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The Influence of Wakeful Prone Positioning on Motor Development During the Early Life

Kuo, Yu-Ling MSc*; Liao, Hua-Fang MSc*†; Chen, Pau-Chung MD, PhD; Hsieh, Wu-Shiun MD§; Hwang, Ai-Wen MSc*

Journal of Developmental & Behavioral Pediatrics: October 2008 - Volume 29 - Issue 5 - p 367-376
doi: 10.1097/DBP.0b013e3181856d54
Original Article

Objective: The “Prone to Play” campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket.

Methods: Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months.

Results: The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes.

Conclusion: Wakeful prone positioning promotes prone-specific motor milestones in early infancy. “Prone to play for a certain amount of time in an interactive and supervised environment” might be advocated.

From the *School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine; †Department of Rehabilitation Medicine, National Taiwan University Hospital; ‡Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health; and §Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Received March 7, 2008; accepted June 14, 2008.

Address for reprints: Hua-Fang Liao, MSc, School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Floor 3, No. 17, Xuzhou Road, Taipei, Taiwan; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.