Fundamental motor skills (FMS) are considered the “ABCs” of movement and physical activity (Payne & Isaacs, 2016). Well-developed FMS have been related to higher levels of physical activity and cardiorespiratory fitness, a healthy weight status and improved cognitive, and social development (Lubans et al., 2010; Payne & Isaacs, 2016; Veldman et al., 2019). Early childhood (up to 5 years) is considered a critical period for the child’s development. In this period, the brain and central nervous system grow rapidly as new connections or synapses between cells are formed (Shonkoff & Philips, 2000). This time is also critical for the development of FMS. Children develop rapidly, and the foundation for specialized movements and sports-specific skills is laid by developing infant reflexes, rudimentary motor skills, and FMS (Payne & Isaacs, 2016). The importance of motor development in early childhood for sports throughout life has also been emphasized by models on motor development (Clark & Metcalf, 2002; Seefeldt, 1980). The cognitive developmental theory by Piaget (1953) also emphasized the importance of movement for increased cognitive development in especially the early years of life (Piaget & Cook, 1952). Cognitive processes are enhanced by actions created by the body, and this is especially apparent in the sensorimotor stage of development (ages 0–2 years).
Recent studies demonstrate that in the last decade, FMS competence has declined across children of different ages, and low FMS competence has also been observed in early childhood (Bardid et al., 2016; Brian et al., 2019; Veldman et al., 2018). To support the optimal development of FMS, children need to be encouraged and provided with appropriate instruction and feedback, learning opportunities, and practice (Van Capelle et al., 2017; Veldman et al., 2016). Several systematic reviews concluded that interventions targeting FMS in early childhood are effective at promoting skill development (Van Capelle et al., 2017; Veldman et al., 2016; Wick et al., 2017). However, due to a lack of high-quality studies, it is unknown which intervention components are most effective, and it is unclear whether tailored interventions are necessary and, if so, for whom (Lopes et al., 2021; Veldman et al., 2016).
To inform future interventions, it is important to identify correlates of FMS in this young age group. According to Newell’s constraints theory, several factors can limit, contain, or help shape motor development. These factors are related to the movement task, individual characteristics of the child—including structural (e.g., body mass), and functional (e.g., motivation) factors—and the child’s environment, and all can cause constraints of the trajectory of FMS development (Newell, 1986). Previous reviews on correlates of FMS have only included studies in preschoolers aged 3–5 years (Iivonen & Sääkslahti, 2013; Venetsanou & Kambas, 2010), studies in a wider age range (i.e., aged 3–18 years; Barnett et al., 2016), or solely focused on environmental factors (Flôres et al., 2019; Venetsanou & Kambas, 2010). Additional limitations of previous reviews include the absence of a methodological quality assessment (Iivonen & Sääkslahti, 2013; Venetsanou & Kambas, 2010) or only including studies that identified significant positive associations (Iivonen & Sääkslahti, 2013). The current review expands on previous reviews by summarizing all types of correlates of FMS in typically developing children aged 0–4 years, taking into account the methodological quality of included studies.
Therefore, the aim of this systematic review is to identify correlates of FMS in typically developing children aged 0–4 years. To cover this full age range, one overall definition of FMS was used to determine search terms: FMS involve movements primarily controlled by the large muscles in the body and can be subdivided into locomotor skills (e.g., jumping and running), object control skills (e.g., kicking and catching), and stationary skills (e.g., balance on one leg; Logan et al., 2018). The results however will be presented per age group: <1 year, 1–2 years, and 2–4 years due to the rapid development of FMS in young children (Payne & Isaacs, 2016).
Methods
Protocol and Registration
We developed a review protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (Moher et al., 2009). This systematic review was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42020166189).
Eligibility Criteria
Studies were included if they (a) examined associations between a potential correlate and FMS in typically developing, apparently healthy children aged 0–4 years (mean age of <4 years at time of FMS assessment), (b) used a longitudinal (observational cohort or intervention) or cross-sectional design, (c) assessed FMS quantitatively using a summary score of at least two individual skills, as our aim is to review correlates of FMS and specific motor skills are not necessarily representative of FMS, and (d) were published in English after 2000 (to ensure relevance for future interventions) in a peer-reviewed scientific journal.
Exclusion criteria were studies (a) solely presenting data on children born preterm (<37 weeks) or children with nontypical development; (b) using a measurement tool including both fine and FMS, using a screening tool for motor delay or measuring the achievement of individual motor milestones; and (c) examining a prenatal potential correlate, except for prenatally assessed sociodemographic factors as this contributes to identifying which groups should be targeted for interventions.
Literature Search and Study Selection
A comprehensive search was performed in the bibliographic databases PubMed, Embase, PsycINFO, and SPORTDiscus in collaboration with a medical librarian. Databases were searched from inception up to May 23, 2022. The following terms were used (including synonyms and closely related words) as index terms or free-text words: “Infant,” “Motor skills,” “Motor development,” and “Risk factors.” The full search strategies for all databases can be found in Supplementary Material S1 (available online).
After removal of duplicates, two independent reviewers (S.L.C. Veldman and J.M. Koedijker or A.S. Singh) individually screened all titles and abstracts. Discrepancies (∼10%) were discussed until consensus was reached. One reviewer (S.L.C. Veldman) screened all full-text articles to determine whether inclusion criteria were met. A second reviewer (J.S. Gubbels) screened 10% of each of the exclusion categories (e.g., age and outcome; see Figure 1) to check the first reviewer’s decision. Discrepancies (∼8%) were discussed until consensus was reached.
—PRISMA flowchart. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From: “Preferred Resporting Items for Systematic Reviews and Meta-Analysis: The Prisma Statement,” D. Moher, A. Liberati, J. Tetziaff, & D. Altman, 2009, PLoS Medicine, 6(7), Article 1000097.
Citation: Journal of Motor Learning and Development 12, 1; 10.1123/jmld.2023-0003
Data Extraction
Two independent reviewers (S.L.C. Veldman and A.S. Singh or J.M. Koedijker or L. Balk) extracted the following data using a structured form: study methodology (e.g., study design, duration, and points of data collection), participants (e.g., sample size, mean age, and percentage girls), FMS (e.g., summary scores assessed and measurement tool used), correlate(s) (e.g., type and measurement tool used), and results. p values < .05 were accepted as statistically significant. Results were compared, and discrepancies were discussed until consensus was reached. When multiple studies reported on the same outcomes in the same sample, the study with the most advanced analysis (e.g., adjusted for potential confounders) was included.
Presentation of Results
An ecological perspective has been used to present factors that potentially influence FMS in early childhood in a clear and comprehensive way (Sallis et al., 2008; Swinburn et al., 1999). Potential correlates of FMS were therefore categorized into two main categories with seven subcategories: (a) Individual, including subcategories Biological, Behavioral attributes, and Cognitive, emotional, or psychological; and (b) Environmental, including subcategories Physical (related to availability), Economic (related to costs), Political (related to rules and organization), and Sociocultural (related to community’s or society’s attitudes). Results are presented in three age groups, based on children’s developmental stages: <1 year, 1–2 years, and 2–4 years. If studies included children covering multiple age groups, results are presented in the age group that best represented the age range of the children included in the study, based on the mean age of the included children or the percentage of children in a certain age range. When included children equally covered multiple age ranges, results were presented in all relevant age groups.
Quality Assessment
Two researchers (S.L.C. Veldman and A.S. Singh, M.J.M. Chinapaw, or T.M. Altenburg) independently scored the methodological quality of included studies using an adjusted version of the “Quality Assessment Tool for Quantitative Studies” (Jackson & Waters, 2005; Thomas et al., 2004; see Supplementary Material S2 [available online]). The tool was developed in the Effective Public Health Practice Project contains 19 items divided over eight quality criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals and dropouts, intervention integrity, and data analyses. The tool was adjusted to rate the methodological quality of observational studies, taking into account the measurement tools used for both FMS and correlates, and to rate the number of participants in relation to the number of confounders included used in the analyses. This resulted in changes in the rating of the study design (B), data collection methods (E), and data analyses (H). Per quality criterion, a quality score was calculated: good, fair, or poor. Discrepancies in scores (∼20%) were discussed until consensus was reached. The overall methodological quality of a study was classified as “high” when none of the quality criteria were scored as poor. A study was classified as “moderate” when at most one quality criterion was scored as poor. The overall methodological quality of a study was classified as “low” when two or more quality criteria were scored as poor (Jackson & Waters, 2005; Thomas et al., 2004).
Synthesis of Evidence
A best evidence synthesis was applied to draw conclusions on the level of evidence for the association between a potential correlate and FMS in children aged 0–4 years, in line with previous reviews (Chinapaw et al., 2011; Hayden et al., 2005; van Ekris et al., 2017). This synthesis was based on the number of studies, their methodological quality, and the consistency of findings (Slavin, 1995):
- •Strong evidence: consistent findings in multiple studies (≥2) of high methodological quality.
- •Moderate evidence: consistent findings in one study of high methodological quality and at least one study of moderate or low methodological quality, or consistent findings in multiple studies (≥2) of moderate or low methodological quality.
- •Insufficient evidence: only one study available, or inconsistent findings in multiple studies (≥2).
- •No evidence: consistent findings for the absence of an association in multiple studies (≥2) of high or moderate methodological quality.
Results were considered consistent when ≥75% of studies demonstrated findings in the same direction. A finding was defined by a significance of p < .05 in the fully adjusted model. If a study examined multiple associations for the same correlate (e.g., analyzing the association with multiple measures of FMS [e.g., overall score and subtest], or analyzed multiple variables that reflect the same construct, e.g., BMI standard deviation score and weight-for-age), they were considered to add evidence when consistently demonstrating a significant association, that is, when >50% of examined associations showed results in the same direction. If two or more studies of high methodological quality were available, results of studies with moderate or low methodological quality were ignored in determining the level of evidence.
Results
Overview of Studies
The search identified 13,790 hits. After removing duplicates (n = 4,076) and checking eligibility, 83 studies were included. Most common reasons for exclusion were an ineligible assessment of FMS (e.g., a combination of fine and FMS), date of publication, or age. Figure 1 presents the flow diagram of studies. Tables 1–3 present the characteristics of included studies and results for the three age groups (i.e., children aged <1 year, 1–2 years, and 2–4 years).
Characteristics of Included Studies and Results Regarding Correlates of Fundamental Motor Skills in Children Aged <1 Year, Sorted by Study Design, Analysis, and First Author
| Reference (author, year, country) | Sample size (n), age, %girls | Fundamental motor skill assessment and outcome(s) | Correlate(s), association (+/0/−)b,c |
|---|---|---|---|
| Intervention studies | |||
| Heinig et al. (2006), United States | 70, 4–10 months, 51%d | AIMS, overall score, seven assessments | INT: Zinc supplements, CON: Placebo, for 6 months (0) |
| Wicklow et al. (2015), Canada | 55, 3, and 6 months ± 1 week, 44%d | AIMS, overall score, and subtests prone, supine, sitting, standing | INT 1: 400 IU Vitamin D3/day dose, INT 2: 800 IU Vitamin D3/day dose, INT 3: 1,200 IU Vitamin D3/day dose (+INT 2 > INT 1 overall score and subtest prone and sitting; INT 3 > INT 1 overall score and subtest sitting), for 6 months |
| Valentini et al. (2020), Brazil | 176, 7.8–10.2 months, 52%d | AIMS, overall score | INT: Home-based cognitive-motor intervention (40 sessions, 5×/week for 30 min); CON: No intervention (+) |
| Zhang et al. (2018), Vietnam | 196, 30.4 ± 0.7 weeks, 44%d | BSID-III, overall score | INT: 2×/day maternal milk supplementation up to 12 weeks and four breastfeeding education and support sessions, CON: Standard antenatal care, including continued supplementation from enrollment to delivery with folic acid and iron and breastfeeding advice (0) |
| Reference (author, year, country) | Sample size (n), age at (first) motor assessment(s), %girls | Fundamental motor skill assessment, outcome(s), and assessments if >1 | Correlate(s), association (+/0/−)b |
|---|---|---|---|
| Observational studies, longitudinal analysis | |||
| Caparros-Gonzalez et al. (2019), Spain | 41, 6.3 ± 0.4 months, 54% | BSID-III, overall score | Maternal stress at 10 days: Cortisol level mothers (+) and cortisol level infants (−) |
| Carmeli et al. (2009), India | 75, 6 months, unknown | AIMS, overall score, and subtests: Prone and supine | Perceived preferred position (side, supine, or prone) per activity: At 1 month: Sleep (0 for all scores), awake (0 for all scores), play (0 for all scores), and uninterrupted position (0 for all scores) At 3 months: Sleep (0 for all scores), awake (0 for all scores), play (0 for all scores), and uninterrupted position (0 for all scores) At 6 months: Sleep (0 for all scores), awake (0 for all scores), play (0 for all scores), and uninterrupted position (0 for all scores) |
| Jensen et al. (2019), Bangladesh | 130, 6 months, unknown | MSEL, overall score, second assessment after 21 months | T1 = Poverty (0 for all indirect pathways: maternal distress, family care, inflammation, HAZ), maternal distress (0), family care (0), inflammation (0), HAZ (0) |
| Nahar et al. (2019), Bangladesh | 189, 6 months ± 43 days, 49%d | BSID-III, overall score, three assessments every 9 months | Age (0), sex (0), stunted (−), underweight (−), and wasted (−), mother’s age (0), mother’s BMI at 2 months after delivery (+), mother’s education (+ for completing primary school vs. nonschooling), maternal depressive symptoms (0) |
| Pinheiro et al. (2014), Brazil | 152, 4 months, 53% | AIMS, overall score | Sex (0), birth weight (0), type of delivery (0), social class measured at 4 months (0), maternal age measured at 4 months (0), maternal history of affective disorders measured at 4 months (0), maternal postpartum affective disorder measured at 4 months (−), maternal anxiety disorder measured at 4 months (−), maternal type of postpartum affective disorders episode measured at 4 months (0), biomarkers at 60–90 days: maternal brain-derived neurotrophic factor level (0), maternal nerve growth factor level (+), maternal IL-6 level (0), maternal cortisol level (0), and infant cortisol level (−) |
| Tinius et al. (2020), United States | 33, 4 months, 36% | AIMS, overall score | Feeding practices: Breastfeeding vs. formula vs. combination (+ exclusive breastfeeding > combination and exclusive breastfeeding > exclusive formula), mode of feeding: bottle vs. nursing vs. combination (0) |
| Tsuchiya et al. (2012), Japan | 742, 6 months ± 30 days, 49%d | MSEL, overall score, three assessments every 4 months | T0 = Birth weight (+), maternal age measured during pregnancy (0), paternal age measured during pregnancy (0), annual income measured during pregnancy (0), breastfeeding (0), seasonality of birth: winter (0), spring (+), summer (0), autumn (0) T1 = Birth weight (+), maternal age measured during pregnancy (−), paternal age measured during pregnancy (0), annual income measured during pregnancy (0), breastfeeding (0), seasonality of birth: winter (+), spring (0), summer (+), autumn (0) T2 = Birth weight (+), maternal age measured during pregnancy (−), paternal age measured during pregnancy (0), annual income measured during pregnancy (0), breastfeeding (0), seasonality of birth: winter (0), spring (0), summer (+), autumn (0) |
| Zielinska et al. (2019), Poland | 39, 6.6 ± 0.2 months, 54% | DSR, overall score | Concentrations of selected long-chain polyunsaturated fatty acids (LC PUFA) and carotenoids in breast milk, average of first and third month of lactation: linoleic acid (0), alpha-linolenic acid (+), arachidonic acid (AA) (0), eicosapentaenoic acid (0), docosahexaenoic acid (DHA) (+), n-3 (+) and n-6 (0) and n-3/n-6 ratio LC PUFA (−), lutein + zeaxanthin (0), AA/DHA ratio (0), β-carotene (+), lycopene (0) |
| Observational studies, longitudinal, and cross-sectional analysis | |||
| de Paiva et al. (2010), Brazil | 136, 9–12 months, 43% | BSID-III, overall score | Longitudinal analysis Breastfeeding assessed retrospectively (0), hospitalization assessed retrospectively (0) |
| Cross-sectional analysis Sex (0), length-for-age (0), weight-for-age (0), head circumference (0), exclusive socioeconomic index (0), per capita family monthly income (0), maternal age (0), maternal schooling (0), paternal schooling (0), maternal employment (0), paternal employment (0), family size: ≤4 (−), head of family’s employment (0), children under 5 years (0), house ownership (0), toilet (0), radio (0), television (+), cell phone (+) | |||
| Lohaus et al. (2011), Germany and Cameroon | 272, 3 months −2 + 10 days, 52% | BSID-III, overall score, second assessment after 3 months | Longitudinal analysis Δ T1–T2 = Cultural context: Cameroon > Germany (0) |
| Cross-sectional analysis T1 = Cultural context: Cameroon > Germany (+) T2 = Cultural context: Cameroon > Germany (+) | |||
| Majnemer and Barr (2006), Canada | Sample 1 = 71, 4.4 ± 0.2 months, 52%; Sample 2 = 50, 6.4 ± 0.4 months, 56% | AIMS, overall score, and subtests prone and supine, one assessment at baseline (age 4 or 6 months), and PDMS, GMQ, two assessments: at baseline (age 4 or 6 months) and 15 months | Longitudinal analysis Infant sleeping position prone vs. supine at baseline (0 for GMQ) |
| Cross-sectional analysis Infant sleeping position: Sample 1: Prone vs. supine at 4 months (+ for subtest prone, 0 for overall score and GMQ) Sample 2: Prone vs. supine at 6 months (+ for all scores) | |||
| Miquelote et al. (2012), Brazil | 32, 9 ± 2.1 months, 50% | BSID-III, overall score, second assessment after 6 months | Longitudinal analysis Quality home environment for enhancing motor development (0) |
| Cross-sectional analysis T0 = Quality home environment for enhancing motor development at 9 months (0) T1 = Quality home environment for enhancing motor development at 15 months (0) | |||
| Observational studies, cross-sectional analysis | |||
| Abbott and Bartlett (2000), Canada | 43, 8 ± 0.3 months, unknown | AIMS, overall score | Total home equipment (−), jolly jumper (0), walker (0), exersaucer (−), playpen (0), highchair (other than for meals), (−), automatic swing (0), infant seat (−) |
| Abbott et al. (2001), Canada | 43, 8 months, 40% | AIMS, overall score | Total home environment (0): Subscales maternal responsivity (0), provision of appropriate learning materials (0), and maternal involvement (0) |
| Atun-Einy et al. (2013), Israela | 27, 7 months, 37% | AIMS, overall score, seven assessments every 3 weeks | T1 = Motivation to move (+) T2 = Motivation to move (+) T3 = Motivation to move (+) T4 = Motivation to move (0) T5 = Motivation to move (+) T6 = Motivation to move (+) T7 = Motivation to move (+) |
| Cabral et al. (2015), Brazil | 15, 19.8 ± 3.56 weeks, 47% | AIMS, overall score, subtests prone, and sitting | Sensory processing (0 for all scores): Reactivity to tactile deep pressure (0 for all scores) and reactivity to vestibular stimulation (0 for all scores) |
| de Borba and Valentini (2015), Brazil | 40, 6.5 ± 3 months, 45% | AIMS, overall score, subscales prone, supine, sitting, and standing, three assessments every 2 months | T1 = Age mothers: adolescent (15–19 years) vs. adults (25–39 years; 0 for all scores) T2 = Age mothers: adolescent (15–19 years) vs. adults (25–39 years; 0 for all scores) T3 = Age mothers: adolescent (15–19 years) vs. adults (25–39 years; + for subscale supine; 0 for overall scores and subscales prone, sitting and standing) |
| Karwowski et al. (2017), United States | 85, 300 days, 48% | BSID-III, overall score | Aluminum in hair (0) and aluminum in blood (0) |
| Li et al. (2021), China | 159, 6 months, n.r. | PDMS-II, overall score, subtests stationary and locomotion, second assessment after 6 months | Season (+ at 6 and 12 months), sleep (0 at 6 months, + at 12 months) |
| Majnemer and Barr (2005), Canada | Sample 1 = 71, 4.4 ± 0.2 months, 47% Sample 2 = 50, 6.4 ± 0.4 months, 58% | AIMS: overall score, and PDMS: GMQ | Sample 1 = Age (+ for GMQ; 0 for overall score), maternal age (− for overall score; 0 for GMQ), paternal age (− for overall score; 0 for GMQ), parental education (0), infant’s positioning as prone and awake (0), supine and awake (0), held and awake (0), supported sitting (0), unsupported sitting (0), supported standing (0) Sample 2 = Age (0), maternal age (0), paternal age (− for GMQ; 0 for overall score), parental education (0), infant’s positioning as prone and awake (+), supine and awake (0), held and awake (0), supported sitting (+ for GMQ; 0 for overall score), unsupported sitting (0), supported standing (0) |
| Makela et al. (2018), Finland | 128, 247 ± 13.6 days (±8 months), 50%d | BSID-III, overall score, second assessment after 16 months | Age (+) T1 = Night waking at 8 months (3× or more vs. max once; 0) T2 = Night waking at 24 months (3× or more vs. max once; 0) |
| Monson et al. (2003), United States | 30, 6 months ± 16.5 days, 77%d | AIMS, overall score and subtests: prone, supine, sitting, and standing | Prone position frequency: Sometimes and frequently in prone > rarely in prone (+ for overall score, subtests prone and supine, 0 for subtests sitting and standing) |
| Osei et al. (2016), South Africa | 386, 6.2 ± 0.2 months, 49% | KDI, subtest locomotor | Iodine concentrations in: Infant urine (0), maternal urine (0), and breast milk (0) |
| Piallini et al. (2016), Italy | 119, 6 months (0–11 months), 54% | PDMS-II, overall score, subtests reflexes (administered ages <11 months), stationary, locomotion, object control (administered ages >12 months) | Age (+ for subtests reflexes, stationary, locomotion, 0 for overall score and subtest object control), maternal subclinical symptoms assessed in subgroups normative and subclinical: Somatization (− for subtest reflexes in mothers in subgroup subclinical; 0 for overall score, subtests stationary, locomotion, object control), obsessiveness–compulsiveness (0 for all scores), interpersonal sensitivity (0 for all scores), depression (+ for subtest stationary in mothers in subgroup subclinical, 0 for overall score, subtests reflexes, locomotion, object control), anxiety (0 for all scores), hostility (− for subtests stationary in mothers in subgroup subclinical, 0 for overall score, subtests reflexes, locomotion, object control), phobic anxiety (0 for all scores), paranoid ideation (0 for all scores), psychoticism (0 for all scores), Global Severity Index (0 for all scores), Positive Symptom Distress Index (0 for all scores), Positive Symptom Total (0 for all scores) |
| Pin et al. (2019), Hong Kong | 20, 4–12 months, 50% | AIMS, subtests prone, supine, sitting, and standing, nine assessments | T1 = Head/trunk control: At rest/static control (0 for all scores), during head and/or arm movements/active control (0 for all scores), and after external perturbations/reactive control (0 for all scores) T2 = Head/trunk control: At rest/static control (0 for all scores), during head and/or arm movements/active control (0 for all scores), and after external perturbations/reactive control (0 for all scores) T3 = Head/trunk control: At rest/static control (0 for all scores), during head and/or arm movements/active control (0 for all scores), and after external perturbations/reactive control (0 for all scores) T4 = Head/trunk control: At rest/static control (0 for all scores), during head and/or arm movements/active control (0 for all scores), and after external perturbations/reactive control (0 for all scores) T5 = Head/trunk control: At rest/static control (+ for subtest sitting), during head and/or arm movements/active control (+ for subtests supine and sitting, 0 for subtests prone and standing), and after external perturbations/reactive control (0 for all scores) T6 = Head/trunk control: At rest/static control (0 for all scores), during head and/or arm movements/active control (0 for all scores), and after external perturbations/reactive control (0 for all scores) T7 = Head/trunk control: At rest/static control (+ for subtests prone and sitting, 0 for subtests supine and standing), during head and/or arm movements/active control (+ for subtests prone and sitting, 0 for subtests supine and standing), and after external perturbations/reactive control (0 for all scores) T8 = Head/trunk control: At rest/static control (+ for subtest sitting, 0 for subtest prone, supine, and standing), during head and/or arm movements/active control (+ for subtest sitting, 0 for subtest prone, supine and sitting), and after external perturbations/reactive control (+ for subtests prone, supine and sitting, 0 for subtest standing) T9 = Head/trunk control: At rest/static control (+ for subtest sitting, 0 for subtests prone, supine, and standing), during head and/or arm movements/active control (0 for all scores), and after external perturbations/reactive control (0 for all scores) |
| Righetto Greco et al. (2019), Finland (subgroup) | 26, 39.5 ± 1.4 weeks, 35% | AIMS, overall score, and subtests prone, supine, sitting, standing | Age (+ for overall score, subtests prone, supine, sitting; 0 for subtest standing) and trunk control (+ for overall score, subtests supine, sitting at 6 months and subtest sitting at 7 months; 0 for subtests prone and standing at 6 months and overall score, subtests prone, supine, and standing at 7 months) |
| Rubio-Codina et al. (2016), Colombia | 1,330, 6–42 months, 49% | BSID-III, overall score | Household wealth index: Dwelling characteristics (e.g., high-quality floors, garage, and shared kitchen) and assets (e.g., fridge, car, and computer), quality home environment (e.g., number of books, owning/providing a particular toy, or form of stimulation) (0) |
| Siziba et al. (2018), South Africa | 353, 6.2 ± 0.3 months, 47% | KDI, subtest locomotor | Age (+), sex: boys > girls (−), hemoglobin (0), length-for-age (+), plasma phospholipid fatty acid patterns: Plant‐based C18 fatty acid pattern scores (0), high n−6 LC PUFA pattern scores (0), C16:1 and long‐chain fatty acid pattern scores (+) and high n−3 and low n−6 LC PUFA pattern scores (+) |
| Syrengelas et al. (2014), Greece | 345, 0–19 months, 47% | AIMS, overall score | Sex (0), birth order (0), maternal age (0), maternal educational level (+), paternal educational level (0), monthly family income (0), person responsible for infant’s raising: Grandparents > parents (+) |
| Syrengelas et al. (2022), Greece | 1,087, 0–19 months, 44% | AIMS, overall score, and subscores prone, supine, sitting, and standing | Age (+), gender (− for boys in children < 12 months, 0 in children > 12 months), SGA (0), gestational age (+ in children < 12 months, 0 in children > 12 months) |
| Varsi et al. (2022), Norway | 94, 6 months, n.r. | AIMS, overall score | Per- and polyfluoroalkyl substances concentrations: PFOA (−), PFNA (−), PFDA (0), PFUnDA (0) |
| Watts et al. (2018), Kenya | 81, 8.5 ± 5.6 months, 59% | BSID-III, overall score | Higher maternal psychological distress (0), lower provision of psychosocial stimulation (0), and negative appraisal of parenting experience (0) |
Note. + = positive association or intervention effect; − = negative association of intervention effect; 0 = no association or intervention effect; BSID-III = Bayley Scales of Infant Development—third edition; AIMS = Alberta Infant Motor Scale; MSEL = Mullen Scales of Early Development; KDI = Kilifi Developmental Inventory; DSR = Children Development Scale; PDMS-II = Peabody Developmental Motor Scales—second edition; GMQ = Gross motor quotient; PFOA = perfluorooctanoate; PFNA = perfluorononanoate; PFDA = perfluorodecanoate; PFUnDA = perfluoroundecanoate; INT = intervention; CON = control; AA = arachidonic acid; DHA = docosahexaenoic acid; HAZ = height-for-age.
aStudy examined correlate(s) that were only examined once. bFor correlates for which the timing of assessment was not relevant, the timing was not indicated in the table, for example, sex. cScores for association or intervention effects. dWeighted average across groups.
Characteristics of Included Studies and Results Regarding Correlates of Fundamental Motor Skills in Children Aged 1–2 Years, Sorted by Study Design, Analysis, and First Author
| Reference (author, year, country) | Sample size (n), age, %girls | Fundamental motor skill assessment and outcome(s) | Correlate(s), association (+/0/−)b, c |
|---|---|---|---|
| Intervention studies | |||
| Borioni et al. (2022), Italy | INT: 12, 13 ± 7 months; CON: 15, 22 ± 6 months, 63% | PDMS-II, overall score | INT: Baby swimming 10 weeks, 45 min/week, CON: Regular activities (+) |
| Locks et al. (2017), Tanzania | 247, 14.5 months, 49%d | BSID-III, overall score | INT 1: Zinc supplements, INT 2: Multivitamin supplements, INT 3: Zinc + multivitamin supplements, CON: Placebo, for approximately 13.5 months (0) |
| Olney et al. (2019), Burundi | 4–24 months: 2,276, 14.4 ± 5.9 months, 50% | Parent report questionnaire, overall score | INT: Food (micronutrient-fortified corn–soy blend and oil), health (health-strengthening activities and promotion of preventive and curative health services), and care (health, hygiene, and nutrition)—INT 1: Pregnancy till 24 months; INT 2: Pregnancy till 18 months; INT 3: 0–24 months; and CON: No benefits (+) |
| Reference (author, year, country) | Sample size (n), age at (first) motor assessment(s), %girls | Fundamental motor skill assessment, outcome(s) and assessments if >1 | Correlate(s), association (+/0/−)b |
|---|---|---|---|
| Observational studies, longitudinal analysis | |||
| Cuartas et al. (2020), Colombia | 1,277, 17.8 ± 3.7 months, 50% | BSID-III, overall score | Maternal knowledge (0 for direct pathway; + for indirect paths through maternal stimulation), maternal stimulation (+) |
| Keim et al. (2011), United States | 358, 12 months, 49% | MSEL, overall score | Mother’s depressive symptoms at 4 months (+ nonlinear; low level > median level < high level) and perceived stress at 4 months (+ nonlinear; low level > median level < high level) |
| Koutra et al. (2013), Greece | 470, 18.1 ± 0.7 months, 46% | BSID-III, overall score | Maternal depressive symptoms at 8 weeks (0), anxiety at 8 weeks (0), and personality traits at 8 weeks (0) |
| Kumwenda et al. (2017), Malawi | 172, 18 months, 53% | KDI, overall score | Breast milk intake at 9–10 months: in g/day (0), g/kg/day (0), and %total energy intake (0) |
| Leventakou et al. (2015), Greece | 540, 18 months ± 6 weeks, 46% | BSID-III, overall score | Breastfeeding initiation (never/ever; 0) and duration: Per month (0) and categories (never, 1–6 months, >6 months) (0) |
| Little et al. (2002), United Kingdoma | 915, 18 months ± 2 weeks, unknown | Griffiths, subtest locomotor | Alcohol exposure via breast milk at 8 weeks: Average daily use (0) and binge drinking (>4 glasses; 0) |
| Lubczynska et al. (2017), The Netherlands (subcohort) | 4,704, 1 year, unknown | MIDI, overall score | Air pollution at birth: Copper (0), iron (0), potassium (0), nickel (0), sulfur (0), silicon (0), vanadium (0), and zinc (0) |
| Ribas-Fito et al. (2003), Spain | 92, 13 months ± 6 weeks, 54%d | Griffiths, subtest locomotor | Breastfeeding duration: <16 weeks (0), >16 weeks (+) |
| Ribe et al. (2018), Tanzania | 137, 455 ± 15 days (±15 months), 56% | BSID-III, overall score | Sex (0), weight-for-age z score at 6 months (+), length-for-age z score at 6 months (+), weight-for-length z score at 6 months (0), tribe (0), socioeconomic status measured at 6 months: Water/sanitation, assets, maternal education, and income index (0), sanitation (0), assets (0), maternal education (0), monthly income (0), home environment at 6 months: Emotional and verbal responsivity (0), organization (0), opportunities for interaction (0), cleanliness of child (0) |
| Observational studies, longitudinal, and cross-sectional analysis | |||
| Koutra et al. (2012), Greece | 605, 18.2 ± 0.7 months, 46% | BSID-III, overall score | Longitudinal analysis Sex (0), singleton birth (0), birth weight (0), siblings (−), maternal age measured during first trimester (0), paternal age measured during first trimester (0), maternal origin measured during first trimester (0), paternal origin measured during first trimester (0), maternal education measured during first trimester (−), paternal education measured during first trimester (0), maternal employment status measured during first trimester (+), perceived financial status measured during first trimester (0), hospitalization in intensive care (0) |
| Cross-sectional analysis Hours with mother at 18 months (0), hours with father at 18 months (0), | |||
| Leonard and Hill (2016), United Kingdom | 23, 18 months, 48% | MSEL, overall score | Longitudinal analysis Older siblings’ age (0), older siblings’ sex (0), older siblings’ achieving motor milestones (0), older siblings’ motor skills at 12 months (0), infant achieving motor milestones (0) |
| Cross-sectional analysis Older siblings’ motor skills at 18 months (0), perceived relationship of peers by parents: Warmth, rivalry/competition, agonism (+) | |||
| Observational studies, cross-sectional analysis | |||
| Costa et al. (2021) Brazil | 40, 16.9 ± 10.3 months, 50% | BSID-III, overall score | Age (+), gender (0), parental education (0), visual acuity (−) |
| Hauck and Felzer-Kim (2019), United States | 26, 18 ± 2 months, 58% | BDIS-III, overall score, second assessment after 6 months | T1 = Sedentary behavior (−), light physical activity (−), moderate physical activity (0) T2 = Sedentary behavior (−), light physical activity (0), moderate physical activity (0) |
| Houwen et al. (2016), The Netherlands (subgroup) | 130, 1.1 ± 1.1 years, 57% | BSID-III, overall score | Cognitive development quotient (+), expressive communication (+), receptive communication (+) |
| Koura et al. (2013), Benin | 357, 12 months, 50% | MSEL, overall score | Family wealth (+), home environment (+), maternal intellectual quotient (+), maternal depressive symptoms (0), maternal education (0), maternal marital status (0), parental perceptions: Developmental milestones (+), comprehension (+), movement (+), seizure (0), learning (0), speech (0), intellectual impairment (+) |
| Rebelo et al. (2020), Portugal | 12–23 months: 107, 18.8 ± 3.7 months | PDMS-II, overall score/GMQ, and subtests locomotor, object control, and stationary | Siblings (0 for all scores) |
| Rubio-Codina et al. (2016), Colombia | 1,330, 6–42 months, 49% | BSID-III, overall score | Household wealth index: Dwelling characteristics (e.g., high-quality floors, garage, and shared kitchen) and assets (e.g., fridge, car, and computer), quality home environment (e.g., number of books, owning/providing a particular toy, or form of stimulation) (0) |
| Santos et al. (2013), Brazil | 44, 13–24 months, 53% | BSID-III, overall score | Type of daycare: Public < private (0) and maternal education (0) |
| Veldman et al. (2018), Australia | 335, 19.8 ± 4.1 months, 46% | PDMS-III, overall score/GMQ (all correlates), and subtests locomotor, object control, and stationary (only sex) | Age (−), sex: Boys > girls (+ for object control, 0 for overall score, locomotor and stability), BMI (0), Australian Socioeconomic Index for Areas (+), mother’s education (+ primary school or year 10 or equivalent vs. year 12 or equivalent or university degree), mother’s employment (0), and family income (0) |
Note. + = positive association or intervention effect; − = negative association of intervention effect; 0 = no association or intervention effect; BSID-III = Bayley Scales of Infant Development—third edition; MSEL = Mullen Scales of Early Development; KDI = Kilifi Developmental Inventory; Griffiths = Griffiths Scales of Mental Development; MIDI = Minnesota Infant Development Inventory; PDMS-II/III = Peabody Developmental Motor Scales—second/third edition; ZNA = Zurich Neuromotor Assessment; GMQ = gross motor quotient; BMI = body mass index; INT = intervention; CON = control.
aStudy examined correlate(s) that were only examined once. bFor correlates for which the timing of assessment was not relevant, the timing was not indicated in the table, for example, sex. cScores for association or intervention effects. dWeighted average across groups.
Characteristics of Included Studies and Results Regarding Correlates of FMS in Children Aged <2–4 Years, Sorted by Study Design, Analysis, and First Author
| Reference (author, year, country) | Sample size (n), age, %girls | Fundamental motor skill assessment and outcome(s) | Correlate(s), association (+/0/−)a,b |
|---|---|---|---|
| Intervention studies | |||
| Olney et al. (2019), Burundi | 24–42 months: 3,560, 32.8 ± 5.6 months, 50%c | Parent report questionnaire, overall score | INT: Food (micronutrient-fortified corn–soy blend and oil), health (health-strengthening activities and promotion of preventive and curative health services), and care (health, hygiene, and nutrition)—INT 1: Pregnancy till 24 months; INT 2: Pregnancy till 18 months; INT 3: 0–24 months; and CON: No benefits (0) |
| Reference (author, year, country) | Sample size (n), age at (first) motor assessment(s), %girls | Fundamental motor skill assessment, outcome(s), and assessments if >1 | Correlate(s), association (+/0/−)b |
|---|---|---|---|
| Observational studies, longitudinal analysis | |||
| Donald et al. (2019), South Africa | 734, 24.1 ± 0.5 months, 48% | BSID-III, overall score | Age (0), sex (0), education mother measured at 28–32 weeks gestation (0) |
| Dupont et al. (2018), Canada | 756, 24 months, 50% | BSID-III, overall score | Head circumference 0–12 months (+ in boys; 0 in girls), income status (0 for both sexes), maternal education (0 for both sexes) |
| Jensen et al. (2019), Bangladesh | 130, 36 months, unknown | MSEL, overall score | Poverty (− for indirect pathway via HAZ, 0 all indirect pathways: Maternal distress, family care, inflammation), maternal distress (0), family care (+), inflammation (−), HAZ (+) |
| Liu et al. (2022), China | 703, 2.6 ± 0.1 years, 35% | GDDS (Chinese version), overall score | Metals: Magnesium (0), aluminum (0), calcium (0), titanium (0), vanadium (0), chromium (0), manganese (0), iron (+), nickel (0), cobalt (−), copper (0), zinc (0), rubidium (0), strontium (0), molybdenum (0), cadmium (0), tin (+), antimony (0), barium (0), lead (0), arsenic (0), selenium (0) |
| Messerli-Burgy et al. (2021), Switzerland | 555, 3.9 years, 47% | ZNA, dynamic and static balance | Onset of walking (+) |
| Pang et al. (2020), Singapore | 215, 24 months, 49%c | BSID-III, overall score | Breastfeeding: Fully breastfed for 3 months = breastfed + bottle (0); breastfed + formula or breastfed only vs. formula only (+) |
| Viholanen et al. (2006), Finland | 130, 3.5 years, 46%c | M-ABC, overall score | Early body control 0–12 months (head control, turning, sitting, upright posture, walking, and manipulation) (+) |
| Villar et al. (2020), Brazil, India, Italy, Kenya, United Kingdom | 1,306, 25.1 ± 2.2 months, 52% | INTER-NDA, overall score | Breastfeeding: Number of months of exclusive/predominant breastfeeding (+), number of breastfeeds per day (+) and total months exposed to any breastfeeding (+), duration of formula use (−), age of weaning (+) |
| Observational studies, longitudinal, and cross-sectional analysis | |||
| Kashala-Abotnes et al. (2018), Democratic Republic of Congo | 53, 30.4 ± 3.9 months, 44% | MSEL, overall score | Longitudinal analysis Child’s weaning age (0), introduction of solid food <6 m assessed retrospectively (0) |
| Cross-sectional analysis Age (0), sex (0), length-for-age z score (+), weight–for-age z score (0), developmental age (0), psychomotor development (0), mother’s and father’s education (0), wealth index (0), monthly income (0), maternal depression and anxiety symptoms (0), cyanogenic exposure: urine child (0), urine mother (0), cyanogen in flour (0), number of nights of cassava soaking (0), cassava cyanogen (0) | |||
| Observational studies, cross-sectional analysis | |||
| Bonvin et al.(2012), Switzerland | 529, 3.4 ± 0.6 years, 49% | ZNA, overall score | Sex (0), weight status (0) |
| Chow and Chan (2011), Hong Kong | 239, 3.6 ± 0.2 years, 49% | TGMD-2, overall score, subtests locomotor and object control | Sex (0 for all scores), BMI (0 for all scores), school type: Larger play area > smaller play area (+ for subtest locomotor and object control, 0 for overall score) |
| Duff et al. (2019), Ireland | 124, 3.9 ± 0.5 years, 50% | TGMD-2 and Victorian FMS Manual, overall score | Sedentary behavior (0), light physical activity (−), moderate physical activity (−), total physical activity (0) |
| Honrubia-Montesinos et al. (2021), Spain | 109, 3 years, unknown | TGMD-2, subtests locomotor and object control | Sex: Boys > girls (+ for all scores) |
| Jiang et al. (2022), Taiwan | 53, 2.9 ± 0.3 years, 59% | BSID-III, overall score | Arsenic (−), cadmium (0), lead (0) |
| Kakebeeke et al. (2017), Switzerland | 476, 3.9 ± 0.7 years, 47% | ZNA, subtests dynamic + static balance | BMI (0 for all scores), waist circumference (0 for all scores), skinfold thickness (− for dynamic balance subtest) |
| Kracht et al. (2020), United States | 107, 3.4 ± 0.6 years, 55% | TGMD-3: Overall score, subtests locomotor and object control | Light physical activity (0 for all scores), moderate-to-vigorous physical activity (+ for overall score and locomotor subtest, 0 for object control subtest), sleep (0 for all scores), screen time (0 for all scores), meeting physical activity guideline (0 for all scores), meeting sleep guideline (0 for all scores), meeting screen time guideline (0 for all scores), meeting one guideline (0 for all scores), meeting two guidelines (0 for all scores), meeting three guidelines (0 for all scores) |
| Leao et al. (2021), Brazil | 3,879, 24 months, 49% | INTER-NDA, overall score | Sex (+ for boys), low birth weight (0), maternal age (0), income (0), maternal education (0), maternal depression (0), storytelling (0), child visits park (0), child visits other houses (+), participation in government program to enhance development (0), childcare attendance (0) |
| Lin et al. (2019), China | 163, 38.7 ± 4.9 months, 47% | CDSC, overall score | Sex (0), single child (0), early childhood education program (+ private > government), father’s education (0), mother’s education (0), household income (+), maternal play beliefs (0), paternal profile (+ pragmatic: Higher value academic outcomes > hedonistic fathers: Higher value free play outcomes) |
| Martins et al. (2020), Brazil | 42, 3.8 ± 0.7 years, 43% | TGMD-2, subtests locomotor and object control | Sex (+ for boys for all scores) |
| Martins et al. (2021), Brazil | 212, 3.9 years, 49% | TGMD-2, subtests locomotor and object control | Adherence to combination of: Physical activity guideline, sleep time guideline, and screen time guideline (+ for object control subtest, 0 for locomotor subtest); physical activity and sleep time guidelines (0 for all scores); physical activity and screen time guidelines (0 for all scores); sleep time and screen time guidelines (+ for all scores) |
| Nobre et al. (2019), Brazil | 104, 23–42 months, 55% | BSID-III, overall score | Quality of interactive media use (0) |
| Rebelo et al. (2020), Portugal | 24–35 months: 153, 28.1 ± 3.4 months; 36–48 months: 145, 39.3 ± 3.6 months | PDMS-II, overall score/GMQ, and subtests locomotor, object control, and stationary | Siblings (+ for all scores 24–35 months; + for overall score, subtests locomotion and object control skills 36–48 months; 0 for subtest stationary 36–48 months) |
| Rink et al. (2014), Uruguay | 60, 28.8 ± 8.2 months, 57% | BSID-III, overall score | Hair manganese concentrations (0) |
| Rubio-Codina et al. (2016), Colombia | 1330, 6–42 months, 49% | BSID-III, overall score | Household wealth index: Dwelling characteristics (e.g., high-quality floors, garage, and shared kitchen) and assets (e.g., fridge, car, and computer), quality home environment (e.g., number of books, owning/providing a particular toy, or form of stimulation) (0) |
| Sansavini et al. (2021), Italy | 200, low-risk preterm = 32.0 ± 1 months; full-term = 30.3 ± 0.5 months, 52% | Early Motor Questionnaire, overall score | Poor language profile vs. weak, average, or advanced profile (−) |
| Santos et al. (2013), Brazil | 70, 25–41 months, 53% | BSID-III, overall score | Type of daycare: Public < private (+) and maternal education (0) |
| Saraiva et al. (2013), Portugal | 122, 42.2 ± 3.4 months, 50% | PDMS-II, subtests locomotor, object control and stationary | Age (+ for all scores), sex: Boys > girls (+ for subtest object control, 0 for subtests locomotor and stationary), weight-for-age (0), length-for-age (+ for subtest stationary, 0 for subtests locomotor, and object control), BMI (0) |
| Schmutz et al. (2020), Switzerland | 550, 3.9 ± 0.7 years, 53% | ZNA, overall score | Physical activity: Total physical activity (+) and moderate-to-vigorous physical activity (+) |
| Tan et al. (2020), China | 110, 39.8 ± 4.5 months, 51% | GDS, overall score | Dietary ganglioside intake: GD3 (+), GM3 (0) total ganglioside (+). Serum ganglioside concentration: GD3 (+), GM3 (0) total ganglioside (+). Food category intake: Grain (0), starchy food (0), vegetable (0), fruit (0), meat (0), seafood (+), freshwater products (0), eggs (0), dairy products (0), soybean products (0), nuts (0), beverages (0) |
| Valadi (2021), Iran | 247, 29 ± 8.6 months // FMS at 36–42 months, 52% | TGMD-2, overall score, locomotor score, object control score | Daycare attendance vs. nondaycare (+), home environment: Total (+ for overall score, locomotor, object control subtest), inside space (+ for overall score, 0 for locomotor, object control subtest), variety of stimulation (0), toys (+ for overall score, locomotor subtest, 0 for object control subtest) |
Note. + = positive association or intervention effect; − = negative association of intervention effect; 0 = no association or intervention effect; BSID-III = Bayley Scales of Infant Development—third edition; MSEL = Mullen Scales of Early Development; M-ABC-2 = Movement ABC—second edition; PDMS-II = Peabody Developmental Motor Scales—second edition; ZNA = Zurich Neuromotor Assessment; TGMD-2/3 = Test of Gross Motor Development—second/third edition; CDSC = China Developmental Scale for Children; GMQ = gross motor quotient; BMI = body mass index; INT = intervention; CON = control; FMS = fundamental motor skills; GD(D)S = Gesell Developmental (Diagnosis) Scale; INTER-NDA = Intergrowth-21st Neurodevelopmental Assessment.
aFor correlates for which the timing of assessment was not relevant, the timing was not indicated in the table, for example, sex. bScores for association or intervention effects. cWeighted average across groups.
In total, 31 studies had a longitudinal observational design, with follow-up durations ranging from 4 months to 3.5 years. Some of these studies additionally presented cross-sectional analyses. Forty-five studies had a cross-sectional design, and there were seven intervention studies. Sample sizes ranged from 15 to 5,836 participants. Most studies had a sample size of 101–200 participants (n = 24).
Most studies were conducted in children <1 year (n = 35), 28 studies were conducted in 2- to 4-year-olds, and 26 studies were conducted in 1- to 2-year-olds. Most studies were conducted in Europe (n = 29), followed by Asia (n = 17), South America (n = 15), North America (n = 13), Africa (n = 12), and Oceania (n = 1). Some of these studies included multiple age groups (n = 4) and/or samples from multiple countries/continents (n = 2). Eighteen different instruments were used to assess FMS, including the Bayley Scales of Infant Motor Development (n = 26), the Alberta Infant Motor Scales (n = 17), the Mullen Scales of Early Development (n = 6), the Test of Gross Motor Development (n = 7), and the Peabody Developmental Motor Scales (n = 8). Most studies used a total score for analysis (n = 76), and some studies (additionally) used summary scores for subtests (n = 25).
In total, 50 different correlates were assessed: 13 biological correlates; 10 behavioral attributes correlates; three cognitive, emotional, or psychological correlates; three physical environmental correlates; four economic correlates; two political correlates; and 15 sociocultural correlates. The correlates that were only examined in one study are not further discussed in this review, as we could only conclude insufficient evidence for these correlates. Tables 3–6 present the summary of results regarding correlates of FMS.
Summary of Results Regarding Correlates of FMS in Children aged <1 year
| Correlate | Included studiesa | Summary coding (n/N, %)a | Evidence synthesis |
|---|---|---|---|
| Biological correlates | |||
| Sex | 0 0 0 0 − − | ? | Based on inconsistent findings among the studies with high methodological quality, there is insufficient evidence for an association between sex and FMS. |
| Age | + + + + + 0 0 | ? | Based on inconsistent findings among studies with low-to-high methodological quality, there is insufficient evidence for an association between age and FMS. |
| Growth-related variables | + 0 0 0 − | ? | Based on inconsistent findings among the studies with low-to-high methodological quality, there is insufficient evidence for an association between growth- and weigh status-related variables, and FMS. |
| Early motor or neurological development | + + 0 | ? | Based on inconsistent finding among studies with low-to-moderate quality, there is insufficient evidence for an association between earlier motor development and FMS. |
| Birth weight | + 0 | ? | Based on inconsistent findings among the studies with high methodological quality, there is insufficient evidence for an association between birth weight and FMS. |
| Behavioral attributes correlates | |||
| Breastfeeding-related variables | 0 0 0 0 ? | 0 (4/5, 80%) | Based on consistent findings among the studies with low-to-high methodological quality, there is no evidence for an association between breastfeeding and FMS. |
| Micronutrient intake | + 0 | ? | Based on inconsistent finding among studies with low-to-moderate quality, there is insufficient evidence for an association between micronutrient intake and FMS. |
| Physical activity-related variables | + 0 0 | ? | Based on inconsistent finding among studies with low-to-moderate quality, there is insufficient evidence for an association between physical activity-related variables and FMS. |
| Sleep-related variables | 0 0 0 0 | 0 (4/4, 100%) | Based on consistent finding among studies with low-to-moderate methodological quality, there is no evidence for an association between sleep and FMS. |
| Environmental physical correlates | |||
| Home environment | 0 0 0 ? | 0 (3/4, 75%) | Based on consistent findings among studies with low-to-moderate methodological quality, there is no evidence for an association between the home environment and FMS. |
| Toxicity | 0 ? | ? | Based on inconsistent finding among studies with moderate-to-high quality, there is insufficient evidence for an association between toxicity and FMS. |
| Economic correlates | |||
| Parental education | + 0 0 ? | ? | Based on inconsistent findings among the studies with moderate-to-high methodological quality, there is insufficient evidence for an association between parental education and FMS |
| Family income | 0 0 0 | 0 (2/2, 100%) | Based on consistent findings among the studies with high methodological quality, there is no evidence for an association between family income and FMS. |
| Socioeconomic variables | 0 0 0 | 0 (3/3, 100%) | Based on consistent findings among the studies with low-to-high methodological quality, there is no evidence for an association between socioeconomic-related variables and FMS |
| Sociocultural correlates | |||
| Maternal depression and/or anxiety | 0 0 ? | ? | Based on inconsistent findings among studies with moderate-to-high methodological quality, there is insufficient evidence for an association between maternal depression and/or anxiety and FMS. |
| Maternal stress | 0 0 ? | ? | Based on inconsistent findings among studies with low-to-moderate methodological quality, there is insufficient evidence for an association between maternal stress and FMS. |
| Parental age | 0 0 0 0 0 0 | 0 (3/3, 100%) | Based on consistent findings among studies with high methodological quality, there is no evidence for an association between parental age and FMS. |
| Parental involvement in raising the child | + 0 | ? | Based on inconsistent findings among studies with moderate-to-high methodological quality, there is insufficient evidence for an association between parental involvement in raising the child and FMS. |
Note. + = consistent positive association; − = consistent negative association; 0 = consistent no association; ? = inconsistent findings; score is based on all studies unless two or more high-quality studies were available. Bold indicates results from high-quality study. FMS = fundamental motor skills.
aSummary score.
Summary of Results Regarding Correlates of FMS in Children Aged 1–2 years
| Correlate | Included studiesa | Summary coding (n/N, %)a | Evidence synthesis |
|---|---|---|---|
| Biological correlates | |||
| Sex | 0 0 0 0 | 0 (2/2, 100%) | Based on consistent findings among studies with high methodological quality, there is insufficient evidence for an association between sex and FMS. |
| Age | + − | ? | Based on inconsistent findings among the studies with moderate-to-high methodological quality, there is insufficient evidence for an association between age and FMS. |
| Growth-related variables | 0 0 | 0 (2/2, 100%) | Based on consistent findings among studies with low-to-moderate methodological quality, there is no evidence for an association between growth- and weigh status-related variables and FMS. |
| Singleton birth | 0 0 | 0 (2/2, 100%) | Based on consistent findings among studies with moderate-to-high methodological quality, there is no evidence for an association between singleton birth and FMS. |
| Behavioral attributes and skill-related correlates | |||
| Breastfeeding-related variables | 0 0 ? | ? | Based on inconsistent finding among studies with low-to-high quality, there is insufficient evidence for an association between breastfeeding and FMS. |
| Physical activity-related variables | + 0 | ? | Based on inconsistent finding among studies with low-to-moderate quality, there is insufficient evidence for an association between physical activity-related variables and FMS. |
| Environmental physical correlates | |||
| Home environment | + 0 0 | ? | Based on inconsistent findings among studies with low-to-moderate methodological quality, there is insufficient evidence for an association between the home environment and FMS. |
| Economic correlates | |||
| Parental education | + 0 0 0 0 ? | ? | Based on inconsistent findings among the studies with high methodological quality, there is insufficient evidence for an association between parental education and FMS. |
| Family income | 0 0 0 | 0 (3/3, 100%) | Based on consistent findings among the studies with low-to-high methodological quality, there is no evidence for an association between family income and FMS. |
| Socioeconomic variables | + 0 | ? | Based on inconsistent findings among the studies with low-to-moderate methodological quality, there is insufficient evidence for an association between socioeconomic-related variables and FMS. |
| Parental employment | + 0 | ? | Based on inconsistent findings among the studies with moderate-to-high methodological quality, there is insufficient evidence for an association between parental employment and FMS. |
| Sociocultural correlates | |||
| Maternal depression and/or anxiety | + 0 0 | ? | Based on inconsistent findings among studies with moderate-to-high methodological quality, there is insufficient evidence for an association between maternal depression and/or anxiety and FMS. |
| Family size-related variables | 0 − | ? | Based on inconsistent findings among studies with low-to-high methodological quality, there is insufficient evidence for an association between family size-related variables and FMS. |
| Cultural background/origin | 0 0 | 0 (2/2, 100%) | Based on consistent findings among studies with low-to-high methodological quality, there is there is no evidence for an association between different countries and origins and FMS. |
Note. + = consistent positive association; − = consistent negative association; 0 = consistent no association; ? = inconsistent findings; score is based on all studies unless two or more high-quality studies were available. Bold indicates results from high-quality study. FMS = fundamental motor skills.
aSummary score.
Summary of Results Regarding Correlates of FMS in Children Aged 2–4 years
| Correlate | Included studiesa | Summary coding (n/N, %)a | Evidence synthesis |
|---|---|---|---|
| Biological correlates | |||
| Sex | + + + + 0 0 0 0 0 | ? | Based on inconsistent findings among the studies with low-to-high methodological quality, there is insufficient evidence for an association between sex and FMS. |
| Age | + 0 0 | ? | Based on inconsistent findings among studies with low-to-moderate methodological quality, there is insufficient evidence for an association between age and FMS. |
| Growth-related variables | + 0 0 0 0 ? ? | ? | Based on inconsistent findings among studies with low-to-moderate methodological quality, there is insufficient evidence for an association between growth- and weigh status-related variables, and FMS. |
| Early motor or neurological development | + + 0 | ? | Based on inconsistent finding among studies with low-to-moderate quality, there is insufficient evidence for an association between earlier motor development and FMS. |
| Behavioral attributes and skill-related correlates | |||
| Breastfeeding-related variables | + 0 ? | ? | Based on inconsistent findings among studies with low-to-moderate methodological quality, there is insufficient evidence for an association breastfeeding and FMS |
| Physical activity-related variables | + 0 − | ? | Based on inconsistent finding among studies with low-to-moderate quality, there is insufficient evidence for an association between physical activity-related variables and FMS. |
| Sedentary (screen) behavior | 0 0 | 0 (2/2, 100%) | Based on consistent finding among studies with low methodological quality, there is no evidence for an association between sedentary (screen) behavior and FMS. |
| Environmental physical correlates | |||
| Home environment | + 0 | ? | Based on inconsistent findings among studies with low-to-moderate methodological quality, there is insufficient evidence for an association between the home environment and FMS. |
| Toxicity | 0 0 0 0 | 0 (4/4, 100%) | Based on consistent finding among studies with moderate-to-high methodological quality, there is no evidence for an association between toxicity and FMS. |
| Economic correlates | |||
| Parental education | 0 0 0 0 0 0 | 0 (6/6, 100%) | Based on consistent finding among studies with low-to-high methodological quality, there is no evidence for an association between parental education and FMS. |
| Family income | + 0 0 0 | 0 (3/4, 75%) | Based on consistent findings among the studies with low-to-high methodological quality, there is no evidence for an association between family income and FMS. |
| Socioeconomic variables | 0 0 | 0 (2/2, 100%) | Based on consistent findings among the studies with low-to-moderate methodological quality, there is no evidence for an association between socioeconomic-related variables and FMS. |
| Political correlates | |||
| Type of ECEC setting | + + | + (2/2, 100%) | Based on consistent findings among the studies with low-to-moderate methodological quality, there is moderate evidence for an association between the type of ECEC setting and FMS. |
| Sociocultural correlates | |||
| Maternal depression and/or anxiety | 0 0 | 0 (2/2, 100%) | Based on consistent findings among the studies with moderate-to-high methodological quality, there is no evidence for an association between maternal depression and/or anxiety and FMS. |
Note. + = consistent positive association; − = consistent negative association; 0 = consistent no association; ? = inconsistent findings; score is based on all studies unless two or more high-quality studies were available. Bold indicates results from high-quality study. ECEC = early childhood education and care, FMS = fundamental motor skills.
aSummary score.
Overview of Methodological Quality
Twelve out of 83 studies were rated as high methodological quality, 37 studies were rated as moderate methodological quality, and 34 studies were rated as low methodological quality. Overall, the item “selection bias” was rated as poor most frequently, with 66 out of 83 studies scoring poor on this criterion. Most included studies controlled for confounders (e.g., sex and age) by using standardized FMS scores or adjusting for these variables in the analysis. Additionally, for studies with a longitudinal design, the item “withdrawals and dropouts” received low scores, while for intervention studies, the item “intervention integrity” received low scores. Most high-quality studies were in the categories biological (n = 8), economic (n = 4), and sociocultural correlates (n = 5). The categories cognitive, emotional or psychological, and political correlates did not have any high-quality studies. Figure 2 and Supplementary Table S1 (available online) present the methodological quality of included studies.
—Methodological quality.
Citation: Journal of Motor Learning and Development 12, 1; 10.1123/jmld.2023-0003
Individual Correlates
Biological Correlates
Sex was most frequently examined (n = 19), followed by growth-related variables (n = 13; e.g., length-for-age and body mass index), age (n = 12), early motor or neurological development (n = 7), birth weight (n = 4), singleton birth (n = 2), and history of hospitalization (n = 2). As history of hospitalization was only examined in one study within the different age groups, this correlate is not further discussed.
In children aged <1 year, two high-quality studies found no association between sex and FMS in children, and one high-quality study found that boys had lower FMS scores than girls (Pinheiro et al., 2014; Syrengelas et al., 2014, 2022). In children aged 1–2 years, two high-quality studies found no significant association between sex and FMS (Costa et al., 2021; Koutra et al., 2012). In children aged 2–4 years, five studies found no significant association between sex and FMS (Bonvin et al., 2012; Chow & Chan, 2011; Donald et al., 2019; Kashala-Abotnes et al., 2018; Lin et al., 2019), and four studies, of which one study of high methodological quality, found that boys had higher FMS scores than girls (Honrubia-Montesinos et al., 2021; Leão et al., 2021; Martins et al., 2020; Saraiva et al., 2013). We found insufficient evidence for an association between sex and FMS in children aged <1 year and 2–4 years and no evidence for an association in children aged 1–2 years.
In children aged <1 year, five studies, of which one study was rated as having high methodological quality, found a positive association between age and FMS (Makela et al., 2018; Piallini et al., 2016; Righetto Greco et al., 2019; Siziba et al., 2018; Syrengelas et al., 2022), and two studies found no association (Majnemer & Barr, 2005; Nahar et al., 2019). In children aged 1–2 years, one study rated as having high methodological quality found a positive association between age and FMS (Costa et al., 2021), and one study found a negative association (Veldman et al., 2018). In children aged 2–4 years, one study found a positive association between age and FMS (Saraiva et al., 2013), and two studies found no association (Donald et al., 2019; Kashala-Abotnes et al., 2018). For all three age groups, we found insufficient evidence for an association between age and FMS.
Three studies examining the association between growth-related variables and FMS, of which one was rated as having high methodological quality, found no association in children aged <1 year (de Paiva et al., 2010; Jensen et al., 2019; Syrengelas et al., 2022), one study found a positive association (Siziba et al., 2018), and one study found a negative association (Nahar et al., 2019). Both studies examining the association between growth-related variables and FMS in children aged 1–2 years found no association (Ribe et al., 2018; Veldman et al., 2018). In children aged 2–4 years, four studies found no association between growth-related variables and FMS (Bonvin et al., 2012; Chow & Chan, 2011; Kakebeeke et al., 2017; Saraiva et al., 2013), two studies found mixed results (Dupont et al., 2018; Kashala-Abotnes et al., 2018), and one study found a positive association (Jensen et al., 2019). For children aged <1 and 2–4 years, we found insufficient evidence for an association between growth-related variables and FMS. We found no evidence for an association between growth- and weigh status-related variables and FMS in children aged 1–2 years.
Two studies examining the association between early motor or neurological development and FMS found a positive association in children aged <1 year (Righetto Greco et al., 2019; Valentini et al., 2020), and one study found no association (Pin et al., 2019). Similarly, in children aged 2–4 years, two studies found a positive association (Messerli-Bürgy et al., 2021; Viholanen et al., 2006), and one study found no association (Kashala-Abotnes et al., 2018). We found insufficient evidence for an association between early motor development and FMS in children aged <1 year and children aged 2–4 years.
Two high-quality studies examined the association between birth weight and FMS in children aged <1 years, with one study showing a positive association (Tsuchiya et al., 2012) and one study showing no association (Pinheiro et al., 2014).
In children aged 1–2 years, two studies, of which one study was rated as having high methodological quality, showed no association between singleton birth and FMS (Koutra et al., 2012; Lin et al., 2019). We found no evidence for an association between singleton birth and FMS in children aged 1–2 years.
Behavioral Attributes Correlates
Correlates related to dietary intake were examined most (n = 15), including breastfeeding-related variables (n = 11; e.g., exclusive vs. nonexclusive, and weaning age) and micronutrient intake (n = 4). Eight studies examined physical activity-related variables (e.g., prone positioning or physical activity at various intensities), five studies examined sleep-related variables, and four studies examined sedentary (screen) behavior.
In children aged <1 year, four studies, of which one with a high methodological quality, found no association between breastfeeding-related variables (de Paiva et al., 2010; Tsuchiya et al., 2012; Zhang et al., 2018; Zielinska et al., 2019), and one study found mixed results (Tinius et al., 2020). In children aged 1–2 years, two studies, of which one with a high methodological quality, found no association between breastfeeding-related variables (Kumwenda et al., 2017; Leventakou et al., 2015), and one study found mixed results (Ribas-Fito et al., 2003). In children aged 2–4 years, one study found a positive association between breastfeeding-related variables (Villar et al., 2020), one study found no association (Kashala-Abotnes et al., 2018), and one study found a negative association (Pang et al., 2020). We found no evidence for an association between breastfeeding and FMS in children aged <1 year and insufficient evidence for an association breastfeeding and FMS in children aged 1–2 years and 2–4 years.
In children aged <1 year, one study found a positive association (Wicklow et al., 2015) and one study found no association (Heinig et al., 2006) between micronutrient intake and FMS, resulting in insufficient evidence for an association between micronutrient intake and FMS.
Two studies found no association between physical activity-related variables and FMS in children aged <1 year (Carmeli et al., 2009; Majnemer & Barr, 2005), and one study found a positive association (Monson et al., 2003). In children aged 1–2 years, one study found a positive association between physical activity-related variables and FMS (Borioni et al., 2022), and one study found no association (Hauck & Felzer-Kim, 2019). In children aged 2–4 years, one study found a positive association between physical activity-related variables and FMS (Schmutz et al., 2020), one study found no association (Kracht et al., 2020), and one study found a negative association (Duff et al., 2019). For all three age groups, we found insufficient evidence for an association between physical activity-related variables and FMS.
In children aged 2–4 years, two studies found no association between screen behavior and FMS (Kracht et al., 2020; Nobre et al., 2019). We found no evidence for an association between screen behavior and FMS in children aged 2–4 years.
All four studies examining sleep-related variables in children aged <1 year found no association with FMS (Carmeli et al., 2009; Li et al., 2021; Majnemer & Barr, 2006; Makela et al., 2018). We found no evidence for an association between sleep-related variables and FMS in children aged <1 year.
Environmental Correlates
Physical Environmental Correlates
Three studies found no association between the home environment and FMS in children aged <1 years (Abbott et al., 2001; Miquelote et al., 2012; Rubio-Codina et al., 2016), and one study found mixed results (Abbott & Bartlett, 2000). In children aged 1–2 years, two studies found no association between the home environment and FMS (Ribe et al., 2018; Rubio-Codina et al., 2016), and one study found a positive association (Koura et al., 2013). In children aged 2–4 years, one study found a positive association between the home environment and FMS (Valadi, 2021), and one study found no association (Rubio-Codina et al., 2016). We found no evidence for an association between the home environment and FMS in children aged <1 year and insufficient evidence for an association the home environment and FMS in children aged 1–2 years and 2–4 years.
In children aged <1 year, two studies examining the association between toxicity and FMS, of which one study was rated as having a high methodological quality, found no association (Karwowski et al., 2017) or mixed results (Varsi et al., 2022). In children aged 2–4 years, all four studies, of which one study was rated as having a high methodological quality, found no association between toxicity and FMS (Jiang et al., 2022; Kashala-Abotnes et al., 2018; Liu et al., 2022; Rink et al., 2014). We found insufficient evidence for an association between toxicity and FMS in children aged <1 year. In children aged 2–4 years, we found no evidence for an association between toxicity and FMS.
Socioeconomic Correlates
Parental educational level (one or both parents) was the most examined correlate (n = 15), followed by family income (n = 10), socioeconomic variables (n = 6), and parental employment (n = 3).
In children aged <1 year, two studies found no association between parental education and FMS (de Paiva et al., 2010; Majnemer & Barr, 2005), one study found a positive association (Nahar et al., 2019), and one study with high methodological quality found mixed results (Syrengelas et al., 2014). In children aged 1–2 years, two studies that were rated as high methodological quality examined the association between parental education and FMS, of which one study found no association (Costa et al., 2021), and one study found mixed results (Koutra et al., 2012). Six studies, of which one study was rated as having a high methodological quality, found no association between parental education and FMS in children aged 2-4 years (Donald et al., 2019; Dupont et al., 2018; Kashala-Abotnes et al., 2018; Leão et al., 2021; Lin et al., 2019; Santos et al., 2013). We found insufficient evidence for an association between parental education and FMS in children aged <1 and 1–2 years, and no evidence in children aged 2–4 years.
Two high-quality studies found no association between family income and FMS in children aged <1 year (Syrengelas et al., 2014; Tsuchiya et al., 2012). Three studies, of which one high-quality study, found no association in children aged 1–2 years (Koutra et al., 2012; Ribe et al., 2018; Veldman et al., 2018). In children aged 2–4 years, three studies, of which one with a high methodological quality rating, found no association between family income and FMS (Dupont et al., 2018; Kashala-Abotnes et al., 2018; Leão et al., 2021), and one study found a positive association (Lin et al., 2019). We found no evidence for an association between family income and FMS across all three age groups.
Three studies, of which one study was rated as having high methodological quality, examining socioeconomic variables and FMS in children aged <1 year, found no association (de Paiva et al., 2010; Jensen et al., 2019; Pinheiro et al., 2014). In children aged 1–2 years, one study found a positive association between socioeconomic variables and FMS (Veldman et al., 2018), and one study found no association (Ribe et al., 2018). In children aged 2–4 years, two studies found no association between socioeconomic variables and FMS (Jensen et al., 2019; Kashala-Abotnes et al., 2018). We found no evidence for an association between socioeconomic-related variables and FMS in children aged <1 year and 2–4 years, and insufficient evidence in children aged 1–2 years.
In children aged 1–2 years, one study that was rated as having high methodical quality found a positive association between parental employment and FMS (Koutra et al., 2012), and one study found no association (Veldman et al., 2018), resulting in insufficient evidence for an association between parental employment and FMS.
Political Correlates
Two studies found a positive association between political-related factors in the early childhood education and care (ECEC) settings and FMS in children aged 2–4 years (Lin et al., 2019; Santos et al., 2013). We found moderate evidence for an association between the type of ECEC setting and FMS in children aged 2–4 years.
Sociocultural Correlates
Eight studies examined maternal depression and/or anxiety as a correlate of FMS, eight studies examined parental age, four studies examined maternal stress, three studies examined family size-related variables (e.g., having siblings), three studies examined parental involvement in raising the child, and three studies examined cultural background.
In children aged <1 year, two studies found no association between maternal depression and/or anxiety and FMS (Nahar et al., 2019; Piallini et al., 2016), and one study that was rated as having a high methodological quality found mixed results (Pinheiro et al., 2014). Two studies in children aged 1–2 years, of which one was rated as having high methodological quality, found no association between maternal depression and/or anxiety and FMS (Koura et al., 2013; Koutra et al., 2013), and one study found a positive association (Keim et al., 2011). Two studies, of which one was rated as having high methodological quality, found no association between maternal depression and/or anxiety and FMS in children aged 2–4 years (Kashala-Abotnes et al., 2018; Leão et al., 2021). We found insufficient evidence for an association between maternal depression and/or anxiety and FMS in children aged <1 year and 1–2 years, and no evidence in children aged 2–4 years.
Two studies found no association between maternal stress and FMS in children aged <1 year (Jensen et al., 2019; Watts et al., 2018), and one study found mixed results (Caparros-Gonzalez et al., 2019), resulting in insufficient evidence for an association between maternal stress and FMS in children aged <1 year.
Three studies that were rated as having high methodological quality found no association between parental age and FMS in children aged <1 year (Pinheiro et al., 2014; Syrengelas et al., 2014; Tsuchiya et al., 2012), resulting in no evidence for an association between parental age and FMS in children aged <1 year.
In children aged <1 year, one study that was rated as having high methodological quality found a positive association between parental involvement in raising the child and FMS (Syrengelas et al., 2014), and one study found no association (Abbott et al., 2001), resulting in insufficient evidence for an association between parental involvement in raising the child and FMS.
In children aged 1–2 years, one study found no association between family size-related variables and FMS (Rebelo et al., 2020), and one study that was rated as having high methodological quality found a negative association (Koutra et al., 2012), resulting in insufficient evidence for an association between family size-related variables and FMS.
In children aged 1–2 years, two studies of which one was rated as having high methodological quality found no association between cultural background and FMS (Koutra et al., 2012; Ribe et al., 2018), resulting in no evidence for an association between cultural background and FMS.
Discussion
Overview of Findings
This systematic review aimed to identify correlates of FMS in typically developing children aged 0–4 years. In children aged <1 year, we found no evidence for an association between family income, breastfeeding-related variables, sleep-related variables, the home environment, and socioeconomic variables, and FMS. In children aged 1–2 years, we found no evidence for an association between sex, growth-related variables, singleton birth and family income, and FMS. In children aged 2–4 years, we found moderate evidence for a positive association between type of ECEC setting and FMS, and no evidence for an association between sedentary (screen) behavior, toxicity, parental education, family income, socioeconomic variables and maternal depression and/or anxiety, and FMS. For other examined correlates, the evidence was insufficient (inconsistent findings or only one study available).
As this is the first review examining correlates of FMS that includes children under the age of 3 years, only the results in the age group 2–4 years are compared to reviews in preschoolers (3–5 years) or single studies unless indicated otherwise. It is important to note that correlates are likely to change with age, and therefore, comparisons of our results in the age groups <1 year and 1–2 years with reviews conducted in older children should be viewed with caution. Most included studies have been published in the past 5 years, indicating early childhood FMS is an emerging area of research.
A noteworthy finding of this review is the methodological quality of included studies. This was rated as moderate or low in over 85% of the included studies. These studies scored especially low on the items “selection bias” and “withdrawals and dropouts.” For the item selection bias, this can be explained by a combination of nonrepresentative samples included in the study and the lack of information provided on recruitment rates. Additional information provided through references was often not sufficient. Poor reporting was also seen for the items “withdrawals and dropouts” and “intervention integrity.” The low ratings for the item “withdrawals and dropouts” were mainly due to the large number of dropouts. The review by Barnett et al. included a risk of bias assessment in which four criteria were individually assessed (Barnett et al., 2016). One of these criteria was representative sampling. They found that 68% of the included studies did not include representative samples (Barnett et al., 2016), which is comparable to the findings regarding selection bias in the current review. Additional reasons for a low methodological quality can be the lack of golden standards, dependence of parental report in this young age group, or the inclusion of studies that were not specifically aimed at examining correlates of FMS. When two or more studies of high methodological quality were available in this review, we did not include studies of low or moderate quality in determining the level of evidence, which could have influenced our results.
For all age groups, we found insufficient evidence to draw conclusions on an association with FMS for over half of the examined correlates. In addition to the low methodological quality, this can be explained by several factors. The studies showed a large variation in measurement instruments to assess FMS, including observations, performance tests, and questionnaires, limiting comparability between studies. Despite examining correlates in age groups, this variation remains. This is a common issue, and there is a need to reach consensus on what instruments to use or (further) develop a field-based FMS measurement instrument that can be used internationally (Hulteen et al., 2020; Lopes et al., 2021). Such an instrument should be useable across different age groups and across different sociocultural contexts, allowing for monitoring of FMS over time and comparisons between populations and countries. The large variation in measurement instruments was an additional reason to use one definition of FMS and not include studies examining specific separate skills (rather than a composite score) as this would have further increased heterogeneity of included studies. Regarding examined correlates, there was a large variation in the correlates examined and how correlates were assessed. When possible, we combined studies examining a similar construct despite using different measures. However, it must be acknowledged that this may also have resulted in a dilution of the evidence. This highlights the need to reach consensus on the definition and measurement of constructs of correlates.
We found insufficient evidence for sex as correlate in children aged <1 year and 2–4 years and no evidence for an association between sex and FMS in children aged 1–2 years. A previous review in preschoolers concluded that boys demonstrated better developed object control skills than girls (Iivonen & Sääkslahti, 2013). Most studies in the current review did not include FMS subtests given the young age of the children or did not report on analyses for subtests. However, when specifically looking at object control skills, all four studies (one study in children aged 1–2 years and three studies in children aged 2–4 years) showed boys outperformed girls (Honrubia-Montesinos et al., 2021; Martins et al., 2020; Saraiva et al., 2013; Veldman et al., 2018). These sex differences in early childhood may partly be due to social and environmental influences and cultural background, such as different activities and upbringing for boys and girls by family and teachers, rather than biological or physiological factors (Thomas & French, 1985). Our findings on insufficient evidence for an association between age and FMS are in contrast to findings from a previous review that concluded on a positive association (Iivonen & Sääkslahti, 2013). The common use of FMS scores standardized for sex and age may explain the lack of an association if a child follows a steady developmental trajectory.
In the behavioral attributes and skill-related correlates category (e.g., physical activity, sleep, and dietary intake), a large variation of measures per construct was used, often with poor or unknown validity and reliability, which should be acknowledged as a limitation of these studies. However, measuring 24-h movement behaviors (physical activity, sedentary [screen] behavior, and sleep; Arts et al., 2022; Thompson et al., 2010; Veldman et al., 2021) or dietary intake (Arts et al., 2022; Thompson et al., 2010; Veldman et al., 2021) in young children is challenging.
In contrast to a previous review in preschoolers, which found a higher socioeconomic status associated with better developed FMS (Venetsanou & Kambas, 2010), we found no evidence in children aged <1 years and 2–4 years. For children aged 1–2 years, our evidence was insufficient. It has to be acknowledged that half of the studies included in the current review were conducted in low-income settings, and there might not have been enough variation to examine such an association. Additionally, the construct socioeconomic variables comprised different indicators (e.g., poverty and socioeconomic index), whereas parental education (n = 15) and family income (n = 10) were considered separately. However, if all measures reflecting socioeconomic status were combined (e.g., parental education, family income, and other socioeconomic variables), this still results in no evidence. When looking at child development in general, literature shows that a higher socioeconomic status and less childhood poverty are related to improved development through more stimulation, attention, support, and materials as well as better nutrition (McPhillips & Jordan-Black, 2007; Shonkoff & Philips, 2000).
We found moderate evidence for a private ECEC setting being associated with better developed FMS compared to a public ECEC setting. This correlate has not been identified in previous reviews examining correlates of FMS. An explanation might be the difficulty around comparing public and private settings. When looking at ECEC settings, there is a wide variety in beliefs and policies across countries which in turn influences the quality of care. Additionally, definitions for public and private vary across countries, if the distinction between public and private even exists, making it difficult to compare the two (Vermeer et al., 2016).
Strengths and Limitations
A strength of this review was the use of a methodological quality assessment and best evidence synthesis. Additional strengths are the thorough and extensive literature search and the reporting per age group. A limitation of this review is the use of an overall definition of FMS across all age groups for the search terms. The decision to report results per age group was taken when data extraction was completed. Additionally, we did not contact authors of the original studies to gain more information on their methodology for practical reasons. Given the large number of different measurement instruments used for correlates, we combined studies examining a similar construct, which may have influenced results. Furthermore, publication bias or selective reporting of significant findings could have influenced our results. Another limitation is that we only included publications in English.
Recommendations for Future Research
To further examine correlates of FMS in early childhood and to inform future interventions, we recommend:
- 1.Investing in better methodologies and improved reporting to ensure high-quality studies, including:
- a.the use of valid and reliable measurement instruments for FMS in early childhood and reaching consensus regarding instruments (per age group);
- b.defining constructs and definitions of potential correlates per age group, the use of valid and reliable measurement instruments for correlates, and reaching consensus regarding core outcome sets;
- c.investing in higher retention rates as an important focus for future research; and
- d.reporting of sufficient study details, especially around measurement outcomes, recruitment and retention rates, and intervention details (e.g., information on intervention content and procedures);
- 2.Focusing on sociocultural, physical, environmental, and political correlates as currently only few studies examined these correlates, or there was a large variation in the correlates examined and how correlates were assessed; and
- 3.Exploring interactions between factors that could influence FMS, as currently few studies examined such interactions, including context (e.g., rural vs. urban areas, home vs. ECEC setting) and sample characteristics (e.g., gender differences, ethnicity, and culture).
Conclusions
This systematic review summarized the correlates of FMS in typically developing children aged 0–4 years. Even though this is an important area of research, we found either insufficient or no evidence for most included correlates to draw conclusions on potential associations. This is most likely due to the rapid development of young children resulting in heterogeneity in type and measurement instruments regarding both FMS and correlates.
These results prevent us from making specific recommendations for interventions but rather lead to recommendations for future research on correlates of FMS in early childhood. In order to identify correlates of FMS in early childhood and inform future interventions to improve FMS, we recommend investing in better methodologies and improved reporting to ensure more high-quality studies.
Acknowledgments
We would like to thank Ralph de Vries and Lisanne Balk for their contributions to the data search and data extraction, respectively. Funding: This study was funded by The Netherlands Organization for Health Research and Development (ZonMw; Project No. 546003008); the Bernard van Leer Foundation; and the Ministry of Health, Welfare and Sport. The funding bodies had no role in the design of the study; the collection, analysis, and interpretation of data; or the writing of the manuscript. Author Contributions: Conceptualization of the study: Veldman, Gubbels, Chinapaw, Altenburg. Literature searches: Veldman, Ralph de Vries. Screening of studies, data extraction, and quality assessment: Veldman, Balk, Singh, Koedijker, Chinapaw, Altenburg, Gubbels. First draft of the manuscript: Veldman, Gubbels, Altenburg. Read, revised, and approved the final manuscript: All authors.
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