Objective Children born < 30 weeks’ gestation have more motor impairment than do children born at term (37–42 weeks’ gestation), but reported outcomes have largely focused on cerebral palsy (CP) and Developmental Coordination Disorder (DCD). The aim of this study was to compare muscle strength, motor skills and physical activity of preschool-aged children born < 30 weeks with those born at term. Methods In this cohort study, 123 children born < 30 weeks and 128 born at term were assessed. Children were ≥ 4 years, 0 months and < 6 years, 0 months’ corrected age at the time of the assessment. Outcomes included: grip strength (kg), Movement Assessment Battery for Children 2nd edition (MABC-2), Little Developmental Coordination Disorder Questionnaire (L-DCDQ), accelerometer-measured physical activity (PA), and a parent-completed PA diary. Linear regression and mixed effects models were used to examine differences between children born < 30 weeks and those born at term. Results Children born < 30 weeks had poorer grip strength (preferred hand; mean difference [95% confidence interval] -0.60 kg [−1.04, −0.15], p = 0.008) and poorer motor competence (MABC-2 standard score mean difference − 2.17 [−3.07, −1.27], p < 0.001; L-DCDQ total score mean difference − 5.5 [−9.2, −2.8], p < 0.001) than term-born children. Children born < 30 weeks also completed fewer minutes of accelerometer-measured PA (mean difference − 41 minutes, [−62, −20], p < 0.001), more minutes of accelerometer-measured stationary behavior (mean difference 33 minutes, [12, 54], p = 0.002), and more minutes of parent-reported screen time (mean difference 21 minutes, [10, 32], p < 0.001) per day. Conclusions Preschool-aged children born < 30 weeks had poorer muscle strength, motor skills and physical activity levels than term-born children. These findings suggest that preschool-aged children born < 30 weeks may benefit from enhanced surveillance and PA promotion to improve life-long health outcomes. Impact In our study, children born < 30 weeks had reduced muscle strength, poorer motor skills, participated in less physical activity (PA), and had more stationary and screen behaviour than term-born children. These findings emphasize that awareness of multidomain motor deficits in children born < 30 weeks’ gestation is needed in clinical practice. Given the associations between higher PA and health benefits, and recognition that PA levels can track from early childhood into adulthood, our study highlights the need for assessment and promotion of PA in preschool-aged children born < 30 weeks’ gestation. Lay Summary Children born < 30 weeks had reduced muscle strength, poorer motor skills, participated in less physical activity (PA), and had more stationary and screen behavior than term-born children. Awareness of multidomain motor deficits in children born at < 30 weeks’ gestation is needed in clinical practice. Given the associations between higher PA and health benefits, and in recognition that PA levels can track from early childhood into adulthood, this study highlights the need for assessment and promotion of PA in preschool-aged children born at < 30 weeks’ gestation.

Walking is a central skill of daily living. A delay in the onset of walking can be a sign of abnormal motor development. Further, abnormalities in gait can also affect physical functioning. Children born preterm are at significant risk for neurodevelopmental impairments; however, little is known about how preterm birth affects walking. This review describes current evidence of walking in children born preterm with a focus on the age at onset of walking and comparisons of gait characteristics of children born preterm with those born full-term.