Integrating Tummy Time Into Routine NICU Care: Healthcare Workers’ Perspectives on Long‐Term Implementation in India
Amruta Chutke, Kripa Dholakia, Tanmay Bagade, Puja PadbidriABSTRACT
Background and Purpose
Prone positioning for play (‘Tummy Time’) is an evidence‐based recommendation that supports early sensory‐motor development during infancy. Infants who require neonatal intensive care face a heightened risk of motor developmental delays, underscoring the importance of early developmental care practices. Routine implementation of tummy time remains limited in many settings in India and is not included in national guidelines. Socio‐cultural factors further influence the adaptation of such a cost‐effective intervention in India. In response, a structured tummy time practice was introduced at discharge from the neonatal intensive care unit (NICU) of a tertiary‐care hospital in India in 2016. This study explored multidisciplinary NICU healthcare workers' perspectives on implementing tummy time, including its perceived feasibility, acceptability and long‐term integration into routine practice.
Methods
We conducted in‐depth semi‐structured interviews with 12 NICU staff members representing varied professional roles. Interviews followed a predefined schedule, they were audio‐recorded, transcribed verbatim, translated where needed and analysed thematically using MAXQDA software.
Results
We identified the following five themes: knowledge of practice: indications, benefits and precautions; attitudes towards tummy time; family beliefs, caregiver confidence and cultural influences; translating knowledge into practice (staff learning, family coaching and follow‐up) and solutions and strategies (engagement and awareness). The health workers reported being knowledgeable about tummy time and considered it easy to implement. Key barriers centred on parents' lack of confidence in handling their infants. Participants noted that frequent counselling and practical demonstrations can address these barriers. They also highlighted the need for greater awareness in the community and among medical professionals to support consistent practice.
Discussion
NICU staff viewed tummy time positively, considered it feasible to deliver as part of routine care and felt it had become integrated into routine clinical practice 5 years after its initial introduction. These findings support the integration of structured tummy time education and demonstration into standardized NICU discharge pathways in tertiary‐care hospitals in India, alongside strategies to strengthen caregiver confidence and broader awareness among healthcare providers and the community.