Infant Positioning and Handling in Guatemala

          

Infant Positioning and Handling to Enhance Motor Development

 

                  

A UNC PT Outreach Project in Guatemala

Jaime Emel

 Introduction:

I am thrilled to fulfill my passion for early intervention physical therapy and enhance my cultural competence during the UNC PT Outreach trip to Guatemala! Initiated in 2010, UNC PT Outreach aims to meet the needs of underserved populations while increasing cultural competence among future PTs.¹ I will be part of a team including 13 students, 2 UNC faculty members, and 6 practicing physical therapists who will educate persons in Guatemala through health fairs and presentations. We will also work alongside Guatemalan therapists and students to treat children and adults with disabilities in the hospital, clinic, and school settings.

This project aims to educate new or expectant mothers about infant positioning and handling to enhance motor development and prevent deformity. To achieve this goal, I will present educational materials and demonstrate techniques at two health fairs organized as part of the Outreach trip. The community health fairs will take place in San Juan Alotenango at Enseñame a Pescar, and in Pastores at Clínicas Médicas San José.

Enseñame a Pescar (teach me how to fish) is a school for children with developmental disabilities founded in 2010 by Juan Cojolón Chavac. Through volunteer work, their aims are to provide an educational site for children with learning disabilities, autism, cerebral palsy, Down syndrome, and other developmental and cognitive delays, who otherwise would not have access to an education.² Clínicas Médicas San José, is a free healthcare clinic created in 2011 by the nonprofit organization “From Houses to Homes.” The clinic’s mission is to “help individuals achieve their highest levels of health through outpatient care, preventative care and health education, while respecting their cultural traditions;” since opening they have served more than 10,000 people from the Pastores community.³

Literature Review:

To develop accurate educational materials I completed extensive literature review and  developed two evidence tables. The first evidence table aimed to address the PICO question: “For babies, ages birth to six months, does participation in regularly scheduled prone positioning (“tummy time”) vs. unstructured positioning improve gross motor development?” Research indicates that prone positioning is important for the development of antigravity behaviors including head, neck and trunk control, upper extremity weight bearing, shifting and reaching.⁴ These skills prepare the infant for mobility through creeping, pull to stand and eventually ambulation. Infant mobility is crucial for environment exploration, object manipulation, and problem solving which lead to neurologic and sensory development.⁵ Children who achieve motor milestones late may risk long term motor and neurologic developmental delay.⁵ As a whole, the research demonstrates a positive correlation between prone positioning and gross motor development.^4-8 The results also support value and need for a parent education initiative targeting wakeful prone position participation.^5,8-9 I also completed a research paper that expands upon the evidence table information.

The second evidence table explores varied positioning and developmental activity “training” along with effects impacting gross motor development in rural Guatemala. Evidence indicates that varying infant positions frequently is important to prevent muscular imbalances, and parent-facilitated developmental activity results in improved motor abilities.^10,11 The average age of unsupported walking in Guatemala is 15 months; later milestone achievement is correlated with poor postnatal growth and malnutrition.¹²

Educational Materials:

I completed a health literacy assessment to ensure that my handouts are culturally sensitive and appropriate for use by the women of Guatemala. It was determined that many persons in Guatemala have a low literacy level, therefore materials are primarily composed of images with a few, short sentences.  With the help of my Capstone committee members and advisor, I created 3 handouts to supplement the verbal education at the health fair. The first handout (English/Spanish) discusses tummy time recommendations and provides examples of different prone activities. The second handout (English/Spanish) emphasizes a supine sleep position to reduce the risk of SIDS and describes swaddling practices for infant comfort. Finally, the third handout (English/Spanish) describes infant carrying strategies and the importance of varying positions.

        

I am not fluent in Spanish, therefore I created a script (English/Spanish) to guide the verbal education. This will allow me to provide the basic information and demonstrations without the assistance of a translator. However, a translator will be available at the health fair to assist as needed to answer questions and during unscripted conversation. I also collected toy and blanket donations and will provide these items to the patrons of my booth. This will allow the mothers to participate in swaddling recommendations and engage their baby during tummy time.

Evaluation:

To assess personal goal achievement and the success of my project, I created a peer evaluation form. This form will be completed by PT students, practicing PTs, and UNC faculty who are in attendance at the health fair(s). I will enlist the feedback of anyone who observes my interaction with persons at the health fair to rate the perceived level of effectiveness and appropriateness. Peer feedback rather than patron feedback was chosen due to the anticipated low literacy level of the population of interest, and to prevent inappropriate requests of the health fair patrons.

Special Thanks:

I would like to extend a HUGE thank you to everyone who made this project possible! Thank you to my Capstone advisor, Katie Ollendick for excellent guidance and support, and my committee members, Marian Stein and Andrea Hartzell for great feedback and suggestions. Additionally, muchas gracias to Chris Peña and Sadye Paez Errickson for translating my Capstone materials. Finally, I am very appreciative of the Scott family and the Pugliese family for their generous toy and blanket donations.  I couldn’t have done it without each and every one of you!

Please feel free to contact me directly with any questions or comments at emel@med.unc.edu or by utilizing the comments section below.

Visit http://uncptoutreach.blogspot.com/ to follow our experiences with UNC PT Outreach in Guatemala April 22-April 30, 2014!

 

References:

1. UNC Department of Allied Health Sciences: Physical Therapy. UNC PT Outreach 2012. http://www.med.unc.edu/ahs/physical/news/unc-pt-outreach-2012. Accessed April 16, 2014.

2. UNC Physical Therapy Outreach. Statement of Purpose. https://uncstudentorgs.collegiatelink.net/organization/uncptoutreach/DocumentLibrary/View/137839. Accessed April 16, 2014.

3. Clínicas Médicas San José. From Houses to Homes. http://www.fromhousestohomes.org/clinicasmedicas.html#!staff/c13dq. Accessed April 16, 2014.

4. Dudek-Shriber L, Zelazny S. The effects of prone positioning on the quality and acquisition of developmental milestones in four-month-old infants. Pediatr Phys Ther. 2007;19(1):48-55.

5. Lobo MA, Galloway JC. Enhanced handling and positioning in early infancy advances development throughout the first year. Child Dev. 2012;83(4):1290-1302.

6. Kuo YL, Liao HF, Chen PC, Hsieh WS, Hwang AW. The influence of wakeful prone positioning on motor development during the early life. J Dev Behav Pediatr. 2008;29(5):367-376.

7. Rocha NA, Tudella E. The influence of lying positions and postural control on hand-mouth and hand-hand behaviors in 0-4-month-old infants. Infant Behav Dev. 2008;31(1):107-114.

8. Jennings JT, Sarbaugh BG, Payne NS. Conveying the message about optimal infant positions. Phys Occup Ther Pediatr. 2005;25(3):3-18.

9. Zachry AH, Kitzmann KM. Caregiver awareness of prone play recommendations. Am J Occup Ther. 2011;65(1):101-105.

10. Lee HM, Galloway JC. Early intensive postural and movement training advances head control in very young infants. Phys Ther. 2012;92(7):935-947.

11. Vaivre-Douret L, Ennouri K, Jrad I, et al. Effect of positioning on the incidence of abnormalities of muscle tone in low-risk preterm infants. Eur J Paediatr Neurol. 2004;8(1):21-34.

12. Kuklina EV, Ramakrishnan U, Stein AD, et al. Growth and diet quality are associated with the attainment of walking in rural Guatemala. J Nutr. 2004;134(12):3296-300.