Home environment opportunities and motor development of infants in the first year

Introduction: The home environment is a fundamental agent for infant development in the first year of life. Objective: To evaluate the opportunities for environmental stimulation and the motor development of infants at 3, 6, 9, and 12 months of age and determine the association between these opportunities and the parents’ schooling and economic levels, at each age studied. Methods: This is a longitudinal study using the Alberta Infant Motor Scale (AIMS) to assess motor development, the Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) questionnaire to assess the stimulation opportunities at home, and the Brazilian Association of Research Companies (ABEP) questionnaire to classify the economic level of the families. The association between opportunities for environmental stimulation and schooling and economic levels was determined by the chi-squared test. Results: Thirty-seven infants participated, 54.1% of whom were boys. At 3 months of age, the opportunities for environmental stimulation were unsatisfactory, while at 6, 9, and 12 months satisfactory opportunities predominated. Three infants scored below 10% on the AIMS at 3 months of age, indicating delayed motor development. There was a significant association between economic level and total AHEMD-IS score (p = 0.031), and the toy dimension for gross (p = 0.016) and fine (p = 0.043) motor skills. Conclusion: The infants’ home environment did not provide sufficient opportunities for stimulation in the first months, but improved during the first year. Motor development was considered delayed for three infants, but was suitable in subsequent evaluations.


Introduction
Motor development is characterized by changes in motor skills over time, caused by the interaction between biological, genetic and environmental processes. 1 Significant improvements in motor skills occur during childhood, evolving to more complex abilities. 2 The first year of life is extremely important for child development, since motor skills progress rapidly, allowing greater mobility. 3 Monitoring motor development is important because impaired development can have negative consequences over the course of an individual's life. 4 Thus, assessing child development in the first year should include not only biological aspects, but also analysis and monitoring of environmental factors. 2 Economic conditions, parental schooling, family dynamic, family purchasing power, family relations, characteristics of the physical environment, availability of toys and the variability of stimulation provided by the parents are critical indicators of environmental quality that may influence child development. 2,5,6 Studies demonstrate that children living in environments with little stimulation, 2 from families with low purchasing power and low schooling levels, more frequently exhibit delayed motor development. 7 Given that infants tend to spend most of their time at home during the first year of life, this environment becomes a crucial factor for motor development. 8 Thus, the present study aimed at assessing home environment opportunities and the development of infants at 3, 6, 9 and 12 months of age and determine whether there is an association between environmental stimulation opportunities and parental schooling and economic level, at each age studied.

Methods
This is a longitudinal observational study of infants variety of stimulations, and gross and fine motor skills toys. 8 The scores were converted into four descriptive categories: "less than adequate", "moderately adequate", "adequate" and "excellent", which provides information on the opportunities at home for infant motor development. 8 Parental schooling and a number of home characteristics were also obtained from this questionnaire.
The Alberta Infant Motor Scale (AIMS) was used to assess motor development by observing spontaneous movement and motor skills in the prone, supine, sitting and standing positions, considering motor development delay at less than 10%. 11,12 The assessors were trained to apply the scale and the intra and interrater reliability was All the parents or guardians that agreed to take part were informed of the study objectives and procedures and provided written informed consent.

Results
A total of 183 parents/guardians of the infants were contacted, 37 of whom were assessed at 3 months, 21 at 6 months, 18 at 9 months, and 10 at 12 months. contained two adults and two children (40.5%), followed by only one child (37.8%). The descriptive characteristics of the participants are presented in Table 1.   The association between stimulation opportunities at home (total AHEMD-IS score and dimensions), parental schooling and family economic level (ABEP) was also analyzed at each age studied. At 3 months of age there was a statistically significant association between economic level and the fine motor toys dimension (p = 0.043). At 6 months, there was a statistically significant association between economic level and the gross motor toys dimension (p = 0.016) and between economic level and total AHEMD-IS score (p = 0.031) (Table 4). At 9 and 12 months, no statistically significant associations were found between stimulation opportunities at home and schooling and economic levels. All the variables were analyzed, but due to their large number, only those with significant associations (p < 0.05) are presented in Table 4.
We were unable to determine the association between opportunities at home and motor development owing to the small number of participants and because only three infants displayed delayed development, in a single assessment.