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Characteristics of tummy time and dose-response relationships with development in infants

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Abstract

This study aimed to examine change in tummy time patterns and preferences in the first 6 months of life, as well as dose–response relationships between tummy time duration and development at 2, 4, and 6 months. Participants were parents of infants from the Early Movers project in Edmonton, Canada (baseline: n = 411). At 2, 4, and 6 months, infant tummy time duration and preference (i.e., 1 = really likes to 5 = really dislikes) and development (i.e., Ages & Stages Questionnaire (ASQ-3) communication, fine motor, gross motor, problem-solving, personal-social) were measured by a parental questionnaire. In a subsample (n = 127), tummy time patterns (i.e., bout frequency, mean and median bout length) were measured using a 3-day time-use diary. Tummy time bout frequency, bout length, and preference significantly increased over time. Linear dose–response relationships between tummy time duration and development outcomes were observed at 4 (gross motor) and 6 months (all development outcomes). Moreover, at 2 months, 30–44 min/day of tummy time was associated with a higher total development score (vs. < 15 min/day; B = 11.14; 95%CI: 1.60, 20.68). At 6 months, 61–120 min/day (vs. < 30 min/day; B = 27.12; 95%CI: 11.93, 42.32) and > 120 min/day (vs. < 30 min/day; B = 33.80; 95%CI: 18.90, 48.70) of tummy time were associated with higher total development scores. Differences in threshold doses between some developmental outcomes were observed.

 Conclusion: In the first 6 months of life, increases were observed in tummy time preference as well as tummy time bout frequent and length. This finding may explain why the optimal amount of tummy time needed for more advanced development appeared to increase with age.

What is Known:

• Tummy time is a type of physical activity in infancy. International and national guidelines recommend at least 30 minutes of tummy time per day for infants who are not yet mobile.

What is New:

• In the first six months of life, preference for tummy time as well as tummy time bout frequency and length increased.

• Tummy time duration had dose-response associations with several development outcomes, and the optimal amount of tummy time needed for more advanced development appeared to increase with age.

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Abbreviations

ASQ-3:

Ages and Stages Questionnaire

B:

Unstandardized beta coefficient

CI:

Confidence interval

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Acknowledgements

The authors are grateful for all the families that participated in the study. The authors would like to thank April English for her help with the project coordination and Jasmine Rai for her help with time-use diary data entry. Study data were collected and managed using REDCap [28] electronic data capture tools hosted and supported by the Women and Children’s Health Research Institute at the University of Alberta.

Funding

This research was funded by the Canadian Institutes of Health Research (CIHR), Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute, and the Faculty of Kinesiology, Sport, and Recreation at the University of Alberta. The sponsor had no role in the study design; collection, analysis, and interpretation of data; and in writing the manuscript. VC is supported by a CIHR New Investigator Salary Award and a Killam Accelerator Research Award.

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Authors and Affiliations

  1. Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada

    Zhiguang Zhang, Madison Predy & Valerie Carson

  2. Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia

    Kylie D Hesketh

  3. Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada

    Lesley Pritchard

Authors
  1. Zhiguang Zhang
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  2. Madison Predy
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  3. Kylie D Hesketh
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  4. Lesley Pritchard
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  5. Valerie Carson
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Contributions

ZZ analyzed the data, interpreted the results, and drafted the manuscript. MP helped with the recruitment and data collection. KH and LP made contributions to the conception and design of the study. VC conceived and designed the study, secured funding, and oversaw the study conduct, data analysis, and the interpretation of the results. All the authors critically revised the paper for important intellectual content. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Valerie Carson.

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Ethics approval was obtained from the University of Alberta Research Ethics Board.

Consent to participate

Written informed consent was obtained from all participating parents.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Zhang, Z., Predy, M., Hesketh, K.D. et al. Characteristics of tummy time and dose-response relationships with development in infants. Eur J Pediatr 182, 113–121 (2023). https://doi.org/10.1007/s00431-022-04647-w

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