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Another look at "tummy time" for primary plagiocephaly prevention and motor development
Elizabeth Williams1, Mary Galea2
1The University of Melbourne, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, VIC 3010, Australia.
Insights
Safe infant sleeping practices, while crucial for preventing sudden unexpected infant death (SUID), are linked to positional plagiocephaly. Early head control development, including "face time," may offer better primary prevention than solely relying on "tummy time."
Area of Science:
- Pediatrics
- Developmental Pediatrics
- Public Health
Background:
- The
- back to sleep
- safe sleeping
- initiative, recommended three decades ago, significantly reduced sudden unexpected infant death (SUID).
- Infant sleeping position is associated with, but not the cause of, positional plagiocephaly, a common condition characterized by a misshapen head.
- Children with a history of infant positional plagiocephaly may exhibit lower developmental scores, particularly in motor skills, potentially indicating developmental delay.
Purpose of the Study:
- To synthesize the history and impact of positional plagiocephaly.
- To review primary prevention strategies for positional plagiocephaly, focusing on facilitating motor development.
- To identify gaps in current advice regarding early infant head control development.
Main Methods:
- A scoping review of published literature on positional plagiocephaly prevention and infant motor development.
- Analysis of articles concerning primary prevention strategies versus treatment post-diagnosis.
- Examination of the role of
- tummy time
- and other interventions in head control development.
Main Results:
- Limited evidence supports the effectiveness of
- tummy time
- in preventing plagiocephaly, with some indication it promotes only prone-specific skills.
- Gaps exist in advice for facilitating early infant head control, particularly antigravity neck flexor strength and coordinated head/neck movement.
- Preschoolers with a history of plagiocephaly show persistent lower developmental scores, highlighting the long-term impact.
Conclusions:
- While
- tummy time
- aids infant development, its role in plagiocephaly prevention is not fully established.
- There is a need to revisit and potentially enhance strategies for early infant head control development.
- Incorporating
- face time
- alongside
- tummy time
- may represent a more comprehensive primary prevention approach for positional plagiocephaly.
Abstract:
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.
