Factors associated with gross motor development from birth to independent walking: A systematic review of longitudinal research

Assessing Infant Gross Motor Performance With an At-Home Wearable

BACKGROUND

Early development of gross motor skills is foundational for the upcoming neurocognitive performance. Here, we studied whether at-home wearable measurements performed by the parents could be used to quantify and track infants' developing motor abilities.

METHODS

Unsupervised at-home measurements of the infants' spontaneous activity were made repeatedly by the parents using a multisensor wearable suit (altogether 620 measurements from 134 infants at age 4-22 months). Machine learning-based algorithms were developed to detect the reaching of gross motor milestones (GMM), to measure times spent in key postures, and to track the overall motor development longitudinally. Parental questionnaires regarding GMMs were used for developing the algorithms, and the results were benchmarked with the interrater agreement levels established by World Health Organization (WHO). A total of 97 infants were used for the algorithm development and cross-validation, whereas an external validation was done using 37 infants from an independent recruitment in the same hospital.

RESULTS

The algorithms detected the reaching of GMMs very accurately (cross-validation: accuracy, 90.9%-95.5%; external validation, 92.4%-96.8%), which compares well with the human experts in the WHO reference study. The wearable-derived postural times showed strong correlation to parental assessments (ρ = .48-.81). Individual trajectories of motor maturation showed strong correlation to infants' age (ρ = .93).

CONCLUSIONS

These findings suggest that infants' gross motor skills can be quantified reliably and automatically from unsupervised at-home wearable recordings. Such methodology could be used in health care practice and in all developmental studies for gaining real-world quantitation and tracking of infants' motor abilities.

Severity of bronchopulmonary dysplasia and characteristics of neuro-motor development prior to acquisition of independent walking in very preterm and/or very low-birth-weight infants: A retrospective cohort study in a children's medical centre in Japan

OBJECTIVE

This study aimed to determine the effect of bronchopulmonary dysplasia (BPD) and its severity on neurological examination at equivalent to full term and the development of gross motor skills prior to the acquisition of independent walking in very preterm and/or very low-birth-weight (VLBW) infants.

METHODS

This study was a retrospective cohort study. Participants were very preterm and/or VLBW infants who were admitted to a neonatal intensive care unit at a children's hospital in Japan between 2017 and 2021. Clinical, demographic, and outcome variables were retrospectively extracted from medical records. The main outcome measures were the Hammersmith Neonatal Neurological Examination (HNNE) score, a neurological examination at the equivalent of full term, and the age at acquisition of each gross motor skill.

RESULTS

In total, 123 infants were included, of whom 62 did not have BPD, 23 had mild BPD, 25 had moderate BPD, and 13 had severe BPD. No significant differences were observed between groups in the neurological examination results for either the total or categorical HNNE scores. For gross motor skills, the results of hierarchical multiple regression analyses adjusted for confounding factors showed that severe BPD remained a factor that delayed the acquisition of most gross motor milestones, even after changing the models. The unstandardised coefficients (beta) restored to the exponent ranged from 1.16 to 1.32 for all models.

CONCLUSIONS

Clinicians involved in the follow-up of very preterm and/or VLBW infants should monitor and support the development of infants with severe BPD from the early postnatal period.

Two-Year Longitudinal Motor Performance of Very Preterm and/or Very-Low-Birth-Weight Infants in Suriname

Background/Objectives: Follow-up studies in very preterm infants are common, but fewer studies are situated in low- or middle-income countries. In a prospective cohort study, we explored longitudinal motor performance trajectories and influencing factors, including an early motor intervention program. Very preterm infants (gestational age < 32 weeks and/or very-low-birth-weight < 1500 g) in the middle-income country of Suriname were included. Methods: We assessed 149 (49.7% boys) infants (mean gestational age 29+6, mean birth weight 1271 g) at 3, 12, and 24 months with the Bayley Scales of Infant and Toddler Development for fine motor (FM), gross motor (GM), and composite scores (CSs). Influencing perinatal and environmental factors were explored. Delayed-scoring infants were referred to a motor intervention program. Data were analyzed using mixed-model linear regression. Results: The Bayley mean FM and GM scores decreased between 3 and 12 months and stabilized at 24 months. The mean CS at 3, 12, and 24 months was 102.3, 92.7, and 92.2, respectively. The latter two were significantly below the reference values (100, SD 15, p < 0.01). Birth weight z-scores significantly influenced FM (p = 0.013) and CS (p = 0.009); a lower birth weight was associated with initially lower scores and a smaller decline over time than a higher birth weight. The motor intervention program (n = 54) showed no significant interaction effects at all time points after correction for frequency of interventions (no; 1-5; >5 interventions). Conclusions: Motor performance was normal at 3 months and delayed at 12 and 24 months. Birth weight, but not the early intervention program, influenced longitudinal motor trajectories. We recommend follow-up of motor performance and suggest adding the Prechtl General Movement assessment at 3 months of age. The clinical implementation of the early motor invention program needs additional studies to reach an adequate training level.

Latent motor growth trajectories of term and preterm infants based on caregiver report

Early motor development is a key predictor of development in other skill domains and specific neurodevelopmental disorders, but it is typically measured as achievement of milestones rather than rate of development. To explore the value of the latter approach, this study utilized a novel caregiver report method to examine differences in the developmental trajectory of motor development in term-born compared to preterm-born infants. Caregiver-infant dyads (331 term, 240 preterm) were followed from birth through 12 months (48% female; 6.4% Hispanic; 34.1% Black; 10.3% Mixed or Biracial; and 48.3% White). Longitudinal Item Response Theory (IRT) modeling was used to compare growth trajectories of motor skills between term and preterm infants. The moderating effects of biological sex on group differences also were examined. The main effect for term status was significant. Preterm infants exhibited slower rates of growth in motor ability over the first 12 months compared with term infants. Differences in rate of growth were significant by 6 months of age. In the term group only, females exhibited more rapid growth than males in motor ability. Findings indicate that caregiver report yields reliable estimates of growth in the latent trait of motor ability, with slower rate of growth in infants born preterm. Estimates of latent growth in motor ability may provide more sensitive measures of neurodevelopmental risk and a method to examine response to treatment.

Instability of revised Korean Developmental Screening Test classification in first year of life

BACKGROUND

Early development is characterized by considerable variability.

PURPOSE

This study aimed to examine the stability of developmental classifications using the revised Korean Developmental Screening Test (K-DST) in healthy term infants aged 4-6 and 10-12 months.

METHODS

Data were obtained from the Korean Children's Environmental Health Study, a nationwide prospective birth cohort. Sixty-nine healthy term infants (26 boys, 43 girls) underwent serial K-DST assessments at 4-6 and 10-12 months of age, between August 2017 and December 2019.

RESULTS

At 4-5 months, over 50% of infants were categorized in the ≥-1 standard deviation (SD) group, with the lowest prevalence in the gross motor domain (52.7%). Seven infants (10.1%) scored below -2 SD in at least one domain, most commonly in gross and fine motor domains (7.3%). At 10-12 months, over 70% of infants scored in the ≥-1 SD group, except in the language domain. Six infants (9.5%) scored below -2 SD in at least one domain, (cognition 4.8%, language 3.2%, gross motor 3.2%). Serial follow-up showed significant improvement, with many infants moving to the ≥-1 SD group, particularly in the gross motor domain (33.3%). Of the seven infants scoring below -2 SD at 4-5 months, only two remained in this category at 10-12 months.

CONCLUSION

Infants scoring below -2 SD on the revised K-DST 4-5 months questionnaire, especially in the gross motor domain, should undergo close monitoring and repeated evaluations in the absence of neurological abnormalities or developmental red flags.

Sitting Acquisition and Early Communication Development: Are There Associations in Very Preterm Infants at Six Months of Corrected Age?

Background: Research in typically and some atypically developing populations showed associations between early motor and communication development, documenting how postural development can support communicative advancements. However, these relations have scarcely been investigated in the preterm population. Aims: The present study aimed to describe motor (gross and fine motor) and communication (receptive and expressive) skills of very preterm infants at six months of corrected age and their associations, focusing on sitting posture achievement and early vocal production. Methods: Seventy very preterm infants (≤32 weeks) with no major brain injuries were assessed with the BSID-III for gross and fine motor skills, receptive and expressive language skills, and cognitive skills and were categorized as mastering (sitters), partially mastering (emerging sitters), or not mastering (non sitters) unsupported sitting. The proportional duration of sitting postures (caregiver supported, arms supported, and unsupported) in an observative section was coded with the Interact software (version 20.8.3.0). Frequency per minute of vocal utterances (vocalizations, babbling, and total) during a parent-infant play interaction was coded with the CHILDES software v11. Results: Correlational analyses showed significant positive associations between motor composite score and language scores (composite and expressive scaled) and between gross motor and expressive language scaled scores but a negative association between arms supported sitting duration and vocal utterances. In addition, ANCOVAs showed that sitters had significantly higher BSID-III expressive language scaled scores and vocal utterances than non sitters and emerging sitters. Conclusions: These findings brought new evidence linking early motor and vocal development in very preterm infants, emphasizing the importance of using observational tools alongside standardized ones to identify developmental delays and plan tailored intervention programmes.

The Breastfeeding Experiences of Mother-Infant Dyads and the Effects of an FMR1 Mutation

This study examined the early breastfeeding experiences of mothers with an FMR1 premutation (FXPM) and their infants with and without fragile X syndrome (FXS) to identify early feeding needs and potential opportunities for intervention. Data collection occurred through a retrospective national survey that captured data on breastfeeding experiences and co-occurring conditions of mother and child. Participants were 246 mothers with an FXPM. Of their 384 infants, 287 had FXS and 97 were unaffected (i.e., they did not have FXS or an FXPM). Unaffected infants had a longer breastfeeding duration relative to infants with FXS, and infants of mothers who had postpartum depression (PPD). Additionally, infants who were reported to display aggressiveness towards others later in childhood had a shorter breastfeeding duration than those who did not go on to display aggression. Approximately 42% percent of mothers reported difficulties with breastfeeding infants with FXS compared to only 17% of unaffected infants. The most common reason for breastfeeding cessation for mothers of children with FXS was perceived difficulties in breastfeeding for the child (37%), whereas the most common reason for mothers of unaffected infants was a personal choice to stop (37%). This study provides preliminary evidence that infants with FXS show early phenotypes that make breastfeeding more difficult. Future research should investigate whether interventions for infants with FXS could improve breastfeeding outcomes.

Safe sleep practices for infants: Comprehensive analysis of YouTube videos

AIM

This study aimed to analyze the accuracy, quality, and reliability of the content of YouTube videos on safe sleep for infants in relation to the safe sleep recommendations from the American Academy of Pediatrics (AAP).

METHODS

The research was conducted by searching the video-sharing platform YouTube for the keywords "safe sleep." The videos were subjected to a review and evaluation process conducted by two independent reviewers. The modified DISCERN and Global Quality Scale (GQS) were employed to assess the quality and reliability of the videos. The content of the videos was evaluated using an eight-item checklist prepared by the researchers in accordance with the recommendations of the AAP. The Kruskal-Wallis-H, Mann-Whitney U, and Pearson correlation analyses were employed for the purpose of data analysis. All statistical data were deemed significant at the 0.05 level.

RESULTS

The 100 most relevant videos were viewed, and 85 videos that met the inclusion criteria were subjected to analysis. The mean values for the quality and reliability of the videos are 2.98 for the modified DISCERN score and 3.26 for the GQS. The mean value for the total checklist score was 4.78 out of 8. As indicated by the checklist developed in this study for the assessment of safe sleep video content, four of the eight items were present in over 80 % of the videos. The remaining four items were present in less than 42 % of the videos. A strong correlation was observed between the total score on the checklist and the modified DISCERN score (r = 0.915, p < 0.001) and the GQS (r = 0.918, p < 0.001).

CONCLUSION

The evidence presented in this study indicates that improvements are needed in the quality and reliability of content on safe sleep practices for infants on YouTube.

Perinatal and early life risk factors of adverse early childhood developmental outcomes: Protocol for systematic review using socioecological model

BACKGROUND

Adverse early childhood developmental outcomes impact later schooling and adulthood life courses. However, there needs to be more comprehensive evidence on the effect of various perinatal and early life risk exposures. Hence, we aimed to systematically identify the various perinatal and early childhood risk factors using a socioecological model to inform appropriate prevention strategies.

METHOD

The systematic review will adhere to the 2020 PRISMA guidelines. The protocol was registered in PROSPERO with a registration number of CRD42023447352. We will systematically search for articles on adverse early childhood developmental outcomes, which include physical, cognitive, language and communication and social-emotional development from main databases, such as EMBASE, Medline, Global Health, PsycINFO, CINAHL and Web of Science Core Collection, dating from 2000. We will use Population, Exposure, Comparator, Outcome and Study Design (PECOS) criteria to select eligible studies for our review: 1) Population includes children in early childhood age (i.e., up to eight years) undergoing developmental assessments. 2) Exposure: various perinatal and early life risk factors. 3) Comparators: Children with no or low levels of exposure to the risk factors. 4) Outcome: adverse early childhood developmental outcome. 5) Study design: all observational studies that report the prevalence or incidence of adverse early childhood developmental outcomes and associated risk factors published since 2000. There will be no restriction based on country of origin or geographical location except language (only published in English). Textual and narrative synthesis using the socioecological model will be used to synthesise the data.

Investigating the link between temperamental and motor development: a longitudinal study of infants aged 6-42 months

BACKGROUND

Since the 1920s, motor development has been a strong research theme, focusing on infants' acquisition of motor skills, such as turning over and crawling. In the 1980s, a dynamic systems approach began emphasizing children's own motivation, which helped explain individual differences in the emergence of motor skills. However, few studies have examined factors contributing to individual differences in early motor development. In response, we investigated directional associations between temperament and motor development in children aged 6 months to 3 years.

METHOD

The Japan Environment and Children's Study (JECS-A) recruited mothers between January 2011 and March 2014. 2,639 mothers were sent a questionnaire at 6 months, and responses were received from 1,657 of them, with full data for children aged 6 months, 2 years, and 3 years, including from three mothers of twins, were analyzed through structural equation modeling. Question items regarding fine and gross motor activities at each age were selected by pediatric neurologists specializing in developmental disorders. The Japanese version of the Little Developmental Coordination Disorder Questionnaire was administered at 42 months. Temperament was assessed through the parent-reported Behavior Questionnaire (short version) for infants, toddlers, and children. In all three measures, Surgency and Negative Affectivity were extracted, and Effortful Control, a major form of self-regulation, was found from toddlerhood onward, as in previous studies.

RESULTS

A path diagram reveals that at 6 months, Surgency and Orienting/Regulation interacted positively with the motor function (respectively, r = .57; r = 40, ps < .001). Up to about 3 years, Effortful Control plays a role in facilitating the motor function, resulting in positive effects on Control During Movement (CDM), General Coordination (GC), and Fine Motor Movement (FMM) (β = 14; β = 30; β = 37, ps < .001). Surgency had a positive effect on CDM and GC (β = 18; β = 06, ps < .001), whereas Negative Affect had a negative influence on FMM and GC (β = -.08; β = -.08, ps < .001).

CONCLUSION

While Surgency may be a key reactive factor in early motor development, Effortful Control and Movement develop in an interactive manner.

TRIAL REGISTRATION

UMIN000030786. Scientific Title: The Japan Environment and Children's Study. Date of disclosure of the study: 2018/01/15. Only questionnaires were administered in the study.

Application of the Hammersmith Infant Neurological Examination in the developmental follow-up of high-risk infants

AIM

To investigate the independent influences affecting the global score of the Hammersmith Infant Neurological Examination (HINE) in the early life of high-risk infants and to provide evidence for early effective screening and for evaluating interventions.

METHOD

We conducted a prospective cohort study of 258 high-risk infants assessed by the HINE and Gesell Developmental Diagnosis Schedule at 3, 6, 9, and 12 months corrected age. A multiple linear regression model was developed to investigate independent influences on HINE global score at 3 months corrected age. The accuracy of the HINE global score was analysed by calculating the discriminant, concurrent, and predictive validities according to ages.

RESULTS

There were nine independent influences affecting the HINE global score at 3 months corrected age in high-risk infants. The discriminant, concurrent, and predictive validities of the HINE for gross motor developmental delays at 12 months corrected age were all statistically significant (p < 0.05).

INTERPRETATION

Different neonatal clinical settings are related to the HINE global score of high-risk infants early in life. The HINE can be used for longitudinal monitoring of neurological development in the first year of life in a typical Chinese clinical setting and the findings at all four ages tested relate to neuromotor outcomes at 12 months corrected age.

Hammersmith

目的

探讨影响高危儿生命早期Hammersmith婴儿神经学检查(HINE)总分的独立影响因素，并为早期有效筛查和评估干预疗效提供证据。

方法

我们对258名高危儿进行了前瞻性队列研究，分别在矫正3、6、9 和12月龄时接受了 HINE和Gesell发育诊断表的评估。一个多元线性回归模型被建立以探究矫正3月龄时HINE总分的独立影响因素。通过计算不同年龄段的区分效度、同时效度和预测效度，分析HINE 总分的准确性。

结果

高危儿HINE总分在矫正3月龄时有9个独立影响因素。在矫正2月龄时，HINE总分对粗大运动发育迟缓的区分效度、同时效度和预测效度均有统计学意义(P < 0.05)。

结果

不同的新生儿临床状况与其生命早期HINE总分有关。在典型的中国临床环境中，HINE可用于纵向监测高危儿出生后第一年的神经系统发育情况，而且四个年龄段的筛查结果都与矫正12月龄时的神经运动发育结果有关。

Prevalence and socio-economic determinants of growth and developmental delays among Iranian children aged under five years: A cross sectional study

BACKGROUND

The main cause of growth and development delays remains unknown, but it can occur as an interaction between genetic, environmental, and socio-economic factors.

OBJECTIVE

The aim of the study was to investigate the prevalence and social determinants of growth and developmental delays among children aged under five years in Qazvin, Iran.

METHODS

A cross-sectional study was conducted between January 2019 to December 2020 with participation of 1800 mothers with children aged 4-60 months who were referred to comprehensive health centers in Qazvin city, Iran. Structural and intermediate social determinants of health were assessed including: parents and children socio-demographic characteristics, families' living and economic status, parents' behavioral factors, household food security, mother's general health, and perceived social support. Children's growth was assessed based on their anthropometric assessment and their development was assessed using their age-specific Ages and Stages Questionnaire. Data were analyzed using univariable and multivariable logistic regression models using SPSS software version 24 and Stata version 14.

RESULTS

The prevalence of developmental problems in each domain were 4.28% for personal and social delay, 5.72% for gross motor delay, 6.5% for communication delay, 6.72% for fine motor delay, and 8% for problem-solving delay. The prevalence of weight growth delays was 13.56% and height growth delays was 4.66%. Communication, gross motor, and problem-solving delays were higher among children whose fathers' smoked cigarettes. Fine motor delays were lower among mothers with education status of high school diploma and university degree vs. the under diploma group. Personal and social delay was significantly higher among families with fair economic status and lower among children when their fathers were employed (vs. unemployed). Weight and height growth delays were higher among mothers who had experienced pregnancy complications and household food insecure families, respectively.

CONCLUSION

There are different predictors of growth and developmental delay problems among Iranian children aged under five years including fathers' smoking, families' economic status, and household food insecurity as well as history of mothers' pregnancy complications. The present study's findings can be used to screen for at-risk of growth and developmental delays among children and could help in designing and implementation of timely interventions.

A Review of Developmental Scales in Pediatric Practice: Recent Guidelines

Imitation, fine motor abilities, eye-to-hand coordination, perception, gross motor abilities, mental abilities, and verbal cognitive abilities are assessed on the developmental scale. The behavioral scale also assesses social interaction, emotional expression, activity, curiosity, sensory reactivity, and language. The current developmental scales in pediatrics are discussed in this paper. These scales have evolved. International scales for Indian children are difficult to administer due to cultural differences in self-care and gender roles. If parental awareness and demand are raised, postnatal growth interventions for psychosocial development will benefit infants in developing nations. Routine screening involves identifying an appropriate opportunity, acquisition, tool selection, administration, interpreting data, scoring, counseling, and training.

Pre-Pregnancy Obesity and Infants' Motor Development within the First Twelve Months of Life: Who Is Expected to Be the Ultimate Carrier of the Obesity Burden?

INTRODUCTION

Pre-pregnancy obesity is a significant public health concern with profound implications for maternal and child health. The burgeoning evidence suggests that maternal obesity prior to conception is intricately linked with an increased risk of gestational complications, as well as with adverse neonatal outcomes. Furthermore, the long and short-term health of offspring, including the risk of early motor development impairment, obesity, and metabolic syndrome in childhood and adulthood, may be adversely affected as well. Addressing pre-pregnancy obesity is critical for improving overall maternal and child health outcomes, and therefore, the aim of this study was to evaluate the connections linking pre-pregnancy obesity with infants' motor development within the first twelve months of infants' lives.

MATERIAL AND METHODS

This study included 200 mother-infant pairs divided into two groups based on their pre-pregnancy body mass index values. To assess infants' early motor development, we used the Alberta Infant Motor Scale (AIMS) and evaluated the parameters of infants' early motor development at the ages of three, six, nine, and twelve months.

RESULTS

Pre-pregnancy overweight/obesity was significantly associated with excessive gestational weight gain (p < 0.001), fetal macrosomia (p = 0.022), and a family history of diabetes and cardiovascular diseases (p = 0.048 and p = 0.041, respectively), as well as with all observed parameters of early motor development at the ages of three, six, nine, and twelve months: AIMS 3 months total (p < 0.001), AIMS 6 months total (p < 0.001), AIMS 9 months total (p < 0.001), and AIMS 12 months total (p < 0.001). Furthermore, pre-pregnancy overweight/obesity was a significant predictor for AIMS 6 months total (p = 0.043) and AIMS 6 months supination (p = 0.017).

CONCLUSIONS

Pre-pregnancy obesity is a critical determinant of pregnancy outcomes and offspring early motor development, with possible far-reaching implications for children's long-term well-being. Addressing this issue requires a comprehensive approach that includes preconception weight management, targeted interventions during the pregnancy and postpartum periods, and ongoing research to better understand the underlying mechanisms and develop effective strategies for prevention and management.

Early child development and its determinants: Findings from a large cohort of healthy children growing up in a low-risk environment

BACKGROUND

Despite numerous studies on early child development, there is still much to be discovered about the significance of possible risk factors. This study examines cognitive, motor, and language development of healthy children growing up in a low-risk environment and how various individual and environmental factors are associated with it. The study also considers whether the importance of particular parameters changes depending on child age.

METHODS

Within the framework of the LIFE Child study in Leipzig, Germany, 481 children participated in a total of 832 visits between 1 and 36 months of age. Developmental status was assessed using the Third Edition of the Bayley Scales of Infant and Toddler Development. Linear regression analyses were applied to examine the associations between child development and sex, gestational age, birth weight, birth mode, overweight, height, and parental education.

RESULTS

Mean Bayley composite scores for cognitive, language, and motor development were close to the standard value of 100. Poorer developmental outcomes were significantly associated with lower gestational age, vacuum cup/forceps birth, being overweight, small height, and lower parental education, although some of the associations became insignificant after applying multivariate models. While the association between gestational age and language development became weaker with advancing age, our interaction models found disparities related to parental education to become more apparent in older children across all three domains of early child development.

CONCLUSIONS

Several factors were identified to be associated with early child development. As children grow older, obstetric parameters, for example, gestational age, might become less relevant compared with sociodemographic factors, for example, parental education.

Developmental factors influencing bone strength in precocial mammals: An infant pig model

Most vertebrates are precocial in locomotion, able to walk and run soon after birth. Precociality requires a bony skeleton of sufficient strength to resist mechanical loading during early locomotor efforts. The aim of this study was to use an animal model-the preterm infant pig-to investigate some of the proximate factors that might determine variation in bone strength in precocial animals. Based on the prior literature, we tested the null predictions that skeletal integrity would be significantly compromised by truncated gestation (i.e., preterm birth) and reduced body mass at birth. We generated a suite of both morphometric measures (tissue mineral density and cross-sectional geometry) and performance-related metrics (ability to resist loading, deformation, and fracture during three-point bending tests) of the appendicular skeleton of preterm and full-term infant pigs. Results showed that very few measures in our ontogenetic infant pig sample significantly varied with either gestation length or birth mass. Overall, our results contribute to a growing body of literature demonstrating the early functional capacity of the precocial infant musculoskeletal system and suggest that bone strength in perinatal precocial mammals may be robust to the factors shown to compromise skeletal integrity in more altricial taxa.

Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review

This systematic review investigated the possible effects of exposing infants to formal activities in aquatic environments. A literature search of eight databases was concluded on 12 December 2022. Studies were eligible if they: (i) focused on 0-36 months of age infants, (ii) addressed the exposure of infants to formal aquatic activities, and (iii) compared the 'same condition of aquatic exposure with the control' or 'before and after exposure'. The PRISMA protocol was used. Articles considered for inclusion (n = 18) were clustered in the health, development, and physiological outcome domains. The results show that research is focused on indoor activities, mainly in baby swimming programs and baby aquatic therapy interventions. Swimming and aquatic therapy practices are generally safe for babies' health, and there are benefits to preterm and newborns exposed to aquatic therapy once the physiological parameters are maintained in normal and safe patterns. A positive effect is also suggested in general gross and fine motor skills, visual motion perception, cognitive flexibility, and response selection accuracy for infants who participated in aquatic programs. Further investigation with high-quality experimental designs is required to establish the effect of exposure of infants to formal aquatic activities (Systematic Review Registration: CRD42021248054).

Maternal Vitamin B12 Status during Pregnancy and Early Infant Neurodevelopment: The ECLIPSES Study

In this prospective cohort study of 434 mother-infant pairs from the ECLIPSES study, we examine the association between maternal vitamin B12 status at the beginning and end of pregnancy and the neurodevelopmental outcomes of infants 40 days after birth in a pregnant population from a Mediterranean region of northern Spain. Maternal vitamin B12 concentrations were determined in the first and third trimesters, and sociodemographic, nutritional, and psychological data were collected. At 40 days postpartum, the Bayley Scales of Infant Development-III (BSID-III, cognitive, language, and motor skills) were administered to the infants and several obstetrical data were recorded. In the multivariable models, medium maternal first-trimester vitamin B12 levels (312 to 408 pg/mL, tertile 2) were associated with better neonatal performance in the motor, gross motor, language, and cognitive skills with respect to tertile 1 (<312 pg/mL). The probability of obtaining a neonatal motor, gross motor, and receptive language score >75th percentile was significantly higher also in the tertile 2 group. In summary, good maternal vitamin B12 status in the early stage of pregnancy appears to be associated with better infant motor, language, and cognitive performance at 40 days postpartum.

Modeling gross motor developmental curves of extremely and very preterm infants using the AIMS home-video method

BACKGROUND

Motor development is one of the first signals to identify whether an infant is developing well. For very preterm (VPT) infants without severe perinatal complications, little is known about their motor developmental curves.

AIMS

Explore gross motor developmental curves from 3 until 18 months corrected age (CA) of VPT infants, and related factors. Explore whether separate profiles can be distinguished and compare these to profiles of Dutch term-born infants.

STUDY DESIGN

Prospective cohort study with parents repeatedly recording their infant, using the Alberta Infant Motor Scale (AIMS) home-video method, from 3 to 18 months CA.

SUBJECTS

Forty-two Dutch infants born ≤32.0 weeks gestational age and/or with a birthweight (BW) of <1500 g without severe perinatal complications.

OUTCOME MEASURES

Gross motor development measured with the AIMS.

RESULTS

In total 208 assessments were analyzed, with 27 infants ≥five assessments, 12 with <four, and three with one assessment. Sigmoid-shaped gross motor curves show unidirectional growth and variability. No infant or parental factors significantly influenced motor development, although a trend was seen for the model where lower BW, five-minute Apgar score <7, and Dutch native-speaking parents were associated with slower motor development. Three motor developmental profiles of VPT infants were identified, early developers, gradual developers, and late bloomers, which until 12 months CA are comparable in shape and speed to profiles of Dutch term-born infants.

CONCLUSIONS

VPT infants show great intra- and interindividual variability in gross motor development, with three motor profiles being distinguished. From 12 months CA onwards, VPT infants appear to develop at a slower pace. With some caution, classifying infants into motor developmental profiles may assist clinical decision-making.

Vitamin D supplementation and gross motor development: A 3-year follow-up of a randomized trial

BACKGROUND

Vitamin D status during pregnancy, early childhood and season-at-birth are implicated in gross motor development (GMD).

AIM

To test whether vitamin D intake in infancy and season-at-birth affect GMD in early childhood.

STUDY DESIGN

3-year follow up study of a single-center trial.

SUBJECTS

Healthy infants (n = 116) were allocated to 400 (standard-of-care), 800 or 1200 IU/day of vitamin D3 supplementation from 1 to 12 months; n = 70 returned for follow-up at 3-years.

OUTCOME MEASURES

The main outcome was GMD using the Peabody Developmental Motor Scales-2 which includes gross motor quotient (GMQ) and stationary, locomotion and object manipulation subtests.

RESULTS

GMQ scores were normal (≥85) in 94 %. An interaction between dosage group and season-at-birth (p = 0.01) was observed for GMQ and stationary standardized score; among winter/spring born children, the 1200 IU/d scored higher vs. 400 and 800 IU/d groups. Object manipulation standardized score was higher (p = 0.04) in children in the 1200 vs. 400 IU/d group, without interaction with season-at-birth.

CONCLUSIONS

GMD in young children who received 400 IU/d of supplemental vitamin D in infancy is not influenced by season-at-birth. This dose of vitamin D of 400 IU/d as recommended in North America adequately supports GMD. The modest enhancement in GMD with 1200 IU/d in winter/spring born children requires further study.

Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review

Background

Though recommended by numerous guidelines, adherence to supine sleep position during the first year of life is variable across the globe.

Methods

This systematic review of randomized trials and observational studies assessed the effect of the supine compared to non-supine (prone or side) sleep position on healthy newborns. Key outcomes were neonatal mortality, sudden infant death syndrome (SIDS), sudden unexpected death in infancy (SUDI), acute life-threatening event (ALTE), neurodevelopment, and positional plagiocephaly. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021). Two authors separately evaluated the risk of bias, extracted data, and synthesised effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.

Results

We included 54 studies (43 observational studies and 11 intervention trials) involving 474 672 participants. A single study meeting the inclusion criteria suggested that the supine sleep position might reduce the risk of SUDI (0-1 year; OR = 0.39, 95% confidence interval (CI) = 0.23-0.65; 384 infants), compared to non-supine position. Supine sleep position might reduce the risk of SIDS (0-1 year; OR = 0.51, 95% CI = 0.42-0.61; 26 studies, 59332 infants) and unexplained SIDS/severe ALTE (neonatal period; OR = 0.16, 95% CI = 0.03-0.82; 1 study, 119 newborns), but the evidence was very uncertain. Supine sleep position probably increased the odds of being 0.5 standard deviation (SD) below mean on Gross Motor Scale at 6 months (OR = 1.67, 95% CI = 1.22-2.27; 1 study, 2097 participants), but might have little to no effect at 18 months of age (OR = 1.16, 95% CI = 0.96, 1.43; 1 study, 1919 participants). An increase in positional plagiocephaly at 2-7 months of age with supine sleep position is possible (OR = 2.77, 95% CI = 2.06-3.72; 6 studies, 1774 participants).

Conclusions

Low- to very low-certainty evidence suggests that supine sleep position may reduce the risk of SUDI (0-1 year) and SIDS (0-1 year). Limited evidence suggests that supine sleeping probably delays short-term ‘gross motor’ development at 6 months, but the effect on long-term neurodevelopment at 18 months may be negligible.

Achievement of Developmental Milestones Recorded in Real Time: A Mobile App-Based Study

OBJECTIVE

To clarify the characteristics of milestone achievement of Japanese infants using data assessed and recorded in real time via a Web-based app by caregivers.

STUDY DESIGN

Between 2014 and 2019, the achievement of developmental milestones of 16 627 Japanese infants were recorded via the mobile app Papatto Ikuji along with pertinent information including sex, birth date, anthropometric measurements, and information on feeding. The milestones consisted of 20 items belonging to 4 domains: personal-social, fine motor-adaptative, language, and gross motor. The distribution of age at milestone achievement was compared with 4 conventional normative data. Subgroup analyses according to sex, season of birth, and feeding methods were performed with restricted mean survival time analysis.

RESULTS

Age distributions of milestone achievement were generally similar in the app-based and conventional data. The exception was "Smile responsively," for which the age at achievement seemed higher in the app-based data. Subgroup analyses showed female-dominant sex differences in the achievement of person-social and language milestones. The results also showed seasonality in achievement of gross motor milestones, with earlier achievement in infants born in winter compared with those born in summer.

CONCLUSIONS

We describe mobile app-based data on developmental milestone achievements that were recorded in real time. The app-based data were generally comparable with conventional normative data, suggesting that its potential to assess the development of children in real time. This could be used complementarily with the current well-child visits at scheduled time points.

Intra-Individual Variability in Gross Motor Development in Healthy Full-Term Infants Aged 0-13 Months and Associated Factors during Child Rearing

The gross motor development of a typically developing infant is a dynamic process, the intra-individual variability of which can be investigated through longitudinal assessments. Changes in gross motor development vary, according to the interaction of multiple sub-systems within the child, environment, task setting, and experience or practice of movement. At present, studies on environmental factors that influence gross motor development in full-term infants over time are limited. The main aim of this study was to investigate environmental factors affecting intra-individual variability from birth to 13 months. The gross motor development of 41 full-term infants was longitudinally assessed every month from the age of 15 days using the Alberta Infant Motor Scale. Parents were interviewed monthly about environmental factors during childcare. Infants showed fluctuations in the percentile of gross motor development, and no systematic pattern was detected. The total mean range of gross motor percentile was 65.95 (SD = 15.74; SEM = 2.28). The percentiles of gross motor skills over the 14 assessments ranged from 36 to 93 percentile points. Factors that were significantly associated with the gross motor development percentile were the use of a baby walker (Coef. = -8.83, p ≤ 0.0001) and a baby hammock (Coef. = 7.33, p = 0.04). The use of baby hammocks could increase the gross motor percentile by 7.33 points. Although the usage of a baby walker is common practice in childcare, it may cause a decrease in the gross motor percentile by 8.83 points according to this study. In conclusion, healthy full-term infants exhibited a natural variability in gross motor development. Placing infants in a baby walker during the first year of age should be approached with caution due to the risk of delayed gross motor development.

Families' Perceptions of the Motor Development and Quality of Life of Their Children Aged 0-3 Years during Home Confinement Due to the COVID-19 Pandemic. A Descriptive Study

The child's interaction with the natural environment allows different learning opportunities and favors their motor development, which may be affected after a period of environmental deprivation, a consequence of home confinement due to the COVID-19 pandemic. The main objective of the study was to analyze the different areas of motor development, as well as the quality of life of children aged 0 to 3 years old after home confinement by COVID-19 and the possible correlation between both variables, and the influence of parental stimulation on motor development during this time of exclusive interaction with the immediate environment (home and family). A descriptive study was performed. A simple and anonymous questionnaire was created for parents of children between 0 and 3 years old who lived in Spain during the period of home confinement due to COVID-19 (March to June 2020). The measurement instrument used was a questionnaire made in "Google Forms", where the variables were collected: Motor development (measured through the Ages & Stages Questionnaire, ASQ3), Quality of life (assessed with the Pediatric Quality of Life Inventory, PedsQL) and other variables, such as stimulation, performed during home confinement. Eighty-eight questionnaires were validated. The highest score in the motor development domains were obtained in children 2-3 years old. The motor domain of children aged 2-3 years old that obtained the highest score was communication (M = 54.69 ± 10.03) and the highest score in the quality of life was obtained in children aged 0-1 years old (M = 85.47 ± 12.39), also acquiring the lowest score in the emotional domain in all age groups (0-1, 1-2 and 2-3 years old). The assessment of motor development and quality of life after home confinement due to the COVID-19 pandemic did not determine low values, so it would not have been affected during this period of lack of interaction with the natural environment. Emphasizing that the emotional aspect within quality of life was the lowest score, this indicates that children from 0 to 3 years old need more emotional support in situations of variability of daily routines and of family stress.

Association Between Age of Achieving Gross Motor Development Milestones During Infancy and Body Fat Percentage at 6 to 7 Years of Age

OBJECTIVES

The later achievement of gross motor milestones during infancy is associated with adiposity in early childhood. However, the associations between gross motor development and adiposity after entering primary school are unclear. This study examined the associations between the ages at which six gross motor milestones were achieved and adiposity during early school years.

METHODS

This retrospective study was conducted in 2012 and 2013. Data were collected from 225 first-grade primary school children (mean age, 6.9 years; 39% girls). Adiposity was assessed using dual-energy X-ray absorptiometry and expressed as body fat percentage. Data describing the ages of achieving six gross motor milestones (holding head up, sitting, crawling, standing supported, walking supported, and independent walking) were obtained from the Maternal and Child Health Handbooks.

RESULTS

Mean body fat percentage was 21.7%. Multiple linear regression analyses revealed that later ages of achieving crawling (p < .001 [95% confidence interval: 0.33-1.16]), standing supported (p < .001 [95% confidence interval: 0.64-1.65]), and walking supported [p = .013 (95% confidence interval: 0.13-1.07)] were associated with increased fat. However, the ages of achieving holding head up (p = .053), sitting (p = .175), and independent walking (p = .736) were not statistically significant.

CONCLUSIONS

Achieving crawling, standing supported, and walking supported later predict increased body fat when aged 6-7 years. The practice of observing gross motor milestone achievements may allow early targeted interventions to optimize body composition before beginning school and thereby, potentially prevent childhood obesity.

Factors associated with gross motor development from birth to independent walking: A systematic review of longitudinal research

AIM

The aim of this study is to gain more insight into child and environmental factors that influence gross motor development (GMD) of healthy infants from birth until reaching the milestone of independent walking, based on longitudinal research.

BACKGROUND

A systematic search was conducted using Scopus, PsycINFO, MEDLINE and CINAHL to identify studies from inception to February 2020. Studies that investigated the association between child or environmental factors and infant GMD using longitudinal measurements of infant GMD were eligible. Two independent reviewers extracted key information and assessed risk of bias of the selected studies, using the Quality in Prognostic Studies tool (QUIPS). Strength of evidence (strong, moderate, limited, conflicting and no evidence) for the factors identified was described according to a previously established classification.

RESULTS

In 36 studies, six children and 11 environmental factors were identified. Five studies were categorized as having low risk of bias. Strong evidence was found for the association between birthweight and GMD in healthy full-term and preterm infants. Moderate evidence was found for associations between gestational age and GMD, and sleeping position and GMD. There was conflicting evidence for associations between twinning and GMD, and breastfeeding and GMD. No evidence was found for an association between maternal postpartum depression and GMD. Evidence for the association of other factors with GMD was classified as 'limited' because each of these factors was examined in only one longitudinal study.

CONCLUSION

Infant GMD appears associated with two child factors (birthweight and gestational age) and one environmental factor (sleeping position). For the other factors identified in this review, insufficient evidence for an association with GMD was found. For those factors that were examined in only one longitudinal study, and are therefore classified as having limited evidence, more research would be needed to reach a conclusion.