Purpose: The World Health Organization recommends tummy time for infants due to the benefits of improved motor development and reduced likelihood of plagiocephaly. As uptake of these recommendations are poor, the association of tummy time with other health outcomes requires further investigation. The aim of this study was to review existing evidence regarding the association of tummy time with a broad range of health outcomes.

Methods: Electronic databases were searched up to April 2019 (and an update will be conducted in January 2022). Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months); used an observational or experimental study design containing an objective or subjective measure of tummy time; and examined associations with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms). Two reviewers independently extracted data and assessed study quality.

Results: Sixteen articles representing 4237 participants from 8 countries were identified in 2019. Tummy time was positively associated with: gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication. Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present. Updated results, including studies identified in 2022, will be discussed.

Conclusions: These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines in young children.

Purpose: Despite many countries issuing 24-hour movement guidance for under 5s, no country to date has an appropriate national surveillance system to assess physical activity in infants and toddlers (0-3 years). Having valid and reliable methods to assess movement behaviours, and the time children spend therein, is therefore vital. Importantly, methods must also be feasible and acceptable to parents for them to be widely used. This study therefore explored possible questionnaire measures, and sought to understand parental preferences relating to measurement, of 24-hour movement behaviours in a sample of UK 0-18 month olds.

Methods: A UK-wide exploratory cross-sectional study was conducted in July 2020 and June 2021, with participants recruited via social media. Participants were eligible to participate if they were a UK resident, aged >18 years, and a parent or caregiver of a child aged 0-18 months old. Participants were asked to complete an online questionnaire, including questions about time spent in various activities, and preferences for activity monitor placement (i.e. hip, ankle, wrist or thigh). Prevalence and preference data were described and differences between age groups tested using independent measures ANOVA and chi-square tests.

Results: A total of 167 parents (child mean age: 9.6 months, 52.1% boys) provided data. On average, children spent 24.2 minutes/day in tummy time, 17 min/day in front of screens, 131.6 minutes/day restrained, and slept 13.1 hours/day. While no significant differences were found between age groups, trends of increasing tummy time, screen time and time spent restrained up to 8-11.9 months were seen; sleep decreased with age. For all age groups, most parents (65.5%) reported a preference for their child wearing an ankle monitor, and were least likely to let their child wear a thigh or hip monitor (70.1% and 57.5%, respectively).

Conclusions: This study highlights the potential of questionnaire-based measures to be used in surveillance to assess movement behaviours in under 2s. For device-based measures, parents have very clear preferences for monitor placement. This may in turn influence the likelihood of parents allowing their child to participate in studies, and should be considered by researchers.

Purpose: To examine: 1) longitudinal adherence to the Canadian 24-Hour Movement Guidelines in a sample of infants and 2) longitudinal associations between adherence to the guidelines and development.

Methods: Participants were 250 parent-infant dyads from the Early Movers project in Edmonton, Alberta. At 2, 4, and 6 months of age, physical activity, sedentary behaviour, sleep, and development were measured with a parental questionnaire that included items from the Ages & Stages Questionnaire (ASQ-3). Parents also reported the dates six major gross motor milestones were acquired during the first 18 months of life according to World Health Organization criteria. In a subsample (n=93), movement behaviours were also measured with a time-use diary at 2, 4, and 6 months and gross motor development was measured by a physiotherapist using the Alberta Infant Motor Scale (AIMS) at 6 months. Guideline adherence was defined as: 1) ≥30 minutes/day of tummy time, 2) no screen time, some reading time, no restrained bouts >1 hour (time-use diary only), and 3) 14-17 hours (2 months) or 12-16 hours (4 and 6 months) of sleep per 24-hour period. Generalized estimating equations were conducted as well as linear mixed models and linear regression models that adjusted for demographic characteristics.

Results: Few infants met the guidelines at all time-points (questionnaire: 2%; time-use diary: 0%). Infants that met a recommendation at 2 months, compared to those that did not, were 1.8-8.2 times more likely to meet that recommendation at subsequent time-points. Meeting more recommendations across time-points, according to both measures, was associated with a higher mean ASQ-3 gross motor score. Each additional time-point of tummy time recommendation adherence (questionnaire-measured) was associated with a 5-11-day earlier acquisition of independent sitting, crawling, and independent standing milestones. In the sub-sample, each additional time-point of guideline adherence was associated with a 16% higher AIMS score at 6 months.

Conclusions: Guideline adherence was low across the first 6 months of infancy. Overall, meeting more recommendations over this period appeared important for gross motor development. Parents and caregivers should be targeted as early as possible with guideline dissemination and activation strategies to promote healthy infant development.