Educating Caregivers about Infant Positioning and Improving Infant Intolerance of Tummy Time

Abstract

Each year in the United States, approximately 3,500 infants die suddenly and unexpectedly (Centers for Disease Control, 2018). The number of infant deaths has declined sharply since the early 1990s when the American Academy of Pediatrics (AAP) recommended that caregivers place infants in the supine position (i.e., on their backs) for sleep. As a part of the recommendations to place infants on their backs for sleep, the AAP also recommended that infants be placed in prone (positioned on their stomachs) for play, known as "tummy time." Lack of tummy time has been associated with developmental delays and head deformation (e.g., Davis, Moon, Sachs, & Ottolini, 1998; Graham, Kreutzman, et al., 2005). Of caregivers who report awareness of these recommendations, a number of caregivers report barriers to implementing these recommendations, such as infant intolerance of the position (e.g., Dudek-Shriber & Zelazny, 2007; Koren, Reece, D'angelo, & Mederios, 2010; Zachry & Kitzmann, 2011). Additionally, although infant intolerance of tummy time is frequently reported in the literature and the AAP has recommended interventions to improve tummy time (e.g., provision of toys), very limited research has been conducted on the efficacy of these recommended interventions. To date, the study was the first to our knowledge to: (a) identify expectant parents' knowledge of the AAP positioning recommendations, (b) study the effectiveness of a video designed to educate caregivers of the AAP positioning recommendations for safe sleep and tummy time, and (c) evaluate the individual and combined effectiveness of toys and interaction on infants' negative vocalizations and head elevation during tummy time.