Developing a Parent Education Program
for Infant Prone Positioning
Shelby Gordon, SPT, Kristin Lemenager, SPT, Molly Peterson, SPT, Jan McElroy, PT, PhD
Background/Hypothesis
The National Institute of Health initiated the “back to sleep” campaign in 1992, due to
the rise in sudden infant death syndrome (SIDS), urging parents to put their sleeping
infants in the supine position. Since the initiation of the back to sleep campaign, there
has been an increase in:
1. Positional plagiocephaly (PP), a condition in which an infant’s head develops an
abnormally flattened appearance (increasing from less than one percent of infants to
twenty percent of infants aged two months).3
2. Torticollis, a condition which is characterized by lateral flexion of the head to one
side and cervical rotation to the opposite side.1
3. Delayed gross motor development
Prone positioning during waking hours, even in small increments, may offset the risk of
developing PP, torticollis, and delayed gross motor development.6 Infants are often
unhappy in prone; however, early prone positioning, using a variety of positions in small
increments, may lead to an increased tolerance of “tummy-time.”
Pediatric health professionals are in an excellent position to inform and educate new
and expecting parents about the importance of prone positioning, “tummy-time.”
We hypothesize that early additional education to parents on the importance of prone
positioning will lead to an increase in prone positioning play during infant awake hours
and a subsequent decrease in plagiocephaly, torticollis, and developmental delay
diagnoses.
Participants/Methods
Prone
to
Play
The study cohort will consist of typically developing infants
who will be recruited at their 2 week post birth follow up
appointments with their pediatricians. Infants and their families
will be divided into three groups. Group 1 will receive prone to
play information at 3 weeks, group 2 will receive it at 3 months,
and group 3 will receive it at 6 months.
Tummy time is
more than just
laying flat on
the ground!
2 weeks
prone on chest
6 months
football carry
Make “tummy-time” fun and interactive
● Parents, family, or
siblings are the
most interesting to
infants
● Get in infant’s line
of sight
● Use bright,
interesting toys
● Emphasis is on
PLAY!
Parents will receive an educational video and an informational
handout regarding the importance of “tummy time.”
Participants’ gross motor development will be tracked using
the Alberta Infant Motor Scale (AIMS) at 3, 6, 9, and 12
months or until they reach independent walking. Our goal is to
provide parents with information that will make “tummy time”
enjoyable for the infant and parent.
The purpose of this project was to develop an informational
video to educate parents to on prone to play and on the use of
alternative prone positions for infants at 3 weeks, 3 months,
and 6 months of age. Preparatory steps for the study included
a literature search, survey development, and IRB preparation.
This research study will evaluate the gross motor skills and
time spent in prone to play of infants whose parents received
additional prone positioning information compared to parents
who received a standard packet of information from the
hospital and/or their pediatricians.
Outcome Measures
Clinical Relevance
The Alberta Infant Motor Scale (AIMS)
● The AIMS is a norm-referenced outcome measure used for infants 0-18 months or walking age.
The test takes about 20-30 minutes to complete.
● The AIMS will be administered at months 3, 6, 9, and walking age
Prone positioning helps infants to develop strength in the neck, back, and
shoulder muscles necessary for head control, independent sitting , and overall
gross motor development.3
Prone to play time and pleasure surveys
● Parents will also complete surveys at 3, 6, 9, months and walking age. Surveys will provide data on
the amount of time infants spend in prone to play at each age and how well the child tolerates the
prone position.
● Plagiocephaly is estimated to have
increased fivefold since 19924
● It is estimated that 1 out of every 60
infants
will
be
diagnosed
with
plagiocephaly4
Parents can make tummy time more of a priority and more enjoyable for their
infants when given early information and education. An improved balance
between back to sleep and prone to play will contribute to increased time spent in
prone and a decrease in infants who develop conditions such as developmental
delay, positional plagiocephaly, and torticollis.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #T73MC00022, Missouri LEND. This information
or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.
References:
1. Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther.
2013;25(4):348-394.
2. Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Valkama AM. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. Eur J Pediatr. 2015;174(9):1197-1208.
3. Kuo YL, Liao HF, Chen PC, Hsieh WS, Hwang AW. The influence of wakeful prone positioning on motor development during early life. Journal of Developmental and Behavioral Pediatrics. 2008;29:367–376.
4. McKinney CM, Cunningham ML, Holt VL, Leroux B, Starr JR. Characteristics of 2733 cases diagnosed with deformational plagiocephaly and changes in risk factors over time. Cleft Palate Craniofac J. 2008;45(2):208–216.
5. Biggs WS. Diagnosis and management of positional head deformity. Am Fam Physician. 2003;67:1953–1956.
6. Jones, M. W. (2004). Supine and prone infant positioning: A winning combination. Journal of Perinatal Education, 13, 10–20.