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Infants at high biological risk of or with a neurodevelopmental disorder run a high risk of delayed school readiness. This is especially true for infants in low- and middle-income countries (LMICs). This perspective paper first summarizes evidence on intervention elements that are effective in promoting family well-being and child development in infants at high biological risk in high income countries. Crucial elements are family centeredness, goal orientation, a home setting, focus on activity and participation, and challenging the infant to explore the world and the own body by means of self-produced movements. The studies revealed that coaching as applied in COPCA (COPing and CAring for infants with special needs) is a pivotal element determining the success of intervention.The paper continues by describing COPCA and its coaching. Next, we report on two pilot studies addressing COPCA's implementation in Brazil. Finally, we discuss why COPCA is a promising early intervention program for infants at high biological risk of neurodisability in LMICs: COPCA is adapted to the families' strengths and needs, it empowers families and promotes child development therewith facilitating school readiness. Moreover, it may be delivered by tele-coaching therewith eliminating families' burden to travel to distant intervention clinics.

PURPOSE: This commentary examines the provisions for early childhood development (ECD) in the global action plan for rehabilitation published by the World Health Organisation (WHO) within the context of the United Nations' Sustainable Development Goal (SDG) for inclusive education. METHODS: The meeting reports of the WHO Rehabilitation 2030 for 2017 and 2019 and the related documents were reviewed along with ECD policy documents from WHO, UNICEF, UNESCO, and the World Bank. RESULTS: The importance of a life-course approach to rehabilitation for the health and wellbeing of persons with disabilities was highlighted in the Rehabilitation 2030. However, the critical and foundational role of rehabilitation in ECD for children with disabilities to facilitate inclusive education, especially in low- and middle-income countries as envisioned by the SDG 4.2, was not clearly addressed. Children under 5 years with developmental delays and disabilities who are not developmentally on track in health and psychosocial wellbeing require timely rehabilitation to ensure that they benefit from inclusive education. CONCLUSIONS: The culture and practice of rehabilitation should be nurtured from infancy as an indispensable component of ECD to adequately prepare children with developmental disabilities for inclusive education and ensure effective rehabilitation services over the life course. IMPLICATIONS FOR REHABILITATIONRehabilitation is an integral and critical component of early childhood development to optimise school readiness for children with developmental disabilities.Routine newborn screening, developmental assessment, and surveillance of children from birth are foundational to any effective rehabilitation in early childhood.Global investment to promote and support rehabilitation services from early childhood within the health systems and across all levels of service delivery including community settings is warranted to achieve the sustainable development goals for children with disabilities.

Kinder mit einem erhöhten Risiko einer motorischen Entwicklungsstörung stellen eine heterogene Gruppe von Kindern dar. Zu dieser Gruppe zählen z.B. Frühgeborene, Kinder mit einer frühen Hirnschädigung oder einem angeborenen komplexen Herzfehler. Die frühe Beurteilung des motorischen Entwicklungsstandes dieser Kinder ist von zentraler Bedeutung, damit der aktuelle Entwicklungsstand des Kindes bestimmt werden kann und allfällige schon vorhandene oder zukünftig drohende Entwicklungsstörungen erkannt werden können. Im Falle einer vorhandenen oder drohenden motorischen Entwicklungsstörung kann dem Kind und seiner Familie eine entsprechende Frühtherapie (z.B. Physiotherapie) angeboten werden. Da die Plastizität des Gehirns in den beiden ersten Lebensjahren sehr groß ist, empfiehlt es sich eine Intervention bei gegebener Indikation möglichst früh zu beginnen. In diesem Artikel stellen wir Ihnen eine vielversprechende, moderne Methode zur Beurteilung der Motorik von Säuglingen und Kleinkindern – das Infant Motor Profile (IMP) – vor. Das IMP ermöglicht es neben der Bestimmung des aktuellen motorischen Entwicklungsstandes und der Vorhersage der weiteren motorischen Entwicklung des Kindes auch eine indizierte Frühintervention gezielt zu planen und durchzuführen. Im ersten Teil dieses Artikels erläutern wir die Entwicklung des menschlichen Nervensystems und deren Folgen für die Früherkennung von Entwicklungsstörungen und Diagnosestellung. Im zweiten Abschnitt berichten wir über unterschiedliche Entwicklungstheorien und deren Einfluss auf das Denken und Handeln von Berufsleuten die sich mit Entwicklungsstörungen auseinandersetzen. Im dritten Teil stellen wir Ihnen dann die Konstruktion des IMP, seine psychometrischen Eigenschaften und seine Bedeutung für die Frühintervention vor.

Introduction and aim: The COVID-pandemic confronted us with the need of remote intervention and tele-guidance of families. It increased awareness on the importance of including family members as active and equal partners in the intervention process. Coaching of family members, with the aim of empowering the family to support their child’s development in the home environment, turned out to be an essential intervention strategy. Coaching is an appropriate approach to allow for family’s strengths, to deal with their needs and to support their informed decisions. Coaching is partnering with families in a thought-provoking and creative process. Equal partnership, involving family members as active partners and coaching of the family are key-characteristics of the family-centred early intervention programme ‘COPing with and CAring for infants with special needs’ (COPCA). The aim of this symposium is 1) to highlight the usefulness of COPCA’s coaching approach, especially in these challenging times; 2) to show the different impact of coaching versus instructing on the quality of partnership between health professionals and family members and family well-being and infant outcome; and 3) to show how coaching functions in different cultures. Content: • Mijna Hadders-Algra (Netherlands): Mini-introduction on COPCA as a family centred approach with coaching as key element, very suitable in Covid times • Schirin Akhbari Ziegler (Switzerland): What is coaching; what is the difference with teaching and instruction? • Rosane Luzia de Souza Morais (Brazil): Experience with COPCA coaching in Brazil • Nava Gelkop (Israel): Need of COPCA coaching in Israel. • Schirin Akhbari Ziegler: Short wrap-up

Children with motor development disorders benefit greatly from early interventions. An early diagnosis in pediatric preventive care (U2-U5) can be improved by automated screening. Current approaches to automated motion analysis, however, are expensive, require lots of technical support, and cannot be used in broad clinical application. Here we present an inexpensive, marker-free video analysis tool (KineMAT) for infants, which digitizes 3-D movements of the entire body over time allowing automated analysis in the future. Three-minute video sequences of spontaneously moving infants were recorded with a commercially available depth-imaging camera and aligned with a virtual infant body model (SMIL model). The virtual image generated allows any measurements to be carried out in 3-D with high precision. We demonstrate seven infants with different diagnoses. A selection of possible movement parameters was quantified and aligned with diagnosis-specific movement characteristics. KineMAT and the SMIL model allow reliable, three-dimensional measurements of spontaneous activity in infants with a very low error rate. Based on machine-learning algorithms, KineMAT can be trained to automatically recognize pathological spontaneous motor skills. It is inexpensive and easy to use and can be developed into a screening tool for preventive care for children.

Background: ‘COPing with and CAring for Infants with special Needs’ (COPCA) is a novel family-centred early intervention programme in paediatric physiotherapy. COPCA differs from well-known approaches, e.g. the therapist takes on the role of a coach and uses hands-off approaches. This implies, that to become a COPCA-coach, the therapist needs to change behaviour. Thus, it may be assumed that for successful implementation of new approaches, theories of human behaviour have to be taken into account. Purpose: The study aims to measure behaviour changes in therapists following a COPCA course in order to identify the challenges that interfere with the implementation of the COPCA program in daily practice. Methods: Data were collected during a three-part COPCA course over 6 months (with two months intervals between parts) in which 15 therapists learned to become a COPCA-coach. To document behaviour changes four treatment sessions (one prior to part I T0), one in each interval (T1, T2), and one after part III (T3) of each participant (n=60) were video-recorded and analysed quantitatively with the Groningen Observation Protocol version 2 (GOP 2.0). The videos were randomized and masked to the chronology of recording moment. GOP 2.0 is a quantitative tool to assess therapeutic behaviour in different categories, e.g. “educational actions toward caregivers” or “neuromotor actions”. It allows for a quantification of the relative duration of therapeutic actions (percentage of total treatment time) during a session. Interrater reliability of the GOP 2.0 was evaluated. The first author analysed changes in therapeutic behaviour over time with the Wilcox-sign rank test. Median changes and corresponding non-parametric confidence intervals were computed using the Hodges-Lehmann estimator (HL). Results: Interrater reliability of the GOP 2.0 (ICC2) was 0.48-1.00 (median 0.92). Course participation was associated especially with changes in “educational actions toward caregivers” and “ neuromotor actions”. Time spent on ‘caregiver coaching’ increased: between T0 and T1 by 77.9% (99% confidence interval (CI) 48.7-99.1) and between T0 and T3 by 96.1% (99%CI 51.7-100). Also time spent on hands-off techniques increased, 37.9% (99%CI 18.8-59.5) between T0 and T1 and 40.3% (99%CI 17.8-57.7) between T0 and T3. The implementation of hands-off approaches developed at a slower rate and somewhat less sustainable than that of coaching. Conclusions: Behaviours with a slower and less sustainable rate of change represented strong habits. The neural substrate of strong habits is located subcortically, making them relatively resistant to cognitive input. To overcome this challenge, future COPCA courses need to be adapted, by including (1) more modelling of desired behaviour and (2) more repetition and practice for the behaviours in the neuromotor domain. Implication: Quantitative analysis of therapeutic behaviour is a useful method to monitor changes in behaviour of therapists and – by doing so – may assist the implementation of new approaches. To implement new approaches successfully, theories of human behaviour have to be taken into account. The Behaviour Change Wheel of Michie et al., a method to characterise and design behaviour change in interventions, is a helpful framework to understand the nature of behaviour and to overcome behaviour change barriers.

Background Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social‐emotional development. Literature suggests that task‐specific training, such as locomotor treadmill training, facilitates motor development. Objectives To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre‐ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. Search methods In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. Selection criteria We included randomised controlled trials (RCTs) and quasi‐RCTs that evaluated the effect of treadmill intervention in the target population. Data collection and analysis Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. Main results This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high‐ versus low‐intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta‐analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low. The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) ‐2.08, 95% confidence intervals (CI) ‐5.38 to 1.22, 2 studies, 58 children; moderate‐quality evidence): 30 children with Down syndrome benefited from treadmill training (MD ‐4.00, 95% CI ‐6.96 to ‐1.04), but 28 children at moderate risk of developmental delay did not (MD ‐0.60, 95% CI ‐2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI ‐5.96 to 6.16), and high‐ versus low‐intensity treadmill interventions in 30 children with Down syndrome (MD ‐2.13, 95% ‐4.96 to 0.70). Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI ‐4.54 to 6.30, 2 studies, 36 children; moderate‐quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI ‐1.64 to 12.43, 2 studies, 32 children; low‐quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low‐quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD ‐8.40, 95% CI ‐14.55 to ‐2.25). Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high‐quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI ‐0.09 to 0.45). Authors' conclusions This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.

Ruim één op de tien paren kampt met subfertiliteit: hen lukt het niet om binnen een jaar zwanger te worden. Een toenemend aantal paren maakt gebruik van vruchtbaarheidsbehandelingen, zoals in-vitrofertilisatie (IVF). De gezondheid en ontwikkeling van IVF-kinderen is daarom van maatschappelijk belang. In dit artikel vatten we de literatuur over dit onderwerp samen. We maken hierbij ook gebruik van de gegevens van de Groningen ART (assisted reproductive technology) cohortstudie, een prospectieve, longitudinale follow-upstudie die de gezondheid en ontwikkeling van eenlingen van subfertiele paren, die al dan niet IVF ondergingen, in kaart brengt. Tot op heden werd de ontwikkeling van deze kinderen tot en met de leeftijd van vier jaar onderzocht. De belangrijkste conclusie is dat niet zozeer IVF-behandelingen, maar juist de onderliggende subfertiliteit van de ouders geassocieerd is met aangeboren afwijkingen en een minder optimale ontwikkeling van het zenuwstelsel. Een langere ‘tijd tot zwangerschap’ (TTZ), een maat voor de ernst van subfertiliteit, is hierbij bepalend. De resultaten benadrukken het belang van langdurige follow-up van kinderen van subfertiele ouders, die met of zonder IVF zwanger werden. Dit is vooral belangrijk in de huidige maatschappij waar de maternale leeftijd ten tijde van de conceptie, subfertiliteit en het toepassen van vruchtbaarheidsbehandelingen toenemen.

AIM: Long-chain polyunsaturated fatty acid (LCPUFA) supplementation of infant formula may have a beneficial effect on cognitive development. This study aimed to investigate the effect of LCPUFA formula supplementation primarily on cognition and secondarily on behaviour at age 9 years. Special attention was paid to the potentially modifying effect of maternal smoking during pregnancy. METHOD: A double-blind, randomized control study was performed in two groups of healthy infants born at term: one group, constituting the control group, received standard formula (n=169) and another group received standard formula supplemented with LCPUFAs (n=146). A breastfed group (n=159) served as an additional reference. At 9 years of age, 72% of the children (control group: n=123; 71 males, 52 females; LCPUFA group: n=91; 42 males, 49 females; breastfed group: n=127, 64 males, 63 females) underwent extensive cognitive and behavioural testing. RESULTS: An interaction between infant nutrition and smoking during pregnancy was found. Among children exposed to smoking during pregnancy, LCPUFA supplementation was associated with higher mean verbal IQ scores (p=0.007) and learning and memory (p=0.006). Among children not exposed to smoking during pregnancy, LCPUFA supplementation was associated with lower mean verbal memory scores (p=0.003). Executive function scores were significantly lower in the LCPUFA-supplemented group than in the control group (p=0.001). Breastfeeding was associated with better performance on IQ (p=0.005). INTERPRETATION: No consistent beneficial effect of LCPUFA formula supplementation on cognitive development in term-born infants was found. The study confirmed that breastfeeding is associated with better cognition.

AIM The Infant Motor Profile (IMP) is a novel qualitative assessment of motor behaviour in infancy. The aim of this study was to determine whether IMP scores throughout infancy differ between children with and without cerebral palsy (CP) at 18 months. Furthermore, we evaluated the predictive ability of IMP scores throughout infancy for CP. METHOD Fifty-nine preterm (median gestational age 29.7wk, median birthweight 1285g) and 30 term infants (median gestational age 40.1wk, median birthweight 3588g) were included. IMP assessments were longitudinally performed at (corrected) ages of 4, 6, 10, and 12 months. Neurological outcome was determined at 18 months with the neurological examination according to Hempel. We compared total and domain IMP scores throughout infancy between infants with and without CP. RESULTS In the term group none of the children was diagnosed with CP at the age of 18 months, in the preterm group eight had CP at 18 months (14%). Three had unilateral spastic CP, and five bilateral spastic CP. Children with CP (n=8) at 18 months had lower IMP scores throughout infancy than children without. These differences were most pronounced for the domains variation and performance. The predictive ability of the total IMP scores throughout infancy for CP was high (area under receiver operating characteristic curve 0.89-0.99) and most pronounced for the variation and performance domains. INTERPRETATION IMP scores throughout infancy and CP at 18 months are strongly related. In particular, low scores on the variation and performance domains were important indicators for CP. To determine the exact predictive ability of the IMP, further research is needed.

AIM Abnormal general movements at around 3 months corrected age indicate a high risk of cerebral palsy (CP). We aimed to determine whether specific movement characteristics can improve the predictive power of definitely abnormal general movements. METHOD Video recordings of 46 infants with definitely abnormal general movements at 9 to 13 weeks corrected age (20 males; 26 females; median gestational age 30 wks; median birthweight 1200g) were analysed for the following characteristics: presence of fidgety, cramped synchronized, stiff, or jerky movements and asymmetrical tonic neck reflex pattern. Neurological condition (presence or absence of CP), gross motor development (Alberta Infant Motor Scales), quality of motor behaviour (Infant Motor Profile), functional mobility (Pediatric Evaluation of Disability Inventory), and Mental Developmental Index (Bayley Scales) were assessed at 18 months corrected age. Infants were excluded from participating in the study if they had severe congenital anomalies or if their caregivers had an insufficient knowledge of the Dutch language. RESULTS Of the 46 assessed infants, 10 developed spastic CP (Gross Motor Function Classification System levels I to V; eight bilateral spastic CP, two unilateral spastic CP). The absence of fidgety movements and the presence of predominantly stiff movements were associated with CP (Fisher's exact test, p=0.018 and p=0.007 respectively) and lower Infant Motor Profile scores (Mann-Whitney U test, p=0.015 and p=0.022 respectively); stiff and predominantly stiff movements were associated with lower Alberta Infant Motor Scales scores (Mann-Whitney U test, p=0.01 and p=0.004 respectively). Cramped synchronized movements and the asymmetrical tonic neck reflex pattern were not related to outcome. None of the movement characteristics were associated with Pediatric Evaluation of Disability Inventory scores or the Mental Developmental Index. INTERPRETATION The assessment of fidgety movements and movement stiffness may improve the predictive power of definitely abnormal general movements for developmental outcome. However, the presence of fidgety movements does not preclude the development of CP.

Aim The aim of this study was to improve the understanding of brain function in children with autism spectrum disorder (ASD) in relation to minor neurological dysfunctions (MNDs). Method We studied MNDs in 122 children (93 males, 29 females; mean age 8y 1mo, SD 2y 6mo) who, among a total cohort of 705 children (513 males, 192 females; mean age 9y, SD 2y 0.5mo) referred to a regional outpatient non-academic psychiatric centre in the Netherlands, were diagnosed with ASD after an extensive multidisciplinary psychiatric assessment. Children with clear neurological abnormalities (e.g. cerebral palsy or spina bifida) were excluded from the study. MNDs were assessed in all 705 children using the Touwen examination method. Special attention was paid to the severity and type of MND. Data of the children with ASD were compared with neurological morbidity data of children with other psychiatric disorders and with children in the general population, who were born at Groningen University Hospital between 1975 and 1978. Results Seventy-four percent of the children with ASD showed complex MNDs compared with 52% of the children with other psychiatric disorders and 6% of the reference group (chi 2=18.0, p

AIM: The aim of this study was to examine the relationship between the severity and type of minor neurological dysfunction (MND) and IQ in 9-year-old children born at term. METHOD: Three hundred and forty-one children (177 males, 164 females; mean age 9y, SD 3mo, range 8y 10mo-9y 7mo) who were born at term were neurologically assessed according to Touwen. Children with perinatal risk or with a congenital disorder were excluded. Special attention was paid to the severity and type of MND. Eight domains of dysfunction were distinguished, including fine manipulative ability and coordination. On the basis of the number of dysfunctional domains, the severity of dysfunction was expressed as simple MND (sMND) or complex MND (cMND). Verbal, Performance, and Full-scale IQ (FSIQ) were assessed with the Wechsler Abbreviated Scale of Intelligence. Univariate and multivariate statistical analyses were performed. RESULTS: Neurologically normal children had higher IQ scores than those with sMND and cMND (mean FSIQ 104 [95% confidence interval (CI) 102-106] to 100 [95% CI 97-102] and 95 [95% CI 91-98] respectively). Multivariate statistics confirmed that the IQ scores of children with sMND and cMND did not differ. Fine manipulative disability and coordination problems were associated with lower IQ scores but other dysfunctions were not. INTERPRETATION: The type of MND rather than the severity is associated with lower IQ in children born at term.

Aim: To investigate the relationship between motor performance and minor neurological dysfunction (MND) at school age. Methods: Two hundred and fifty-three children (158 boys, 95 girls; mean age 8 years and 7 months) of whom 167 children received mainstream education and 86 children special education were neurologically examined according to Touwen. Special attention was paid to the severity of MND (simple or complex form) and type of dysfunction. Motor performance was assessed with the Movement Assessment Battery for Children (MABC), a parental questionnaire (Developmental Coordination Disorder Questionnaire; DCD-Q) and a teacher's questionnaire (Motor Observation Questionnaire for Teachers; MOQ-T). Results: Total scores of MABC, DCD-Q and MOQ-T were strongly related to the severity of MND and to dysfunctional coordination and fine manipulation. Mild dysfunction in posture and muscle tone was only weakly related to limited motor performance. Children with a MABC score 15th percentile (54% vs 17% and 10%). Conclusion: Limited motor performance is related to the severity and type of MND. Coordination problems and fine manipulative disability are strongly related to poor motor performance, mild dysfunctions of posture and muscle tone to a lesser extent.

AIM To improve understanding of brain function in children with severe dyslexia in terms of minor neurological dysfunctions (MNDs). METHOD One hundred and four children (81 males, 23 females; age range 7-12y; mean age 9y 7mo, SD 1y 2mo;) with severe dyslexia (the presence of a Full-scale IQ score of 85, retardation in single-word or text reading of >= 2y), assessed in a department of dyslexia of a third-level regional psychiatric centre, underwent a neurological examination according to Touwen and a multidisciplinary child psychiatric assessment. Special attention was paid to severity and type of MND. Data were compared with neurological morbidity data of children in the general population. RESULTS Most children had MND (87%): 43% had simple MND, 44% complex MND. The incidence of MND was significantly higher(p

Aim The study investigated the relationships between handwriting, visuomotor integration, and neurological condition. We paid particular attention to the presence of minor neurological dysfunction (MND). Method Participants were 200 children (131 males, 69 females; age range 8-13y) of whom 118 received mainstream education (mean age 10y 5mo, SD 1y 4mo) and 82 special education (mean age 10y 8mo, SD 1y 2mo). Each child had four assessments: a neurological examination, which paid attention to the type and severity of MND, a test to measure motor performance, a handwriting test, and the Developmental Test of Visual Motor Integration. Results Dysgraphic handwriting and slow writing speed were closely related to the severity of neurological dysfunction (both p

AIM The Infant Motor Profile (IMP) is a qualitative assessment of motor behaviour of infants aged 3 to 18 months. The aim of this study was to investigate construct validity of the IMP through the relation of IMP scores with prenatal, perinatal, and neonatal variables, including the presence of brain pathology indicated by neonatal ultrasound imaging of the brain. METHOD A longitudinal prospective study was performed in a group of 30 term infants (12 females, 18 males; median gestational age 40.1wks, range 37.6-42wks) and 59 preterm infants (25 females, 34 males; median gestational age 29.7wks, range 25-34.7wks). IMP assessments were performed at (corrected) ages of 4, 6, 10, 12, and 18 months. Socio-economic and perinatal data were collected, which, in the case of preterm infants, included information on periventricular leukomalacia and intraventricular haemorrhage based on neonatal cranial ultrasound. Data were analysed by fitting mixed-effects models. RESULTS Gestational age, socio-economic status, and 5-minute Apgar scores were significant determinants of IMP scores in the total group of infants (p INTERPRETATION The findings support the construct validity of the IMP: IMP scores are clearly associated with relevant determinants of neuromotor function.

Aim Definitely abnormal general movements in populations of high-risk infants predict serious neurodevelopmental impairment. This study aimed to assess predictive values of definitely abnormal general movements at 3 months for serious neurodevelopmental impairment in a representative sample of the general population. Method A prospective cohort study of 455 3-month-old infants was performed (241 females, 214 males; mean birthweight 3452g, SD 604g; mean gestational age 39.4wks, SD 1.96; n=32 born preterm). At enrolment, general movement quality was assessed by means of video recording. At 4 years, all participants were reassessed by well-baby health clinicians; if serious neurodevelopmental impairment was identified, clinical records were reviewed. Predictive values of definitely abnormal general movement quality for major neurodevelopmental impairment were calculated. Results Five children were diagnosed as having a major neurodevelopmental disorder with serious implications for daily life, including three children with cerebral palsy (CP). Three out of the five had shown definitely abnormal general movements; they had lesions involving the periventricular white matter. Two children did not show definitely abnormal general movements; one had unilateral spastic CP due to a cortical lesion and the other had ataxia due to cerebellar atrophy. The positive predictive value of definitely abnormal general movements for major neurodevelopmental impairment was 18/100, and for CP it was 12/100. Negative predictive values approached 100%. Interpretation The good predictive value of general movement assessment in high-risk populations cannot be generalized to the general population.

Child psychiatric diagnoses are generally based on a clinical examination and not on standardized questionnaires. The present study assessed whether symptom diagnostics based on clinical records facilitates the use of non-standardized clinical material for research. Six hundred and eighty-five children, referred to a third level child psychiatric centre in the Netherlands, were, after extensive multidisciplinary examination, classified according to the multi-axial classification scheme for psychiatric disorders in childhood and adolescence (MAC-ICD-9). By two raters 44 behavioural symptoms were scored based on the clinical records of these children. Interrater agreement on symptoms in 50 records was performed. Principal components analysis on symptom scores of all children was performed; factor scores were related with MAC-ICD-9 classifications. Interrater reliability for behavioural symptoms was excellent (kappa = 0.88). Many children with psychiatric problems suffer from a large number of behavioural symptoms. Factor scores of the symptoms revealed recognizable and well interpretable entities and indicated overlap in symptomatology and comorbidity. A symptom-based diagnostic approach based on extensive clinical patient files may provide a special dimension to improve the reliability of psychiatric classification.

Introduction: Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for neurodevelopment. Maternal diet influences milk DHA, whereas milk AA seems rather constant. We investigated milk AA, DHA and DHA/AA after supplementation of AA plus DHA, or DHA alone during pregnancy and lactation.Subjects and methods: Women were supplemented with AA+DHA (220 mg each/day), DHA (220 mg/day) or placebo during pregnancy and lactation. Milk samples were collected at 2 (n = 86) and 12 weeks (n = 69) postpartum.Results: Supplementation of AA+DHA elevated milk AA (week 2,14%; week 12, 23%) and DHA (43% and 52%) as compared to placebo. DHA tended to decrease milk AA and vice versa. Milk AA, DHA and DHA/AA decreased from 2 to 12 weeks postpartum.Conclusions: Milk AA and in particular DHA are sensitive to maternal supplementation. It seems that maternal AA and notably DHA status decline with advancing lactation. (C) 2008 Elsevier Ltd. All rights reserved.

Few studies have examined the overall effect of maternal fish intake during pregnancy on child development or examined whether the developmental benefits of maternal fish intake are greater in infants breastfed for a shorter duration.We aimed to study associations of maternal prenatal fish intake and breastfeeding duration with child developmental milestones.We studied 25 446 children born to mothers participating in the Danish National Birth Cohort, a prospective population-based cohort study including pregnant women enrolled between 1997 and 2002. Mothers reported child development by a standardized interview, which we used to generate developmental scores at ages 6 and 18 mo. We used multivariate cumulative ordinal logistic regression to evaluate the odds of higher developmental scores associated with maternal fish intake and breastfeeding, after adjustment for child age, sex, and growth; maternal size and pregnancy characteristics; and parental education and social status.Higher maternal fish intake and greater duration of breastfeeding were associated with higher child developmental scores at 18 mo [odds ratio: 1.29 (95% CI: 1.20, 1.38) for the highest versus the lowest quintile of fish intake, and 1.28 (1.18, 1.38) for breastfeeding foror =10 mo compared with breastfeeding foror =1 mo]. Associations were similar for development at 6 mo. Associations of fish intake with child development did not differ by breastfeeding duration.Maternal fish intake during pregnancy and the duration of breastfeeding are independently associated with better early child development. Future research and consumption guidelines, incorporating nutritional benefits as well as contaminant risks, should consider the overall effect of prenatal fish consumption on child development.

AIM The aim of this study was to examine the effects of intervention in infants at risk of developmental disorders onmotor outcome, as measured by the InfantMotor Profile (IMP) and using the combined approach of a randomized controlled trial and process evaluation. METHOD At a corrected age of 3 months, 46 infants (20 males, 26 females) recruited from the neonatal intensive care unit at the University Medical Centre Groningen (median birthweight 1210g, range 585-4750g; median gestational age 30wks, range 25-40wks) were included on the basis of definitely abnormal general movements. Exclusion criteria were severe congenital disorders and insufficient understanding of the Dutch language. The infants were assigned to either the family-centred COPing with and CAring for Infants with Special Needs (COPCA) intervention group (n=21; 9 males, 12 females) or the traditional infant physiotherapy (TIP) intervention group (n=25; 11 males, 14 females) for a period of 3 months. Three infants assigned to the TIP group (one male, two females) did not receive physiotherapy. IMP scores were measured by blinded assessors at 3, 4, 5, 6, and 18 months. At each age, the infants were neurologically examined. Physiotherapeutic sessions at 4 and 6 months were videotaped. Quantified physiotherapeutic actions were correlated with IMP scores at 6 and 18 months. RESULTS The IMP scores of both the COPCA and TIP groups before, during, and after the intervention did not differ. Some physiotherapeutic actions were associated with IMP outcomes; the associations differed for infants who developed cerebral palsy (n=10) and those who did not (n=33). INTERPRETATION At randomized controlled trial level, the scores of both the TIP and COPCA groups did not differ in effect on motor outcome, as measured with the IMP. The analysis of physiotherapeutic actions revealed associations between these actions and IMP outcomes. However, the small sample size of this study precludes pertinent conclusions.

Physiotherapeutische Behandlungsansätze in der Pädiatrie wurden seit jeher von den zur jeweiligen Zeit anerkannten Entwicklungstheorien abgeleitet. Die hochaktuelle "Theorie der Selektion neuronaler Gruppen" stützt sich auf neuste wissenschaftliche Erkenntnisse und liefert wertvolle Hinweise zur Gestaltung wirksamer Behandlungsansätze bei Kindern. In diesem Artikel stellen wir Ihnen die Theorie und die hieraus abgeleiteten Empfehlungen zu einer Physiotherapie vor, die vor allem die Eigenaktivität des Kindes in den Vordergrund stellt.

Motorische Funktionsstörungen bei Säuglingen werden in der Physiotherapie oft nach einem traditionellen Ansatz behandelt. Eine Studie zeigt nun, dass ein neues Behandlungsprogramm mit Fokus auf einem Coaching der Eltern und Herausforderung des Säuglings zur motorischen Eigenaktivität bessere Resultate bringt.

At early age, it is important to determine which children are at high risk of a neurodevelopmental disorder. This makes it possible to start early intervention; a definite diagnosis is not necessary. It is well known that neurological signs may assist early prediction, but knowledge on the contribution of specific signs is limited. This thesis addresses the prevalence and possible underlying mechanisms of specific neurological signs in infancy. We studied two groups of children. The first group comprised low-risk infants from the general Dutch population; the second group consisted of children at very high risk of neurodevelopmental disorders, in particular cerebral palsy (CP). In the low-risk group we found a high, yet with age decreasing prevalence of a prevailing head position to one side during the first 6 months of life. From 4 months onwards a prevailing head position was associated with perinatal risk factors and suboptimal development. Atypical muscle tone in 1 or 2 body parts was common with limited clinical significance, whereas atypical muscle tone in 3 or 4 body parts was clinically relevant. The very high-risk children virtually always presented with atypical muscle tone in early infancy. From 7 months of age onwards, specific atypical tone patterns were associated with CP. Besides, in the very high-risk group, the presence of a tonic knee jerk response during infancy assisted prediction of CP, and infant motor development assisted prediction of developmental outcome at school-age.

This thesis provides insight in the application and effect of infant physiotherapy in Switzerland. It focuses on the implementation in daily practice of the family-centred early intervention programme “COPing with and CAring for infants with special needs” (COPCA). COPCA has been developed since the beginning of this century by Tineke Dirks (paediatric physiotherapist) and Mijna Hadders-Algra (developmental neurologist) from the University Medical Center Groningen. They developed COPCA because of lacking evidence on the effectiveness of existing physiotherapeutic programmes on motor development of infants at risk of developmental disorders. COPCA differs from typical physiotherapeutic programmes in two ways (1) by including the whole family as active partners; (2) by offering the infant opportunities to learn through self-produced motor behaviour and trial-and error experiences. The thesis shows, that it is possible to implement COPCA successfully in Switzerland, and that Swiss parents of infants with impaired motor development highly appreciate COPCA. They especially valued its home-based setting, the support from the COPCA coach, and the experience being able to promote their infant’s development by integrating stimulating activities in daily routines. The thesis includes a small randomized controlled trial that demonstrated that COPCA was associated with better motor outcomes in infants with motor impairments. The thesis concludes that COPCA enables parents to promote their infants’ motor development in an autonomous way in their real life environment. The promising results of this thesis should be strengthened through studies evaluating the effect of COPCA in a larger group of infants at risk of motor developmental disorders.