目的 调查我国现阶段婴幼儿大运动发育里程碑在人群的分布,绘制我国婴幼儿大运动发育里程碑曲线图,为开展婴幼儿个体评估与干预提供依据。方法 于2020年9—12月,在中国15省(自治区/直辖市)15个城市30个区/县,对 1～36 月龄正常发育儿童的照养人进行婴幼儿发育里程碑指标的横断面调查,获得照养人自我报告的婴幼儿大运动发育里程碑的达到情况,按“头部控制”、“坐”、“翻身”、“爬行”、“站”、“走、跑”、“上肢力量”、“蹲、跳”、“上楼梯”、“单脚使用”10类大运动能力绘制大运动发育里程碑曲线图,并描述各指标的第50百分位月龄。结果 本研究共纳入1～36月龄正常儿童8 010例,绘制的大运动发育里程碑曲线图显示我国婴幼儿在30个大运动发育指标中的达到情况。其中部分里程碑的中位月龄为:“俯卧抬头90度”3.2月龄,“仰卧翻俯卧”4.6月龄,“独坐稳”6.3月龄,“用手和膝爬”7.6月龄、“独站稳”11.4月龄、“独走稳”13.1月龄、“跑稳”15.8月龄、“单脚独站1秒以上”18.7月龄,“双脚同时离地跳起”20.4月龄。曲线图反映出不同月龄里程碑的达到情况,并提示各里程碑的达到率在一定月龄段迅速增加。如婴儿头部控制能力发展主要集中在6月龄内,3月龄翻身的达到率不足15%,婴幼儿大运动能力转换和熟练发展需要一定时间,其中“独坐稳”和“独站稳”的中位转换时间约为5.1个月,同类指标中从“扶坐”到“独坐稳”约需2.2个月。结论 大运动发育里程碑曲线图反映了我国婴幼儿30个大运动发育指标的发展轨迹,为我国儿童保健临床评估、早期干预和发展预测等提供依据。
Abstract
Objective To investigate the population distribution of gross motor milestones in children under 3 years old in China, and to map the development process of major indicators of gross motor development, so as to provide evidence for individualized assessment and intervention for infants and toddlers. Methods From September to December 2020, a cross-sectional survey was conducted on the development of normal children aged 1 to 36 months in 30 districts/counties of 15 cities in 15 provinces (autonomous regions/municipalities) of China. The developmental process map was drawn according to 10 categories of motor abilities, including "head control", "sitting", "turning over", "crawling", "standing", "walking/running", "upper limb strength", "squatting/jumping", "walking up stairs" and "single-foot use", and the 50th percentile age of each indicator was described. Results A total of 8 010 normal children aged 1 to 36 months were included in this study. The milestone curves of gross motor development showed the achievement of 30 indicators of gross motor development in Chinese infants. The median age of "lifts head 90°(prone)" was at 3.2 months, "supine turning prone" was at 4.6 months, "sit without hand support" was at 6.3 months, "hands-and-knees crawling" was at 7.6 months, "stand alone" was at 11.4 months,"walk alone" was at 13.1 months, "run with good balance" was at 15.8 months, "balance on each foot(≥1 s)" was at 18.7 months, "jump up with both feet together" was at 20.4 months. The curves reflected the attainment of milestones at different ages and suggested that the rate of attainment of each milestone increased rapidly over a certain age range of months. For example, infants' head control ability developed mainly within 6 months of age. The rate of turning over at 3 months was less than 15%. It took a certain amount of time for infants to transform their gross motor ability and develop proficiency. The median switching time between "sit without hand support" and "stand alone" was about 5.1 months. It took about 2.2 months from "sit with support" to "sit without hand support". Conclusion The milestone curve of gross motor development reflects the development trajectory of 30 gross motor development indicators of infants in China, providing basis for clinical evaluation, early intervention and development prediction of children's health care in China.
关键词
大运动 /
里程碑 /
发育进程 /
儿童
Key words
gross motor /
milestone /
development process /
children
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参考文献
[1] Black MM,Walker SP,Fernald LC,et al. Early childhood development coming of age:Science through the life course [J].Lancet,2017,389 (10064):77-90.
[2] Richter LM,Daelmans B,Lombardi J,et al. Investing in the foundation of sustainable development:Pathways to scale up for early childhood development [J].Lancet,2017,389 (10064): 103-118.
[3] Kuruvilla S,Bustreo F,Kuo T,et al. The global strategy for women's,children's and adolescents' health (2016-2030):A roadmap based on evidence and country experience [J].Bulletin of the World Health Organization,2016,94(5):398-400.
[4] Vaivada T,Gaffey MF,Bhutta ZA. Promoting early child development with interventions in health and nutrition:A systematic review [J].Pediatrics,2017,140(2): e20164308.
[5] Marta RC,Caridad AM,Orazio A,et al. Concurrent validity and feasibility of short tests currently used to measure early childhood development in large scale studies: Methodology and results [J].PLoS ONE,2016,11(8):e0160962.
[6] Walker SP,Wachs TD,Grantham-Mcgregor S,et al. Inequality in early childhood:Risk and protective factors for early child development [J].Lancet,2011,378(9799):1325-1338.
[7] Grantham-McGregor S,Cheung YB,Cueto S,et al. Development potential in the first five years for children in developing countries [J]. Lancet,2007,369:60-70.
[8] Payne G,耿培新,梁国立.人类动作发展概论[M].北京:人民教育出版社,2008:1-160.
[9] Ngoun C,Mey PD,Baesel K,et al. Cambodian Developmental Milestone Assessment Tool (cDMAT): Performance reference charts and reliability check of a tool to assess early childhood development in Cambodian children [J].Early Hum Dev,2019,141(5):104934.
[10] Piper MC, Darrah J.发育中婴儿的运动评估-Alberta 婴儿运动量表[M].黄真,李明,译.北京:北京大学出版社,2009:178.
[11] 国家卫生健康委员会,2019中国卫生健康统计年鉴[M]. 北京:中国协和医科大学出版社,2019:2.
[12] 潘虹地,张悦,冯云杰,等. 基于专家咨询法的中国儿童发育里程碑指标体系的构建[J].中国儿童保健杂志, 2020,28(8):859-862.
[13] 张亚钦,李辉,武华红,等. 2015年中国九城市婴幼儿大动作发育的调查研究 [J].中华儿科杂志,2018,56(12):923-928.
[14] WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: Windows of achievement for six gross motor development milestones [J].Acta Paediatr,2006,450(Suppl):86-95.
[15] 杨玉凤.儿童发育行为心理评定量表[M].北京:人民卫生出版社:2016:29-37.
[16] Ilgi OE,Vibha K,Mphelekedzeni CM,et al. Similarities and differences in child development from birth to age 3 years by sex and across four countries:A cross-sectional, observational study [J]. Lancet Glob Health,2018,6(3):279-291.
[17] Small JW,Hix-small H,Vargas-baron E,et al. Comparative use of the ages and stages questionnaires in low-and middle-income countries[J].Dev Med Child Neurol,2018,61(Suppl 2):431-443.
[18] Milner KM,Bernal R,Brentani A,et al. Contextual design choices and partnerships for scaling early child development programmes [J]. Arch Dis Child,2019,104(Suppl 1):3-12.
[19] WHO Multicentre Growth Reference Study Group.Assessment of sex differences and heterogeneity in motor milestone attainment among populations in the WHO Multicentre Growth Reference Study[J].Acta Paediatrica,2006,450(Suppl):66-75.
[20] Lancaster GA,Mccray G,Kariger P,et al. Creation of the WHO Indicators of Infant and Young Child Development (IYCD): Metadata synthesis across 10 countries [J].BMJ Global Health,2018,3(5):1-15.
基金
中国疾病预防控制中心妇幼中心科技创新与发展项目(2019KJ05)
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