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Barbara Hodge, PT, Coordinator-Instructor Pediatric NDT

Q. Is there value of “tummy time” for children with neuromuscular issues?

 I do say for many children with neuromuscular issues the floor is not their friend.

 The value of tummy time for typical children is undisputed. Among other things it helps elongate and activate the abdominals, especially the obliques, it gets mobility of the rib cage/ ribs to spine. It lengthens hip flexors as they extend away from the floor and activates the gluts, develops the secondary curves of the spine, and the one we focus so much on, shoulder girdle alignment and stability, early formation of the hand arches for fine motor, with appropriate scapular depression and adduction.

The documentation of the benefit of tummy time on plagiocephaly and also torticollis is all there, not mention all the sensory systems that are vital for development.

However, when we put the children we treat in prone on the floor we need to ask ourselves which of the above is being promoted by putting them there.

Are they getting what we want, or are they in fact reinforcing the very impairments we are trying to minimize. If what we see, particularly with the hypertonic children, is increasing  adduction/internal rot of the humerus/ winging of the scapulae , the head in hyperextension, thoracic spine in flexion and the thoracic-lumbar junction in hyperextension, and adduction/internal rotation of the lower extremities, then compulsory tummy time , as in prone on the floor, is not a good plan.

 For those with hypotonia who melt into the floor, lifting the head from this position (prone) is hard. Having them in upright and pushing their hands into the surface is a place they can often get some activation and is therefore a better position to begin in.

We definitely need to work on all the same components that typical children do when on the floor, but we need to find alternatives, such as on the therapist’s lap, on the ball, held supported against the mother, and pushing away from that surface etc. The foundation of much of our handling techniques will be in places where we can help them get alignment and activation for developing function.

In general, I think that if a technique or position works it’s fine to  use, but what we need to emphasize is the observation and analysis skills to be able to ask: why are you doing this, are you getting what you want, and if not, how can you modify it to be productive?

I get many mothers who tell me that take the message that they have from therapists is that their child must be placed in prone on the floor as tummy time is vital. The components of tummy time are vital, but we would promote the thought that they often cannot be successfully achieved in prone on the floor, and may in fact be detrimental for their particular child.

We welcome your thoughts and experiences