Development of Movement and Postural Patterns in Full-Term Infants Who Are at Low Risk in Belgium, India, Norway, and
Lynn Boswell1,2, Lars Adde3,4, Toril Fjørtoft3,4
1Division of Rehabilitative Services, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Fidgety movements in infants are generally normal and unaffected by country or environment, indicating universal development. However, age adequacy and overall motor scores show country-specific variations, suggesting potential needs for local norms in infant motor assessments.
Area of Science:
- Developmental Pediatrics
- Neuroscience
- Global Health
Background:
- Understanding typical infant motor development is crucial for identifying atypical patterns.
- The General Movement Assessment (GMA) is a validated tool for evaluating infant motor skills.
- Cross-cultural studies are needed to establish the universality of developmental milestones.
Purpose of the Study:
- To investigate factors influencing motor development in low-risk infants across Belgium, India, Norway, and the United States.
- To assess the impact of country, sex, and perinatal factors on infant motor development using the GMA.
- To determine if fidgety movements are culturally invariant.
Main Methods:
- A cross-sectional study of 186 healthy, full-term infants aged 10-16 weeks postterm.
- Certified observers used the General Movement Assessment to evaluate fidgety movements, movement quality, and the Motor Optimality Score-Revised (MOS-R).
- Statistical analyses explored associations between motor scores and infant characteristics (sex, birth weight, gestational age) and country.
Main Results:
- The vast majority of infants exhibited normal fidgety movements (96.2%), with no significant variation by country or other factors.
- Variability was observed in age adequacy of movement repertoire (74.9%), postural patterns (89.6%), and smooth movement character (75.4%).
- Younger postterm age was associated with atypical postural patterns, and both postterm age and country influenced age adequacy; infants from India had lower optimal MOS-R scores compared to Norway.
Conclusions:
- Fidgety movements appear to be a reliable indicator of typical motor development, unaffected by cultural or environmental influences.
- While fidgety movements are universal, other aspects of motor development assessed by MOS-R show country-specific variations.
- Further research with larger cohorts and longitudinal follow-up is recommended to establish local norms for MOS-R interpretation.
Objective:
The objective of this study was to investigate the influences on motor development in infants who are at low risk from Belgium, India, Norway, and the United States using the General Movement Assessment at 10-16 weeks postterm age.
Methods:
This was a cross-sectional study of prospectively enrolled full-term infants at low risk (n = 186). Certified General Movement Assessment observers rated the fidgety movements, quality of the movement patterns, age-adequacy of the movement repertoire, postural patterns, movement character, and overall Motor Optimality Score-Revised (MOS-R). Scores were evaluated for associations with sex, birth weight category, gestational age, postterm age at video, and country.
Results:
The majority of infants had normal fidgety movements (179/186, 96.2%). This did not vary by sex, birth weight, gestational age, postterm age at video, or country. All infants showed normal>atypical movement patterns. Variability was seen for age adequacy (optimal: 137/183, 74.9%), postural patterns (normal>atypical: 164/183, 89.6%), and smooth/ fluent movement character (138/183, 75.4%). Gestational age and postterm age at video were associated with atypical postural patterns, but in multivariable regression, only younger postterm age retained significance (OR = 2.94, 95% CI = 1.05-8.24). Lack of age adequacy was associated with postterm age (OR = 13.15, 95% CI = 4.36-39.72) and country (compared with Norway; Belgium OR = 3.38 95% CI = 12.4-9.22; India OR = 3.16, 95% CI = 1.01-9.87; United States not significant). Infants from India also showed lower rates of an optimal MOS-R (25-28) than infants from Norway.
Conclusion:
The normality and temporal organization of fidgety movements did not differ by sex, birth weight, postterm age, or country, suggesting that the fidgety movements are free of cultural and environmental influences. The majority of full-term infants who were healthy in this cohort showed normal scores for all aspects of motor development tested using the MOS-R. Differences in age adequacy and MOS-R by country warrant investigation with larger cohorts and longitudinal follow-up.
Impact:
Understanding variations in typical motor development is essential to interpreting patterns of movement and posture in infants at risk for atypical development. Using the framework of Prechtl's General Movement Assessment, this study showed that the development of movement and posture in healthy infants was affected by age and country of birth, but the development of the fidgety movements appeared to be free of these influences. Local norms may be needed to interpret the Motor Optimality Score-Revised in all populations, but further research on this topic is needed.
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