An evidence based care package to improve motor skills of infants living in foster care according to integrative review approach

Document Type: Narrative and Integrative Review


1 Instructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, Iran

2 MS in pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, Iran

3 Full Professor, Pediatrics Department, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Infancy is the most important extra uterine period of brain development. And it requires environmental stimulation for expression of the developmental capabilities. Meanwhile, due to repeated environmental disparities foster care children are at risk for developmental delay.
Aim: designing evidence based care package to improve motor skills of orphan living infants according to integrative review approach.
Methods: In this integrative review after problem identification, search was made with a combination of assigned index (MESH) terms and text words including Motor development, Infant, Stimulation, Intervention, Improvement, Environment between May 2012 to May 2013 and research span of 1970 to 2013, in the following databases: The Cochrane Central Register of Controlled Trials, AMED, CINAHL, EMBASE, Ovid MEDLINE, MEDLINE Advanced, PsycINFO, Google scholar. After the final selection based on the inclusion and exclusion criteria, articles were translated, data were collected using a data collection form, and analysis/ coding were done according to constant comparative analysis method. Then the findings were combined and edited according to the assigned codes, until the various components of the package have been appeared and completed.
Results: Of the 180 citations, 141 citations were excluded
due to lack of the necessary criteria and the data obtained from the 39 citations including appropriate toys, skills, child-care givers interactions, care practices and environments to stimulate motor development, were been integrated to made an evidence-based care package to promote motor development of orphan living infants.
Conclusion: Evidence-based care programs could be achieved, with incorporating rich information obtained from the studies of infant development, in the form of high-quality review studies. Providing similar packages for other communities and areas of development is proposed.


1. Restak RM, Grubin D. The Secret Life of the Brain. Washington, DC: Joseph Henry Press; 2001.

2. Jensen E. Teaching with the Brain in Mind, Revised 2nd Edition 2ed. Alexandria, VA: Association for Supervision & Curriculum Development 2005.

3. Thompson RA. Development in the First Years of Life. The Future of children / Center for the Future of Children, the David and Lucile Packard Foundation. 2001;11(1):20-33.

4. Schiller P. Bright Beginnings for Babies. Child Care Information Exchange. 2003;150:5.

5. Ehsanpor S, Javanmardi Z, Abdyazdan Z, Malbosizadeh M. Comprative Study of the Growth  of Infants with  Low Birth Weight and Normal to Two  Years in Isfahan Health Centers. Nursing and midwifery. 1380; 3(1):69-74 (persian).

6. Kosarian M, Vahidshahi K, Shafaat A, Abaskhanian A, Azizi S, Shahrokh S, et al. Screening for Developmental Disorders in Children Sari Child Care in 1385. Mazandaran university of Medical Sciences. 1386;59(17):69-7 (persian).

7. Dareh F, Bayat GF. A Developmental Status of Children 4-60 Month with a History of Hospitalization in the Neonatal Intensive Care Based on the Questionnaire ASQ in Amir kabir  Hospital. Ardabil university of Medical Sciences. 1390;11(2):143-50  (persian).

8. Bruskas D. Children in Foster Care: A Vulnerable Population  at Risk. Child and Adolescent Psychiatric Nursing. 2008;21(2):70-7.

9. Turner AM, Greenough WT. Differential Rearing Effects on Rat Visual Cortex Synapses. I. Synaptic and Neuronal Density and Synapses per Neuron. Brain Res. 1985;329(1-2):195-203.

10. Bengoetxea H, Ortuzar N, Bulnes S, Rico-Barrio I, Lafuente JV, Argandona EG. Enriched and Deprived Sensory Experience Induces Structural Changes and Rewires Connectivity During the Postnatal Development of the Brain. Neural Plast. 2012;2012:305693.

11. Mustard J. Experience-Based Brain Development: Scientific Underpinnings of the Importance of Early Child Development in a Global World. Paediatr Child Health. 2006;11(9):571-2.

12. Grossman AW, Churchill JD, McKinney BC, Kodish IM, Otte SL, Greenough WT. Experience Effects on Brain Development: Possible Contributions to Psychopathology. J Child Psychol Psychiatry.  2003;44(1):33-63.

13. Bayat M, Jerani MN, Shahsavari A, Miri M, Naderifar M. Frequency of Physical Problem Among 7-11 Years Old Children in Foster Care Centers. Iranian Journal of Nursing. 2010;23(63):635-44.

15. Latifi S, khalilpour A, Rabiee L, Amani N. The Barriers to Research Findings  Utilization Among.Clinical Nurses. Mazand Univ Med Sci. 2012;22(87):88-9 (persian).

16. 22thousand Orphans in. Iran 2013 [cited 2013]; Available from:[persian].

17.      Leppo ML, Davis D, Crim B. The Basics of Exercising the Mind and Body. Childhood Education. 2000;76(3):6.

18. Dawson G, Ashman SB, Carver LJ. The Role of Early Experience in Shaping Behavioral and Brain Development and its Implications for Social Policy. Dev Psychopathol. 2000;12(4):695-712.

19. Bos S. Brain research: Implications for Teaching and Learning Brattleboro, Vermont: Community Works Press; 1997.

20. Bayat M, far MN, Bayat M, Miri M, Foroghi s. Social Health of Children 7-11  Years Old  Livining in Foster Care. Nursing and midwifery. 1386;51(20):97-105 (persian).

21. Rodgers BL, Knafl KA. Integrative Literature Reviews for the Development

of Concepts.  Concept Development in Nursing. 2 ed. Philadelphia: Saunders 1993. p. 231-50.

22. Whittemore R, Knafl K. The Integrative Review: Updated Methodology. J Adv Nurs.  2005;52(5):546-53.

23. Evans D, Pearson A. Systematic Reviews: Gatekeepers of Nursing Knowledge. J Clin Nurs.  2001;10:7.

24. Cacola P, Gabbard C, Santos DC, Batistela AC. Development of the Affordances in the Home Environment for Motor Development-Infant Scale. Pediatr Int. 2011;53(6):820-5.

25. Chopra G, Sharma S, Nagar S. The Impact of Intervention on Motor and Mental Development of Rural Female Infants in District Kangra of Himachal Pradesh. journal of human ecology. 2004;15(3):5.

26. Miquelote AF, Santos DC, Cacola PM, Montebelo MI, Gabbard C. Effect of the Home Environment on Motor and Cognitive Behavior of Infants. Infant Behav Dev. 2012;35(3):329-34.

27. Isbell C, Isbell RT. On the Move: Environments That Stimulate Motor and Cognitive Development in Infants. Dimensions of Early Chilhood. 2007;35(3):6.

28. Nielsen M, Dissanayake C. Pretend Play, Mirror Self-Recognition and Imitation: a Longitudinal Investigation Through the Second Year. Infant Behavior & Development. 2004;27(3):342-65.

29. Eickmann SH, Lima ACV, Guerra MQ, Lima MC, Lira PIC, Huttly SRA, et al. Improved cognitive and motor development in a community-based intervention of Psychosocial Stimulation in Northeast Brazil. Dev Med Child Neurol.2003;45(8):536-41.

30. Rochat P. Object Manipulation and Exploration in 2- to 5-Month-Old Infants. Developmental Psychology. 1989;25(6):14.

31. Adolph KE, Karasik LB, Tamis-LeMonda CS. Moving Between Cultures:Cross-Cultural Research on Motor Development. Handbook of cross-cultural developmental science.1:23.

32. Lekskulchai R, Cole J. Effect of a Developmental Program on Motor Performance in Infants Born Preterm. Aust J Physiother. 2001;47(3):169-76.

33. Nagar S, Sharma S. Influence of Intervention on Temperament and Developmental Outcomes of Infants. Journal of human ecology. 2009;28(2):6.

34. Beier JS, Spelke ES. Infants' Developing Understanding of Social Gaze. Child Development. 2012;83(2):486-96.

35. Field TM. Interventions for Premature Infants. J Pediatr. 1986;109(1):183-91.

36. Majnemer A, Barr RG. Association Between Sleep Position and Early Motor Development. J Pediatr. 2006;149(5):623-9.

37. Monson RM, Deitz J, Kartin D. The Relationship Between Awake Positioning and Motor Performance Among Infants Who Slept Supine. Pediatr Phys Ther.  2003;15(4):196-203.

38. Ratliff-schaub K, Hunt CE, Crowell D, Golub H, Smok-Pearsall S, Palmer P, et al. Relationship Between Infant Sleep Position and Motor Development in Preterm Infants. J Dev Behav Pediatr. 2001;22(5):7.

39. Kuo YL, Liao HF, Chen PC, Hsieh WS, Hwang AW. The Influence of Wakeful Prone Positioning on Motor Development During the Early Life. J Dev Behav Pediatr. 2008;29(5):367-76.

40. Rezaeian a. Pediatric Nursing Textbook of Mashhad Medical University. Mashad: Mashhad Medical University; 1390[persian].

41. Karimi H, Nazi S, Sajedi F, Fahimi NA, Karimloo M. Comparsion The Effect of Simultaneous Sensory Stimulation and Current Occupational Therapy Approach on Motor Development of The Infants With Down Syndrome. Iranian Journal of Children Neurlology 2010;4(3):6.

42. Humphries N. The Effects of Sensorimotor Stimulation on the Physical Development of Institutionalized HIV/AIDS Infants. BabyGym Institute: Johannesburg: Faculty of health sciences at the university of pretoria; 2008.

43. Kanagasabai PS, Mohan D, Lewis LE, Kamath A, Rao BK. Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants. Indian J Pediatr.2013;80(6):460-4.

44. Niklasson M. Could Motor Development Be an Emergent Property of Vestibular Stimulation and Primary Reflex Inhibition? A Tentative Approach to Sensorimotor Therapy.

45. Sharma S, Nagar S. Influence of Home Environment on Psychomotor Development of Infants in Kangra District of Himachal Pradesh. Journal of social science. 2009;21(3):5.

46. Chapman JS. The Relationship Between Auditory Stimulation and Gross Motor Activity of Short-Gestation Infants. Res Nurs Health. 1978;1(1):8.

47. Trainor LJ, Zacharias CA. Infants Prefeer Higher-Pitched Singing. Infant behavior & Development. 1998;21(4):7.

48. Valvano J, Rapport MJ. Activity-Focused Motor Interventions for Infants and Young Children with Neurological Conditions. Infant Young Child.2006;19(4):292-307.

49. Weiss SJ, Wilson P, Morrison D. Maternal Tactile Stimulation and the Neurodevelopment of Low Birth Weight Infants. Infancy. 2004;5(1):85-107.

50. Bennett C, Underdown A, Barlow J. Massage for Promoting Mental and Physical Health in Typically Developing Infants Under the Age of Six Months. Cochrane database of systematic reviews. 2013;4:CD005038.

51. Abbott AL, Bartlett DJ. Infant Motor Development and Equipment Use in the Home. Child Care Hlth Dev. 2001;27(3):295-306.

52. Defilipo EC, Fronio Jda S, Teixeira MT, Leite IC, Bastos RR, Vieira Mde T, et al. Opportunities in the Home Environment for Motor Development. Rev Saude Publica. 2012;46(4):633-41.

53. Abbott AL, Bartlett DJ, E.Fanning J, Kncalc M, Kramer J. Infant Motor Development and Aspects of the Home Environment. Pediatric Physical Therapy. 2000;12(2):6.

54. Souza CT, Santos DC, Tolocka RE, Baltieri L, Gibim NC, Habechian FA. Assessment of Global Motor Performance and Gross and Fine motor Skills of Infants Attending Day Care Centers. Rev Bras Fisioter. 2010;14(4):309-15.

55. Orton J, Spittle A, Doyle L, Anderson P, Boyd R. Do Early Intervention Programmes Improve Cognitive and Motor Outcomes for Preterm Infants After Discharge? A Systematic Review. Dev Med Child Neurol.  2009;51(11):851-9.

56. Spittle A, Orton J, Anderson P, Boyd R, Doyle LW. Early Developmental Intervention Programmes Post-Hospital Discharge to Prevent Motor and Cognitive Impairments in Preterm Infants. Cochrane database of systematic reviews. 2012;12:CD005495.

57. Nair MK, George B, Mathews S, Lekshmi S, Philip E. Early Intervention Program for High Risk Babies--Use of Infant Motor Screen. I Indian J Pediatr.  1992;59(6):687-90.

58. Blauw-Hospers CH, Hadders-Algra M. A Systematic Review of the Effects of Early Intervention on Motor Development. Dev Med Child Neurol. 2005;47(6):421-32.

59. Care AAoPCoECaAaD. Developmental Issues for Young Children in Foster Care. Pediatrics. 2000;106(5):6. Epub 2000/11/04.

60. Darrah J, Redfern L, Maguire TO, Beaulne AP, Watt J. Intra-Individual Stability of Rate of Gross Motor Development in Full-Term Infants. Early human development. Early Hum Dev. 1998; 53(2): 169-79.

61. Kimura-Ohba S, Sawada A, Shiotani Y, Matsuzawa S, Awaya T, Ikeda H, et al. Variations in Early Gross Motor Milestones and in the Age of Walking in Japanese Children. Pediatr Int.  2011;53(6):950-5.

62. Dusing SC, Harbourne RT. Variability in Postural Control During Infancy: Implications for Development, Assessment, and Intervention. Physical therapy. 2010;90(12):1838-49.

63. Mahoney G, Robinson C, Fewell RR. The Effects of Early Motor Intervention on Children with Down Syndrome or Cerebral Palsy: A Field-Based Study. J Dev Behav Pediatr. 2001;22(3):153-62.

64. Zentall SS, Zentall TR. Optimal Stimulation: a Model of Disordered Activity and Performance in Normal and Deviant Children. Psychol Bull.  1983;94(3):446-71.

65. Thakur A, Sharma S, Rani R. Assessment of Mental and Motor Development of Infants in Hamirpur District of Himachal Pradesh. Anthropologist,. 2004;6(2):4.

66. Garza C, de Onis M, Martorell R, Lartey A, Dewey KG, Reference WMG. Relationship Between Physical Growth and Motor Development in the WHO Child Growth Standards. Acta Paediatr. 2006;95:96-101.

67. Manaseki-Holland S, Spier E, Bavuusuren B, Bayandorj T, Sprachman S, Marshall T. Effects of Traditional Swaddling on Development: a Randomized Controlled Trial. Pediatrics. 2010;126(6):e1485-92.

68. Crouchman M. The effects of Babywalkers on Early Locomotor Development. Dev Med Child Neurol.1986;28(6):757-61.

69. Whinnery KW, Whinnery SB. Move - Systematic Programming for Early Motor intervention. Infant Young Child. 2007;20(2):102-8.