Infant Development in Prone

Original Editor - User Name

Top Contributors - Stacy Schiurring and Jess Bell  

Introduction

Many families feel insecure and unsure about placing their infant in the prone position.  These feelings can stem from fear and confusion about the benefits of wakeful prone tummy time. It is important for rehabilitation professionals to understand the benefits and clinical reasoning behind supervised wakeful prone positioning on the physical, cognitive, and social development of typically-developing infants.

This article will overview the development in prone of typically-developing infants from birth to crawling.

Birth to Three Months

Phase indicator: when infants are placed prone they learn to lift their heads in a sustained manner.

Special Topic: Back-to-Sleep Campaign

While the developmental benefits of prone positioning is widely supported by research, prone positioning is not recommended during sleep.  

Sudden Infant Death Syndrome (SIDS) is defined as the “sudden death on an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.”  Research has shown a dramatic decrease in the incidence of SIDS worldwide with the introduction of the Back-to-Sleep campaign.

One of the hallmark recommendations of The American Academy of Pediatrics’s (AAP) Back-to-Sleep campaign recommends infants be placed in a supine position for every sleep by every caregiver until the child reaches 1 year of age to reduce the risk of sleep-related death.  To learn more abou the AAP’s other recommendations please read this article.

Phase	Head	Spine	Upper Extremities	Lower Extremities	Special Notes
Newborn	Head kept turned to one side The infant is able to lift the head briefly and turn it to one side to free the airway	Full flexion of the hips in prone lying is associated with a posterior tilt of the lumbar spine	The upper limbs are held close to the torso with the shoulders in adduction and the elbows in flexion	Hips and knees flexed	Newborn position is influenced by the limited in utero space in the final weeks before birth, which create the “physiological contractures of the newborn” The body weight is distributed across the head, chest, and lower limbs
One to two months	Able to lift head up and off the support surface for increasing periods of time	Increasing strength and endurance of cervical and thoracic extensor muscle activity to lift and hold up head	Ability to lift head and shoulders up off the support surface allows infant to push up and support self on hands These actions allow the infant to roll back onto their back	Engages in active vigorous kicking: alternating unilateral and bilateral hip/knee flexion and extension Hip and knee flexion is associated with hip abduction. Hip extension is associated with hip adduction Active kicking contributes to stretching out flexed newborn position	Infants begin to discover how to roll themselves onto their backs
Two to Three months	Improved ability to lift their head and extend their thoracic spine This improving strength is also associated with taking some weight through their hands	Extension of the cervical and thoracic spine is associated with increasing extension and adduction of their hips		Continues to increase hip and knee extension Developmental feature: hip extension with adduction contributes to the increasing range of movement of the hips This phase marks the beginning of uncoupling of combined hip and knee flexion, and ability to dissociate movements of the two joints

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