Course:KIN366/ConceptLibrary/HomeEquipment

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
Email: shannon.bredin@ubc.ca
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Home equipment for infants includes items such as baby walkers, jolly jumpers, infant seats, infant swings, cribs, and others. Infant equipment refers to items that are meant to provide support for the child where the parent does not have give physical supervision. Infant equipment has been used for many reasons as given by the parents. Parents have given reasons for using infant equipment such as to keep their infant quiet and happy, to encourage mobility and promote walking, to provide exercise, and to hold the infant during feeding (Committee on Injury and Poison Prevention, 2001). The biggest reason for infant equipment use is that parents believe it will keep their infant safe (Committee on Injury and Poison Prevention, 2001). Many parents also believe that using equipment such as baby walkers will help their infant to walk sooner than normal (Abbott & Bartlett, 2002). This page will explore whether the use of home equipment aids in the acquisition of motor skills. It will also take into account the association of infant equipment with injuries.

Definitions

Before continuing with this analysis, there are a few key definitions that will help in the discussion of home equipment for infants.

Motor development

The changes in motor behavior across the lifespan. Motor behavior is affected by how the organism, the environment, and the task affect the process of change in motor behavior (Garcia & Garcia, 2013).

Motor milestones

A set of functional skills or age-specific tasks that most children can do at a certain age range; these tasks help determine how well a child is developing (Garcia and Garcia, 2013).

Infant equipment

Equipment and furniture used by infants and babies in the home, car, and play area including strollers, high chairs, cribs, baby walkers, and infant swings (Abbott & Bartlett, 2002).

Preterm

An infant who is born before 37 weeks of gestation (Bartlett & Kneale Fanning, 2003).

History


Healthcare providers and parents have used early motor development as an indicator of an infant’s neurological development for many years. Many theories of motor development suggest that learning motor skills comes from an interaction of the infant, the environment, and the task (Garcia & Garcia, 2013). These three systems are composed of many different components that interact with each other to create movement (Garcia & Garcia, 2013). The task is one system that can be easily manipulated by a teacher, a parent, or some type of equipment. (Garcia & Garcia, 2013). By exploring the use of infant equipment as a tool for motor development, we can better understand how the use of this equipment affects the acquisition of motor skills.

Types of Infant Equipment


There is a large variety of infant equipment available, but there have been very few studies researching the influence of equipment such as jolly jumpers, infant seats, exersaucers, and swings on early motor development. The most researched type of infant equipment has been baby or infant walkers. An infant walker consists of a wheeled base supporting a rigid frame that holds a fabric seat with leg openings and usually a plastic tray (Thein et al., 1997). It is designed to support an infant who is not yet able to walk while still allowing mobility with the feet touching the floor (Thein et al., 1997). There are different types of walkers that may have extra features such as bouncing mechanisms, activity toys, or locking devices to keep them from moving (Thein et al., 1997).

Other types of infant equipment are included in the list below.

Stroller

A small carriage with four wheels that a baby or small child can ride in while someone pushes it (Dictionary.com, 2014).

Jolly jumper

A type of fixed sprung baby harness in which an infant may be placed and allowed to bounce up and down for exercise (Dictionary.com, 2014).

Exersaucer

Similar to the infant walker except it does not allow the baby to move forward or backwards using its feet. The baby can move up and down and it has toys attached for entertainment (Dictionary.com, 2014).

High Chair

A small chair with long legs for a baby or small child, fitted with a tray that is used as a table at mealtimes (Dictionary.com, 2014).

Infant swing

A stationary unit with a frame and powered mechanism that enables an infant to swing in a seated position. The intended use is from birth until the child is able to sit up unassisted (Dictionary.com, 2014).

The above list of infant equipment is not extensive, but provides examples of the types of equipment used by parents for their children in the home in order to keep the child safe and occupied. The infant equipment that has not been extensively researched in terms of its effect on motor development is not included in this list to make sure that parents and health care professionals can make the most informed decision possible on what types of equipment they want to use for their infant.

Debate on Infant Equipment Use


The main debate on using infant equipment is whether the use promotes or delays the acquisition of motor skills. Bartlett and Fanning (2003) studied infants born preterm and they did not find any negative relationships between the use of equipment and motor development besides the use of an infant swing. The swing is most often used to soothe an irritable child and should only be used under six months of age. In order to develop antigravity postural control in sitting, the swing should not be used after six months of age and the parent should consult a therapist to consider other options of soothing the child and decreasing irritability without impeding on the acquisition of sitting independently (Bartlett & Fanning, 2003). They suggest that children who do not yet have the motor capability to sit independently might actually benefit from the use of infant equipment such as high chairs, other infant seats, and exersaucers (Bartlett & Fanning, 2004). They believe that because this type of equipment can be modified to give various degrees of support, it can provide graded opportunities to develop antigravity control. They also found a negative relationship in terms of motor development between carrying and the ability to sit. The most common reason for carrying the child was for safety and so they suggest that a playpen can be used for part of the day to ensure safety as well as to develop infant-parent independence (Bartlett & Fanning, 2003). This study was done on preterm infants, which means that these suggestions are more highly recommended for that population.

Abbott and Bartlett (2000) studied typically developing infants and found that equipment use and infant motor development are inversely related. Infants with high equipment use tend to score lower on infant motor development. They also looked at previous studies done on equipment use and motor development. Crouchman (1986) researched the effect of baby walkers of the mobility of typically developing infants (Abbott & Bartlett, 2000). He found that infants who used the baby walker more than two hours per day were less mobile in the prone position, but found no differences for independent sitting or walking (Abbott & Bartlett, 2000). Kauffman and Ridenour (1977) and Ridenour (1982) also found no difference in the onset of independent walking between infants who had used a baby walker and those who had not (Abbott & Bartlett, 2000). They did find that the quality of walking patterns was significantly different between the two groups. The infants who used the baby walker showed decreased knee flexion and stride length, and greater forward lean when walking independently. These errors disappeared after the baby walkers were no longer being used, which suggests that the effect of the baby walker on the quality of movement is only temporary (Abbott & Bartlett, 2000). Simpkiss and Raikes (1972) found that excessive use of baby walkers and bouncers reinforced primitive responses and delayed the onset of voluntary movements in children, including delayed manipulative skills and delay in the onset of rolling (Abbott & Bartlett, 2000). They suggest that using this equipment too much will emphasize the disabilities of a handicap infant and show abnormal development in a typically developing child (Abbott & Bartlett, 2000).

Provasi and Lequien (1993) examined the effect of seating devices in relation to infant motor development and found that infants using a non-rigid seating device slept more, were quieter, and demonstrated fewer motor behaviors associated with prematurity such as clonus and startles (rapid successions of flexion and extension in a group of muscles). Although there is not much research in this area, using seating devices may be beneficial when children are very young according to Provasi and Lequien (1993).

In summary, the existing research shows that the use of most infant equipment either has, in the best case, no effect on infant motor development or, in the worst case scenario, has harmful effects on infants developing both typically and atypically. The research does not show that there are any notable benefits to using infant equipment. The only area where the use of infant equipment enhances the quality of motor development is in preterm infants.

Infant equipment and play positions

One reason that the use of infant equipment may be detrimental to the motor development of a child is because the position of an infant needs to be varied throughout the day to help develop motor skills (Pin et al., 2007). Pin et al. (2007) reviewed the effects of play position and equipment use of motor development in infants. It has been found that prone position is of particular importance in the development of head control and gravity extension and prone extension is essential for the development of stability in various weight bearing positions such as on all fours and sitting (Pin et al., 2007). When infants have a lack of experience in the prone position, it may have detrimental effects on their motor development. Pin et al (2007) suggest that the use of baby walkers, baby bouncers, or infant seating devices is another way of varying the position of the infant. In agreement with the studies mentioned above, they found that infants using baby walkers and infant seating devices showed delays in motor development or differences in their upright movement patterns, but all the infants walked independently within the normal time frame (Pin et al, 2007). This study shows that using infant equipment does not speed up or slow down motor development and negative effects of the equipment are transient. This study also found that even infants who spent less time in prone position still developed within normal age limits and walked independently within the normal age range. They suggest that it may not be the effect of simply changing the position of the infant that promotes motor development, but a supportive and stimulating environment including human interaction and stimulation may be more effective (Pin et al., 2007).

Injuries


Although there is some literature on infant equipment and motor development, most of the literature on using equipment for children is associated with the injuries they cause. In 1999, an estimated 8800 children younger than 15 months of age were treated for injuries associated with baby walkers in the United States (Pediatrics, 2001). Injuries are mostly caused by falls with the infant still in the walker. Stairs were involved in 75-96% of cases. A small number of cases were due to pinching injuries to fingers and toes as well as burns due to infants being able to reach higher places in the baby walker (Pediatrics, 2001). An estimated 181654 children younger than 2 years of age were treated in emergency departments in the US for injuries related to cribs, playpens, and bassinets during the 19-year study period; most injuries involved cribs, followed by playpens then bassinets (Yeh et al., 2011).

Prevention

Because there have been many instances where infant equipment has caused injury, there needs to be some strategies for preventing these injuries. The Committee on Injury and Poison Prevention (2001) suggests five strategies to prevent injuries associated with baby walkers: warning labels and public education, adult supervision, barriers such as stair gates, infant walker design changes to prevent falls down stairs, and a proposed ban on mobile infant walkers. Even though parents see the warning labels, they still continue to use baby walkers after the occurrence of injury, which shows that labeling and educational efforts are not likely to lead to a decrease in walker related injury. Adult supervision also does not necessarily prevent injuries because the infant could already be across the room in their walker before the adult has a chance to react (Committee on Injury and Poison Prevention, 2001). Even stair gates have not been a reliable prevention method; in one study, more than one third of falls down stairs occurred with stair gates in place but they were either left open or improperly attached (Committee on Injury and Poison Prevention, 2001). The only real injury prevention method is through the mandatory and voluntary standards put in place by the Consumer Product Safety Commission (CPSC) (United States CPSC, 2012). There has been a mandatory standard in place since 1971 that addresses injuries caused by pinching or shearing in the frame (United States CPSC, 2012). Due to the present infrequency of these injuries, these standards are deemed effective. A voluntary standard was put in place in 1996 to prevent falls down stairs (United States CPSC, 2012). The walkers need to be wider than a 36 inch doorway or must have a braking mechanism designed to stop the walker if one or more wheels drop off the riding surface. Because it is voluntary, it remains to be evaluated whether the industry is following this standard. Some companies may choose not to follow these standards, so it is important for parents to research they type of infant walker they want to buy and make sure these important safety features are present. There has been a reduction in injury since walkers with these safety standards have hit the market, which demonstrates that the CPSC should consider making this a mandatory standard for all baby walkers. Canada was the first country in the world to put a ban on the sale, advertising, and import of baby walkers. This occurred in 2004 and other countries have yet to follow suit.

Recommendations

It is recommended that other countries follow suit with Canada and place a ban on mobile infant walkers. There are no clear benefits from their use and the injuries outweigh any benefits that there could be. If this ban does not occur, it is important that the baby walkers follow the standards to prevent falls down stairs (ASTM F977-96). Parents need to be educated about the hazards and risks associated with baby walkers through media campaigns as well as through health care professionals. Immobile activity centers should be promoted as an alternative to mobile baby walkers as a way to keep an infant safe and occupied.

Practical Applications


In addition to the recommendations above, there are also a few more considerations that practitioners and parents should remember about the use of infant equipment. Decisions around the use of infant equipment need to be made individually and in the context of the child and family factors. For example, it may be beneficial for an infant born preterm to use infant equipment to enhance motor abilities, but the same decision may not be made for a typically developing child. It is also important to remember that child rearing habits and the family environment are more important to motor development than the use of infant equipment. Practitioners can inform parents of specific handling techniques and caregiving practices that expose infants to postural challenges associated with motor development. Education should be provided on moderate home equipment use and giving children adequate floor time to practice and explore different motor abilities. This will help to enhance motor outcomes of infants. In order to promote motor development, a supportive and stimulating environment accompanied by human interaction is recommended.


References


Abbott, A.L., & Bartlett, D.J. (2002). Infant motor development and equipment use in the home. Child: Care, Health and Development, 27, 295-306.

Bartlett, D.J., & Kneale Fanning, J.E. (2003). Relationships of equipment use and play positions to motor development at eight months corrected age of infants born preterm. Pediatric Physical Therapy, 15, 8-15.

Committee on Injury and Poison Prevention. (2001). Injuries associated with infant walkers. Pediatrics, 108, 790-793.

Dictionary.com Unabridged. Retrieved March 02, 2014, from Dictionary.com website: http://dictionary.reference.com/browse.

Garcia, C. & Garcia, L. (2013). A motor-development and motor-learning perspective. Journal of Physical Education, Recreation, and Dance, 77, 31-33.

Pin, T., Eldridge, B., and Galea, M.P. (2007). A review of the effects of sleep position, play position, and equipment use on motor development in infants. Developmental Medicine and Child Neurology, 49, 858-867.

Provasi, J. & Lequien, P. (1993). Effects of nonrigid reclining infant seat on preterm behavioral states and motor activity. Early Human Development, 35, 129-140.

Thein, M.M., Lee, J., Tay, V., and Ling, S.L. (1997). Infant walker use, injuries, and motor development. Injury Prevention, 3, 63-66.

United States Consumer Product Safety Commission. (2012). Safety Standard for Infant Swings (FR Doc. 2012-27027)

Yeh, E.S., Rochette, L.M., McKenzie, L.B., and Smith, G.A. (2011). Injuries associated with cribs, playpens, and bassinets among young children in the US, 1990 – 2008. Journal of the American Academy of Pediatrics, 127, 479-486.