Risk and protective factors in early childhood development: a scoping review

Martins, Isabela Melo; Perazzo, Matheus França; Corrêa-Faria, Patricia; Santos, Ingrid Garcia; Mateus, Ana Claudia; Fernandez, Amanda Meira; Tavares, Naraiana de Oliveira; Costa, Luciane Rezende

doi:10.1590/1806-9304202500000166-en

person Isabela Melo Martins

conception · study design · analysis · interpretation of data · writing of the manuscript · critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0002-5371-6286

person Matheus França Perazzo

analysis and critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0003-1231-689X

person Patricia Corrêa-Faria

analysis and critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0002-0528-1425

person Ingrid Garcia Santos

conception · study design · analysis and critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade de Cuiabá. Cuiabá, MT, Brazil.

0000-0001-6117-853X

person Ana Claudia Mateus

conception · study design · analysis and critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0003-2447-9039

person Amanda Meira Fernandez

conception · study design · critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0001-5639-5986

person Naraiana de Oliveira Tavares

conception · study design · analysis and critical and intellectual review of the manuscript · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0003-3953-3958

person Luciane Rezende Costa

conception and study design · acquisition · analysis and interpretation of data · critical and intellectual review of the study · authors approved the final version of the article

schoolUniversidade Federal de Goiás. Av. Universitária Esquina com 1^a Avenida, s.n. St. Universitário. Goiânia, GO, Brasil. CEP: 74.605-220. E-mail: isabela_melo@discente.ufg.br.

0000-0001-7637-0049

declare no conflict of interest

Electronic Base	Search Strategy
PubMed	((((((Child preschool[MeSH Terms]) OR(lnfant[MeSH Terms])) OR(lnfant*[Title/Abstract])) OR(pediatric[Title/Abstract])) OR(paediatric[Title/Abstract])) AND ((((((child development [MeSH Terms]) OR(child development[Title/Abstract])) OR(mental health[MESH])) OR (Mentalhealth[TIAB])) OR (child guidance[TIAB])) OR (child guidance[MeSH]))) AND((Protective Factors [MeSH]) OR (Risk Factors[MeSH])).
Embase	(mh:(child, preschool)) OR (mh:(pre-escolar)) OR (mh:(Preescolar)) OR (lnfant$)
Cochrane	(“Child preschool” OR Infant* OR pediatric OR paediatric) AND (“child development” OR “mental health” OR “child guidance”) AND (“Protective Factors” OR “Risk Factors”)
Apa PsycNet	(“Child preschool” OR Infant* OR pediatric OR paediatric) AND (“child development” OR “mental health” OR “child guidance”) AND (“Protective Factors” OR “Risk Factors”)
BVS	(“Child preschool” OR Infant* OR pediatric OR paediatric) AND (“child development” OR “mental health” OR “child guidance”) AND (“Protective Factors” OR “Risk Factors”)

ID	Author / Year/ State	Outline	Participants and age range	Instrument used to assess development	Assessment (Outcome)	Risk Factors	Protection Factors
1.	Araújo et al.²⁶/ 2020/SP	Cross-sectional observational	259 children between eight to tern months	Bayley Scales of Infant and Toddler Development - Third Edition (BAYLEY-III) e Affordances in the Home Environment for the Motor Development - Infant Scale (AHEMD-IS)	Cognitive, language and motor development	Not mentioned	Suitable environment with quality resources (p<0.001) Absence of RIHL - Risk indicators for hearing loss (p<0.001)
2.	Araújo et al.²⁷/2017/SP	Cross-sectional observational	154 infants and their caregivers; age range eight to ten months	BAYLEY-III and AHEMD-IS	Cognitive, language and motor development	Presence of RIHL - Risk indicators for hearing impairment (motor (p=0.0001), cognitive (p=0.001) and language (p=0.0304))	Not mentioned
3.	Araújo et al.²⁸/2017/PR	Cross-sectional observational	77 children between six to 36 months of age	Denver II Test Anthropometric measurements	Neuropsychomotor development Nutritional status	Low birth weight (OR=181.0; 95%CI=1.902-17,229.589; p=0.025), monthly family income (OR=9.90; 95%CI=1.11-87.92; p=0.040), absence of father (OR=34.51; 95%CI=1.033-1,153.490, p=0.048)	Father’s presence (quantitative data not available)
4.	Boo et al.⁴/ 2018/ CE	Cross-sectional observational	2.755 children between zero to 28 months og age	Denver II test and Home Observation of the Environment - HOME	Development and well-being	Low birth weight (p<0.01; p<0.05), nutrition problems (p<0.05), male (p<0.01) and premature childbirth (p<0.01)	Positive parenting practices (reading books and counting numbers (p<0.01), high maternal schooling (p<0.01; p<0.05), higher monthly income (p<0.01)
5.	Borba e Valentini³⁴/ 2015/RS	Longitudinal Study (5-month follow-up with a two-month interval between assessments)	40 infants aged zero to 18 months, 20 of which were born of teenage mothers (15-19 years old) and 20 to adult mothers (25-39 years old)	Alberta Infant Motor Scale (AIMS), Bayley Scale of Infant Development II	Cognitive and motor development	Babies born of teenage mothers scored lower than babies born to adult mothers on one motor skill (supine position) (p=0.046)	Partner support (quantitative data not available)
6.	Caetano et al.⁴⁰/2021/ SP	Cohort Study (6-month follow-up)	1.292 children aged four to five	Child Behavior Checklist (CBCL) and of ages and stages Questionnaires: Socioemotional (ASQ:SE)	Behavioral mental disorders (internalizing and externalizing) and delays in socioemotional development	Stressful family relationships: (Parental stress (3.97 (2.13-7.41) p<0.001), parental psychopathology (depression and/or anxiety) (2.96 (2.21-3.96) p<0.001)) and lower share capital (0.99 (0.98-1.00) p=0.04)	Not mentioned
7.	Correia et al.⁴¹/2019/CE	Cross-sectional observational	3.566 children aged 2 - 72 months	Ages and Stages Questionnaire ASQ-BR	Five domains of development (communication, gross motor coordination, fine motor coordination, problem solving and personal/social)	Male (95%CI=25.8-30.5 p<0.001) family income/social class (p<0.05), food insecurity (p<0.02)	Higher monthly income. The increase in the monthly income quintile was associated with a reduced risk of delay in the communication, gross motor and fine motor domains and delay in any domain (p<0.05).
8.	Costa et al.³³ /2015/PA	Cross-sectional observational	319 children 36-48 months of age	Denver II Test and questionnaire on Biopsychosocial Characteristics of Children (QBCC)	Neuropsychomotor development	Poverty (χ² =8.588; df=1; p<0.003), low maternal and paternal education (χ²= 13.83; df=3; p=0.003), adolescent mothers (χ²= 8.78; df=3; p=0.03)	Parents’ schooling
9.	Rocha Neves et al.²²/2016/MG	Cross-sectional observational	92 children 24-36 months of age	Anthropometric indices World Health Organization (WHO) BAYLEY-III, ITERS-R, HOME	Growth and cognitive/ language development	69,6% of the children’s environment was considered risky (infrastructure (p=0.022), interaction and trust between neighbors (p=0.006)	Not mentioned
10.	Gonçalves et al:⁶/2019/ RS	Cross-sectional comparative	571 children from four to six years old	Early Development Instrument (EDI);	Physical Health and Well-being; Social Competence; Emotional Maturity; Language and Cognitive Development; and (Communication Skills and General Knowledge.	Male (OR=1.67; 95%CI=1.00-2.78; p=0.05), family income (OR=1.86; 95%CI=1.01-3.41; p=0.04 and OR=2.28; 95%CI=1.14-4.57; p=0.02), leaving PIM before 55 months of age (OR=2.19; 95%CI=1.15-4.18;p=0.01)	Not mentioned
11.	Negrão et al.²⁹/ 2020/SP	Prospective cohort (2-year follow-up)	1.006 children, from zero to 24 months	BAYLEY-III	Children’s cognitive, and motor development	Concomitant exposure to alcohol and tobacco during pregnancy (RR=2.81, 95%CI=1.65-4.77, p<0.001) when compared to the no consumption group	Not mentioned
12.	Nunes et al.-³⁰/2020/ RS	Longitudinal study (2-year follow-up)	42 babies from zero to 24 months of age	PREAUT (Programme de Recherche et Evaluation sur l’autisme); infant development risk indicators (IRDI); M-CHAT (TEA); BAYLEY-III, Prechtl’s General Movements Assessment (GMA).	Cognitive, language and motor development	There was no association between complications during pregnancy; medication during pregnancy; alcohol and smoking during pregnancy; complications at childbirth; need for ICU admission and developmental risk.	There was no association between the type of breastfeeding (p=0.16)
13.	Oliveira et al.³¹/ 2017/SE	Longitudinal study (6-month follow-up)	16 infants from zero to six months of age	Denver II test.	Neuropsychomotor development	Not mentioned	Breastfeeding (qunatitative data not available)
14.	Pamplona et al.³⁷/2019/ PA	Case-control study	118 children from zero to 12 months of age	Denver II test.	Neuropsychomotor development	Vertical transmission from HIV-1 infected mothers (33.3% had delays in neuropsychomotor development)	Prenatal (p=0,0001)
15.	Pantoja et al.²³/ 2018/PA	Cross-sectional observational and qualitative	50 children aged 24 -36 months	Denver II test, HOME (Family environment)	Neuropsychomotor development	Quality of stimulation of the family environment (p<0.01) and socioeconomic and social conditions accommodation where the babies live (treated water, availability of electricity, private bathroom) (p<0.01)	Better quality of family environment (p<0.01)
16.	Pereira et al.³⁵/2017/GO	Cross-sectional observational	61 children between four and six years old	Denver II test, Child Biological Characterization Guide at Preschool Age	Neuropsychomotor development	Normal childbirth (p=0.010), shorter height at birth (p=0.007) and shorter height at preschool age (p=0.030); and low monthly family income (p=0.009)	Not mentioned
17.	Pereira et al.,²⁵/2016/RS	Prospective cohort study (4 months follow-up)	49 infants aged two to 12 months	Alberta Infant Motor Scale (AIMS), Bayley AHEMD-IS (Family environment) (DAIS) (maternal practices)	Cognitive and motor development	Low family income (p=0,002)	Maternal practices and knowledge (p=0.001) Biological factors (female) (p=0.001) Home environment (accessibility to toys, adequate physical space) (p<0.001) Child’s attendance at daycare (p<0.001)
18.	Pereira et al.;¹⁷/2015/MS	Descriptive and correlational study	57 babies from zero to three months	Operationalized Portage Inventory (OPI)	Motor development	Maternal age (teenagers and over 35 years old) (p=0.046)	Not mentioned
19.	Santos et al.,¹⁸/ 2020/SC	Cross-sectional study nested within cohort	199 cchildren aged four to five years old	Pre-Literacy Skills and Knowledge test (THCP ®)	Perceptual-motor skill	Not attending school (OR=4.61; 95% Cl=1.21-17.49) Monthly family income <5 MW (OR=4.28;95%CI=1.49-12.26) Male (OR=2.10; 95%CI=1.14-3.88)	Not mentioned
20.	Schiavo e Perosa³⁸/ 2020/ SP	Prospective longitudinal study (14 months ollow-up)	139 babies from six to 14 months old	Denver II test	Neuropsychomotor development Gross motor sub-area and personal-social sub-area Gross motor sub-area Language	Maternal depressive symptoms in the pre- and postnatal care (OR=6.12; 95%CI=1.53-24.4; p=0.01) Maternal insecurity at first care (OR=3.40; 95%CI=1.06-10.9; p=0.04) Being hospitalized after birth (OR=3.75; 95%CI=1.12-12.5;p=0.03) Did not breastfeed for the first hour (OR=32.4; 95%CI=1.58-665.3; p=0.02),	Positive perception of the baby (OR=0.28; 95% Cl=0.10-0.79; p=0.01) Mother who finds pleasure in performing the maternal role (OR=0.06; 95%CI=0.00-0.83; p=0.03) Did not smoke during pregnancy (OR=0.06; 95%CI=0.00-0.83; p=0.03) Mothers with higher schooling (OR=19.1; 95%CI=1.038-353.8; p=0.04)
21.	Silva et al.,³⁹/ 2015/ PB	Sectional study	112 children from six to 18 months old	Denver II test	Neuropsychomotor development	Age greater than 12 months (OR=4.3; 95%CI=2.4-7.4), Normal childbirth (OR=4.4; 95%CI=1.6-11.7) Use of phototherapy (OR=7.9; 95% Cl=1.6-38.8), Daycare center not monitored by the Family Health Strategy (FHS) (RC=2.9; 95%CI= 1.3-6.7)	Not mentioned
22.	Telia et al.,³²/ 2018/SP	Cross-sectional study nested in a cohort	444 infants aged six to nine months old	BAYLEY-III	Cognitive, language and motor development	Low income (p=0.03) Fewer years of maternal schooling (p=0.03)	Not mentioned
23.	Pinheiro et al.,¹⁹/2024/MG	Prospective cohort study (12 month follow-up)	449 children from zero to 12 months old	SYWC-BR	Cognitive, language and motor development	Children born by cesarean section were 1.56 times more likely to have developmental delays than children born by vaginal birth (95%CI=1.04-3.48). children whose mother had depressive symptoms were 1.91 times more likely to have developmental delays (95%CI=1.01-3.10). Gestational exposure to SARS-CoV-2 did not predict suspected developmental delay.	Not mentioned
24.	Bortagarai et al.,³⁶/ 2021/RS	Longitudinal (22 months follow-up)	165 in stage 1 (babies aged three - four months and 29 days), 130 stage 2 (babies aged eight - nine months and 29 days) and 102 stage 3 (babies aged 11-12 months and 29 days) Age ranges from zero to 18 months	Denver II test PREAUT	Fine and gross motor development	Fine Motor Skills (FMS) Stage 1 Females are three times more likely to experience delays in FMS (3.22(1.42-7.28) Living with up to 4 people at home (2.92(1.20-5.53) psychic risk in PREAUT signals (PRS) 2.60(1.22-5.53) Stage 2 Professionally active mothers (2.42(1.07-5.45) Cesarean section 3.17(1.24-8.11) Parents who participate in the routine 11.80(1.70-81.91) Feeding difficulty 3.18(1.39-7.25) PREAUT PRS 8.04(2.99-21.66) Stage 3 Cesarean section 4.88(1.34-17.74) Intercurrences during pregnancy 4.01(1.33-12.03) Males 5.38(1.69-17.11) Mothers without professional activity 7,535(2.34-24.24) Lower number of prenatal consultations 9.04(2.57-31.75) Gross Motor Skills (GMS) Stage 1 Low maternal schooling 3.63(1.92-6.88) Lack of pregnancy planning 3.04(1.04-3.81) PREAUT PRS 2.82(1.49-5.37) Stage 2 Medication during pregnancy 4.15(1.51-11.41) PREAUT PRS 4.13(1.59-10.71) Stage 2 Not having a sibling 9.32(1.47-59.08) Needing mechanical ventilation at birth 4.91(1.21-19.87)	Not mentioned

Category	Risk Factors	Article
Socioeconomic status	Low family income	Araújo et al.,²⁸ Caetano et al.,⁴⁰ Correia et al.,⁴¹ Gonçalves et al.¹⁶ Pereira et al.,³⁵ Pereira et al.,²⁵ Tella et al.,³²
	Poverty¹	Costa et al.,³³
	Worse socioeconomic conditions	Pantoja et al.,²³
	Monthly family income <5MW	Santos et al.,¹⁸
	Males	Boo et al.,⁴ Correia et al.,⁴¹ Gonçalves et al.,¹⁶ Santos et al.,¹⁸ Bortagarai et al.,³⁶
	Low Birth weight²	Araújo et al.,²⁸ Boo et al.,⁴
	Nutritional problems³	Boo et al.,⁴
	Premature birth	Boo et al.,⁴
	Shorter height at birth	Pereira et al.,³⁵
	Shorter height at preschool age	Pereira et al.,³⁵
	Children older than 12 months	Silva et al.,³⁹
Individual characteristics
	Being hospitalized after birth	Schiavo and Perosa³⁸
	Not breastfeeding in the first hour of life	Schiavo and Perosa³⁸
	Neonatal phototherapy⁴	Silva et al.,³⁹
	Females	Bortagarai et al.,³⁶
	Psychic risk in PREAUT signs	Bortagarai et al.,³⁶
	Feeding difficulties⁵	Bortagarai et al.,³⁶
	Not having a sibling	Bortagarai et al.,³⁶
	Needing mechanical ventilation at birth	Bortagarai et al.,³⁶
	Normal childbirth	Pereira et al.,³⁵ Silva et al.,³⁹
	Cesarean delivery	Pinheiro et al.,¹⁹ Bortagarai et al.,³⁶
	Teenage mothers	Borba et al.,³⁴ Costa et al.,³³
	Mothers infected with HIV-1	Pamplona et al.,³⁷
	Maternal age (adolescents and >35 anos)	Pereira et al.,¹⁷
	Maternal insecurity in the first care of the baby	Schiavo and Perosa³⁸
Maternal characteristics	Alcohol and tobacco during pregnancy	‘Negrão et al.,²⁹
	Mothers with professional activity⁶	Bortagarai et al.,³⁶
	Complications during pregnancy	Bortagarai et al.,³⁶
	Mothers without professional activity⁷	Bortagarai et al.,³⁶
	Fewer numbers of prenatal consultations	Bortagarai et al.,³⁶
	Unplanned pregnancy	Bortagarai et al.,³⁶
	Medication during pregnancy	Bortagarai et al.,³⁶
	Parental stress	Caetano et al.,⁴⁰
	Parental depressive symptoms	Caetano et al.,⁴⁰ Schiavo and Perosa,³⁸ Pinheiro et al.,¹⁹
	Low maternal and paternal schooling	Costa et al.,³³ Telia et al.,³² Bortagarai et al.,³⁶
Family characteristics	Leaving the PIM before 55 months of age	Gonçalves et al.,¹⁶
	Father’s absence	Araújo et al.,²⁸
	Food insecurity	Correia et al.,⁴¹
	Parents who participate of the routine	Bortagarai et al.,³⁶
	Infrastructure	Rocha Neves et al.,²²
	Interaction and trust in the neighborhood environment	Rocha Neves et al.,²²
Environmental factors	Stimulation of quality in the family environment	Pantoja et al.,²³
	Daycare center attended by the child without FHS monitoring	Silva et al.,³⁹

Category	Protection Factors	Article
Socioeconomic status	Highest monthly income	Boo et al.,⁴ Correia et al.,⁴¹
	Children without RIHL	Araújo et al.,²⁶
Individual characteristics
	Child’s attendance at daycare	Pereira et al.,²⁵
	High maternal schooling	Boo et al.,⁴ Schiavo and Perosa,³⁸
	Breastfeeding Prenatal care	Oliveira et al.,³¹ Pamplona et al.,³⁷
	Practices and knowledge about infant development	Pereira et al.,²⁵
Maternal characteristics
	Positive perception of the baby¹	Schiavo and Perosa,³⁸
	Mother who enjoys performing maternal functions	Schiavo and Perosa,³⁸
	Does not smoke during pregnancy	Schiavo and Perosa,³⁸
	Paternal presence	Araújo et al.,²⁸
Family characteristics	Positive parenting practices (reading books and counting numbers)	Boo et al.,⁴
	Partner’s Support	Borba et al.,³⁴
	Parents’ schooling	Costa et al.,³³
Environmental factors	Quality of the family environment (physical space, variety of stimuli and toys)	Araújo et al.,²⁶ Pantoja et al.,²³ Pereira et al.,²⁵

[TFN1] PubMed=National Library of Medicine ; Embase= Elsevier Base; Cochrane= Biblioteca Cochrane; BVS= Biblioteca Virtual de Saude; APA PsycNet= American Psychological Association.

Risk and protective factors in early childhood development: a scoping review

Abstract