Degree Name

Doctor of Philosophy


Early Start


Background: Tummy time is recommended by the World Health Organization (WHO) to improve infant motor development. These recommendations are based on proxy-questionnaires that rely on parent recall. As a result, the association and effectiveness of tummy time on infant health outcomes using objective realtime measurement techniques are unknown. A sequence of studies based on the behavioural epidemiology framework will contribute to strengthen the evidence regarding tummy time recommendations. Aims: To investigate 1) the prevalence of tummy time; 2) the association of tummy time with infant health outcomes; 3) the validation of accelerometers to objectively measure tummy time; 4) the correlates of tummy time; and 5) an intervention to promote tummy time. Methods: A thesis by compilation of six manuscripts. The six manuscripts include 1) an observational study to determine the prevalence of tummy time (Study 1); 2) two systematic reviews, with one investigating the association of tummy time with infant health outcomes (Study 2), and the second investigating the correlates of tummy time (Study 5); 3) two measurement validation studies, with one validating objective measures of tummy time (Study 3) and the second determining how to define wear and non-wear time of the GENEActiv accelerometer when worn by infants (Study 4); and 4) a pilot randomised controlled trial to assess the feasibility, acceptability and potential efficacy of a tummy time intervention (Study 6).



Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.