Barriers and facilitators to community participation for preschool age children born very preterm: a prospective cohort study

Abstract

Aim We compared preschool age children born very preterm with term‐born controls to: (1) understand the association between very preterm birth and community participation, (2) determine if motor impairment or social risk affect participation differently between groups, and (3) understand environmental barriers and supports to participation for parents. Method Forty‐eight children born very preterm (<30wks’ gestation; 22 males, 26 females) and 96 controls (47 males, 49 females) were assessed at 4 to 5 years’ corrected age for community participation using the Young Children’s Participation and Environment Measure. Motor skills were assessed using the Movement Assessment Battery for Children, Second Edition and the Little Developmental Coordination Disorder Questionnaire. Results Children born very preterm participated less frequently than term‐born children (difference in means=–0.28, 95% confidence interval [CI] –0.54 to –0.03, p=0.029). Social risk was associated with lower frequency (interaction p<0.001) and involvement (interaction p=0.05) in community activities for children in the very preterm group only. Parents of children born very preterm perceived more barriers (odds ratio=4.32, 95% CI 1.46–12.77, p=0.008) and environmental factors to be less supportive of participation than parents of controls (difference in medians=–6.21, 95% CI –11.42 to –1.00, p=0.02). Interpretation Children born very preterm may benefit from ongoing support to promote participation, especially in families of higher social risk.

The impact of parent involvement on improving participation of children born preterm: The story in the baseline

“…These children have significantly lower adaptive behavior in comparison to age-matched term-born infants [ 1 ] which in turn has a negative effect on their level of participation, particularly in play [ 2 ]. Parents of children born very preterm also attend community activities less regularly and report more barriers in participation than term-born controls [ 3 ]. Long-term repercussions are characterized by limited participation into adolescence, in comparison to full-term youth [ 4 ], especially in physical and skill-based activities [ 5 ].…”

Developmental coordination disorder in preterm children: A systematic review and meta‐analysis

“…The International Clinical Practice Recommendation for DCD advises researchers and clinicians to consider the 15th percentile as a percentile cut‐off (Blank et al, 2019). Nevertheless, some studies considered the most restricted cut‐off percentile for DCD (5th percentile) (Bolk et al, 2018; Cameron et al, 2021; Doyle et al, 2014; Foulder‐Hughes & Cooke, 2003; Kwok et al, 2019; Lahti et al, 2020; Örtqvist et al, 2022; Pierrat et al, 2021; Roberts et al, 2011; Setänen et al, 2016; Tommiska et al, 2020; Uusitalo et al, 2020); several of these studies were conducted before 2019. Additionally, others reported the children ‘at risk for DCD’ (6th percentile to 15th percentile) in the same group for analysis (Brown et al, 2015; Dewey et al, 2019; de Kieviet et al, 2013; Goyen & Lui, 2009, Lingam et al, 2009; Lingam et al, 2009; Spittle et al, 2021; Sustersic et al, 2012; Wocadlo & Rieger, 2008; Zamir et al, 2021; Zwicker et al, 2013) highlighting an extensive range between the results and the need to follow the standard cut‐off percentile recommendation to compare the results of different studies, populations and regions.…”

Associations between physical activity and development in preschool-aged children born <30 weeks’ gestation: a cohort study

“…Effects of PA on continuous developmental outcomes (MABC-2 total and subscale standard scores, L-DCDQ total scores, WPPSI-IV full-scale IQ and index scores, and SDQ total difficulties and subscale scores) were estimated using univariable and multivariable linear regression models, fitted with generalised estimating equations (GEEs) to allow for clustering among multiple births within a family, reported with robust (sandwich) SEs. Based on the DAG, multivariable models included adjustment for confounding factors (sex and social risk status) known to influence both PA and child development for children born preterm 22–25. Associations between perinatal risk factors and PA were estimated using univariable linear regression models, fitted with GEEs and reported with robust SEs.…”