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

2020, The Author(s). 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\u27s 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\u27s 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 \u3c 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\u27s 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\u27s group setting were shown to be feasible and acceptable. A larger randomized controlled trial is warranted. Trial registration: ANZCTR, ACTRN12617001298303p. Registered 11 September 201

Tummy time, health and development in infants

Background: Tummy time is recommended by the World Health Organization (WHO) to improve infant motor development. These recommendations are based on proxy-questionnaires that rely on parent recall. As a result, the association and effectiveness of tummy time on infant health outcomes using objective realtime measurement techniques are unknown. A sequence of studies based on the behavioural epidemiology framework will contribute to strengthen the evidence regarding tummy time recommendations. Aims: To investigate 1) the prevalence of tummy time; 2) the association of tummy time with infant health outcomes; 3) the validation of accelerometers to objectively measure tummy time; 4) the correlates of tummy time; and 5) an intervention to promote tummy time. Methods: A thesis by compilation of six manuscripts. The six manuscripts include 1) an observational study to determine the prevalence of tummy time (Study 1); 2) two systematic reviews, with one investigating the association of tummy time with infant health outcomes (Study 2), and the second investigating the correlates of tummy time (Study 5); 3) two measurement validation studies, with one validating objective measures of tummy time (Study 3) and the second determining how to define wear and non-wear time of the GENEActiv accelerometer when worn by infants (Study 4); and 4) a pilot randomised controlled trial to assess the feasibility, acceptability and potential efficacy of a tummy time intervention (Study 6)

Correlates of tummy time in infants aged 0-12 months old: A systematic review

Background: Tummy time, defined as an infant being placed on their stomach whilst they are awake and supervised, has been shown to have a positive effect on infant development and head shape. Tummy time can be influenced by a number of factors. Using a social ecological model, categories of potential variables can be examined to determine their influence on behaviours such as tummy time. The purpose of this systematic review was to examine potential correlates of tummy time in infants from birth to 12 months old. Methods: Electronic databases were originally searched between March to December 2016. Included studies needed to be peer-reviewed, written in English, and meet a priori study criteria. The population was apparently healthy infants aged from birth to 12 months old. The article needed to contain an objective or subjective measure of tummy time as a dependent variable and examine the association between a demographic, psychological, behavioral, and/or environmental variable and tummy time. For this study, tummy time could include the ability of the infant to move whilst being positioned on their stomach, for example, the infant\u27s ability to roll from back to front, or lift their head when lying on their stomach (prone positioning ability), or the capacity, time spent, age started, or parent attitudes/behaviours regarding the infant being placed on their stomach. The outcomes were the relationships between potential correlates and tummy time. Risk of bias was assessed at the individual study level using the Cochrane risk of bias assessment for observational studies. Results: 15 articles representing 2372 unique participants from 7 countries were included. Correlates that were positively correlated with tummy time were age, prone sleeping, spending greater than 15 minutes whilst awake in tummy time when 2 months old, amount of time in the bath, order of achievement of prone extension and prone on elbow positions and parents/carers setting aside time for tummy time. Risk of bias of the included studies ranged from low to high. Conclusions: Specific demographic, environmental and behavioral variables were found to be positively and negatively associated with tummy time. This evidence could assist future research regarding interventions to promote tummy time, enhance motor development, increase infant physical activity and contribute to future tummy time recommendations for parents and health care providers

Objective measurement of tummy time in infants (0-6 months): A validation study

The 2017 Australian and Canadian 24-hour movement guidelines recommend infants receive 30 minutes of tummy time daily. Currently, there are no validated objective measurement tools or devices to assess tummy time. The purpose of this study was to: 1) test the practicality of using devices on infants as an objective measure of tummy time, and 2) test the accuracy of developed algorithms and cut-points for predicting prone posture. Thirty-two healthy infants aged 4 to 25 weeks completed a protocol of 12 positions. Infants were placed in each position for 3 minutes while wearing a MonBaby (chest), GENEActiv (right hip) and two ActiGraphs (right hip and ankle). Direct observation was the criterion measure. The accuracy of the algorithms or cut-points to predict prone on floor, non-prone and prone supported positions were analyzed. Parents also completed a practicality questionnaire. Algorithms and cut-points to classify posture using devices from MonBaby, GENEActiv and ActiGraph (hip and ankle) were 79%, 95%, 90% and 88% accurate at defining tummy time and 100%, 98%, 100% and 96% accurate at defining non-prone positions, respectively. GENEActiv had the smallest mean difference and limits of agreement (-8.4s, limits of agreement [LoA]: -78.2 to 61.3s) for the prone on floor positions and ActiGraph Hip had the smallest mean difference and LoA for the non-prone positions (-0.2s, LoA: -1.2 to 0.9s). The majority of parents agreed all devices were practical and feasible to use with MonBaby being the preferred device. The evaluated algorithms and cut-points for GENEActiv and ActiGraph (hip) are of acceptable accuracy to objectively measure tummy time (time spent prone on floor). Accurate measurement of infant positioning practices will be important in the observation of 24-hour movement guidelines in the early years

Cognitive screening in persons with an amputation: A retrospective medical record audit

Objective:To determine the rate of cognitive screening undertaken with patients undergoing amputation and to determine the demographics of the sample.Study design:Retrospective medical record audit.Methods:The medical records of a convenience sample of persons who had undergone amputation, upper and lower limb, from one local health district were reviewed. The sample date range was between January 1st, 2017, and December 31st, 2018. The incidence and type of cognitive screening were also recorded. Descriptive statistics were used to describe the results.Results:A total of 178 episodes of amputation care were identified during retrospective medical record auditing (mean age, 69.7 years). Thirty nine of the 178 (21.9%) episodes of care had a cognitive screening measure completed during that inpatient admission (24.2% vascular etiology and 12% nonvascular etiology). All cognitive screens were completed in persons with lower-limb amputations and were completed postoperatively.Conclusion:Cognitive screening is not a routine part of the health care journey for patients with an amputation in this health care district

Child care centre adherence to infant physical activity and screen time recommendations in Australia, Canada and the United States: An observational study

Objective: The aim of this study was to compare adherence to physical activity and sedentary behaviour recommendations within the 2011 Institute of Medicine Early Childhood Obesity Prevention Policies as well as screen time recommendations from the 2013 American Academy of Pediatrics for samples of infants in child care centres in Australia, Canada, and the United States (US). Methods: This cross-sectional study used data from: the Australian 2013 Standing Preschools (N = 9) and the 2014-2017 Early Start Baseline (N = 22) studies; the 2011 Canadian Healthy Living Habits in Pre-School Children study (N = 14); and the American 2008 (N = 31) and 2013-2017 (N = 31) Baby Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) trials. Data were compared on the above infant recommendations. Percentages were used to describe compliance to the recommendations and chi-square tests to determine whether compliance differed by country. Results: Child care centres were most compliant (74%-95%) with recommendations to: provide daily indoor opportunities for infants to move freely under adult supervision, daily tummy time for infants less than 6 months of age, indoor and outdoor recreation areas that encourage infants to be physically active, and discourage screen time. Centres were least compliant (38%-41%) with adhering to recommendations to: limit the use of equipment that restricts an infant\u27s movement and provide education about physical activity to families. Compared with Canadian and US centres, Australian centres were less compliant (46%) with the recommendation to engage with infants on the ground each day, to optimize adult-infant interactions and to limit the use of equipment that restricts the infant\u27s movement. Canadian centres were less compliant (39%) with the recommendation to provide training to staff and education to parents about children\u27s physical activity. US centres were less compliant (25%-41%) with the recommendations to provide daily opportunities for infants to explore their outdoor environment, limit the use of equipment that restricts the infant\u27s movement and provide education to families about children\u27s physical activity. Conclusions: Assisting child care centres on limiting the use of equipment that restricts an infant\u27s movement, and providing education about children\u27s physical activity to families may be important targets for future interventions