Evaluation of a “tummy time” intervention to improve motor skills in infants after cardiac surgery

Background: Infants who require open heart surgery are at increased risk for developmental delays including gross motor impairments which may have implications for later adaptive skills and cognitive performance. We sought to evaluate the feasibility and efficacy of a tummy time intervention to improve motor skill development in infants after cardiac surgery. Methods: Infants <4 months of age who underwent cardiac surgery were randomly assigned to tummy time with or without outpatient reinforcement or standard of care prior to hospital discharge. The Alberta Infant Motor Scale (AIMS) was administered to each infant prior to and 3 months after discharge. Groups were compared, and the association between parent-reported tummy time at home and change in motor scores at follow-up was examined. Results: Parents of infants (n = 64) who had cardiac surgery at a median age of 5 days were randomly assigned to tummy time instruction (n = 20), tummy time + outpatient reinforcement (n = 21) or standard of care (n = 23). Forty-nine (77%) returned for follow-up. At follow-up, reported daily tummy time was not significantly different between groups (p = 0.17). Fifteen infants had <15 minutes of tummy time daily. Infants who received >15 minutes of tummy time daily had a significantly greater improvement in motor scores than infants with <15 minutes of tummy time daily (p = 0.01). Conclusion: In infants following cardiac surgery, <15 minutes of tummy time daily is associated with increased motor skill impairment. Further research is needed to elucidate the best strategies to optimise parental compliance with tummy time recommendations.

Validity of GENEActiv Accelerometer Wear and Nonwear Time for Use in Infants

Background: Tummy time is recommended by the World Health Organization as part of its global movement guidelines for infant physical activity. To enable objective measurement of tummy time, accelerometer wear and nonwear time requires validation. The purpose of this study was to validate GENEActiv wear and nonwear time for use in infants. Methods: The analysis was conducted on accelerometer data from 32 healthy infants (4–25 wk) wearing a GENEActiv (right hip) while completing a positioning protocol (3 min each position). Direct observation (video) was compared with the accelerometer data. The accelerometer data were analyzed by receiver operating characteristic curves to identify optimal cut points for second-by-second wear and nonwear time. Cut points (accelerometer data) were tested against direct observation to determine performance. Statistical analysis was conducted using leave-one-out validation and Bland–Altman plots. Results: Mean temperature (0.941) and z-axis (0.889) had the greatest area under the receiver operating characteristic curve. Cut points were 25.6°C (temperature) and −0.812g (z-axis) and had high sensitivity (0.84, 95% confidence interval, 0.838–0.842) and specificity (0.948, 95% confidence interval, 0.944–0.948). Conclusions: Analyzing GENEActiv data using temperature (>25.6°C) and z-axis (greater than −0.812g) cut points can be used to determine wear time among infants for the purpose of measuring tummy time.

Realistic dosage of tummy time practice during infancy.

Background: The pediatricians recommend “tummy time” (placing a baby on their stomach while awake) as a physical activity for non-locomotor infants. However, parents often do not fully understand specific methods for fulfilling tummy time recommendations, then did not implement tummy time in the early stage of life. Aim of the study: The study aimed to determine the realistic dosage of daily tummy time for parents and infants of various ages. Methods: A total of 11 infants (7 girls, 4 boys, start age 61. 5days) participated in the intervention. Accumulate 60 minutes of tummy time was requested throughout the day. Results: Infants completed the intervention (achievement of sitting milestone age) at an average of 182.18 days old. The average duration of intervention days was 120.63 days. The average daily practice was 50.12 minutes. During the intervention, the percentage of completed days infants meet their required dosage was an average of 46.3 %. The percentage of missing days infants did not practice tummy time at all was an average of 18.64%. The percentage of days that infants did practice tummy time, but were under the required dosage was an average of 23.51%. Conclusion: It was evident that the prescribed dosage of daily practice was a too ambitious goal and maybe far from realistic for non-locomotor infants. Keywords: tummy time, early exercise, physical activity, motor development

A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time

Background: Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants’ health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. Methods: A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. Results: Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08–2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. Conclusions: Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.

Weekly group tummy time classes are feasible and acceptable to mothers with infants: a pilot cluster randomized controlled trial

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