Relationships of equipment use and play positions to motor development at eight months corrected age of infants born preterm

Tummy Time Tracking: Examining Agreement Between Parent Recall and Direct Observation in Infants

IMPORTANCE

Parent recall is the primary method for measuring positioning practices such as tummy time in infants. Concerns regarding the accuracy of parent recall have been raised in the literature. To date, no study has examined the agreement of tummy time recall measures with gold-standard methods.

OBJECTIVE

To assess the agreement between parental recall versus direct observation of tummy time in infants, and to explore the impact of prematurity on this relationship.

DESIGN

Cross-sectional observational study, spanning 1 yr.

SETTING

Participants' homes Participants: Thirty-two infant-parent dyads (19 full-term, 13 preterm), with infants ages 3 to 6 mo and caregivers ages older than 18 yr.

OUTCOME AND MEASURES

Home-recorded videos of infant play across 3 days were used as a proxy for direct observation of tummy time and compared with a 12-item parent recall survey.

RESULTS

Parent recall had a significant moderate correlation (ρ = .54, p = .002) with direct observation in full-term infants but was not correlated (p = .23) with direct observation in preterm infants. On average, parents of preterm infants overestimated tummy time by 2.5 times per day compared with direct observation.

CONCLUSIONS AND RELEVANCE

For full-term infants, parent recall measures of tummy time exhibit an acceptable level of agreement with direct observation and can be reliably used over shorter periods. Parents of preterm infants may display a bias in recalling tummy time, leading to overestimations. To accurately assess tummy time in this population, a combination of subjective and objective measures should be explored. Plain-Language Summary: Tummy time is an essential movement experience for infants, especially for preterm infants, who are at a higher risk for motor delays. The most common way to track tummy time is through parent reports, or recall, versus a practitioner directly observing tummy time in the home. Despite the widespread use of parent recall to track tummy time, no study has examined the accuracy of parent recall versus direct observation in the home. Accurately assessing tummy time is crucial for improving and supporting health outcomes for infants. This study found that prematurity may affect the accuracy of parent recall for assessing tummy time in young infants. The authors discuss the implications of this finding and provide suggestions to guide the selection of appropriate methods to measure tummy time in clinical practice and research studies.

Emergence of locomotor behaviors: Associations with infant characteristics, developmental status, parental beliefs, and practices in typically developing Brazilian infants aged 5 to 15 months

Independent locomotion provides autonomy for infants, drastically changing their relationship with their surroundings. From a dynamic systems perspective, the interaction between environment, tasks, and organismic constraints leads to the emergence of new behaviors over time. This 6-month longitudinal study aimed to verify associations between the emergence of locomotor behaviors and infants' characteristics, developmental status, parental beliefs, and practices. This observational study remotely assessed 37 full-term Brazilian infants aged 5 to 15 months, divided into two groups (G1: 5 to 11 months, n = 19; and G2: 9 to 15 months, n = 18). The motor developmental status of infants was closely associated with the emergence of behaviors (p < 0.05). Infants in G2 whose parents agreed with the statement "In typically developing infants, motor development occurs naturally and there is no need to actively stimulate it" started to walk later than those whose parents disagreed. Infants whose parents expected them to walk around 10-11 months walked earlier compared to those expected to walk after 11 months (G2, p = 0.011). Infants in G2 with a high frequency of staying in the supine position started to walk, both with and without support, later than those with a low frequency (p < 0.05). For infants in G1 with a high frequency of playing on the floor, locomotion (p = 0.041) and crawling on hands-and-knees (p = 0.007) started sooner compared to those with a low frequency. Staying in the cradle more frequently was related to a later emergence of supported walk (p = 0.046) among infants in G2. The emergence of locomotor behaviors is associated with motor developmental status, the surfaces where the infant plays, and body position. Parental beliefs and expectations influence how infants are stimulated and, consequently, the emergence of independent walking.

Does the Degree of Prematurity Relate to the Bayley-4 Scores Earned by Matched Samples of Infants and Toddlers across the Cognitive, Language, and Motor Domains?

The literature on children born prematurely has consistently shown that full-term babies outperform preterm babies by about 12 IQ points, even when tested as adolescents, and this advantage for full-term infants extends to the language and motor domains as well. The results of comprehensive meta-analyses suggest that the degree of prematurity greatly influences later test performance, but these inferences are based on data from an array of separate studies with no control of potential confounding variables such as age. This study analyzed Bayley-4 data for 66 extremely premature infants and toddlers (<32 weeks), 70 moderately premature children (32-36 weeks), and 133 full-term children. All groups were carefully matched on key background variables by the test publisher during the standardization of the Bayley-4. This investigation analyzed data on the five subtests: cognitive, expressive communication, receptive communication, fine motor, and gross motor. A multivariate analysis of covariance (MANCOVA) assessed for group mean differences across the three subsamples, while controlling for the children's age. Extremely premature children scored significantly lower than moderately premature children on all subtests, and both preterm groups were significantly outscored by the full-term sample across all domains. In each set of comparisons, the cognitive and motor subtests yielded the largest differences, whereas language development, both expressive and receptive, appeared the least impacted by prematurity. A follow-up MANOVA was conducted to examine full-term versus preterm discrepancies on the five subtests for infants (2-17 months) vs. toddlers (18-42 months). For that analysis, the two preterm groups were combined into a single preterm sample, and a significant interaction between the age level and group (full-term vs. preterm) was found. Premature infants scored lower than premature toddlers on receptive communication, fine motor, and cognitive. Neither expressive communication nor gross motor produced significant discrepancies between age groups The findings of this study enrich the preterm literature on the degree of prematurity; the age-based interactions have implications for which abilities are most likely to improve as infants grow into toddlerhood.

Information Available to Parents Seeking Education about Infant Play, Milestones, and Development from Popular Sources

Parents commonly seek information about infant development and play, yet it is unclear what information parents find when looking in popular sources. Play, Milestone, and Development Searches in Google identified 313 sources for content analysis by trained researchers using a standardized coding scheme. Sources included websites, books, and apps created by professional organizations, commercial entities, individuals, the popular press, and government organizations/agencies. The results showed that for popular sources: (1) author information (i.e., qualifications, credentials, education/experience) is not consistently provided, nor is information about the developmental process, parents' role in development, or determining an infant's readiness to play; (2) milestones comprise a majority of the content overall; (3) search terminology impacts the information parents receive; (4) sources from the Milestone and Development Searches emphasized a passive approach of observing developmental milestones rather than suggesting activities to actively facilitate learning and milestone development. These findings highlight the need to discuss parents' online information-gathering process and findings. They also highlight the need for innovative universal parent-education programs that focus on activities to facilitate early development. This type of education has potential to benefit all families, with particular benefits for families with children who have unidentified or untreated developmental delays.

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.

Factors Associating with the Segmental Postural Control during Sitting in Moderate-to-Late Preterm Infants via Longitudinal Study

(1) Background: biological variables and particular child rearing practices could be linked to postural control and rates of sitting onset. The segmental Assessment of Trunk Control (SATCo) is currently used as an assessment of postural control with a specific segment on premature infants. However, the association between related factors and segmental trunk control during sitting development in preterm infants via longitudinal assessments is still limited. Objective: to investigate the associations between biological and child rearing factors and segmental trunk control during sitting in moderate to late premature birth from the age of 4 months to age of independent sitting attainment. (2) Methods: forty-two infants born between 32 and 36 weeks of gestation were recruited. Their segmental trunk control was assessed using the SATCo. Their related factors were recorded from the age of 4 months to early onset of independent sitting attainment. The generalised estimating equation (GEE) model was used to identify the association between related factors and the SATCo with a linear distribution. (3) Results: cause of prematurity, baby rocking recliner and baby walker usage were negative factors, while play in a sitting position, opportunity to move on a traditional mat and sleep mattress were positive factors contributing to the segmental control of the trunk. (4) Conclusions: the experience of sitting on different surfaces and an opportunity to sit without support during the child rearing period from age of 4 months corrected could be positive factors associating with the segmental trunk control in moderate-to-late premature infants.

A Clinical Trial Based on Reward Contingency to Improve Prone Tolerance and Motor Development is Feasible in 3- to 6-Month-Old Infants

Aims: The American Academy of Pediatrics recommends “parents to incorporate supervised, awake ‘prone play’ in their infant’s routine to support motor development and minimize the risk of plagiocephaly”. The purpose of this feasibility study was to compare usual care to a reward contingency–based intervention, developed to increase prone tolerance and improve motor skills. Methods: Ten full-term infants, 3–6- months old, with poor prone tolerance were randomized to either the Education group or Reward contingency group. Each group participated in three parent education sessions and 15 intervention sessions, over the period of three weeks. Infants in the Reward contingency group used the Prone Play Activity Center, a technology developed to reinforce motor behavior of infants in prone position. Intervention frequency and parent feedback data determined the feasibility of the interventions. Results: Infants in the Reward contingency group practiced a median of 12 of the 15 anticipated intervention sessions in the Prone Play Activity Center. These infants used the device for a mean of 18 minutes per day. Parents of infants in the Education group practiced a median of 10 sessions of the 15 anticipated intervention sessions. Conclusion: The reward contingency–based intervention is feasible for use in a future clinical trial with some modifications.

Correlates of tummy time in infants aged 0-12 months old: A systematic review

BACKGROUND

Tummy time, defined as an infant being placed on their stomach whilst they are awake and supervised, has been shown to have a positive effect on infant development and head shape. Tummy time can be influenced by a number of factors. Using a social ecological model, categories of potential variables can be examined to determine their influence on behaviours such as tummy time. The purpose of this systematic review was to examine potential correlates of tummy time in infants from birth to 12 months old.

METHODS

Electronic databases were originally searched between March to December 2016. Included studies needed to be peer-reviewed, written in English, and meet a priori study criteria. The population was apparently healthy infants aged from birth to 12 months old. The article needed to contain an objective or subjective measure of tummy time as a dependent variable and examine the association between a demographic, psychological, behavioral, and/or environmental variable and tummy time. For this study, tummy time could include the ability of the infant to move whilst being positioned on their stomach, for example, the infant's ability to roll from back to front, or lift their head when lying on their stomach (prone positioning ability), or the capacity, time spent, age started, or parent attitudes/behaviours regarding the infant being placed on their stomach. The outcomes were the relationships between potential correlates and tummy time. Risk of bias was assessed at the individual study level using the Cochrane risk of bias assessment for observational studies.

RESULTS

15 articles representing 2372 unique participants from 7 countries were included. Correlates that were positively correlated with tummy time were age, prone sleeping, spending greater than 15minutes whilst awake in tummy time when 2 months old, amount of time in the bath, order of achievement of prone extension and prone on elbow positions and parents/carers setting aside time for tummy time. Risk of bias of the included studies ranged from low to high.

CONCLUSIONS

Specific demographic, environmental and behavioral variables were found to be positively and negatively associated with tummy time. This evidence could assist future research regarding interventions to promote tummy time, enhance motor development, increase infant physical activity and contribute to future tummy time recommendations for parents and health care providers.

The Effect of Positional Support on Tolerance of Wakeful Prone in Infants

Supervised wakeful prone promotes motor milestones. Indications are that many infants do not receive adequate prone, with poor tolerance as a contributing factor. A common suggestion is the use of positional support.

AIMS

This study has two main purposes: (1) To determine whether varied levels of positional support affect the duration of time spent in prone, and (2) to determine the effect of positional support with respect to infant size.

METHODS

A convenience sample of 32 healthy infants ranging in size, aged 3.3 ± 0.04 months, were placed in prone in three counterbalanced randomized levels of positional support: a flat blanket (Blanket condition), a rolled blanket (Roll condition), and a pillow (Boppy condition).

RESULTS

There were significant differences in time spent in prone with the Boppy condition affording infants up to three more min in prone across three repeated trials. There were no significant interaction effects between condition and infant size measurements.

CONCLUSIONS

These results provide evidence for increasing positional support, such as through use of a Mini Boppy®, to facilitate tolerance for prone for infants of all sizes.

Immediate Effect of Positioning Devices on Infant Leg Movement Characteristics

PURPOSE

To determine the immediate effects of constraining or encouraging positioning devices on leg movement of infants with typical development (TD) and at-risk for developmental delay (AR).

METHODS

Twenty-six infants (13 TD, 13 AR) were placed in the supine position, a jungle gym, or a car seat. Movement sensors on infants' ankles measured acceleration and angular velocity. We calculated the number of leg movements, peak acceleration, and peak rotational rate of each leg movement. A 2 (group) × 3 (condition) analysis of variance with repeated measures on condition tested for a group effect, a condition effect, and a group by condition interaction for leg movement quantity, average peak acceleration, and average peak rotation.

RESULTS

Leg movement quantity and average peak acceleration were significantly lower for the car seat condition compared with the supine position or the gym.

CONCLUSIONS

Positioning device use has an immediate effect on infant leg movement characteristics. Long-term effects remain unknown.

Achieving motor development milestones at the age of three months may determine, but does not guarantee, proper further development

Proper motor performance at 3rd month is necessary for further motor development. The paper aims to demonstrate the reliability, sensitivity, and predictive value of an original motor performance assessment tool in comparison with the neurological assessment at 3, 6, and 9 months. Children (n = 123), born at term without pre- or perinatal complications, born at term with pre- or perinatal complications, or born preterm, were assessed at the age of 3, 6, and 9 months, by a neurologist and a physiotherapist. The physiotherapist evaluated 15 qualitative features typical for the age of 3 months in the prone and supine positions. The final neurological assessment determined the degree of developmental disorder. Neurological and global physiotherapeutic assessments showed a statistically significant correlation. Qualitative assessment results were very good in healthy children and decreased with worsening neurological diagnoses. Children diagnosed with cerebral palsy did not show proper qualitative features of 3 months when analyzed at 3, 6, and 9 months. Children with delayed motor development revealed minor qualitative performance impairments as early as 3 months but improved with age. Qualitative assessment at 3 months not only facilitates diagnosis of major developmental disorders but is also a good predictor of delayed motor development in children.

Associations of biological factors and affordances in the home with infant motor development

BACKGROUND

Whereas considerable work has been published regarding biological factors associated with infant health, much less is known about the associations of environmental context with infant development - the focus of the present cross-sectional study.

METHODS

Data were collected on 561 infants, aged newborn to 18 months. Measures included the Affordances in the Home Environment for Motor Development-Infant Scale, Alberta Infant Motor Scale, and selected bio/medical factors. Correlation and regression were used to analyze the data.

RESULTS

Home environmental factors were associated with children's motor development as much as some typically high-risk biologic factors.

CONCLUSION

The home environment partially explained infant development outcomes and infants at risk could possibly be helped with a home assessment for affordances.

Family support and education

Family involvement is essential to the developmental outcome of infants born into Neonatal Intensive Care Unit (NICU). In this article, evidence has been presented on the parent's perspective of having an infant in the NICU and the context of family. Key points to an educational assessment are also reviewed. Throughout, the parent's concerns and the educational needs of the family are shared, and strategies are given to help therapists enhance their teaching skills and ways to partner with parents. This article also introduces the NICU Discharge Path for parents "Preparing for Your Baby to Come Home". The Path educates parents on the steps towards home and encourages their participation in the process.

Physical therapy intervention in the neonatal intensive care unit

This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Physical therapy intervention in the NICU is infant-driven and focuses on providing family-centered care. In this context, interventions to facilitate a calm behavioral state and motor organization in the infant, address positioning and handling of the infant, and provide movement therapy are presented.

Cardiorespiratory response during physical therapist intervention for infants and young children with chronic respiratory insufficiency

PURPOSE

To document physical therapist intervention activities and cardiorespiratory response for young children with chronic respiratory insufficiency.

METHODS

Twelve children born prematurely, 6 to 30 months chronological age and admitted to inpatient pulmonary rehabilitation for oxygen and/or ventilation weaning, were included. During 3 intervention sessions, a second physical therapist recorded intervention activity and heart rate (HR), oxygen saturation (SaO2), and respiratory rate. Total time and median HR, SaO2, and respiratory rate for each activity were calculated. An analysis of variance was used to compare HR and SaO2 across activity based on intersession reliability.

RESULTS

Sitting activities were most frequent and prone least frequent. Median cardiorespiratory measures were within reference standards for age. No adverse effects were seen during intervention and no significant difference was found in HR and SaO2 among intervention activities.

CONCLUSION

Young children with chronic respiratory insufficiency are able to tolerate intervention with close monitoring by the physical therapist.

Instituting parent education practices in the neonatal intensive care unit: an administrative case report of practice evaluation and statewide action

BACKGROUND AND PURPOSE

Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU.

CASE DESCRIPTION

Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care.

OUTCOMES

The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life.

DISCUSSION

A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital.

Active head lifting from supine in early infancy: an indicator for non-optimal cognitive outcome in late infancy

AIM

To explore whether active head lifting from supine (AHLS) in early infancy is associated with cognitive outcome in the second year of life.

METHOD

The presence of AHLS was always recorded in the notes of infants admitted to our tertiary neonatal intensive care unit. Random sampling was used to pair infants with AHLS with two comparison infants without AHLS whose sex, gestational age, birth year (1993-2009), time of assessment, and developmental test (Griffiths Mental Development Scales, Mental Scale of the Bayley Scales of Infant Development-II, or cognitive subtest of the Bayley Scales of Infant and Toddler Development-III) were comparable. Brain injury identified from neonatal cranial ultrasound scans was classified as no - mild or moderate - severe. Z-scores of cognitive test outcomes were calculated for multivariable analysis.

RESULTS

Eighty-seven preterm (34 males, 53 females) and 40 term (17 males, 23 females) infants with AHLS were identified. AHLS was documented at a mean (corrected) age of 7.0 (SD 1.7) and 8.1 (SD 2.2) months respectively. The cognitive assessments were performed at a mean corrected age of 15.7 (SD 1.7) and 23.9 (SD 1.6) months in preterm infants, and 19.1 (SD 2.3) months in term infants. The mean cognitive outcome of preterm and term infants with AHLS was lower than that of infants without AHLS (p=0.002 and p=0.004 respectively). This remained after excluding infants with cerebral palsy with matching comparison infants (p=0.001 in preterm and p=0.001 in term infants). The mean difference was highest (1.35SD) between term male infants and comparison infants (p=0.001).

INTERPRETATION

AHLS is associated with a less favourable cognitive outcome in the second year of life in preterm as well as in term-born infants than in comparison infants.

LEARN 2 MOVE 0-2 years: effects of a new intervention program in infants at very high risk for cerebral palsy; a randomized controlled trial

Background

It is widely accepted that infants at risk for cerebral palsy need paediatric physiotherapy. However, there is little evidence for the efficacy of physiotherapeutic intervention. Recently, a new intervention program, COPCA (Coping with and Caring for infants with special needs - a family centered program), was developed. COPCA has educational and motor goals. A previous study indicated that the COPCA-approach is associated with better developmental outcomes for infants at high risk for developmental disorders. LEARN 2 MOVE 0-2 years evaluates the efficacy and the working mechanisms of the COPCA program in infants at very high risk for cerebral palsy in comparison to the efficacy of traditional infant physiotherapy in a randomized controlled trial. The objective is to evaluate the effects of both intervention programs on motor, cognitive and daily functioning of the child and the family and to get insight in the working elements of early intervention methods.

Methods/design

Infants are included at the corrected age of 1 to 9 months and randomized into a group receiving COPCA and a group receiving traditional infant physiotherapy. Both interventions are given once a week during one year. Measurements are performed at baseline, during and after the intervention period and at the corrected age of 21 months. Primary outcome of the study is the Infant Motor Profile, a qualitative evaluation instrument of motor behaviour in infancy. Secondary measurements focus on activities and participation, body functions and structures, family functioning, quality of life and working mechanisms. To cope with the heterogeneity in physiotherapy, physiotherapeutic sessions are video-recorded three times (baseline, after 6 months and at the end of the intervention period). Physiotherapeutic actions will be quantified and related to outcome.

Discussion

LEARN 2 MOVE 0-2 years evaluates and explores the effects of COPCA and TIP. Whatever the outcome of the project, it will improve our understanding of early intervention in children with cerebral palsy. Such knowledge is a prerequisite for tailor-made guidance of children with CP and their families.

Trial registration

The trial is registered under NTR1428.

Infants born preterm exhibit different patterns of center-of-pressure movement than infants born at full term

BACKGROUND

Infants born preterm are at risk for developmental impairments related to postural control.

OBJECTIVE

The purpose of this study was to determine whether infants born preterm and infants born at full term differed in postural control at 1 to 3 weeks after term age.

DESIGN

This study included 17 infants born preterm (mean gestational age=31.9 weeks, range=25.0-34.6) and 15 infants born at full term (mean gestational age=38.9 weeks, range=37.3-40.6). All infants were without diagnosed neurological or genetic conditions.

MEASUREMENT

Center-of-pressure (COP) data were recorded at 5 Hz while each infant was positioned supine on a pressure-sensitive mat in an alert behavioral state. Root mean square (RMS) displacement and approximate entropy (ApEn) were used to describe the COP movement variability in the time series. Differences between groups were identified using independent t tests.

RESULTS

The COP time series were found to be deterministic, suggesting order in the time series. Infants born preterm exhibited significantly larger RMS values in the caudal-cephalic direction than infants born at full term (1.11 and 0.83 cm, respectively; t=-2.6, df=30, P=.01). However, infants born at full term had significantly larger ApEn values in the caudal-cephalic direction (1.19 and 1.11, respectively; t=2.4, df=30, P=.02). The 2 groups did not differ in RMS or ApEn values in the medial-lateral direction or the resultant.

CONCLUSIONS

Infants born at full term exhibited COP displacements in the caudal-cephalic direction that were smaller in amplitude, but may be considered more complex or less predictable, than those of infants born preterm. One explanation is that infants born preterm exhibited more stereotypic patterns of movement, resulting in large, but repetitive, COP excursions. A combination of linear and nonlinear measures may provide insight into the control of posture of young infants.

Preferred sleep position and gross motor achievement in early infancy

The aim of this study was to assess the effect of an infant's favoured position on their motor development at the age of six months. Seventy-five full-term infants were prospectively observed at home for their preferred sleep, awake, play and uninterrupted positions. A parental log was completed daily and then weekly up to the age of six months, when the Alberta Infant Motor Scale (AIMS) was administered. No significant relationship between the preferred or sleep positions as well as the awake and mutual play positions and gross motor developmental attainment at six months of age was noted. A significant change in the preferred recumbent posture with increased prone positioning both during sleep and awake time over the first six months was noted. A balanced positioning policy while awake, regardless of the infant's preference while recumbent, is not associated with gross motor delay.

Harris Infant Neuromotor Test: comparison of US and Canadian normative data and examination of concurrent validity with the Ages and Stages Questionnaire

BACKGROUND

The Harris Infant Neuromotor Test (HINT) was developed as a screening tool for potential motor and cognitive developmental disorders in infants. Scoring on the HINT has been shown to be reliable, and several studies have supported the validity of the HINT. Normative values for the tool have been developed using Canadian infants.

OBJECTIVE

The aims of this study were (1) to further evaluate the validity of the HINT by comparing data obtained on US infants who were developing typically with data previously acquired on Canadian infants and (2) to determine the concurrent validity of the HINT with the Ages and Stages Questionnaire (ASQ). Secondary analyses of HINT scores for US white and nonwhite infants and for US infants who had parents with lower levels of education and US infants who had parents with higher levels of education (as a proxy for socioeconomic status [SES]) were conducted.

DESIGN

Cross-sectional exploratory and quasi-experimental comparative research designs were used to evaluate the validity of the HINT.

METHODS

Sixty-seven infants from the United States who were developing typically and who were aged 2.5 to 12.5 months were recruited via convenience sampling. Sixty-four of these infants were compared with Canadian infants matched for age, sex, ethnicity or race, and parental education. The HINT was administered by raters who had been trained to attain acceptable levels of interrater reliability, and parents completed the ASQ. The HINT scores for US white versus nonwhite infants (n=46) and infants who had parents with lower SES versus a higher SES (n=52) were compared.

RESULTS

There were no significant differences between HINT total scores for US and Canadian infants or for US racial or ethnic groups and SES groups. There were high correlations (r=-.82 to -.84) between HINT and ASQ scores.

LIMITATIONS

The study used a small US sample with limited geographical diversity. Small sample numbers also did not allow for comparisons of specific racial or ethnic groups. The SES groups were created primarily using parental education as a proxy for SES.

CONCLUSIONS

The results suggest that HINT screening in the United States is supported on the basis of Canadian norms and the validity of the HINT in screening for motor and cognitive delays. Although there is preliminary support for the HINT as an appropriate screening tool for US infants who are nonwhite or who have parents with a lower SES, more research is warranted.

The influence of wakeful prone positioning on motor development during the early life

OBJECTIVE

The "Prone to Play" campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket.

METHODS

Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months.

RESULTS

The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes.

CONCLUSION

Wakeful prone positioning promotes prone-specific motor milestones in early infancy. "Prone to play for a certain amount of time in an interactive and supervised environment" might be advocated.

Parenting preemies: a unique program for family support and education after NICU discharge

Research supports the importance of family-centered care in the neonatal intensive care unit (NICU). The significance of continuity in family-centered care beyond the NICU has recently gained attention. Parenting Preemies is a unique and easily replicated postdischarge program designed to ease the transition from hospital to home for NICU graduates and their families. The comprehensive program provides an effective means to demonstrate ongoing, family-centered, and cost-effective outreach after discharge. The specific target population includes premature, low birth-weight, and special needs infants, and their parents. A multidisciplinary team utilizes evidenced-based principles to facilitate an education and support group, in conjunction with home visits, as the foundation for promotion of optimal outcomes for preemies and their parents. Participant satisfaction is consistently positive.

Development of the Daily Activities of Infants Scale: a measure supporting early motor development

We describe the development and preliminary psychometric testing of the Daily Activities of Infants Scale (DAIS), a parent-completed measure of opportunities parents provide infants for development of postural control and movement. First we obtained 1300 photographs of typical activities from 17 families with infants aged 4 to 11 months. Through consensus we established nine dimensions of activities, graded across three levels of opportunity for development. Pilot testing supported content validity of the DAIS. Subsequently, 50 parents of infants born preterm aged 4 to 11 months participated in psychometric testing. There were 25 male and 25 female infant participants with a mean gestational age of 29.4 weeks (SD 3.6) and a mean birthweight of 1266 grams (SD 635). We found that completion of the DAIS over 1 day was representative of data collected over 3 sequential days. Older infants obtained significantly higher DAIS scores than younger infants, providing preliminary evidence for discriminant validity. The DAIS scores demonstrated a part-correlation of 0.20 (p<0.01) with scores on the Alberta Infant Motor Scale obtained concurrently, providing some evidence for convergent validity. The intraclass correlation coefficients reflecting interrater reliability and test-retest reliability of the total DAIS score were 0.76 (95% confidence interval [CI] 0.60-0.86) and 0.77 (95% CI 0.60-0.87) respectively. The DAIS has sufficient reliability and validity for use in clinical practice and research.

A review of the effects of sleep position, play position, and equipment use on motor development in infants

Since 1992, parents have been urged to place their infants on their back when asleep. The resulting lack of experience in a prone position appears to cause developmental delay in infants. Use of various infant equipment, except baby walkers, has not been examined thoroughly to establish their influence on the motor development of infants. The aim of this systematic review was to evaluate the effects of sleep and play positions, and use of infant equipment, on motor development. Nineteen studies with evidence at level II were selected against the selection criteria and scored against the Physiotherapy Evidence Database scale. Despite the generally poor methodological quality, the studies have consistently shown that there was transient delay in motor development for healthy term and low-risk preterm infants who were not exposed to the prone position or who did not use infant equipment. However, most of these infants walked unaided within a normal time frame. Limited evidence was found for the effect on more vulnerable infants. More rigorous longitudinal studies using outcome measures focusing on movement quality are recommended to understand any long-lasting influence on the motor skills in these infants.

Motor development and sleep, play, and feeding positions in very-low-birthweight infants with and without white matter disease

We investigated the association of infants' sleep and awake positioning with motor milestone acquisition as measured by the Alberta Infant Motor Scale (AIMS). Participants were 30 very-low-birthweight (VLBW) infants with preterm white matter disease (PTWMD; 21 males, nine females; mean birthweight [BW] 1,129 g [SD 338]; mean gestational age [GA] 28 wks [SD 2.44]); 21 VLBW infants without preterm WMD (PT; 13 males, eight females; mean BW 1,107 g [SD 370]; mean GA 28.05 wks [SD 2.21]); and 17 term infants (Term; seven males, 10 females; mean BW 3,565 g [SD 382]; mean GA 40 wks [SD 1.31]). Testing occurred at 1, 5, and 9 months of age (corrected for prematurity). Preferred positions during sleeping, playing, and feeding were obtained through parent interview. These positions and group were the independent variables. Prone sleeping was significantly and positively associated with motor development at all ages (1 mo: p=0.005; 5 mo: p=0.011; 9 mo: p=0.040). At 5 months, prone sleeping and playing were significantly and positively associated with AIMS scores (prone sleeping, p=0.016; prone playing, p=0.047). However, group was negatively associated with preterm white matter disease, with the PTWMD group having significantly lower AIMS scores than the Term group (p=0.029). At 9 months, sitting playing and group membership were significantly associated with AIMS scores (sitting playing, p=0.005; group, p=0.012). Prone positioning should be encouraged for awake time, particularly for infants with preterm white matter disease.

Development and construct validation of an inventory for assessing the home environment for motor development

A contemporary view of early childhood motor development considers environmental influences as critical factors in optimal growth and behavior, with the home being the primary agent. However, there has been minimal research examining the relationship between motor development and the home. The present study addresses this gap with the goal of creating an innovative parental self-report instrument to assess the quality and quantity of factors (affordances and events) in the home that are conducive to enhancing motor development in children ages 18-42 months. Following initial face validity determination, expert opinion feedback and selective pilot testing, construct validity was examined using 321 Portuguese families. Factor analysis techniques were used to: (a) compare competingf actorial models according to previous theoretical assumptions, and (b) analyze the fit of the preferred model. Of the five plausible models tested, the five-factor solution provided the best fit to the data. Reliability was established through the scale reliability coefficient with a value of .85. The findings of this study suggest that the Affordances in the Home Environment for Motor Development Self-Report is a valid and reliable instrument to assess how well home environments afford movement and potentially promote motor development.