APTA Recommendations In Line with National Survey Findings
ALEXANDRIA, VA, August 6, 2008 — The American Physical Therapy
Association (APTA) is urging parents and caregivers to ensure that
babies get enough "tummy time" throughout the day while they are awake
and supervised, in light of a recent survey of therapists who say
they've noticed an increase in motor delays in infants who spend too
much time on their backs while awake.
In the national survey of 400 pediatric physical and occupational
therapists, conducted on behalf of Pathways Awareness, a non-profit
group dedicated to early detection of motor delays in children,
two-thirds of those surveyed say they've seen an increase in early motor
delays in infants over the past six years. The survey was conducted with
the assistance of APTA's Section on Pediatrics and the Neuro-Development
Treatment Association (NDTA).
Those physical therapists who saw an increase in motor delays said
that the lack of "tummy time," or the amount of time infants spend lying
on their stomachs while awake, is the number one contributor to the
escalation in cases.
APTA spokesperson Judy Towne Jennings, PT, MA, a physical therapist
and researcher from Fairfield, Ohio, said, "We have seen first-hand what
the lack of tummy time can mean for a baby: developmental, cognitive,
and organizational skills delays, eye-tracking problems, and behavioral
issues, to name just some complications." She added, "New parents are
told of the importance of babies sleeping on their backs to avoid SIDS,
but they are not always informed about the importance of tummy
time."
Jennings explains that because new parents now use car seats that
also serve as infant carriers - many of which fasten directly into
strollers and swings without having to remove the baby from the seat
— this generation of babies spends prolonged periods of time in
one position. She recommends that awake babies be placed in a variety of
positions, including on their tummies, as soon as they return home from
the hospital. "Ideally, babies should be placed on their tummies after
every nap, diaper change and feeding, starting with 1-2 minutes," she
said. Jennings is co-author of the research, "Conveying the Message
about Optimal Infant Positions," Physical and Occupational Therapy in
Pediatrics, Volume 25, Number 3, 2005.
In 1992, the American Academy of Pediatrics launched its successful
"Back to Sleep" campaign, which helped reduce the number of sudden
infant death syndrome (SIDS) cases by educating parents on the
importance of putting infants to sleep on their backs, rather than on
their stomachs. While putting infants to sleep on their backs is still
vitally important in reducing infant deaths, according to APTA, many
physical therapists believe that there should be more education to
parents on the importance of "tummy time" while babies are awake and
supervised.
APTA spokesperson Colleen Coulter-O'Berry, PT, MS, PCS, a physical
therapist at Children's Healthcare of Atlanta, said flattening of the
baby's skull is another side effect of too much time spent on the back.
"Since the early 1990s, we have seen a significant decrease in SIDS
cases, while simultaneously witnessing an alarming increase in skull
deformation," she said. Coulter-O'Berry cites a recent study published
in Cleft Palate-Craniofacial Journal 45(2): 208-16, in which it
was reported that several risk factors for misshapen heads were more
common among babies born after the "Back to Sleep" initiative. The
study, which took place at Children's Hospital and Regional Medical
Center in Seattle, Washington, found that prior to 1992, the prevalence
of misshapen heads among infants was reportedly 5 percent. In recent
years, craniofacial centers and primary care providers reported a
dramatic increase of up to 600 percent in referrals for misshapen
heads.
She also points out that the combination of babies sleeping on their
backs, as well as spending an inordinate amount of time in infant
carriers that double as car seats, puts pressure on the head which can
create a flattening of the skull. In extreme cases, babies are fitted
with a custom-molded band that gently guides the baby's head into a more
normal shape.
According to Coulter-O'Berry, parents can increase tummy time by
incorporating exercises into routine activities such as carrying,
diapering, feeding, and playing with baby. "Increasing the amount of
time your baby lies on his or her tummy promotes muscle development in
the neck and shoulders; helps prevent tight neck muscles and the
development of flat areas on the back of the baby's head; and helps
build the muscles baby needs to roll, sit and crawl," she said.
Coulter-O'Berry is co-author of Tummy Time Tools, an informative
brochure that provides caregivers ideas and activities to ensure that
babies get enough tummy time throughout the day. The brochure is now offered on the APTA Web site, www.moveforwardpt.com.
Karen Karmel-Ross, PT, PCS, LMT, pediatric clinical specialist at
University Hospitals Case Medical Center, Rainbow Babies and Children's
Hospital in Cleveland, Ohio and national lecturer on muscular
torticollis (neck muscle imbalance), says that one way to engage in
tummy time is to spend time during each diaper change encouraging the
infant to find, focus and follow the caregiver's face or a toy with
their eyes looking up, down, left and right. "It's important to get our
infants out of devices that constrain mobility and onto their tummies so
they can focus on neck muscle balance as they interact with their
caregivers," she said.
Physical therapists are highly-educated, licensed health care
professionals who can help patients reduce pain and improve or restore
mobility — in many cases without expensive surgery or the side
effects of prescription medications. APTA represents more than 70,000
physical therapists, physical therapist assistants, and students of
physical therapy nationwide. Its purpose is to improve the health and
quality of life of individuals through the advancement of physical
therapist practice. In most states, patients can make an appointment
directly with a physical therapist, without a physician referral. Learn
more about conditions physical therapists can treat and find a physical
therapist in your area at www.moveforwardpt.com.
Established in 1988, Pathways Awareness is a national, non-profit
organization dedicated to raising awareness about the benefits of
detecting early motor delays and encouraging physical therapy in very
young children. Pathways' critical infant milestones literature has been
recognized and endorsed by the American Academy of Pediatrics and the
National Association of Pediatric Nurse Practitioners as the definitive
resource concerning early motor delays. For more information, visit www.pathwaysawareness.org.