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Tummy Time is Important
... However, the prone position can be uncomfortable and the exercises engaged in during tummy time may be challenging for infants, which can evoke problem behavior such as crying or fussing. This sort of behavior can deter parents from incorporating tummy time into their child's routine (Graham, 2006). Parental nonadherence to treatment recommendations influenced by the child's response to the treatment procedures has been defined as child effects and can create a possible trap in parenchild interactions (Stocco & Thompson, 2015). ...
Tummy time involves placing an infant in a prone position to help build muscle strength. Pediatricians recommend tummy time because it helps with infant development related to milestones such as crawling, rolling over, and sitting up. However, parents sometimes avoid tummy time due to whining or crying when the infant is placed in the prone position. The current study compared two interventions incorporating preferred leisure items (i.e., varied or constant) for five typically developing infants to increase head elevation and decrease negative vocalizations during tummy time. Improvements occurred in infant performance regardless of the preferred items used. In addition, the mothers who implemented the tummy time procedures found the treatment to be socially valid and were more likely to select the use of the constant item when given the opportunity to choose.
... Tummy Time) seem to affect infant motor acquisitions positively. 67,68 Considering the findings of the present study, it is important to note that the more significant changes were observed only after 4 months for both groups. Brazilian mothers tend not to use the prone posture as the most constant in the daily routine, either because of fear, or because of following guidelines regarding the adoption of the supine posture as preferential for prevention of infant sudden death while sleeping, as preconized in the Back to Sleep Program. ...
Background:
Motor development occurs throughout periods of motor skills' acquisition, adjustment and variability. The objectives of this study were analyzed and compare biological and health characteristics and motor skill acquisitions' trajectories of preterm and full-term infants during the first year of life.
Methods:
2,579 infants (1361 preterm) from 22 states were assessed using the Alberta Infant Motor Scale. Multivariate General Linear Model, t-tests, ANOVA, and Tukey tests were used.
Results:
An Age x Groups significant interaction was found for motor scores. Follow up tests revealed that full-term infants presented higher scores in prone, supine, sitting and standing postures that require trunk control from 9 to 10 months of age; although, this advantage was observed for sitting from the second month of life.
Discussion:
During the first trimester preterm infants demonstrate higher scores in the supine and standing postures. Regarding motor trajectories, from newborn to 12 months, the periods of the higher motor acquisition was similar between full-term and preterm infants for prone (3-to-10 months), supine (1-to-6 months), and standing (6-to-12 months). However, for sitting posture full-term infants demonstrated higher periods of acquisitions from the first to 7 months of life, whereas for preterm infants a shorter period was observed (3-to-7 months).
Conclusion:
Although the periods of higher motor acquisitions were similar, full-term infants demonstrated higher scores in more control' demanding postures. Intervention for preterm infants need goes beyond the first months of life and includes guidance to parents to promote motor development strategies to achieve control in the higher postures. This article is protected by copyright. All rights reserved.
... Acknowledging the importance of physical activity (PA), many developed countries and regions have developed PA recommendations for school-age children and preschoolers (Dobbins et al. 2013 preschoolers (aged 2-6) should spend at least 180 total minutes per day in active play and should not spend more than 2 h per day in sedentary activities; for infants, tummy time and floor-based play are recommended as these kinds of activities can help infants improve their muscle performance (Graham 2006). Although these suggestions have been promoted by governmental health organizations, studies still report that plenty of children above 1 year old failed to meet the PA guidelines (Hnatiuk et al. 2012), especially in the area of moderate to vigorous playtime (Colley et al. 2013;Hnatiuk et al. 2012). ...
Objectives Many obesity-related chronic diseases originate from unhealthy childhood habits. The aim of this study was to describe 9-month-old infants' physical activity levels and patterns and to examine the correlates. Understanding these factors is necessary for improving the effectiveness of physical activity intervention programs for infants. Methods In total, 143 infant-mother dyads from Macau, SAR China, participated in this study. Physical activity (PA) was assessed by using the Actigraph GT3X+ accelerometer and the demographic variables were collected by questionnaires. Results The most important findings were that: (1) infants had more screen time during weekdays (p = .044); (2) infants and mothers were least active at 8 a.m. (both weekdays and weekends) in the morning and most active at 7 p.m. (weekdays) and 8 p.m. (weekends) in the evening; (3) infants' PA levels significantly correlated with their mothers' PA intensities during the weekends (r = .192, p = .036), especially the mothers' lower intensities in the mornings and evenings; (4) maternal BMI predicted the PA levels of the 9-month-old infants' (R2 = .06, β = 29.188, p = .009). Conclusions for Practice Physical activity promotion programs for infants should be time-specific starting from early infancy. This study was one of the first to examine 9-month-old infants' PA levels, patterns and correlates. The results may be helpful in improving the effectiveness of future healthy lifestyle intervention programs for infants in Macau and in the region in general.
... The presence of the gastrostomy tube in the abdomen might also lead to avoidance of "tummy time," a well-known position that contributes to motor skills development allowing strengthening of the shoulder muscles, full rotation of the neck, and development of antigravity extensor control. 26 Decreased time in prone position has been found to be associated with de-layed achievement of gross motor milestones. 27 EDI would provide the families of these children with useful resources to promote motor development, as well as it would provide support to prevent the already described oral aversion and the long-term complications with eating and drinking skills. ...
Objective:
To compare the proportion of developmental delay in early complex cardiac surgery (CCS) survivors with and without gastrostomy tube feeding (GTF). To explore acute care predictors of GTF that might help improve care in CCS survivors.
Study group:
This comparison study of 2 groups within an inception cohort included 334 CCS survivors after cardiopulmonary bypass at ≤6 weeks of age (2005-2012) who did not require extracorporeal membrane oxygenation or heart transplantation. Children were assessed at 21 ± 3 months with the Bayley Scales of Infant and Toddler Development-Third Edition and the Adaptive Behavior Assessment System-Second Edition: general adaptive composite score. Delay was determined by scores >2 SD below mean. The χ(2) test compared groups. Predictors of GTF were analyzed using multiple logistic regression analysis, results expressed as OR with 95% CI.
Results:
Of the survivors, 67/334 (20%) had GTF any time before the 21-month assessment. Developmental delays in children with GTF were cognitive in 16 (24%), motor in 18 (27%), language in 24 (36%) vs without GTF in 7 (3%), 8 (3%), and 32 (12%), respectively (P < .001). Gastrostomy group had almost 8 times the number of children delayed on the general adaptive composite score. Independent OR for GTF are presence of a chromosomal abnormality, OR 4.6 (95% CI 1.8, 12.0) (P = .002), single ventricle anatomy, OR 3.4 (95% CI 1.7, 6.8) (P < .001), total postoperative days of open sternum, OR 1.15 (95% CI 1.1, 1.3) (P = .031), and total number of hospital days at CCS, OR 1.03 (95% CI 1.1, 1.04) (P = .002).
Conclusions:
GTF identifies CCS survivors at risk for delay, who would benefit from early developmental intervention. The described mostly nonmodifiable predictors may guide counseling of these children's families.
... The study compared the effects of a preferred stimulus with or without maternal attention on infant behaviors during tummy time. The addition of maternal attention produced more positive outcomes: (Graham 2006;Persing et al. 2003). Despite its reported positive outcomes, parents sometimes have difficulty implementing tummy time because of infants' problem behavior (e.g., crying) during this activity. ...
“Tummy time” is an activity for infants to develop muscle tone; however, it often evokes crying and non-compliance. The current study investigated two interventions for an infant to a) increase elevated head behavior, and b) decrease negative vocalizations. The study compared the effects of a preferred stimulus with or without maternal attention on infant behaviors during tummy time. The addition of maternal attention produced more positive outcomes:
*The science of behavior analysis can be used to treat a broad range of socially significant behaviors like infant behavior during tummy time.
*Preference assessments can be used with infants to identify potentially reinforcing stimuli.
*The continuous provision of a preferred stimulus during tummy time may help infants to increase positive behaviors and decrease problem behaviors.
*Parent attention may have an added benefit to a treatment package for typically developing infants.
... In 1992, the American Academy of Pediatrics (AAP) urged caregivers to place infants in the supine position for sleeping to reduce risk of sudden infant death syndrome (SIDS; Chizawsky & Scott-Findlay, 2005). The number of infants placed in the supine position for sleep increased from 13% to 73% (Szabo, 2008), and the incidence of SIDS had decreased by over 50% (Graham, 2006). While this strong recommendation for caregivers to place infants in the supine position for sleep is of critical importance in reducing SIDS, there is great concern that it has resulted in infants not spending enough time in prone, which may have effects on development. ...
This study employed a cross-sectional questionnaire-based survey of the caregivers of infants born at full term. Three hundred for forty-one surveys were distributed, and 102 were returned (30% return rate). Fifteen were excluded for reasons including the infant being too old and the consent form not being properly completed. In total, 87 usable surveys were entered for data analysis. The majority of respondents had heard about “tummy time” before taking the survey, and the majority felt confident with their tummy time knowledge and implementation. However, approximately 25% of the caregivers did not begin to implement awake prone positioning in the newborn stage in accordance with the American Academy of Pediatric (AAP) recommendation (AAP, 2008), placing infants at risk for negative sequelae. We found that participants’ general knowledge of awake infant prone positioning was not positively correlated with the implementation of infant prone time. Caregivers receiving information from professional sources as compared to casual sources did not have higher knowledge of infant prone positioning. The findings of this study suggest a role for service providers in helping to increase specific knowledge about the implementation of awake prone positioning among expecting parents and parents of young infants.
... Although the "tummy time" campaign urges parents to place infants in a prone posture for play (Chizawsky & Scott-Findlay, 2005), manual and oral exploration was less frequent compared to supine and sitting postures. Practicing prone skills may be useful for promoting muscle growth and deterring the flattening of infants' soft skulls (Graham, 2006), but for object exploration, the prone position is sub-optimal. ...
Recent research has revealed the important role of multimodal object exploration in infants' cognitive and social development. Yet, the real time effects of postural position on infants' object exploration have been largely ignored. In the current study, 5- to 7-month-old infants (N = 29) handled objects while placed in supported sitting, supine, and prone postures, and their spontaneous exploratory behaviors were observed. Infants produced more manual, oral, and visual exploration in sitting compared to lying supine and prone. Moreover, while sitting, infants more often coupled manual exploration with mouthing and visual examination. Infants' opportunities for learning from object exploration are embedded within a real time postural context that constrains the quantity and quality of exploratory behavior.
Infants with Down syndrome often have low muscle tone (hypotonia) and need activities designed to increase muscle tone (e.g., tummy time). However, no study has examined the effects of strategies designed to increase of tummy time for this population. The current study investigated activation of a preferred toy as a strategy to increase head lifting during tummy time for a 5-month-old with Down syndrome and associated hypotonia. The intervention was successful and is a promising early strategy for addressing hypotonia in infants with Down syndrome.
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Objective
To describe the preventive measures of the positional or deformational plagiocephaly.
Search strategy
We reviewed the Medline database up to September 2007, completing this with a search in the Cochrane Library, in other databases and reviewed the articles selected.
Study and data selection
No randomized clinical trials that evaluated the effectiveness of the preventive measures were found. Three prospective cohort studies and 1 case-control study were found together with other less specific epidemiological studies and 1 general clinical practice guideline on plagiocephaly.
Synthesis of results and conclusions
Scientific evidence of preventive measures is scarce, only based on recent reports related to natural history, risk factors and long-term outcome. We propose a series of preventive measures, aimed at the healthy child and secondary preventive ones, for the child with cranial deformation and/or positional preference or torticollis. The more important aspects outlined are that the main risk factors are postnatal/environmental ones; the preventive measures must be adopted as soon as possible, especially during the first 6 weeks of life; and the preventive performance must be energetic, with the employment of positional therapy, together with cervical exercises and motor developmental achievements stimulating when it is indicated.
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Although referrals for nonsynostotic plagiocephaly (NSP) have increased in recent years, the prevalence, natural history, and determinants of the condition have been unclear. The objective of this study was to assess the prevalence and natural history of NSP in normal infants in the first 2 years of life and to identify factors that may contribute to the development of NSP.
Two hundred infants were recruited at birth. At 6 weeks, 4 months, 8 months, 12 months, and 2 years, the head circumference shape was digitally photographed, and head shape was quantified using custom-written software. At each age, infants were classified as cases when the cephalic index was > or =93% and/or the oblique cranial length ratio was > or =106%. Neck rotation and a range of infant, infant care, socioeconomic, and obstetric factors were assessed.
Ninety-six percent of infants were followed to 12 months, and 90.5% were followed to 2 years. Prevalence of plagiocephaly and/or brachycephaly at 6 weeks and 4, 8, 12, and 24 months was 16.0%, 19.7%, 9.2%, 6.8%, and 3.3% respectively. The mean cephalic index by 2 years was 81.6% (range: 72.0%-102.6%); the mean oblique cranial length ratio was 102.6% (range: 100.1%-109.4%). Significant univariate risk factors of NSP at 6 weeks include limited passive neck rotation at birth, preferential head orientation, supine sleep position, and head position not varied when put to sleep. At 4 months, risk factors were male gender, firstborn, limited passive neck rotation at birth, limited active head rotation at 4 months, supine sleeping at birth and 6 weeks, lower activity level, and trying unsuccessfully to vary the head position when putting the infant down to sleep.
There is a wide range of head shapes in infants, and prevalence of NSP increases to 4 months but diminishes as infants grow older. The majority of cases will have resolved by 2 years of age. Limited head rotation, lower activity levels, and supine sleep position seem to be important determinants.
Medical dictionaries and anthropologic sources define brachycephaly as a cranial index (CI = width divided by length x 100%) greater than 81%. We examine the impact of supine sleeping on CI and compare orthotic treatment with repositioning.
We compared the effect of repositioning versus helmet therapy on CI in 193 infants referred for abnormal head shape.
Eighty percent of the infants had a pretreatment CI > 81%. Their initial mean CI at mean age 5.3 months was 89%, and after treatment, their mean CI was 87% (+/-2 SE = 0.9%) at mean age 9.0 months. For 92 infants with an initial CI at or above 90%, their initial mean CI of 96.1% was reduced to a mean of 91.9%.
Post-treatment CI was 86% to 88%, CI in neonates delivered by cesarean section was 80%, and CI in supine-sleeping Asian children was 85% to 91%, versus 78% to 83% for prone-sleeping American children. Repositioning was less effective than cranial orthotic therapy in correcting severe brachycephaly. We recommend varying the head position when putting infants to sleep.
Cranial asymmetry may be present at birth or may develop during the first few months of life. Over the past several years, pediatricians have seen an increase in the number of children with cranial asymmetry, particularly unilateral flattening of the occiput. This increase likely is attributable to parents following the American Academy of Pediatrics "Back to Sleep" positioning recommendations aimed at decreasing the risk of sudden infant death syndrome. Although associated with some risk of deformational plagiocephaly, healthy young infants should be placed down for sleep on their backs. This practice has been associated with a dramatic decrease in the incidence of sudden infant death syndrome. Pediatricians need to be able to properly diagnose skull deformities, educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary. This report provides guidelines for the prevention, diagnosis, and management of positional skull deformity in an otherwise normal infant without evidence of associated anomalies, syndromes, or spinal disease.
During a study of 6756 consecutive newborn infants, congenital sternomastoid torticollis (CST) was observed in association with plagiocephaly (P<<0.001), facial deformities (P<0.05), ipselateral mandibular asymmetry (P<<0.001), postural scoliosis (P<<0.001) and talipes (P<0.001). A similar pattern of maternal pregnancy characteristics (eg. primiparity, oligohydramnios, breech presentation) was observed as is encountered in association with other congenital postural deformities. Clinical and pathological data collected over a 14 year period suggests that CST is due to prenatal fibrosis and shortening of the muscle. This may be caused by ischaemia secondary to venous occlusion due to persistant lateral flexion and rotation of the neck before birth. Trauma to the shortened muscle during delivery may be responsible for secondary damage in some cases.
1) To determine the prevalence of positional preference in the general population of infants up to the age of 6 months; 2) to gather information on possible risk factors; 3) to determine the percentage of children with positional preference undergoing diagnostic evaluation and/or treatment; and 4) to assess the overall outcome of positional preference in infants and toddlers, with currently used diagnostic and treatment practices.
Infant health care centers in The Netherlands.
Seven thousand six hundred nine infants below the age of 6 months were screened for positional preference (cases: n = 623). Anamnestic data and physical signs of asymmetry of the range of motion and the shape of the head were recorded. These data were also registered of an immediate next child visiting the infant health care center with the same sex and about the same age but without positional preference (controls: n = 554). In a first follow-up study, 6 to 8 months after the original study, 468 of the 623 children with positional preference were reexamined for asymmetry of the range of motion and the shape of the head. In a second follow-up study, 24 to 32 months after the original study, 129 of 259 children who still had shown signs of asymmetry in the first follow-up study were again reexamined.
The prevalence of positional preference was 8.2% and was highest in children below 16 weeks of age. The boy:girl ratio was 3:2. Firstborns, premature children, and children with breech position at the time of delivery proved to have a higher risk for positional preference. The supine sleeping position of the child and a strong preference in offering the feeding always from the right or the left side were positively correlated with positional preference. In the first follow-up study, 12% still showed restricted active range of motion, 8% restricted passive range of motion, 47% asymmetric flattening of the occiput, and 23% of the forehead. Thirty-two percent of the children with positional preference had been referred for diagnostical/therapeutical intervention. In the second follow-up study, active range of motion was restricted in 6%, passive rotation in 2%, 45% had an asymmetric flattening of the occiput, and 21% of the forehead.
Positional preference is frequently observed (8.2%) in The Netherlands. It leads to referral, additional diagnostics and, if necessary, treatment of almost 1 of every 3 affected children. Extrapolated to the original population in 1995, 2.4% of all children would still have a restricted range of motion and/or flattening of the skull at the age of 2 to 3 years. The high prevalence of positional preference in infancy, the persistency of accompanying signs, the large number of children referred for further diagnostic and/or treatment, and the resulting high medical expenses strongly call for a primary preventive approach.positional preference, deformational plagiocephaly, asymmetry, infants, population-based study.
Handbook of Normal Physical Measurements
- J G Hall
- U G Froster-Iskenius
- Allan-Son Je