology series Bradford Books imprint
Article
The American Academy of Pediatrics has recommended since 1992 that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since that time, the frequency of prone sleeping has decreased from >70% to ~20% of US infants, and the SIDS rate has decreased by >40%. However, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (eg, maternal smoking), the importance of other hazards, such as soft bedding and covered airways, has been demonstrated only recently. The present statement is intended to review the evidence about prone sleeping and other risk factors and to make recommendations about strategies that may be effective for further reducing the risk of SIDS. This statement is intended to consolidate and supplant previous statements made by this Task Force.
Article
This statement provides an update to the June 1992 American Academy of Pediatrics' policy, 'Infant Positioning and SIDS,' which recommended that healthy term infants be placed on their sides or backs to sleep. Recent data show that the original policy appears to have had a positive effect in decreasing the prevalence of prone sleeping significantly. Simultaneously, the SIDS rate in the United States has also dropped. New data also suggest that the supine position confers the lowest risk; however, the side position is still significantly safer than the prone position. Additional information regarding sleeping surface and exceptions to these recommendations are addressed.
Article
Smith has written a most interesting obituary of Dave Sackett, whom I first met in 1995 at his office at the John Radcliffe Hospital in Oxford.1 I was publishing director for Churchill Livingstone and had made the appointment directly with him by email, of which he was a prolific and early user. Sackett sat at a very large screen, talking to …
Article
The prevalence of prone sleeping has decreased dramatically since the American Academy of Pediatrics (AAP) published sleep position guidelines and launched the Back to Sleep Campaign in 1992. One aspect of the guidelines, which suggests placing infants in the prone position for supervised play time, is often overlooked. This review summarizes published articles related to the effects of sleep/play position on motor development and provides considerations for physical and occupational therapy practice in early infancy. The study results suggested that delays in the attainment of gross motor milestones in the prone position could be observed in infants whose predominant sleep position was supine, but the delays in motor development disappeared later in life. Some studies also found a reverse order of the rolling development. Therapists should educate parents about the less known advised rules of supervised play time in the prone position by the AAP, and include activities in the prone position as part of the home program in early infancy.
Article
Four indoor model ecosystems with natural plankton communities have been run. Two of the systems are exposed to artificial photosynthetic active radiation (PAR, 20 W m−2 for 16 h per day) and UV-B radiation (≈ 0.64 W m−2 for 6 h per day), while the other two are exposed to PAR only. Photosynthesis, nitrogen uptake, nutrient concentrations and contents of chlorophyll, particulate carbon, nitrogen and phosphorus are followed for six days, Photosynthesis and drlorophyli content are significantly reduced by the UV-B radition whilst uptakes of nitrate and ammonia are less affected. The contents of particulate carbon, nitrogen and phosphorus are always as high. or higher. in the UV-B-exposed communities as in the controls, while the content of chlorophyll a is reduced. Together with an increased cell number of bacterial predators, this indicates that the biomass of heterotrophs is enhanced in the UV-B-exposed communities.
Article
The validity of the preschool version of the Home Observation for Measurement of the Environment (HOME) Inventory was examined using 30 male and 30 female black children The home environments of children were assessed when the children were between 3 and 5 years old. The children's academic achievement was assessed during the primary grades using the SRA Achievement battery. Results showed a moderate relation between preschool HOME scores and achievement (around .5). For males the relation seemed largely independent of maternal education and child IQ, but not so for females. The pattern of correlation between HOME subscales and achievement indicated that several of the environmental processes assessed by HOME had independent relations to academic performance among black children. Thus, it appears that the HOME Inventory might be useful in screening black children in order to identify those at risk for school failure.
Article
In contrast to the large array of instruments available for the measurement of individual differences in children, there have been almost no techniques available to permit the precise measurement of the child's home learning environment. The present study involved the administration of a home environment inventory to a sample of 77 mothers and infants. Correlations between home inventory data and measures of infant development over a period of 30 mth were higher than those typically reported relating infant tests or level of parental education to childhood IQ.
Article
The results of the developmental assessment of nine Down's infants are very similar to previous evaluations of Down's infants. Since developmental age and chronological age are very negatively correlated, the supposition is that at some point in time the Down's infant is not so retarded. Current and past evaluations support this view. The onset of developmental delay in Down's seems to occur at 4-6 months of age, the age when most infants show a shift from subcortical to cortical control of behavior.
Article
The purpose of this paper is to examine the evidence-based research supporting the role of the home environment in relation to infant motor development by reviewing the literature investigating deprivation, parental expectations, and the qualities of the home environment associated with poverty. Methodological issues associated with the misinterpretation of data, the presence of confounding variables, and the use of inadequate measurement tools will be discussed. If aspects of the home environment contributing to infant motor development are clarified, important theoretical, research, and clinical implications arise for physical and occupational therapists working in early intervention programs.
Article
To determine whether motor development in premature infants varies according to sleep position, we evaluated 213 infants <1750 g birth weight enrolled in the Collaborative Home Infant Monitoring Evaluation (CHIME). At 56 weeks postconceptional age (PCA), sleep position was determined by maternal report, and the Bayley Scales of Infant Development 2nd Edition (BSID-II) were performed. Infants who slept supine were less likely than infants who slept prone to receive credit for maintaining the head elevated to 45 degrees (p = .021), and infants who slept nonprone were less likely than prone sleepers to receive credit for maintaining the head elevated to 90 degrees and lowering with control (p = .001). The Psychomotor and Mental Development Indices at 56 and 92 weeks PCA were not altered by usual sleep position at 56 weeks PCA. In summary, infants sleeping supine are less able to lift the head and lower with control at 56 weeks PCA, but global developmental status was unaffected. Supine sleeping has been associated with decreased risk for sudden infant death syndrome, but compensatory strategies while awake may be needed to avoid delayed acquisition of head control.
Article
In anticipation of a new century, it is useful to reflect upon how much greater the capability for awareness of our world is today than it was 100 years ago. Communication and travel achievements have erased many boundaries between us, and have made it possible to learn about children and families in cultural settings very remote from our own. This has resulted in an impressive body of evidence that motor development is somewhat variable and can be shaped to meet particular cultural demands. The early surge of interest in cultural variations in motor development has been tempered by information about other factors such as temperature and nutrition which may coincidentally influence motor developmental progress. This paper provides a comprehensive description of cultural variations in motor development, balanced by an emphasis on factors unrelated to or coexisting with culture which may be equally significant. The first part of the paper explores noncultural factors and the second part describes infants' and children's motor developmental patterns in the context of their cultural group. Cultures are determined and maintained through the transmission of values and behaviors from parents to their children. Parental expectations of children, influenced by grandparents and their parents, appear to have an effect on motor development which varies significantly across cultures and among individuals. Information related to parent expectations confirms that parents and grandparents are the most important allies for physical therapists working with children. (Pediatr Phys Ther 1995;7:103-111) (C) Williams & Wilkins 1995. All Rights Reserved.
Article
In buildings that contain laboratories, fume hoods are normally used to control contaminant concentrations. Exhaust stacks with a constant exit velocity are required to make sure that dangerous concentrations do not occur in occupied areas near the building or on the roof top. To achieve constant velocity when exhaust flow rates are less than design, makeup air is introduced to the system at the inlet of the exhaust fan. Since laboratory exhaust airflow is often significantly less than the design airflow, exhaust fans consume significantly more energy than is necessary. To reduce exhaust fan energy, techniques involving multiple exhaust stacks and a variable speed drive (VSD) can be applied to laboratory exhaust systems. The potential fan energy savings depend on optimal selection of the number of stacks, the sizes of the stacks, and the exhaust system ductwork design. This paper introduces application principles, describes the optimal methods of stack sizing, and presents an example to demonstrate these methods. Published in 2005 by John Wiley & Sons, Ltd.
Article
Citing a distinction between informal and formal routines used by mothers in handling their infants, we examined formal handling routines, in which the caregiver acts in a pedagogical manner; these routines are widespread in many non-Western countries. We hypothesised that formal handling serves to facilitate gross motor development during early infancy. To examine this hypothesis, the effects of a Jamaican formal handling routine on a broad range of developmental outcomes was examined. Results showed that the effects were specific to early gross motor development and in particular to postural control along the vertical axis of the body. Information is also provided on other aspects of Jamaican child care. It seems that the handling routine forms part of a folk (developmental) medicine system and may serve not only to promote child health but also as a sort of developmental neurological examination.
Article
Factor analyses were performed on the Infant-Toddler and the Early Childhood versions of the HOME Inventory for 3 groups (blacks, whites, and Hispanics) of premature, low-birthweight children. Participants lived in 8 different U.S. cities. On the IT-HOME, 5 factors were originally retained for each group using the principal factors method of extraction. Factor structures for blacks and whites were similar, accounting for 85% and 75% of the variance, respectively. The structure for Hispanics was somewhat different; a 7-factor solution accounting for 65% of the variance was most interpretable. For the EC-HOME, 6 factors were retained for both black and white groups, accounting for 80% and 73% of the variance, respectively. For Hispanics, an 8-factor solution accounted for 59% of the variance. The factor structures for blacks and whites were largely in agreement with the current organization of items into subscales. The fit for Hispanics was not quite as good, but most factors also corresponded to current subscales.
Article
Seventy-one first-born infants who had been nursed in prone position since birth, were referred for motor assessment at 3 months, 5 months and 9 months. All infants were administered the same checklist of motor items, based on the Amiel-Tison Infant Neurological Evaluation and on the Brunet-Lézine Developmental Psychomotor Scale. Abnormalities in muscular shortening and delay in motor skills were found. These findings are critical as regards environmental influences on postural development, continuities in motor development and issues of early primary prevention. Early identification and follow-up programmes, including frequent changes in posture, are suggested in order to avoid abnormalities of motor behaviour and subsequently in postural patterns.
Article
This study determined whether knowledge of sleeping in the prone position as a risk factor for sudden infant death syndrome (SIDS) influences caregivers' positioning of their infants for play and sleep. One hundred caregivers attending Adelaide metropolitan Child Adolescent and Family Health Services (CAFHS) were surveyed by self-administered questionnaire. Ninety-three per cent of parents reported that their knowledge of SIDS influenced infant positioning for sleep and 84% reported they never put their infant in the prone position for sleep. Thirty-seven per cent reported that SIDS knowledge did influence play positioning and 26% reported never placing their infant prone for play. There was a significant association (P = 0.002) between the influence of SIDS knowledge on play positioning and avoidance of the prone position for play. Community educators may need to clarify that prone positioning for play is not a risk factor for SIDS and that it is desirable for infants to spend supervised wakeful time in the prone position.
Article
To evaluate whether sleeping in the supine position resulted in changes in gross or fine motor developmental milestones observed at routinely scheduled well-child checkups at 4 or 6 months of age. A retrospective chart review. One private pediatric practice involving 2 full-time and 2 part-time board-eligible or board-certified pediatricians. The study included 343 full-term infants whose weights were appropriate or large for gestational age, had no history of hospitalization other than for normal newborn care, and were examined in the office for their 4-month well-child checkup within 2 weeks of being 4 months old. The Denver Developmental Screening Test-Revised was administrated at the 4- and 6-month well-child checkups. The primary sleep positions of the infants were determined by telephone survey, office interview, or letter after the 6-month checkup was completed. Background data collected from the mother for each mother-infant pair included maternal age at the time of birth, parity, and marital status, Medicaid status and ethnicity of the infant, and whether the infant was breast-fed. Infants who slept in the side or supine position were less likely to roll over at the 4-month checkup than infants who slept primarily in the prone position (P < .001). No significant differences were found when comparison by maternal age, parity, or marital status, Medicaid status or ethnicity of the infant, or the use of breast-feeding were considered. Other motor milestones screened did not show statistically significant changes. Sleep position significantly influences the age of achieving the gross motor developmental milestone of rolling over; infants who sleep in the side or supine position roll over later than infants who sleep in the prone position.
Article
To assess whether the recommendations that infants sleep supine could have adverse consequences on their motor and mental development. A prospective study of infants, delivered before, during, and after the Back to Sleep Campaign in the United Kingdom, followed to 18 months of age. The children were participants of the Avon Longitudinal Study of Pregnancy and Childhood born to mothers resident in the three former Bristol-based health districts of Avon, with expected date of delivery from April 1, 1991 to December 31, 1992. Questionnaires were completed on sleeping position at 4 to 6 weeks of age and sets of standardized questions on development at 6 and 18 months. Social, communication, fine and gross motor, and total developmental scales based on the Denver Developmental Screening Test at 6 and 18 months. After adjustment for 27 factors using multiple regression, 3 of the 10 scales and subscales significantly distinguished between front and back sleeping position. At 6 months of age, infants put to sleep on their front had a mean score 0.38 SD (95% confidence interval [CI]: 0.28, 0.49) higher on the gross motor scale, 0.11 SD (95% CI: 0.00, 0.23) higher in the social skills scale, and a total development score 0.20 SD (95% CI: 0.10, 0.30) higher than those on their backs. These differences were no longer apparent at 18 months. There is some evidence that putting infants to sleep in the supine position results in a reduced developmental score at 6 months of age, but this disadvantage appears to be transient. Weighing this against the adverse health effects demonstrated with the prone sleeping position, these results should not change the message of the Back to Sleep Campaign.
Article
As a result of the American Academy of Pediatrics' recommendation that healthy infants be placed on their side or back for sleep, the percentage of infants sleeping prone has decreased dramatically. With the increase in supine sleeping, pediatricians have questioned if there are differences in the rate of acquisition of early motor milestones between prone and supine sleeping infants. To examine this question, we performed a prospective, practice-based study of healthy term infants. Infants were recruited before the age of 2 months. Parents were asked to record infant sleep position and awake time spent prone until 6 months of age. A developmental log was used to track milestones from birth until the infant was walking. Age of acquisition of eight motor milestones was determined, and the mean ages of milestone attainment of prone and supine sleepers were compared. Three hundred fifty-one infants completed the study. Prone sleepers acquired motor milestones at an earlier age than supine sleepers. There was a significant difference in the age of attainment of rolling prone to supine, tripod sitting, creeping, crawling, and pulling to stand. There was no significant difference in age when infants walked. The pattern of early motor development is affected by sleep position. Prone sleepers attain several motor milestones earlier than supine sleepers. However, all infants achieved all milestones within the accepted normal age range. Pediatricians can use this information to reassure parents. This difference in milestone attainment is not a reason to abandon the American Academy of Pediatrics' sleep position recommendations.
Article
There are few reports about developmental behavior relating to roll over among healthy infants. We assessed the relationship between the placed position on sleeping and altered sleeping position the next morning by roll over among healthy infants. A health check-up clinic distributed a total of 1626 questionnaires to parents whose infant's ages are 1.5 years (or 18 months) old. The age at the first roll over and the change in sleeping position the next morning after they started to roll over, were investigated. The mean age of roll over from the supine to the prone among infants who were placed mainly in the prone sleeping position, at least in the first week of life, was 4.0 months (S.D., 1.1). The mean age of roll over from the supine to the prone among infants who were placed mainly in the supine sleeping position during early neonatal life and thereafter was 4.4 months (S.D., 1.2). The age of the first roll over from supine to prone was significantly younger in infants who were placed mainly in the prone sleeping position during early neonatal life. Among 651 infants who had been placed supine, 34.7% were found prone by roll over the next morning. Among 211 infants who had been placed prone, 14.2% were found supine by roll over the next morning. The number of infants who rolled over from supine to prone position was statistically greater than those from prone to supine. It is likely that the healthy human infant tends to sleep in the prone rather than the supine position. The finding is especially important for the correct assessment of the position in which SIDS cases were found dead.
Article
Purpose: Clinical experience has suggested differences in motor development between infants nursed prone, and those nursed supine. This pilot study investigated possible associations between wakeful infant positioning and motor control. Method: Twenty-six infants were examined. Wakeful positional experience was recorded by log book. When the infants were aged between 14 and 18 weeks, motor control was measured using five items from the Movement Assessment of Infants. Results: Analyses revealed associations between age and time spent in stimulating circumstances, and some motor scores, but not an association between time spent in prone and supine positions and motor skills in those positions. Conclusion: Time spent in positions involving greater stimulation from, and closer interaction with, caregivers may be beneficial to motor development in early infancy.
Article
Limited information is available on how sleep and play positions affect infant gross motor skills and occupational development. The overall objective of this descriptive developmental pilot study was to compare normative and sampled infants relative to sleep and awake positioning using the Denver II Gross Motor Sector. A cross-sectional sample of 66 infants 2.0 (n = 23), 4.1 (n = 26), and 6.0 (n = 17) months of age were administered the Denver II Gross Motor Sector. Caregivers identified infants' primary sleep positions and amount of awake-time in prone. Data were analyzed using chi-square goodness-of-fit tests. The sample of 2.0-month-old supine and side sleeping infants differed significantly from the normative population on three gross motor milestones. Two-month-old infants spending 15 min or fewer of awake-time in prone passed the gross motor milestones at significantly lower percentages than the normative population. No significant differences were noted between sampled and normative populations at 4.1 and 6.0 months of age. Results suggest that infant gross motor development may be related to sleep and play positioning. Information regarding infants' sleep and awake positioning may be important to occupational therapists when evaluating gross motor development. Implications for caregiver education and future research are proposed.
Article
The prevalence of prone sleeping has decreased dramatically since the American Academy of Pediatrics (AAP) published sleep position guidelines and launched the Back to Sleep Campaign in 1992. One aspect of the guidelines, which suggests placing infants in the prone position for supervised play time, is often overlooked. This review summarizes published articles related to the effects of sleep/play position on motor development and provides considerations for physical and occupational therapy practice in early infancy. The study results suggested that delays in the attainment of gross motor milestones in the prone position could be observed in infants whose predominant sleep position was supine, but the delays in motor development disappeared later in life. Some studies also found a reverse order of the rolling development. Therapists should educate parents about the less known advised rules of supervised play time in the prone position by the AAP, and include activities in the prone position as part of the home program in early infancy.