1. In a systematic review, awake prone positioning (tummy time) in healthy infants was positively associated with total development, gross motor development, decreased body mass index (BMI), prevention of brachycephaly, and ability to move while prone, supine, crawling, and rolling.
2. These results support the World Health Organization’s (WHO) recommendation that infants experience at least 30 minutes of tummy time over each 24-hour period.
Evidence Rating Level: 2 (Good)
Study Rundown: The “Back to Sleep” campaign, in which the American Academy of Pediatrics (AAP) recommended that all infants be placed supine to sleep starting in 1992, contributed to a 40% decrease in the incidence of sudden infant death syndrome (SIDS) in the United States. However, several subsequent studies showed that infants who sleep supine may be slower to achieve motor milestones and have increased rates of plagiocephaly. Several medical associations recommend awake prone positioning, also known as “tummy time,” in order to counterbalance the negative effects of supine sleep. Despite these guidelines, compliance with current recommendations is low (30% in one study), and the impact of tummy time on several health outcomes is unknown. This systematic review was completed to further evaluate the potential connection between tummy time and infant health outcomes. A total of 16 studies involving 4237 infants from 8 different countries were included in the review. Tummy time had a statistically significant positive association with total development, gross motor development, decreased BMI z-score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. Although most studies were observational in design and tummy time was measured subjectively using parent questionnaires or interviews, this systematic review lends support to current recommendations that infants experience tummy time for at least 30 minutes per day while awake. Results of this review can be used to educate parents and other caregivers about the importance of tummy time, which may improve adherence to tummy time guidelines.
In-Depth [systematic review]: Included studies examined the impact of tummy time on outcomes in healthy infants aged 0 to 12 months. Studies that included other behaviors/interventions in addition to tummy time were excluded in order to obtain the most accurate impact of tummy time on outcome measures. Tummy time was defined as supervised awake prone positioning. A total of 16 articles involving 4237 infants from 8 countries were included in the final review, with varying proportions of males and females. Of these studies, 15 were observational and 1 was experimental (non-randomized intervention). Tummy time was measured using parent questionnaires, interviews, or position diaries. Outcome measures in the studies included: motor development (12 studies), head shape (3), BMI (1), cognition (1). Evidence for a positive association between tummy time and motor development was found in 11 studies. One study revealed an association between greater than 12 minutes of tummy time per day at age 2 months and a decline in BMI-z score at 4 months (p = 0.0412). Indeterminate associations were found between tummy time and the ability to sit, stand, and walk, cognition, and plagiocephaly. No association was found between tummy time and fine motor development and communication.
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