Intolerance to Prone Positioning as a Clinical Marker of Motor Delay in Infants

Background and objectives: The literature over the past decade has shown associations between lack of prone positioning (tummy time) and motor delays. In our clinical practice, we observed that parents of infants with motor delays often reported their children were excessively fussy during tummy time. Our study was designed to explore the association between excessive fussiness in prone and the presence of motor delays. Methods: Data from 303 patients under age 3 presenting to the Early Intervention program at an academic medical center over a two year period were reviewed retrospectively. Historical information on length and tolerance of prone positioning in infancy and developmental diagnosis (Motor Delay, Language Delay, Global Developmental Delay, Autism Spectrum Disorder (ASD) and No Delay were included). Results: Both measures of intolerance to prone position (time in prone and fussiness in prone) showed significant linear associations with developmental diagnosis. Specifically, likelihood of never fussing (Х2 (1)=19.1, p<0.001) and of experiencing >five minutes of prone position daily (Х2 (1)=13.1, p<0.001) were significantly lower in subjects who had motor delays than in subjects with other delays and no delays. There was no significant difference in fussing and time in prone among children with other developmental diagnoses, including language delay, global developmental delay, autism spectrum disorder (ASD). Conclusion: There is an association between the degree of fussiness in infants when placed in prone and the presence of motor delays. Parent report of excessive fussiness may be a useful clinical tool for identifying increased risk of motor delay in infants.