!

SSESSMENTOFGROSSMOTORDEVELOPMENTINTHE7(/
-ULTICENTRE'ROWTH2EFERENCE3TUDY

4RUDY-!7IJNHOVEN-ERCEDESDE/NIS!DELHEID7/NYANGO4RACEY7ANG

'UNN %LIN!"JOERNEBOE.ITA"HANDARI!NNA,ARTEYAND"ADRIYA!L2ASHIDI
FORTHE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDY'ROUP

!BSTRACT SITES CONDUCTED REGULAR STANDARDIZATION SESSIONS $ATA

COLLECTIONANDDATAQUALITYCONTROLTOOKPLACESIMULTA
4HE OBJECTIVE OF THE -OTOR $EVELOPMENT 3TUDY WAS TO NEOUSLY$ATAVERIFICATIONANDCLEANINGWEREPERFORMED
DESCRIBETHEACQUISITIONOFSELECTEDGROSSMOTORMILESTONES UNTILALLQUERIESHADBEENSATISFACTORILYRESOLVED
AMONGAFFLUENTCHILDRENGROWINGUPINDIFFERENTCULTURAL
SETTINGS 4HIS STUDY WAS CONDUCTED IN 'HANA )NDIA
.ORWAY/MANANDTHE5NITED3TATESASPARTOFTHELON +EYWORDS#HILDCHILDDEVELOPMENTINFANTLONGI
GITUDINALCOMPONENTOFTHE7ORLD(EALTH/RGANIZATION TUDINALSTUDYMOTORDEVELOPMENTMOTORSKILLS
7(/ -ULTICENTRE'ROWTH2EFERENCE3TUDY-'23 
)NFANTSWEREFOLLOWEDFROMTHEAGEOFFOURMONTHSUNTIL
THEYCOULDWALKINDEPENDENTLY3IXMILESTONESTHATARE )NTRODUCTION
FUNDAMENTAL TO ACQUIRING SELF SUFFICIENT ERECT LOCOMO
TION AND ARE SIMPLE TO EVALUATE WERE ASSESSED SITTING -OTOR BEHAVIOR IS AN ESSENTIAL ASPECT OF CHILD
WITHOUT SUPPORT HANDS AND KNEES CRAWLING STANDING DEVELOPMENT'IVENTHEUNIQUEOPPORTUNITYPROVIDED
WITHASSISTANCEWALKINGWITHASSISTANCESTANDINGALONE BYTHE7ORLD(EALTH/RGANIZATION7(/ -ULTICENTRE
ANDWALKINGALONE4HEINFORMATIONWASCOLLECTEDBYBOTH 'ROWTH 2EFERENCE 3TUDY -'23  A COMPONENT TO
THECHILDRENSCAREGIVERSANDTRAINED-'23FIELDWORKERS ASSESS GROSS MOTOR DEVELOPMENT WAS INCLUDED IN THE
4HECAREGIVERSASSESSEDANDRECORDEDTHEDATESWHENTHE PROTOCOL -OTOR DEVELOPMENT IS USUALLY ASSESSED IN
MILESTONESWEREACHIEVEDFORTHEFIRSTTIMEACCORDINGTO TERMS OF AGE OF ACHIEVEMENT OF MOTOR MILESTONES
ESTABLISHEDCRITERIA5SINGSTANDARDIZEDPROCEDURESTHE ;= "ESIDES THE DETERMINATION OF AGE AT ATTAINMENT
FIELDWORKERSINDEPENDENTLYASSESSEDTHEMOTORPERFORM LONGITUDINAL ASSESSMENT OF DIFFERENT TYPES OF MOTOR
ANCEOFTHECHILDRENANDCHECKEDPARENTALRECORDINGAT SKILLSHASTHEADVANTAGEOFPROVIDINGAPROFILEOFTHEIR
HOMEVISITS4OENSURESTANDARDIZEDDATACOLLECTIONTHE SEQUENCEANDTEMPO;=(OWEVERFEWSTUDIESUSING
A LONGITUDINAL DESIGN HAVE BEEN DONE ON THE AGE OF
ACHIEVEMENTOFCERTAINMOTORMILESTONES;n=AND
4RUDY-!7IJNHOVEN-ERCEDESDE/NISAND!DELHEID ONLY TWO OF THEM ARE OF A MULTICOUNTRY NATURE ;
7/NYANGOAREAFFILIATEDWITHTHE$EPARTMENTOF.UTRITION
7ORLD (EALTH /RGANIZATION 'ENEVA 3WITZERLAND 4RACEY =
7ANG IS AFFILIATED WITH THE $EPARTMENT OF .UTRITION 4OOURKNOWLEDGETHISISTHEFIRSTLONGITUDINALSTUDY
5NIVERSITYOF#ALIFORNIA$AVIS#ALIFORNIA53!'UNN %LIN THATHASUSEDASTANDARDIZEDPROTOCOLTODESCRIBEGROSS
!"JOERNEBOEISAFFILIATEDWITHTHE.ORWEGIAN$IRECTORATE MOTOR DEVELOPMENT AMONG GROUPS OF CHILDREN WITH
FOR(EALTHAND3OCIAL!FFAIRS/SLO.ORWAY.ITA"HANDARI
IS AFFILIATED WITH THE $EPARTMENT OF 0EDIATRICS !LL )NDIA NOHEALTHENVIRONMENTALORECONOMICCONSTRAINTSON
)NSTITUTEOF-EDICAL3CIENCES.EW$ELHI)NDIA!NNA,ARTEYIS GROWTHLIVINGINDIFFERENTCOUNTRIES4HESTUDYSAMPLE
AFFILIATEDWITHTHE$EPARTMENTOF.UTRITIONAND&OOD3CIENCE DESCRIBEDBYTHE7(/4ASK&ORCEFOR%PIDEMIOLOGICAL
5NIVERSITYOF'HANA,EGON!CCRA'HANA"ADRIYA!L2ASHIDI 2ESEARCH ON 2EPRODUCTIVE (EALTH ;= WAS STRATIFIED
ISAFFILIATEDWITHTHE$IRECTORATE'ENERALOF(EALTH3ERVICES INTO THREE DIFFERENT SOCIOECONOMIC LEVEL GROUPS AND
-USCAT2EGION-INISTRYOF(EALTH-USCAT/MAN
0LEASE DIRECT QUERIES TO -ERCEDES DE /NIS 3TUDY #OOR THESTUDYOF(INDLEYETAL;=WASLIMITEDTOTHEASSESS
DINATOR $EPARTMENT OF .UTRITION 7ORLD (EALTH /RGANI MENTOFONEMOTORMILESTONE4HE-'23AIMEDTOFILL
ZATION  !VENUE !PPIA  'ENEVA  3WITZERLAND THISGAPININFORMATIONBYCOLLECTINGDATAONSIXGROSS
4ELEPHONE     FAX     E MAIL MOTOR MILESTONES IN FIVE OF THE COUNTRIES PARTICIPAT
DEONISM WHOINT
-EMBERS OF THE 7(/ -ULTICENTRE 'ROWTH 2EFERENCE INGINITSLONGITUDINALGROWTHANDDEVELOPMENTSTUDY
3TUDY'ROUPAND!CKNOWLEDGMENTSARELISTEDATTHEENDOF 'HANA)NDIA.ORWAY/MANANDTHE5NITED3TATES
THEFIRSTPAPERINTHISSUPPLEMENTPP3n3  5NDERTHEUMBRELLAOFTHE-'23THE-OTOR$EVELOP

&OODAND.UTRITION"ULLETINVOLNOSUPPLEMENT ©4HE5NITED.ATIONS5NIVERSITY 3

3 4-!7IJNHOVENETAL

MENT 3TUDY PROVIDES A UNIQUE OPPORTUNITY TO ASSESS 'ROSSMOTORMILESTONESDESCRIPTIONCRITERIAAND
GROUPANDINDIVIDUALVARIABILITYINTHEACQUISITIONOF TESTINGPROCEDURE
KEYMOTORSKILLSASWELLASPROVIDINGANOPPORTUNITYTO
ANALYZETHERELATIONSHIPBETWEENPHYSICALGROWTHAND 3IXDISTINCTGROSSMOTORMILESTONESWERESELECTEDFOR
GROSS MOTOR DEVELOPMENT AMONG GROUPS OF AFFLUENT STUDYSITTINGWITHOUTSUPPORTHANDS AND KNEESCRAWL
CHILDRENGROWINGUPINDIFFERENTCULTURALSETTINGS INGSTANDINGWITHASSISTANCEWALKINGWITHASSISTANCE
4HISPAPEROUTLINESTHE-OTOR$EVELOPMENT3TUDY STANDING ALONE AND WALKING ALONE 4HESE MILESTONES
PROTOCOLFORCOLLECTINGINFORMATIONONSIXMOTORMILE WERESELECTEDBECAUSETHEYARECONSIDEREDTOBEUNI
STONESTHEMETHODSANDPROCEDURESOFDATACOLLECTION VERSALFUNDAMENTALTOTHEACQUISITIONOFSELF SUFFICIENT
ANDTHETRAININGANDSTANDARDIZATIONOFFIELDWORKERS ERECTLOCOMOTIONANDSIMPLETOTESTANDEVALUATE
"EFORE THE ACHIEVEMENT OF ANY OF THE SIX MOTOR
SKILLS THE CHILD GOES THROUGH MANY PRECEDING INTER
-ETHODS MEDIATESTAGESOFDEVELOPMENT;=%VALUATIONOF
AMILESTONEPERFORMANCECONSISTSINOBSERVINGNOTONLY
3TUDYSUBJECTSANDSTUDYDESIGN WHATACHILDDOESBUTALSOHOWANDWITHWHATLEVELOF
DEVELOPMENTHEORSHEDOESIT;=4HEREISALSOANEED
4HEMOTORDEVELOPMENTASSESSMENTSWEREDONEFROM TOINCLUDEINTHECRITERIAFORTESTINGWHETHERACHILDCAN
THEAGEOFFOURMONTHSONALLSUBJECTSENROLLEDINTHE PERFORMAMILESTONEINDEPENDENTLYORPERFORMSITAFTER
LONGITUDINALCOMPONENTOFTHE-'23$ETAILSOFTHE HAVINGBEENPLACEDINTOPOSITION;=4HUSINORDERTO
ENROLLMENTOFSUBJECTSTHEINCLUSIONCRITERIAANDTHE MINIMIZEINTERPERSONALINTERPRETATIONDIFFERENCESEACH
-'23 STUDY DESIGN ARE EXPLAINED ELSEWHERE IN THIS TESTITEMNEEDEDTOBECLEARLYDEFINEDWITHRESPECTTO
SUPPLEMENT;=4HESTUDYTOOKPLACEINFIVEOFTHE THEMETHODOFADMINISTRATIONANDTHEINTERPRETATION
SIXCOUNTRIESPARTICIPATINGINTHE-'23'HANA)NDIA OFTHECHILDSPERFORMANCE;=
.ORWAY/MANANDTHE5NITED3TATES4HEIMPLEMEN 4HEDESCRIPTIONSOFTHESIXGROSSMOTORSKILLSUSED
TATIONOFTHESTUDYPROTOCOLSINEACHOFTHESECOUNTRIES IN THIS STUDY ORIGINATED FROM VARIOUS EXISTING DEVEL
IS DESCRIBED IN SEPARATE PAPERS IN THIS SUPPLEMENT OPMENTAL SCALES ;  n= 4HE SEQUENTIAL PRES
;n=4HE"RAZILIANSITEWASUNABLETOPARTICIPATE ENTATIONOFTHEMOTORMILESTONESFOLLOWEDTHEPATTERN
INTHE-OTOR$EVELOPMENT3TUDYBECAUSETHESITEHAD GENERALLY FOUND IN THE LITERATURE ;n= (OWEVER
INITIATED DATA COLLECTION BY THE TIME THE DECISION TO OCCASIONALLY THE SUGGESTED SEQUENCE BETWEEN TWO
ASSESSMOTORDEVELOPMENTWASTAKEN OR MORE MILESTONES MIGHT ACTUALLY BE REVERSED AND
OBSERVED MILESTONES MIGHT BE INHIBITED LATER ;=
4HEREFORENOFIXEDDEVELOPMENTALSEQUENCEOFACHIEVE
MENTWASASSUMED
!LL MILESTONES WERE ASSESSED USING STANDARDIZED

4!",%-'23PERFORMANCECRITERIAFORSIXGROSSMOTORMILESTONES
'ROSSMOTORMILESTONE -'23PERFORMANCECRITERIA
3ITTINGWITHOUTSUPPORT #HILDSITSUPSTRAIGHTWITHTHEHEADERECTFORATLEASTSECONDS#HILDDOESNOTUSEARMS
ORHANDSTOBALANCEBODYORSUPPORTPOSITION
(ANDS AND KNEESCRAWLING #HILDALTERNATELYMOVESFORWARDORBACKWARDONHANDSANDKNEES4HESTOMACHDOESNOT
TOUCHTHESUPPORTINGSURFACE4HEREARECONTINUOUSANDCONSECUTIVEMOVEMENTSATLEAST
THREEINAROW
3TANDINGWITHASSISTANCE #HILDSTANDSINUPRIGHTPOSITIONONBOTHFEETHOLDINGONTOASTABLEOBJECTEGFURNITURE
WITHBOTHHANDSWITHOUTLEANINGONIT4HEBODYDOESNOTTOUCHTHESTABLEOBJECTAND
THELEGSSUPPORTMOSTOFTHEBODYWEIGHT#HILDTHUSSTANDSWITHASSISTANCEFORATLEAST
SECONDS
7ALKINGWITHASSISTANCE #HILDISINUPRIGHTPOSITIONWITHTHEBACKSTRAIGHT#HILDMAKESSIDEWAYSORFORWARDSTEPS
BYHOLDINGONTOASTABLEOBJECTEGFURNITURE WITHONEORBOTHHANDS/NELEGMOVES
FORWARDWHILETHEOTHERSUPPORTSPARTOFTHEBODYWEIGHT#HILDTAKESATLEASTFIVESTEPS
INTHISMANNER
3TANDINGALONE #HILDSTANDSINUPRIGHTPOSITIONONBOTHFEETNOTONTHETOES WITHTHEBACKSTRAIGHT4HE
LEGSSUPPORTOFTHECHILDSWEIGHT4HEREISNOCONTACTWITHAPERSONOROBJECT
#HILDSTANDSALONEFORATLEASTSECONDS
7ALKINGALONE #HILDTAKESATLEASTFIVESTEPSINDEPENDENTLYINUPRIGHTPOSITIONWITHTHEBACKSTRAIGHT
/NELEGMOVESFORWARDWHILETHEOTHERSUPPORTSMOSTOFTHEBODYWEIGHT4HEREISNO
CONTACTWITHAPERSONOROBJECT
!SSESSMENTOFGROSSMOTORDEVELOPMENT 3

&)'3ITTINGWITHOUTSUPPORT &)'(ANDS AND KNEESCRAWLING

TESTINGPROCEDURES4ABLEDESCRIBESTHE-'23PER 3TANDINGWITH
FORMANCECRITERIAFORTHESIXMILESTONES!MILESTONE ASSISTANCElG &)'3TANDINGWITHASSISTANCE
WASCONSIDEREDACHIEVEDONLYIFALLTHEGIVENCRITERIA $ESCRIPTION4HISIS
WEREMET THEFIRSTDIRECTSTEPTOWARDERECTBIPEDALLOCOMOTION
IN WHICH THE CHILD IS FOR THE FIRST TIME CHALLENGED TO
3ITTINGWITHOUTSUPPORTlG MAINTAINSOMEBALANCEOFTHEWHOLEBODYWEIGHTSOTHAT
$ESCRIPTION4HECHILDISABLETOBALANCETHEWEIGHTOF HEORSHECANMOVEFORWARD4HESALIENTCHARACTERISTICIS
THETRUNKANDHEADWITHOUTANYEXTERNALSUPPORTORTHE WHETHERTHECHILDCANACTUALLYSUPPORTHISORHERWEIGHT
USEOFARMSANDHANDS4HECHILDSITSUPSTRAIGHTWITH IFHEORSHEISHOLDINGONTOASTABLEOBJECTEGAPIECE
THEHEADERECTTHATISNOTLEANINGFORWARD /NEOFTHE OFFURNITURE WITHBOTHHANDSWITHOUTLEANINGOVEROR
LOWERLIMBSISUSUALLYFLEXED RESTINGTHEBODYONTHESTABLEOBJECT
#RITERIAA 4HECHILDSHEADISERECTB THECHILDDOES #RITERIAA 4HECHILDISINANUPRIGHTPOSITIONONBOTH
NOTUSETHEARMSORHANDSTOBALANCEBODYORSUPPORT FEETB THECHILDHOLDSONTOASTABLEOBJECTWITHBOTH
POSITION C THE CHILD SITS UP STRAIGHT FOR AT LEAST  HANDSWITHOUTLEANINGONITC THECHILDSBODYDOES
SECONDS NOT TOUCH THE STABLE OBJECT D THE CHILDS LEGS SUP
PORTMOSTOFTHECHILDSBODYWEIGHTE THECHILDTHUS
4ESTING PROCEDURE &ACING THE CHILD AND SMILING THE
STANDSWITHASSISTANCEFORATLEASTSECONDS
FIELDWORKERPLACESTHECHILDINASITTINGPOSITION4HE
FIELDWORKERTHENGIVESTHECHILDATOYTOHANDLEWITH 4ESTINGPROCEDURE4HEFIELDWORKERPLACESTHECHILDIN
BOTHHANDSSOTHATHEORSHEISNOTABLETOUSETHEARMS ASTANDINGPOSITIONSOTHATTHELEGSSUPPORTTHEBODY
TOSUPPORTHIMSELFORHERSELF WEIGHT4HECHILDISPLACEDATADISTANCEFROMWHICH
BOTH HANDS BUT NOT THE BODY CAN REACH AND HOLD
(ANDS AND KNEESCRAWLINGlG ONTO A STABLE OBJECT 4HUS MOST OF THE BODY WEIGHT
$ESCRIPTION4HISISAPHASEOFAMOREORGANIZEDPRONE ISSUPPORTEDBYTHECHILDSOWNFEET4HEFIELDWORKER
MOVEMENTTHATREFERSTOTHEPALM KNEEPOSITIONWITH SHOULD CHECK THAT THE CHILD IS NOT LEANING OVER OR
ALTERNATINGMOVEMENTSOFTHEUPPERANDLOWERLIMBS RESTINGHISORHERBODYONTHESTABLEOBJECT4HEHEIGHT
THERIGHTARMANDLEFTLEGMOVEFORWARDORBACKWARD OFTHESTABLEOBJECTSHOULDBEATABOUTTHESAMELEVEL
SYNCHRONOUSLYANDVICEVERSAINSIMILARLYORDEREDCON ASTHECHILDSSTOMACH
SECUTIVEMOVEMENTS
#RITERIAA !LTERNATINGMOVEMENTFORWARDORBACK
WARDONHANDSANDKNEESB THECHILDSSTOMACHDOES
NOTTOUCHTHESUPPORTINGSURFACEC CONTINUOUSAND
CONSECUTIVEMOVEMENTSATLEASTTHREEINAROW
4ESTINGPROCEDURE4HEFIELDWORKERPLACESTHECHILDIN
THEPRONEPOSITIONWITHTHEABDOMENABOVETHESUP
PORTINGSURFACE4HEFIELDWORKERPLACESHIMSELFORHER
SELFINFRONTOFTHECHILDABOUTTOCMAWAY)F
THECHILDDOESNOTCRAWLSPONTANEOUSLYTHEFIELDWORKER
SHOWSTHECHILDATOYOROBJECTTHATATTRACTSTHECHILDS
VISUALATTENTION4HEFIELDWORKERSOMETIMESWITHTHE
HELP OF THE CAREGIVER THEN TRIES TO COAX THE CHILD TO
CRAWLTOWARDTHETOYANDGRABIT
&)'7ALKINGWITHASSISTANCE
3 4-!7IJNHOVENETAL

7ALKINGWITHASSISTANCElG WHETHERTHECHILDCANMODIFYPOSTUREADJUSTTOTHENEW

$ESCRIPTION4HISINVOLVESADELIBERATEATTEMPTTOMAKE POSITIONANDSTANDALONEFORATLEASTSECONDS
STEPPINGMOVEMENTSANDTOMAKEPOSTURALADJUSTMENTS
TOWARDTHISENDWHILEHOLDINGONTOASTABLEOBJECTEG 7ALKINGALONElG
FURNITURE FORSUPPORT $ESCRIPTION 4HE CHILD SHOWS THE CAPACITY TO BALANCE
THE BODY AND TO CONTROL HIS OR HER FORWARD STEPPING
#RITERIAA 4HECHILDISINANUPRIGHTPOSITIONWITHTHE
MOVEMENTS4HEREISNONEEDFORASSISTANCEBECAUSE
BACKSTRAIGHTB THECHILDMAKESSIDEWAYSORFORWARD
BOTHTHEPOSTURALADJUSTMENTANDTHESTEPPINGMOVE
STEPSBYHOLDINGONTOASTABLEOBJECTWITHONEORBOTH
MENTSAREENGAGEDININDEPENDENTWALKING!NIMPOR
HANDSC ONELEGMOVESFORWARDWHILETHEOTHERSUP
TANTINDICATOROFTHISPHASEOFERECTLOCOMOTIONISTHAT
PORTSPARTOFTHEBODYWEIGHTD THECHILDTAKESATLEAST
MOVEMENTOFTHEENTIREBODYDOESNOTACCOMPANYTHE
FIVESTEPSINTHISMANNER
CHILDSSTEPPINGMOVEMENTS4HISPHASEDOESNOTREFER
4ESTINGPROCEDURE4HEFIELDWORKERPLACESTHECHILDIN TOTHECHILDSFIRSTINDEPENDENTSTEPSWHENTHECHILDIS
A STANDING POSITION SO THAT THE LEGS SUPPORT MOST OF ABLETOTAKETHREEORFOURUNCERTAINSTEPSTOWARDTHE
THEBODYWEIGHT4HECHILDISPLACEDATADISTANCEFROM ADULTSOUTSTRETCHEDHANDS
WHICHHEORSHECANREACHANDHOLDONTOASTABLEOBJECT
#RITERIAA 4HECHILDISINANUPRIGHTPOSITIONWITH
WITH ONE OR BOTH HANDS )F THE CHILD DOES NOT MOVE
THEBACKSTRAIGHTB ONELEGMOVESFORWARDWHILETHE
SPONTANEOUSLY THE FIELDWORKER SHOWS THE CHILD A TOY
OTHERSUPPORTSMOSTOFTHEBODYWEIGHTC THEREISNO
OROBJECTTHATATTRACTSTHECHILDSVISUALATTENTION4HE
CONTACTWITHAPERSONORANOBJECTD THECHILDTAKES
FIELDWORKERSOMETIMESWITHTHEHELPOFTHECAREGIVER
ATLEASTFIVESTEPSINDEPENDENTLY
THENTRIESTOCOAXTHECHILDTOWALKTOWARDTHETOYAND
GRAB IT 4HE HEIGHT OF THE STABLE OBJECT SHOULD BE AT 4ESTINGPROCEDURE4HEFIELDWORKERPLACESTHECHILDIN
ABOUTTHESAMELEVELASTHECHILDSSTOMACH ANERECTPOSITIONOUTOFTHEREACHOFANYSUPPORTING
OBJECT4HENTHEFIELDWORKERTAKESAPOSITIONABOUT
3TANDINGALONElG TOCMINFRONTOFTHECHILDANDCALLSTHECHILDTO
$ESCRIPTION4HECHILDSHOWSTHECAPACITYFORBOTHEQUI MOVETOWARDTHEFIELDWORKER3OMETIMESTHECAREGIVER
LIBRATIONANDSUSTAININGBODYWEIGHTONTHEFEET)NTHIS NEEDSTOENCOURAGETHECHILD
POSITIONTHECHILDSLEGSSHOWNOFLEXIONANDTHECHILD
ISSTANDINGONTHEFEETNOTONTHETOES WITHOUTLEANING 4HECHILDSEMOTIONALSTATE
OVER OR HOLDING ONTO AN OBJECT 4HE CHILD MAINTAINS
CONTINUOUSBALANCEINDEPENDENTLY "ECAUSE EMOTIONAL AROUSAL CAN EITHER ENHANCE OR
UNDERMINEMOTORBEHAVIORTHEFIELDWORKERRATEDTHE
#RITERIA A 4HE CHILD IS IN AN UPRIGHT POSITION ON
OVERALLEMOTIONALSTATEOFTHECHILDDURINGTHETESTING
BOTHFEETNOTONTHETOES WITHTHEBACKSTRAIGHTB
OFALLTHESIXGROSSMOTORMILESTONESACCORDINGTOTWO
THECHILDSLEGSSUPPORTOFTHECHILDSWEIGHTC
SCALES;=&IRSTTHESCALEOFCONSCIOUSNESSWASRATED
THEREISNOCONTACTWITHAPERSONORANOBJECTD THE
EITHER AS DROWSY OR AS AWAKE AND ALERT 3ECOND THE
CHILDSTANDSALONEFORATLEASTSECONDS
CHILDS IRRITABILITY WAS RATED AS BEING CALM FUSSY OR
4ESTING PROCEDURE 4HE FIELDWORKER PLACES THE CHILD UPSETCRYING 
WITHBOTHFEETFLATONTHEFLOORANDSUPPORTSTHECHILD )DEALLY THE CHILD SHOULD BE AWAKE ALERT AND CALM
TOANERECTPOSITION4HENTHEFIELDWORKERWITHDRAWS DURING THE ASSESSMENTS OF MOTOR SKILLS $ROWSINESS
THE SUPPORT GRADUALLY AND TEMPORARILY TO DETERMINE FUSSINESSANDCRYINGWERENOTREASONSFORNOTTESTINGIF
THECHILDWASSTILLABLETODISPLAYTHEMILESTONEUNDER
TESTING(OWEVERIFTHEYINTERFEREDWITHASSESSMENT
THECHILDWASRETESTEDWHENHEORSHEWASCALM)FA
CHILDWASASLEEPHEORSHEWASNOTWOKENUPTOBE
TESTED
)N THE CONTEXT OF THE -'23 THE FIELDWORKERS
PREFERABLYTESTEDTHECHILDONTHEMOTORSKILLSAFTER
THECOMPLETIONOFTHEANTHROPOMETRICMEASUREMENTS
(OWEVERIFTHECHILDWASKNOWNTOBECOMEUPSETBY
THEANTHROPOMETRICMEASUREMENTSTESTINGONMOTOR
MILESTONES OCCURRED PRIOR TO THESE MEASUREMENTS
)F THE CAREGIVER ANDOR THE CHILD WERE OBVIOUSLY
DISTRAUGHTORIFTHECHILDWASSICKDURINGAFOLLOW UP
VISITTESTINGDIDNOTOCCUR

&)'3TANDINGALONE &)'7ALKINGALONE
!SSESSMENTOFGROSSMOTORDEVELOPMENT 3

4RAININGANDSTANDARDIZATIONOFlELDWORKERS AGES OF AGREEMENT WERE GENERATED BY CALCULATING A

CORRELATIONBETWEENTHESTANDARDSCOREANDTHESCORES
4RAINING OBTAINEDBYTHETESTERANDTHEOBSERVERSINASITE
4HE -'23 FIELDWORKERS SELECTED TO CARRY OUT THE 4HE RESULTS OF THE SESSIONS AND COMMENTS ON THE
MOTOR DEVELOPMENT ASSESSMENTS WERE TRAINED AT OBSERVED DISAGREEMENT BETWEEN THE STANDARD SCORE
THEIR OWN STUDY SITE BY AN EXTERNAL EXPERT PRIOR TO AND A FIELDWORKERS SCORE AS WELL AS ON THE TESTERS
THEINITIATIONOFDATACOLLECTION4HETRAININGINVOLVED PERFORMANCEOFTHEASSESSMENTSWERESENTASFEEDBACK
LECTURES DISCUSSIONS OBSERVATIONS AND ASSESSMENTS TOTHESITE!CUTOFFPOINTOFAGREEMENTWASSETTO
OFAGROUPOFABOUTCHILDRENAGEDnMONTHS  DETERMINEWHETHERFURTHERTRAININGWASREQUIRED
)TCONSISTEDOFTWODAYSOFINITIALTRAININGONEDAYOF
EVALUATION OF THE TRAINEES AND TWO DAYS OF GUIDED 3TANDARDIZATIONOFCONDITIONSFORTESTING
HOME VISITS $URING THE TWO DAY INITIAL TRAINING THE
ASSESSMENTSCARRIEDOUTBYTHETRAINEESWEREVIDEOTAPED )TISWELLDOCUMENTEDTHATCHILDREARINGPRACTICES;=
AND REVIEWED AFTERWARDS BY THE TRAINER AND TRAINEES ANDENCOURAGEMENTBYTRAININGANDPRACTICE;=
4HE EVALUATION SESSION WHICH WAS RECORDED AS WELL ACCOUNTFORPARTOFTHEVARIABILITYINTHEACHIEVEMENT
ASSESSEDTHETRAINEESABILITYTOSCORETHEACHIEVEMENT OFMOTORMILESTONES$ATACOLLECTIONINTHESTUDYTOOK
OFTHESIXMOTORMILESTONES4HISSESSIONINVOLVEDBOTH PLACEATTHECHILDRENSHOMESSOTHATTHESTANDARDIZA
TRAINER AND TRAINEES 4HE TRAINER TESTED AND SCORED TION OF THE ENVIRONMENT WAS LIMITED /NE SOURCE OF
APPROXIMATELYTOCHILDRENAGEDnMONTHS VARIABILITYHOWEVERTHATCOULDBECONTROLLEDFORWAS
ANDDIDNOTGIVEANYINDICATIONOFTHECHILDRENSSCORES THESOCIALANDPHYSICALCONTEXTINWHICHTHECHILDWAS
TOTHECAREGIVERSORTRAINEES4HETRAINEESOBSERVEDTHE TESTEDANDTHENATUREOFTHEOBJECTSUSEDFORTESTING
CHILDBEINGTESTEDANDINDEPENDENTLYSCOREDTHECHILDS )F PHYSICALLY POSSIBLE AND CULTURALLY APPROPRIATE THE
PERFORMANCEONEACHTESTEDSKILL!FTERTHEEVALUATION NUMBEROFPERSONSPRESENTDURINGTESTINGWASLIMITED
THETRAINEESSCORESWERECOMPAREDWITHTHETRAINERS TOTHREEFIELDWORKERCAREGIVERANDCHILD )FLIMITATION
SCORES AND IN CASE OF DISAGREEMENTS THESE WERE OFTHENUMBEROFPEOPLEINTHEROOMWASNOTPOSSIBLE
DISCUSSEDBYLOOKINGATTHEVIDEOTAPEDSESSION ITWASIMPERATIVETHATOTHEROBSERVERSDIDNOTMOVEOR
MAKEVERBALCOMMENTSDURINGTESTINGUNLESSREQUESTED
3TANDARDIZATION )DEALLYTHESURFACEOFTHEFLOORWHERETHEASSESSMENTS
4HESITESCONDUCTEDREGULARHALF DAYSTANDARDIZATION TOOK PLACE WAS CLEAN AND FREE OF OBJECTS THAT MIGHT
SESSIONSTODETERMINETHEINTEROBSERVERRELIABILITYRATES INTERFEREWITHLOCOMOTION0RIORTOTESTINGTHEFIELD
OFFIELDWORKERS$URINGEACHSESSIONONEMEMBEROF WORKER ASKED THE CAREGIVER TO SELECT A MAXIMUM OF
THE FIELDWORKERS TEAM TESTED AND SCORED A GROUP OF THREETOYSOROBJECTSTHATTHECHILDLIKEDTOPLAYWITH)T
ABOUT  CHILDREN AGED n MONTHS FOR THE SIX WASPRIMARILYTHEFIELDWORKERWHOCARRIEDOUTMOTOR
MOTOR MILESTONES 4HE ASSESSMENT AND PERFORMANCE DEVELOPMENTASSESSMENTDURINGTHEHOMEVISITS(OW
OFTHECHILDRENWEREVIDEOTAPEDFORSUBSEQUENTSCOR EVERINSOMECASESITWASNECESSARYFORTHEFIELDWORKER
INGBYTHEOTHERFIELDWORKERSATTHESAMESITE!TEACH TOASKFORTHECAREGIVERSHELP
SESSION THE FIELDWORKER DOING THE ACTUAL TESTING WAS
ROTATEDSOTHATADIFFERENTPERSONWASTHETESTER4HE $ATACOLLECTION
CHILDSCAREGIVERWASPRESENTBUTWASREQUESTEDNOTTO
INTERFEREWITHTHEASSESSMENTS(OWEVERWHENNEEDED 4HE DATA WERE RECORDED BY THE CHILDS CAREGIVERS
THETESTERASKEDFORTHECAREGIVERSASSISTANCE4HETESTER BETWEENFOLLOW UPVISITSANDBYTHETRAINEDFOLLOW UP
DID NOT GIVE ANY INDICATION OF THE CHILDS SCORES AND TEAM MEMBERS DURING THESE SCHEDULED VISITS TO THE
WROTE THEM ON A STANDARDIZATION RECORD FORM -ILE CHILDRENSHOMES
STONEPERFORMANCECOULDBERATEDASINABILITYREFUSAL
ABILITYORUNABLETOTESTACCORDINGTOTHEESTABLISHED #AREGIVER
CRITERIA SEE BELOW  4HE OTHER FIELDWORKERS WATCHED !T THE FOUR MONTH FOLLOW UP VISIT THE CAREGIVER WAS
THEVIDEOTAPEDSESSIONANDINDEPENDENTLYSCOREDTHE INFORMED ABOUT THE -OTOR $EVELOPMENT 3TUDY AND
PERFORMANCEOFTHESAMECHILDRENONEACHOFTHESIX ASKEDTOSTARTOBSERVINGANDASSESSINGTHECHILDSMOTOR
MILESTONES DEVELOPMENTALLEVELUNTILTHECHILDHADACHIEVEDALLSIX
!FTERTHECONDUCTOFEACHSESSIONTHEVIDEOTAPEOF MILESTONES 4HE CAREGIVER WAS TOLD TO PLACE THE CHILD
THESESSIONANDTHEFIELDWORKERSSCORESWERESENTTOTHE IN THE APPROPRIATE POSITION ACCORDING TO THE DEFINED
#OORDINATING#ENTREOFTHE-'23AT7(/IN'ENEVA TESTING PROCEDURES AS SOON AS THE CAREGIVER OBSERVED
4HE -OTOR $EVELOPMENT 3TUDY COORDINATOR ON THE THATTHECHILDWASMAKINGTHEFIRSTMOVEMENTSTOWARD
#OORDINATING#ENTRETEAMVIEWEDTHETAPEANDSCORED THE ACHIEVEMENT OF A PARTICULAR MILESTONE .O FIXED
THEPERFORMANCEOFTHECHILDREN4HESCORESGIVENBY ORDEROFMILESTONEACHIEVEMENTWASASSUMED
THE COORDINATOR WERE CONSIDERED TO BE THE STANDARD 4HERECORDFORMFORTHECAREGIVERHADONEPAGEAND
TRUE SCORES )NTEROBSERVER RELIABILITY RATES PERCENT PRESENTED THE SIX DRAWINGS OF THE MILESTONES FIGS
3 4-!7IJNHOVENETAL

n ALONGWITHTHEPERFORMANCECRITERIA!DATEBOX SECONDYEAROFFOLLOW UPIEMONTHSAND 

FOR EACH MILESTONE WAS GIVEN IN WHICH THE CAREGIVER 4HEFIELDWORKERASKEDWHETHERTHECHILDHADACHIEVED
RECORDEDTHEDATETHECHILDMETTHECRITERIAFORTHISITEM ASPECIFICMILESTONEANDREMINDEDTHECAREGIVERTOFILL
ANDTHUSACHIEVEDITFORTHEFIRSTTIME!SSOONASTHE OUTTHEPARENTSRECORDFORM)FTHECHILDHADACHIEVEDA
CAREGIVER HAD RECORDED THE DATES OF FIRST APPEARANCE SPECIFICMILESTONETHEFIELDWORKERVERIFIEDTHISBYGOING
OFALLSIXMILESTONESTHECAREGIVERSTOPPEDTHEMOTOR THROUGHTHECRITERIAWITHTHECAREGIVERONTHEPHONE
DEVELOPMENTASSESSMENTS !FTERWARDS AT THE PLANNED HOME VISIT THE FOLLOWING
MONTHTHEFIELDWORKERCHECKEDTHEACQUISITIONOFTHE
&IELDWORKER REPORTEDMILESTONE&IGURESHOWSTHEDATACOLLECTION
4HEFOLLOW
UPTEAMMEMBERTRAINEDINMOTORDEVEL
FORMUSEDBYTHEFIELDWORKERSFORTHEMOTORDEVELOP

OPMENT ASSESSMENTS TESTED AND SCORED ALL OF THE SIX MENTASSESSMENT
GROSSMOTORMILESTONESATEACHHOMEVISIT7HENBOTH
FIELDWORKERS DOING THE HOME VISITS HAD BEEN TRAINED 0ARENTALRECORDING
INMOTORDEVELOPMENTASSESSMENTONLYONEOFTHEM !TEACHVISITTHEFIELDWORKERASKEDTHECAREGIVERABOUT
CARRIEDOUTTHEASSESSMENTANDSCOREDTHECHILDWITH
THEMILESTONESACHIEVEDSINCETHEPREVIOUSFOLLOW
UP
OUT THE INVOLVEMENT OF THE OTHER FIELDWORKER )T WAS VISIT AND OBTAINED THE DATE THAT THE CAREGIVER HAD
NOTNECESSARYTHATTHESAMEFIELDWORKERCARRYOUTALL WRITTENDOWNONTHERECORDFORM)FITWASFOUNDON
THEMOTORDEVELOPMENTASSESSMENTSFORAGIVENCHILD EXAMINATION THAT THE MILESTONES REPORTED BY THE
-OTOR DEVELOPMENT ASSESSMENTS WERE CARRIED OUT CAREGIVERHADNOTACTUALLYBEENATTAINEDBYTHECHILD
MONTHLYDURINGTHEFIRSTYEAROFLIFESTARTINGFROMTHE THEFIELDWORKERCAREFULLYDISCUSSEDTHISWITHTHECARE

FIVE
MONTH VISIT AND THEN EVERY TWO MONTHS IN THE GIVERANDEXPLAINEDTHECRITERIAAGAINTOMAKESURETHAT
SECONDYEAROFLIFEUNTILTHECHILDACQUIREDTHESKILLOF THE CAREGIVER UNDERSTOOD THE CRITERIA FOR THE SPECIFIC
INDEPENDENT WALKING )F AT THE FOUR
MONTH VISIT THE MILESTONE)FTHECAREGIVERAGREEDTHATTHECHILDDIDNOT
TIME POINT WHEN THE FIELDWORKER INFORMED THE CARE
FULFILLALLTHECRITERIATHEFIELDWORKERDREWANEWDATE
GIVERABOUTTHESTUDYTHEFIELDWORKEROBSERVEDTHATA LINE BELOW THE RECORDED DATE ON THE PARENTS RECORD
CHILDHADACHIEVEDACERTAINMILESTONEORACAREGIVER FORMFORTHEMILESTONEINVOLVEDANDASKEDTHECAREGIVER
REPORTEDITSACHIEVEMENTTHENTHEFIELDWORKERSTARTED TORECORDTHEDATEWHENTHISMILESTONEWASACHIEVED
THEASSESSMENTATTHATVISIT4HEREASONSFOREXAMINING ACCORDING TO THE ESTABLISHED CRITERIA )F ON THE OTHER
ALLTHEMILESTONESATEACHHOMEVISITWERESTANDARDIZA
HANDTHECAREGIVERWASSURETHATTHECHILDHADMETTHE
TIONOFDATACOLLECTIONACROSSSTUDYSITESTHEFACTTHAT CRITERIAFORTHEMILESTONETHEFIELDWORKERTRANSFERREDTO
MOTORMILESTONESMIGHTNOTOCCURINASEQUENTIALWAY THEFORMFIG THEFIRSTWRITTENDATEASTHECAREGIVERS
INALLSUBJECTSANDTHEFACTTHATSOMEMILESTONESMIGHT RECORDED DATE 4HE FIELDWORKER ALSO VERIFIED WHETHER
BEOBSERVEDANDTHENINHIBITEDLATEREGAFTERANILL
THE CAREGIVER HAD ACTUALLY TESTED AND RECORDED THE
NESSORTRAUMA  DATEORSIMPLYRECALLEDTHEDATEOFFIRSTACHIEVEMENT
4HE PERFORMANCE OF EACH MILESTONE WAS EVALUATED )F A CHILD HAPPENED TO PERFORM THE MOTOR SKILL FOR
INDEPENDENTLY BY USING FOUR CODING POSSIBILITIES
INABILITYˆTHECHILDTRIEDBUTFAILEDTOPERFORMTHETEST
ITEM BECAUSE IT SURPASSED HIS OR HER DEVELOPMENTAL
LEVEL REFUSALˆTHE CHILD WAS CALM AND ALERT BUT JUST
REFUSEDTOCOOPERATEABILITYˆTHECHILDPERFORMEDTHE
TESTITEMACCORDINGTOTHESPECIFIEDCRITERIAANDUNABLE
TOTESTˆTHECHILDCOULDNOTBETESTEDONTHISMILESTONE
THE FIRST TIME AT A CERTAIN HOME VISIT THIS DATE WAS
ENTEREDASTHECAREGIVERSDATE4HEFIELDWORKERNEVER
TOLD THE CAREGIVER WHEN A CHILD SHOULD BE ACHIEVING
A PARTICULAR MILESTONE OR GAVE ANY INDICATION ABOUT
WHICHMILESTONESTHECAREGIVERSHOULDBELOOKINGFOR
ASTHECHILDGOTOLDER
BECAUSEHISORHEREMOTIONALSTATEDROWSINESSFUSSI
$ATAQUALITYCONTROL
NESSORCRYING WASINTERFERINGWITHTESTINGTHECHILD
WAS SICK OR THE CHILDS CAREGIVER WAS DISTRAUGHT )N $ATA QUALITY ASSURANCE STARTED WITH THE FIELDWORKERS
PRACTICE IT WAS SOMEWHAT DIFFICULT TO DIFFERENTIATE CAREFULLYFILLINGOUTTHERECORDFORMSANDCHECKINGFOR
BETWEENhREFUSALvANDhUNABLETOTESTv COMPLETENESS AND ACCURACY !DDITIONAL CHECKS WERE
4HE FIELDWORKER TOOK ABOUT  MINUTES TO TEST ALL MADEBYDATAQUALITYCONTROLSTAFFANDSUPERVISORSAT
MILESTONES3INCEITWASNOTALWAYSPOSSIBLETOGETTHE THE SITES %XTENSIVE QUALITY CHECKING WAS CARRIED OUT
CHILDSCOOPERATIONIMMEDIATELYTHEFIELDWORKERWAS ONTHEDATAACCUMULATEDATTHE#OORDINATING#ENTRE
ALLOWED THREE TRIALS FOR THE ASSESSMENT OF EACH MILE
!PRINTOUTOFTHECOMPLETESETOF-OTOR$EVELOPMENT
STONE 4HE FIELDWORKERS WERE GIVEN NO AGES AT WHICH 3TUDYRECORDSFOREACHCHILDWASCHECKEDPERIODICALLY
THEINFANTSWEREEXPECTEDTOACHIEVEEACHMILESTONEAS FOR INCONSISTENCIES SUCH AS MISSING OR INCORRECTLY
THISMIGHTHAVEINFLUENCEDTHEIRJUDGMENT ENTERED CAREGIVERS DATES REPORTED CAREGIVERS DATE
&ORMILESTONESTHATHADNOTBEENACHIEVEDBYTHE
WITHOUT CONFIRMATION OF A MILESTONES ACHIEVEMENT
MONTHVISITTHEFIELDWORKERSCALLEDTHECAREGIVERSINTHE BYAFIELDWORKERDISCONTINUATIONOFTHE-OTOR$EVEL

MONTHSWITHNOSCHEDULEDFOLLOW
UPVISITDURINGTHE OPMENT 3TUDY WITHOUT OBSERVED ACHIEVEMENT OF ALL
 7/2,$(%!,4( -ULTICENTRE'ROWTH2EFERENCE3TUDY
/2'!.):!4)/.
0ROJECT.54n-OTORDEVELOPMENTASSESSMENT
-$3
)DENTIlCATION 4ESTITEMS %XAMINERREPORT #ARETAKERREPORT
A &ORMCODE -$3) A /BSERVED B 0RECISEDATEOFlRST C 4YPEOF
B 3TUDYNUMBER .OINABILITY ACHIEVEMENT RECORD
.54  ) .OREFUSAL 4AKENFROMTHEPARENTSRECORD 4ESTEDAND
C 3ITENUMBER 9ES FORM /NLYENTERDATES FOR RECORDED
!SSESSMENTOFGROSSMOTORDEVELOPMENT

5NABLETOTEST MILESTONES ACHIEVEDFORTHElRST 2ECALLED

D 3UBJECTCODE TIMEBETWEENTHEPREVIOUSFOLLOW
UPANDPRESENTVISIT
E &OLLOW UPVISIT
3ITTINGWITHOUTSUPPORT   
NUMBER
$AY-ONTH9EARO
F #ONTINUEDTESTING (ANDS AND KNEES   
REQUIRED CRAWLING $AY-ONTH9EARO
.O9ES 3TANDINGWITHASSISTANCE   
$AY-ONTH9EARO
G $ATEOFVISIT    7ALKINGWITHASSISTANCE
  
$AY -ONTH 9EAR
$AY-ONTH9EARO
H %XAMINERSCODE 3TANDINGALONE   
$AY-ONTH9EARO
7ALKINGALONE   
2EMARKS $AY-ONTH9EARO
#HILDSEMOTIONALSTATE A &IRSTSCALE B 3ECONDSCALE
2ATETHECHILDSEMOTIONALSTATEDURINGTHE $ROWSY #ALM
TESTINGOFALLTHEMILESTONES !WAKEANDALERT &USSY
#RYING

%NTERACODEFOREACHOFTHETWOSCALES

&)'&IELDWORKERSDATACOLLECTIONFORMFORMOTORDEVELOPMENTASSESSMENT
3
3 4-!7IJNHOVENETAL

SIX MILESTONES OR ORDER OF MILESTONE ACHIEVEMENT SAMETIMEHAVINGCAREGIVERRECORDSOFTHEEXACTDATES

EG WALKING ALONE BEFORE WALKING WITH ASSISTANCE  OF MILESTONE ACHIEVEMENT FACILITATES INTERNAL CROSS
4HE REPORTED INHIBITION OF A MILESTONE WAS QUERIED VALIDATIONWITHFIELDWORKERSRECORDSANDCOMPARISON
ASWELLASDIFFERENCESBETWEENA-OTOR$EVELOPMENT OF THE -'23 DATA WITH PREVIOUS STUDIES THAT RELIED
3TUDYHOMEVISITDATEANDAFOLLOW UPVISITDATE4HE ON PARENTAL REPORTING ALONE!CHIEVEMENT OF THE SIX
INCONSISTENCIESWERESENTTOTHESITESFORINVESTIGATION MILESTONESWASASSESSEDREPEATEDLYBETWEENAND
VERIFICATIONANDCORRECTIONATTHESOURCE4HISPROC MONTHSOFAGEWHICHWILLMAKEITPOSSIBLETODESCRIBE
ESSOFDATAVERIFICATIONANDCLEANINGBETWEENTHESITES THEIRSEQUENCEANDTEMPOINADDITIONTOTHEAGESWHEN
ANDTHE#OORDINATING#ENTREWASCONTINUEDUNTILALL MILESTONESWEREACQUIRED4HEAVAILABILITYINTHE-'23
DATAQUERIESHADBEENSATISFACTORILYRESOLVED$ETAILED OFINFORMATIONONBREASTFEEDINGANDCOMPLEMENTARY
DESCRIPTIONS OF THE -'23 DATA MANAGEMENT PROCE FEEDINGWILLALSOPERMITSTUDIESOFASSOCIATIONSBETWEEN
DURESAREGIVENELSEWHEREINTHISSUPPLEMENT;= CHILDFEEDINGANDMOTORDEVELOPMENT
!LTHOUGH THE STUDY WAS CONDUCTED IN A STANDARD
IZEDMANNERITALSOHADLIMITATIONS7EDIDNOTCOLLECT
#ONCLUSIONS INFORMATIONONSTIMULATIONANDCHILDREARINGPRACTICES
THATMIGHTINFLUENCEMILESTONEACQUISITION;=
4HE-OTOR$EVELOPMENT3TUDYAIMEDTODESCRIBETHE 4HUSALTHOUGHITWILLBEPOSSIBLETOEXAMINEASSOCIA
ACQUISITION OF SIX UNIVERSAL GROSS MOTOR MILESTONES TIONSBETWEENMOTORDEVELOPMENTANDCHILDFEEDING
IN THE FIRST TWO YEARS OF LIFE AMONG AFFLUENT CHILDREN MORBIDITY AND OVERALL PHYSICAL GROWTH ASSESSMENT
GROWINGUPINDIFFERENTCULTURALSETTINGSANDTHEREBY OF THE POSSIBLE INFLUENCE OF PSYCHOSOCIAL STIMULA
FILL AN EXISTING GAP IN KNOWLEDGE 4HE UNIQUENESS OF TIONONTHEREPORTEDOUTCOMESWILLBELIMITEDTOTHE
THISSTUDYINCLUDESTHEOPPORTUNITYTOLINKGROWTHAND EXAMINATIONOFTHEIRECOLOGICALASSOCIATIONSWITHTHE
MOTOR DEVELOPMENT IN ONE INTERNATIONAL REFERENCE SOCIOECONOMICANDDEMOGRAPHICPROFILESFOUNDINTHE
4HESAMEPROTOCOLWASUSEDINTHEFIVECOUNTRIESTHAT -'23$ESPITETHISLIMITATIONTHISSTUDYPROVIDESAN
PARTICIPATEDINTHESTUDYANDTHEMOTORDEVELOPMENT IMPORTANT ADDITION TO THE LITERATURE ON GROSS MOTOR
ASSESSMENTS WERE PERFORMED BY STANDARDIZED DEVELOPMENTINDIFFERENTCULTURALSETTINGSANDSHOULD
FIELDWORKERS 4HIS IS EXPECTED TO MINIMIZE THE SERVE AS A BASELINE FOR MORE FOCUSED STUDIES OF BOTH
INFLUENCEOFRESPONDENTBIASESONTHEOUTCOME!TTHE MOTORANDCOGNITIVEDEVELOPMENT

2EFERENCES
 0HATAK!0HATAK0$EVELOPMENTOF)NDIANBABIESAND  (INDLEY #" &ILLIOZAT !- +LACKENBERG ' .ICOLET
ITSASSESSMENT)N5DANI0-ED4EXTBOOKOFPEDIATRICS -EISTER $ 3AND %! $IFFERENCES IN AGE OF WALKING IN
7ITH SPECIAL REFERENCE TO PROBLEMS OF CHILD HEALTH IN FIVE%UROPEANLONGITUDINALSAMPLES(UM"IOL
DEVELOPINGCOUNTRIES.EW$ELHI*AYPEE"ROTHERS n
n  )LOEJE 3/ /BIEKWE 65 +AINE 7. 'ROSS MOTOR
 (ELLBRUGGE40OHL0-UNICHFUNCTIONALDIAGNOSTICTESTS DEVELOPMENTOF.IGERIANCHILDREN!NN4ROP0AEDIATR
ANDEARLYBEHAVIOURALDIAGNOSIS)N5DANI0-ED4EXT n
BOOKOFPEDIATRICS7ITHSPECIALREFERENCETOPROBLEMSOF  *AHARI!"3ACO 0OLLITT#(USAINI-!0OLLITT%%FFECTS
CHILDHEALTHINDEVELOPINGCOUNTRIES.EW$ELHI*AYPEE OFANENERGYANDMICRONUTRIENTSUPPLEMENTONMOTOR
"ROTHERSn DEVELOPMENT AND MOTOR ACTIVITY IN UNDERNOURISHED
 4HELEN % -OTOR DEVELOPMENT ! NEW SYNTHESIS !M CHILDREN IN )NDONESIA %UR * #LIN .UTR SUPPL
0SYCHOLn  3n
 "HANDARI!'HOSH".!LONGITUDINALSTUDYONCHILD  ,ARGO 2( -OLINARI , 7EBER - #OMENALE 0INTO ,
DEVELOPMENT IN RELATION TO SOCIO ECONOMIC FACTORS $UC'%ARLYDEVELOPMENTOFLOCOMOTIONSIGNIFICANCE
)NDIAN*-ED2ESn OFPREMATURITYCEREBRALPALSYANDSEX$EV-ED#HILD
 #APUTE !* 3HAPIRO "+ 0ALMER &" 2OSS ! 7ACHTEL .EUROLn
2# .ORMAL GROSS MOTOR DEVELOPMENT THE INFLUENCES  .ELIGAN'0RUDHAM$.ORMSFORFOURSTANDARDDEVEL
OFRACESEXANDSOCIO ECONOMICSTATUS$EV-ED#HILD OPMENTAL MILESTONES BY SEX SOCIAL CLASS AND PLACE IN
.EUROLn FAMILY$EV-ED#HILD.EUROLn
 #ARRUTH"23KINNER*$&EEDINGBEHAVIORSANDOTHER  0ALISANO 2* 5SE OF CHRONOLOGICAL AND ADJUSTED AGES
MOTORDEVELOPMENTINHEALTHYCHILDRENnMONTHS  TO COMPARE MOTOR DEVELOPMENT OF HEALTHY PRETERM
*!M#OLL.UTRn AND FULLTERM INFANTS $EV -ED #HILD .EUROL 
 #HEUNG9"9IP03&+ARLBERG*0%&ETALGROWTHEARLY n
POSTNATALGROWTHANDMOTORDEVELOPMENTIN0AKISTANI  0ERSSON + 3TRšMBERG " 3TRUCTURED OBSERVATION OF
INFANTS)NT*%PIDEMIOLn MOTOR PERFORMANCE 3/-0 ) APPLIED TO NEONATALLY
 $AS 6+ 3HARMA ., $EVELOPMENTAL MILESTONES IN A HEALTHY FULLTERM INFANTS AT THE AGES OF n MONTHS
SELECTIVE SAMPLE OF ,UCKNOW CHILDREN ! LONGITUDINAL %ARLY(UM$EVn
STUDY)NDIAN*0EDIATRn  0HATAK 0 -OTOR AND MENTAL DEVELOPMENT OF )NDIAN
 'RANTHAM -C'REGOR3-"ACK%('ROSSMOTORDEVEL BABIESFROMMONTHTOMONTHS)NDIAN0EDIATR
OPMENTIN*AMAICANINFANTS$EV-ED#HILD.EUROL n
n  9AQOOB-&ERNGREN(*ALIL&.AZIR2+ARLBERG*%ARLY
!SSESSMENTOFGROSSMOTORDEVELOPMENT 3

CHILDHEALTHIN,AHORE0AKISTAN8))-ILESTONES!CTA  :UCKERMAN"3&RANK$!)NFANCY)N,EVINE-$#AREY

0AEDIATR3UPPLn 7"#ROCKER!#'ROSS24EDS$EVELOPMENTAL BEHAV
 4OUWEN".EUROLOGICALDEVELOPMENTININFANCY#LINICS IORALPEDIATRICS0HILADELPHIA0A53!7"3AUNDERS
IN$EVELOPMENTAL-EDICINE.O,ONDON7ILLIAM n
(EINEMANN-EDICAL"OOKS  !PPENDIXONNEUROLOGICALDEVELOPMENTININFANCY'RIF
 6AIVRE $OURET , "URNOD9 $EVELOPMENT OF A GLOBAL FITHS$EVELOPMENT3CALEFORTHEFIRSTTWOYEARSOFLIFE
MOTOR RATING SCALE FOR YOUNG CHILDREN n YEARS )N5DANI0-ED4EXTBOOKOFPEDIATRICS7ITHSPECIAL
INCLUDING EYE HAND GRIP COORDINATION #HILD #ARE REFERENCE TO PROBLEMS OF CHILD HEALTH IN DEVELOPING
(EALTH$EVn COUNTRIES.EW$ELHI*AYPEE"ROTHERSn
 7ORLD (EALTH /RGANIZATION 4ASK &ORCE FOR %PIDE  "AYLEY3CALESOF)NFANT$EVELOPMENT-OTORSCALERECORD
MIOLOGICAL 2ESEARCH ON 2EPRODUCTIVE (EALTH 3PECIAL FORM ND ED 3AN !NTONIO 4EX 53! 0SYCHOLOGICAL
0ROGRAMME OF 2ESEARCH $EVELOPMENT AND 2ESEARCH #ORPORATION
4RAINING IN (UMAN 2EPRODUCTION 0ROGESTOGEN ONLY  &RANKENBURG7+$ODDS*"$ENVER))TRAININGMANUAL
CONTRACEPTIVESDURINGLACTATION)))NFANTDEVELOPMENT $ENVER #OL 53! $ENVER $EVELOPMENTAL -ATERIALS
#ONTRACEPTIONn 
 DE/NIS-'ARZA#6ICTORA#'/NYANGO!7&RONGILLO  +NOBLOCH(0ASAMANICK"3HERARD%3!DEVELOPMEN
%!-ARTINES*FORTHE7(/-ULTICENTRE'ROWTH2EFER TALSCREENINGINVENTORYFORINFANTS0EDIATRICS
ENCE3TUDY'ROUP4HE7(/-ULTICENTRE'ROWTH2EF n
ERENCE3TUDYPLANNINGSTUDYDESIGNANDMETHODOLOGY  :DANSKA "RINCKEN-7OLANSKI.!GRAPHICMETHOD
&OOD.UTR"ULL SUPPL 3n FORTHEEVALUATIONOFMOTORDEVELOPMENTININFANTS$EV
 ,ARTEY!/WUSU7"3AGOE -OSES)'OMEZ63AGOE -ED#HILD.EUROLn
-OSES#FORTHE7(/-ULTICENTRE'ROWTH2EFERENCE  #APUTE!*!CCARDO0*4HEINFANTNEURODEVELOPMENTAL
3TUDY'ROUP)MPLEMENTATIONOFTHE7(/-ULTICEN ASSESSMENT A CLINICAL INTERPRETIVE MANUAL FOR #!4
TRE'ROWTH2EFERENCE3TUDYIN'HANA&OOD.UTR"ULL #,!-3INTHEFIRSTTWOYEARSOFLIFEPART#URR0ROBL
 SUPPL 3n 0EDIATRn
 "HANDARI.4ANEJA32ONGSEN4#HETIA*3HARMA0  'ESELL!!MATRUDA#3$EVELOPMENTALDIAGNOSISND
"AHL2+ASHYAP$+"HAN-+FORTHE7(/-ULTICEN ED.EW9ORK0AUL"(OEBER
TRE'ROWTH2EFERENCE3TUDY'ROUP)MPLEMENTATIONOF  +ENNY4*#LEMMENS2,"EHAVIORALPEDIATRICSANDCHILD
THE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDYIN)NDIA DEVELOPMENTACLINICALHANDBOOKNDED"ALTIMORE
&OOD.UTR"ULL SUPPL 3n -D53!7ILLIAMS7ILKINS
 "AERUG!"JOERNEBOE' %!4UFTE%.ORUM+2FOR  .EEDLMAN 2$ 'ROWTH AND DEVELOPMENT )N .ELSON
THE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDY'ROUP 7%"EHRMAN2%+LIEGMAN2-!RVIN!-EDS.ELSON
)MPLEMENTATIONOFTHE7(/-ULTICENTRE'ROWTH2EFER TEXTBOOKOFPEDIATRICSTHED0HILADELPHIA0A53!
ENCE3TUDYIN.ORWAY&OOD.UTR"ULL SUPPL 7"3AUNDERSn
 3n  .ELMS "# -ULLINS 2' 'ROWTH AND DEVELOPMENT !
 0RAKASH.3-ABRY2--OHAMED!*!LASFOOR$FOR PRIMARY HEALTH CARE APPROACH %NGLEWOOD #LIFFS .*
THE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDY'ROUP 53!0RENTICE (ALL
)MPLEMENTATIONOFTHE7(/-ULTICENTRE'ROWTH2EF  "RAZELTON 4" %CHELLE D£VALUATION DU COMPORTEMENT
ERENCE3TUDYIN/MAN&OOD.UTR"ULL SUPPL N£ONATAL.EUROPSYCHIATR%NFANCE!DOLESCn
 3n  7ERNER %% )NFANTS AROUND THE WORLD CROSS CULTURAL
 $EWEY +' #OHEN 2* .OMMSEN 2IVERS ,! (EINIG STUDIESOFPSYCHOMOTORDEVELOPMENTFROMBIRTHTOTWO
-*FORTHE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDY YEARS*#ROSS#ULT0SYCHOLn
'ROUP )MPLEMENTATION OF THE 7(/ -ULTICENTRE  3UPER #- %NVIRONMENTAL EFFECTS ON MOTOR DEVELOP
'ROWTH 2EFERENCE 3TUDY IN THE 5NITED 3TATES &OOD MENT THE CASE OF@!FRICAN INFANT PRECOCITY $EV -ED
.UTR"ULL SUPPL 3n #HILD.EUROLn
 "ERGENN67$ALTON4#,IPSITT,0-YRTLE"-C'RAW  /NYANGO!70INOL!*DE/NIS-FORTHE7(/-UL
AGROWTHSCIENTIST$EV0SYCHOLn TICENTRE'ROWTH2EFERENCE3TUDY'ROUP-ANAGINGDATA
 )LLINGWORTH 23 4HE NORMAL CHILD 3OME PROBLEMS OF FORAMULTICOUNTRYLONGITUDINALSTUDYEXPERIENCEFROM
THEEARLYYEARSANDTHEIRTREATMENTTHED%DINBURGH THE7(/-ULTICENTRE'ROWTH2EFERENCE3TUDY&OOD
3COTLAND#HURCHILL,IVINGSTONE .UTR"ULL SUPPL 3n