Motor Development Scores Research Articles

Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants

Maize-meal porridge is used for infant feeding in many African countries, including South Africa. A low-cost, finely milled, maize-meal porridge was fortified with beta-carotene, iron, and zinc (100% of recommended dietary allowance), as well as ascorbic acid, copper, selenium, riboflavin, vitamin B-6, vitamin B-12, and vitamin E. We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants. Infants aged 6-12 mo (n = 361) were randomly assigned to receive either the fortified or unfortified porridge for 6 mo. Primary outcomes were hemoglobin and serum retinol, zinc, and ferritin concentrations and motor development. Growth was assessed as a secondary outcome. Primary and secondary outcomes were assessed at baseline and 6 mo. Two hundred ninety-two infants completed the study. The fortified-porridge group had an intervention effect of 9.4 microg/L (95% CI: 3.6, 15.1 microg/L) for serum ferritin and 9 g/L (95% CI: 6, 12 g/L) for hemoglobin concentrations. The proportion of infants with anemia decreased from 45% to 17% in the fortified-porridge group, whereas it remained >40% in the control group. The fortified-porridge group achieved on average 15.5 of the 25 motor development score items, whereas the control group achieved 14.4 items (P = 0.007). Serum retinol concentration showed an inconsistent effect, and no intervention effect was observed for serum zinc concentrations. This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor settings. The formulation needs some adjustment in terms of zinc fortification.

Intervention for infants with brain injury: Results of a randomized controlled study

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother–infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study. The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother–infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome.

Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials

To evaluate the effect of iron supplementation on mental and motor development in children through a systematic review of randomised controlled trials (RCTs). Electronic databases, personal files, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk or cereals were evaluated. The outcomes studied were mental and motor development scores and various individual development tests employed, including Bayley mental and psychomotor development indices and intelligence quotient. The pooled estimate (random effects model) of mental development score standardised mean difference (SMD) was 0.30 (95% confidence interval (CI) 0.15 to 0.46, P<0.001; P<0.001 for heterogeneity). Initial anaemia and iron-deficiency anaemia were significant explanatory variables for heterogeneity. The pooled estimate of Bayley Mental Development Index (weighted mean difference) in younger children (<27 months old) was 0.95 (95% CI -0.56 to 2.46, P=0.22; P=0.016 for heterogeneity). For intelligence quotient scores (> or =8 years age), the pooled SMD was 0.41 (95% CI 0.20 to 0.62, P<0.001; P=0.07 for heterogeneity). There was no effect of iron supplementation on motor development score (SMD 0.09, 95% CI -0.08 to 0.26, P=0.28; P=0.028 for heterogeneity). Iron supplementation improves mental development score modestly. This effect is particularly apparent for intelligence tests above 7 years of age and in initially anaemic or iron-deficient anaemic subjects. There is no convincing evidence that iron treatment has an effect on mental development in children below 27 months of age or on motor development.

Improvement of motor development and postural control following intervention in children with sensorineural hearing loss and vestibular impairment

Objective: The purpose of this study was to determine the effect of exercise intervention on the progressive motor development delay and postural control impairments in children with sensorineural hearing loss and concurrent vestibular impairment. Methods: Twenty-one children with sensorineural hearing loss and vestibular impairment were randomly assigned to two groups (exercise and placebo) matched for age and gross motor development level. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. Placebo intervention focused on language development activities. Each intervention was administered three times weekly for 12 weeks. Motor development and posturography testing was completed pre- and post-intervention. To examine the mechanisms of change, somatosensory, visual and vestibular functional effectiveness ratios were calculated from posturography stability scores. Children in the placebo group later participated in exercise intervention, and a second post-test completed. Data were analyzed by group, as well as merged once all had received exercise intervention. Results: Post-intervention, motor development scores significantly improved in the exercise, not the placebo group (P=0.004). Although not significant, improvement in posturography scores were evident in the exercise group. Once the post-exercise data from both groups were merged (n=21), improvements in these scores were significant (≤0.02). The difference from the normative sample was eliminated. Conclusions: Exercise intervention focused on the enhancement of sensory integrative postural control abilities is effective for the arrest of the progressive motor development delay in children with sensorineural hearing loss and vestibular impairment.

Childcare Patterns and Issues for Families of Preschool Children With Disabilities

A longitudinal investigation of childcare for children with developmental disabilities (N = 89) was conducted, with in-person assessments at 12, 15, 30, and 45 months of age, and phone interviews with mothers at 14, 29, 37, and 44 months. When compared with typically developing children from another sample, and with census data, the participants entered childcare at an older age and for fewer hours; they were more likely to be in “informal” (father, relative, in-home nonrelative) care; and they were less likely to transition into more formal care (childcare center, childcare home) with increasing age. Finding good-quality care, the cost of care, distance/transportation issues, and integration with other services/special needs received the highest ratings for childcare issues. Children who were not in childcare had lower adaptive behavior scores if their mothers cited their child's special needs as an issue in keeping them out of care, compared with children whose mothers did not indicate that special needs were an issue. These 2 groups did not differ in their diagnoses, mental, or motor development scores. Results are discussed in the context of family leave policies and welfare work exemptions, and the need for high-quality caregiving options.

Stress during pregnancy is associated with developmental outcome in infancy.

Animal studies show that prenatal maternal stress may be related to cognitive impairments in offspring. Therefore, we examined whether psychological and endocrinologic measures of stress during human pregnancy predicted developmental outcome of the infant at 3 and 8 months. Self-report data about daily hassles and pregnancy-specific anxiety and salivary cortisol levels were collected in 170 nulliparous women in early, mid- and late pregnancy in a prospective design, in which healthy infants born at term were followed up after birth. High levels of pregnancy-specific anxiety in mid-pregnancy predicted lower mental and motor developmental scores at 8 months (p < .05). High amounts of daily hassles in early pregnancy were associated with lower mental developmental scores at 8 months (p < .05). Early morning values of cortisol in late pregnancy were negatively related to both mental and motor development at 3 months (p < .05 and p < .005, respectively) and motor development at 8 months (p < .01). On average a decline of 8 points on the mental and motor development scale was found. All results were adjusted for a large number of covariates. Stress during pregnancy appears to be one of the determinants of delay in motor and mental development in infants of 8 months of age and may be a risk factor for later developmental problems. Further systematic follow-up of the present sample is needed to determine whether these delays are transient, persistent or even progressive.

Prenatal stress and cognitive development and temperament in infants

Studies in rodents and nonhuman primates indicate that maternal stress during pregnancy can influence the developing fetus, resulting in delay of motor and cognitive development and impaired adaptation to stressful situations. These effects may be mediated by the hypothalamic–pituitary–adrenal (HPA) axis. We examined whether stress during pregnancy predicted developmental outcome of human infants in a prospective design. Self-report data about daily hassles and pregnancy-specific anxiety and salivary cortisol levels were collected in nulliparous pregnant women. Dependent measures were scores on the Bayley Scales of Infant Development and on temperamental questionnaires at 3 and 8 months. Pregnancy-specific anxiety in mid pregnancy predicted lower mental and motor developmental scores at 8 months. Early morning values of cortisol in late pregnancy were negatively related to both mental and motor development at 3 months and motor development at 8 months. Pregnancy-specific anxiety explained 7% of the variance of test-affectivity and goal-directedness at 8 months. Increased maternal stress during pregnancy seems to be one of the determinants of temperamental variation and delay of development of infants and may be a risk factor for developing psychopathology later in life.

Neurodevelopmental outcome of young pediatric intensive care survivors of serious brain injury.

To determine the number of children with severe brain injury due to closed head injury or hypoxic-ischemic encephalopathy as a proportion of all admissions of children <3 yrs of age in the regional pediatric intensive care unit; to determine the outcome of these children at >6 mos postinjury; and to explore the relationship of outcome measures to predictors of outcome obtained within the first 24 hrs after brain injury. Prospective, descriptive outcome study of an inception cohort. Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. Of a cohort of 53 children of <3 yrs of age (4% of pediatric intensive care unit admissions, 1995-1998) admitted for severe acquired brain injury (Glasgow Coma Score, <or=8), 12 (23%) died, three (6%) were lost to follow-up, and 38 (71%) survived and received multidisciplinary outcome assessments. Of 50 children with known outcome, 23 (46%) had a good recovery on the Glasgow Outcome Scale; however, only eight (16%) of these had average or above scores on both the mental and motor developmental indices of the Bayley Scales of Infant Development-II at 18-36 mos of age. Acute injury predictors of adverse outcome were apnea at scene, bolus epinephrine given for resuscitation, pupils nonreactive, arterial pH <or=7.2, and Glasgow Coma Score of 3. For 38 survivors, sensitivity and specificity from predictors for the Glasgow Outcome Scale were 73% and 83% respectively; for mental scores, 86% and 93%; for motor scores, 75% and 89%. Of children of <3 yrs of age identified by a Glasgow Coma Score of <or=8 after acute brain injury, >80% have adverse outcome of death, disability, or mental or motor developmental scores below average. A Glasgow Outcome Scale of 5 overestimates good recovery. Universal registry and follow-up of these children are needed.

Developmental Trajectories of Poorly Nourished Toddlers that Received a Micronutrient Supplement with and without Energy

Experimental and quasi-experimental studies on the effects of nutritional supplements on development in young children generally include snapshots of development. Developmental outcomes are better revealed when multiple assessments are made over time. We compared the effects of a micronutrient intervention with and without supplementary energy on the mental and motor growth curves of poorly nourished toddlers in West Java. Subjects (12-mo-old cohort, n = 33; 18-mo-old cohort, n = 42) were randomly assigned to receive energy + micronutrients (E + M) or micronutrients (M) daily for 12 mo. The cohort/treatment groups were then classified as either relatively short or tall. Within the 12-mo cohort, the baseline mean length Z-scores ranged from -2.53 to -1.29 and the baseline mean weight Z-scores ranged from -3.05 to -2.18. The same pretreatment anthropometrics for the older cohort ranged from -3.22 to -1.59 and from -3.42 to -2.26. Mental and motor development scores (Bayley) were obtained at baseline and every 2 mo for 12 mo. There was a Cohort x Length Category x Supplement interaction for mental slopes (P < 0.01). Slopes for tall-E + M (b = 5.35) and tall-M children (b = 5.39) in the 18-mo cohort were equivalent, but slopes for short-E + M (b = 6.13) and short-M (b = 4.67) children differed greatly (P = 0.03). On the basis of this finding and findings previously reported from this study, we concluded that the unfavorable developmental response to the M supplement that was restricted to the shortest children within an already disadvantaged group.

The Effect of Childcare and Early Education Arrangements on Developmental Outcomes of Young Children

This study investigates the relationship between childcare arrangements and developmental outcomes of young children using data from Cycle 1 of the Canadian National Longitudinal Survey of Children and Youth. Models of the determinants of Motor and Social Development (MSD) scores for children aged 0-47 months, and of the Peabody Picture Vocabulary Test assessment scores (PPVT) for children aged 4-5 years are estimated controlling for a variety of non-parental childcare and early education characteristics. The results suggest that infant-toddler non-parental care arrangements have insignificant or negligible impacts on developmental outcomes (MSD). For preschoolers, modes of care and early education do not, on average, influence cognitive development (PPVT). The results of fixed effect estimates for a sample of siblings aged 0-47 months confirm the preceding conclusion. The analysis is repeated to identify the determinants of the probability that the child's MSD (PPVT) score is in the bottom part of the distribution of MSD (PPVT) scores and the conclusions are similar.

The Development of Young Children With Retinoblastoma

To assess the health and development of children with retinoblastoma (RB), or cancer of the retina, and to determine if they are at greater risk for developmental delays than normal children. Specific aims were to determine if type of RB (unilateral vs bilateral), family history, and number of treatment types affected mental and motor development. Descriptive study based on medical record review and pediatric, psychological, and visual evaluations. Major referral center for patients with RB and early intervention program in a voluntary urban hospital. Fifty-four children younger than 41 months with RB who attend an ophthalmology oncology clinic were recruited for study. Measures included demographic variables such as social class and race/ethnicity, and medical factors such as age at diagnosis (<18 months vs >18 months), type of RB (unilateral or bilateral), family history of RB, and number and types of treatments. All children received a pediatric examination that assessed physical growth and health; a behavioral test of visual acuity using Teller acuity cards; and the Bayley Scales of Infant Development II, a standardized test of mental and motor development. Children found to have delays were referred to intervention services to treat their specific areas of weakness. Three quarters of the children had had 1 eye enucleated; 51 of 54 had normal vision in at least 1 eye, and the other 3 had partial vision in 1 eye. Except for the RB, 46 children were largely normal in growth and health, and 8 had medical diagnoses that were unrelated to RB or its treatment. The average mental and motor development scores were in the normal range (91.4 +/- 16.3, and 91.1 +/- 13.4) and not significantly lower than the normal population. Twenty-six children were referred for early intervention services, and 21 of 26 were referred for services to improve their visuomotor coordination. Demographic variables were not associated with medical variables or outcome. Children with bilateral RB, in which both eyes are affected, performed significantly less well in motor development, received many more types of treatments, and were more likely to be referred for visuomotor therapy than children with unilateral RB. Children with RB generally function normally in terms of physical health and mental and motor development. However, they are more likely to show delays in visuomotor integration. Early developmental evaluations may improve the visuomotor development of children with visual impairment due to RB.

Child Care Arrangement and Preschool Development

Baseline data from the Canadian National Longitudinal Survey of Children and Youth were used to evaluate the associations between child care arrangement and poor developmental attainment (PDA). A weighted total of 521,800 children aged 2 to 3 years were studied (N = 2,709). PDA was assessed by age-standardized motor and social development score. Children were grouped by the predominant type of arrangement: care by someone in the child's own home, in another home (family child care), at a child care centre, or none (child care exclusive to parents). Controlling for socioeconomic status, biological factors and maternal immigration, family dysfunction, hostile parenting and low neighbourhood safety were correlated with PDA and positive parent-child interaction decreased the odds of PDA. Whereas centre child care arrangements were beneficial to development overall (OR = 0.41, 99% CI = 0.18, 0.93), an interaction existed between type of child care and maternal depression; among children with depressed mothers, centre child care was associated with increased odds of PDA. Findings suggest that the associations between child care arrangement and child development involve interactions of factors that influence a child's home environment. Future child development studies exploring these interactions are warranted.

Child care arrangement and preschool development.

Baseline data from the Canadian National Longitudinal Survey of Children and Youth were used to evaluate the associations between child care arrangement and poor developmental attainment (PDA). A weighted total of 521,800 children aged 2 to 3 years were studied (N = 2,709). PDA was assessed by age-standardized motor and social development score. Children were grouped by the predominant type of arrangement: care by someone in the child's own home, in another home (family child care), at a child care centre, or none (child care exclusive to parents). Controlling for socioeconomic status, biological factors and maternal immigration, family dysfunction, hostile parenting and low neighbourhood safety were correlated with PDA and positive parent-child interaction decreased the odds of PDA. Whereas centre child care arrangements were beneficial to development overall (OR = 0.41, 99% CI = 0.18, 0.93), an interaction existed between type of child care and maternal depression; among children with depressed mothers, centre child care was associated with increased odds of PDA. Findings suggest that the associations between child care arrangement and child development involve interactions of factors that influence a child's home environment. Future child development studies exploring these interactions are warranted.

Maternal Depressive Symptoms Affect Infant Cognitive Development in Barbados

This longitudinal study is part of a series examining the relationships between maternal mood, feeding practices, and infant growth and development during the first 6 months of life in 226 well-nourished mother-infant dyads in Barbados. In this report, we assessed maternal moods (General Adjustment and Morale Scale and Zung Depression and Anxiety Scales), feeding practices (scales describing breast-feeding and other practices associated with infant feeding in this setting), and infant cognitive development (Griffiths Mental Development Scales). Multivariate analyses, with and without controlling for background variables, established significant relationships between maternal moods and infant cognitive development. Infants of mothers with mild moderate depression had lower Griffiths scores than infants of mothers without depression. Maternal depressive symptoms and lack of trust at 7 weeks predicted lower infant social and performance scores at 3 months. Maternal moods at 6 months were associated with lower scores in motor development at the same age. Although no independent relationships emerged between feeding practices and infant cognitive development, the combination of diminished infant feeding intensity and maternal depression predicted delays in infant social development. These findings demonstrate the need to carefully monitor maternal moods during the postpartum period, in order to maximize the benefits of breast-feeding and related health programs to infant cognitive development.

Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction.

Gross motor development, and the effect of age, sex and vestibular function on it, was examined in 39 24- to 83-mo.-old children with sensorineural hearing impairment. Repeated testing was completed on 18 children. Delayed gross motor development was evident regardless of age, but only children less than 5 years of age had developmental balance deficits on initial testing. Both gross motor and balance development scores were lower on repeated testing. Furthermore, vestibular function scores facilitated identification of those children with a deficit in balance development as well as those with a progressive delay in motor or balance development. Implications for practice are discussed.

EVIDENCE OF PROGRESSIVE DELAY OF MOTOR DEVELOPMENT IN CHILDREN WITH SENSORINEURAL HEARING LOSS AND CONCURRENT VESTIBULAR DYSFUNCTION

Gross motor development, and the effect of age, sex and vestibular function on it, was examined in 39 24- to 83-mo.-old children with sensorineural hearing impairment. Repeated testing was completed on 18 children. Delayed gross motor development was evident regardless of age, but only children Jess than 5 years of age had developmental balance deficits on initial testing. Both gross motor and balance development scores were lower on repeated testing. Furthermore, vestibular function scores facilitated identification of those children with a deficit in balance development as well as those with a progressive delay in motor or balance development. Implications for practice are discussed.

Early childhood neurodevelopment in very low birth weight infants with predischarge apnea

Apnea commonly occurs in preterm infants and may persist beyond term. We prospectively investigated the relationship between apnea that persisted beyond 35 weeks postconceptional age and subsequent neurodevelopment in early childhood. Between January, 1990–November, 1993, we performed predischarge respiratory recordings, using 24-hr, 4-channel pneumography, at 35 weeks or more of postconceptional age in 164 infants (birth weight, <1,250 g; gestational age, ⩽32 weeks), who subsequently underwent multidisciplinary neurodevelopmental assessment at 15–64 (median 24) months of adjusted age. The duration of initial artificial ventilation for respiratory distress syndrome and the grade of intraventricular hemorrhage were independent predictors of neurodevelopmental outcome. Mean oximetry desaturation and frequency of predischarge apnea correlated with mental and motor developmental scores. Mean oximetry desaturation during apnea was an independent predictor for motor score in the total population, and for both mental and motor scores in 50 infants with grade 3 or 4 intraventricular hemorrhage, but not in 114 infants without grade 3 or 4 intraventricular hemorrhage. Despite its limited predictability for early childhood neurodevelopment, predischarge respiratory recordings may be useful in predicting subsequent neurodevelopment of high-risk preterm infants, especially those with severe intraventricular hemorrhage. Pediatr Pulmonol. 1999; 27:14–20. © 1999 Wiley-Liss, Inc.

A Developmental Function of Motor Activity among Nutritionally At-Risk Children

Learning about the dynamics of early childhood development in the context of poverty and malnutrition is an effective way to identify the periods of highest psychosocial vulnerability and the role of timing in the differential responsivity of young children to interventions. Motor activity under natural conditions is one area of development that requires further study because of its biological and psychological developmental importance. This paper presents an estimate of the development function of motor activity among poorly nourished children whose ages ranged from 12 to 30 months. It also focuses on the longitudinal relationship between the nature, level of motor development, and intensity of motor actions, on the one hand, and physical growth, dietary intake, and motor activity, on the other. Two cohorts (12 and 18 months old) of rural West Javanese children were studied. Motor activity, energy intake, physical growth, and motor development were measured every two months. A motor activity score was calculated based on the estimated energy cost and intensity of each activity and their frequency and duration during each of the periods of observation. Intensity was classified according to a three-point scale (high = 1.25, moderate = 1.0, low = 0.75). the Bayley Scale of Motor Development and a scale of motor milestones were used to assess motor development (e.g., crawling, creeping, walking, and running). The developmental function of activity was curvilinear. It showed a moderately fast acceleration from 12 to about 18 to 20 months; at that point the curve reached a plateau. the functions of growth and energy intake were linear. the average motor behaviour of these children was characterized by its low level of intensity. Although the relationship between motor activity and motor development was relatively close up to about 20 months, thereafter the motor activity and motor development scores were independent of each other. the changes in activity level were primarily determined by a significant decline of involvement in activities having a low energy cost and an increase in activities having moderate or high energy cost. the decline of motor activity observed at 18 months is reminiscent of the decline in growth velocity observed during the first six months of life among malnourished children. It is plausible that the pattern of activity observed could be explained by either contextual or cultural factors.

Fundamental movement patterns in Tasmanian primary school children.

Gross motor development, using the Test of Gross Motor Development was investigated in 7- and 10-yr.-old Tasmanian school children (N = 574) to provide normative data for primary school children. The effects of daily physical education, time spent on physical education per week, schools with and without a trained physical educator, motor skill training programs, and their effects upon development of fundamental movement patterns was also investigated. Time spent on physical education instruction per week, significantly influenced Gross Motor Development scores in that the more time spent on physical education, the higher the score. Having a motor skill training program in the school was significant for 10-yr.-olds. A review of daily physical education with perhaps a goal of greater emphasis on manipulative control skills such as kicking, throwing, and striking should take place especially for girls, as their scores were significantly lower than those of boys.

FUNDAMENTAL MOVEMENT PATTERNS IN TASMANIAN PRIMARY SCHOOL CHILDREN

Gross motor development, using the Test of Gross Motor Development was investigated in 7– and 10-yr.-old Tasmanian school children (N = 574) to provide normative data for primary school children. The effects of daily physical education, time spent on physical education per week, schools with and without a trained physical educator, motor skill training programs, and their effects upon development of fundamental movement patterns was also investigated. Time spent on physical education instruction per week, significantly influenced Gross Motor Development scores in that the more time spent on physical education, the higher the score. Having a motor skill training program in the school was significant for 10-yr.-olds. A review of daily physical education with perhaps a goal of greater emphasis on manipulative control skills such as kicking, throwing, and striking should take place especially for girls, as their scores were significantly lower than those of boys.