Indian.7. Pedlar,. 45 : 168, 1978
BEHAVIOURAL
Mira
DEVELOPMENT OF INDIAN INFANTS B I R T H T O SIX M O N T H S *
FROM
lhzrorfvr, ,Nt N. l'ttr,,ztrr, S. SAxv.~zA AND .]'.1~..'Iv[F'.ttTA
7~ipu, Exactly a hundred years ago, it, 1877, Charles Darwin published a detailed account o['the development of one of" his ten children. Since then a lot of work has been done on behavioural growth and mental testing. J a m e s Cattell, Binet and Simon, Arnold Gessel, Charlotte Buhler, Payche Cattell, Illingworth, etc. are well known n a m e s in this field. This subject has, however, been neglected in India, till recently. Uklonskaya etal. (1960) were perhaps the pioneer workers in studying behavioural development in I n d i a n infants. T h e y observed 1000 infants between the ages of one m o n t h a n d one year. Phatak started a longitudinal study using Nancy Bayley's infant scales in 1962. J h a (1969) observed the developmental milestones in a sweeper c o m m u n i t y in Bombay. I t was our a i m in this survey to study the performance of I n d i a n children and the effect of factors like birth weight, socio-economic conditions, education of mothers etc. on behavioural development. Material and Methods
These observations were made during a longitudinal study of growth of infants from birth to six months, conducted at the State Zenana Hospital, Jaipur. *Reprints Address : 2-K-5, R.H.B. Colony, Sastri N,,gar, Ajmcr, Kajasthan. Received on April 16, 1977.
For recording behaviour manifestatl01ll two rnonlh~ were used--interview at~ periodic s,~w'rvisory examination. Th~ behavio,zr manifestatio~l~ were studied Ill three group~: (a)
Those normally attained first three months of age.
durin~ the
(i) Chin up prone (ii) Eyes follow moving objects (iii) Smiles at person (iv) Coos (v) Head steady (b)
Tilose attained between three to s|x months of age. (i) Laughs aloud (ii) Grasps and holds toys (iii) Begins to roll over (iv) Sits frog position (v) Descriminates strangers
(c)
Those attained between six and nine months (i) Transfers toys from one hand to the other (ii) Sits alone (iii) Vocalizes (da, ma, ba) (iv) Crawls (v) Pulls to standing position
Those infants who attained one or more milestones normally attained in the next quarter, at an earlier age, were placed in the early group. Those, who at the end of a quarterly age interval, had not attained all the milestones normally attained during that period, were marked delaved. Those
169
puRoIIlT BT AL~-BEHAVIOURAL DEVEt.OPMJ',,".'I OF INI)JAN INFANTS
tttnining all the milestones in thc~ pv'cscribed Wli~d were labelled as nf~rma!. Behaviour rnanifestations were f~trther observed in relation t,, l]le l'ollo~iilg infhaencing 1. 2. 3. 4. 5
factors. Birth weigl,t Ouarterly weight incren,ents Socio-economic groups Mothers cducali,)r, Morbidity Observations
and Discussion
Development is a continuous process from conception to maturity. T h e sequence ofdevelopment is the same in all children but the rate of development varies f r o m ~,,,d-1-:~t o child. Thus there is no particular age at which a particular developmental milestone must be acquired. It is essential to kn'~w the age range o~er which a particular behaviour manifestation is achieved. Hence the behaviour manifestations were recorded in three groups.
T a b l e 1.
Those of the first group are normally attained during the first three months of life. The earlier miTestoncs of holding chin "2 prone, following moving objects, and smiling, were attained in the first quarter by practically all infams. There was a delay recorded in beginning to coo in 16 infants. Since this milestone was recorded by asking the mother about it, much reliance cannot be placed on it. The last milestone ot the first group, that o f neck holding was, however, observed by the investigators, ira every case. Thus, those infants who had not achieved this by three months of age, were considered to be retarded, and were placed in t h e 'delayed' group (Table !). There were 25 (20%) infants irt~ this group. The rest, that is 100 (80%) infants develooed thL" milestone normally. Uklonskaya (1960) reported 77% of Delhi infants to be holding their heads by tile third month. 56.8% of the Bombay infants studied by Jha (1969) could hold up their heads at this age.
,Vumber of i,~Jnts in various groups according to behaoiour manifestations at quarterly age miervals. No. of Infants
Age intervals
Behaviour Early
Manifestation
Groups
Total
Normal
Delayed
0-3 months
17 (13.6%)
83 (66.4%)
25 (20.0%)
125
3-6 months
40 (62.5%)
17 (26.6%)
7 (10.9%)
64
I
Total
9
I
II
199
t70
INDIAN JOURNAL OF I,~,I)IATRICS
Thus the infants in o , r study are at par with the I)elhi infams, and also with English (lllingworth 1972) infants. Phatak (19139) fottnd Indian infa.ts to be advanced over American infants ~,i~ the Baley scales. By three months, 17 infants were laughing aloud 4 could grasp and }told toys, and 2 could even roll over. TLese were placed in the 'early' group. Thus 17 (13.6%) infants were considered to be advanced. Only 64 infants were studied upto six months, and these were considered during the second quarter. A majority of the infants seemed to attain the milestones early during this age interval. Only 7 (10.9~/o) were in the 'delayed' group, as they could not sit with support and discriminate strangers by "six months. Almost all infants could laugh aloud, hold toys and roll over by the age o f six month. 40 (62.5~/o) were considered advanced, as they had attained milestones which usually develop after the six months. 38 (59.4%) could transfer toys from one hand to the other; 31 (48.5%) could sit alone; 7 (11%) could vocalize (da, ma, ha); 7 (11%) could crawl; and 2 (3.1%) could even pull up to a standing position, Uklonskaya (1960) reported that 70 % of the infants studied were able to sit without support at six months, and 13 % could crawl. Only 12.9 % of the Bombay infants (Jh. 1969) could sit without support at six months but 19.4 % could crawl. Here I n d i a n infants seemed to be advanced over those o f other countries quoted. Phatak (1969) m a d e similar observations Thus we find that during the first six months of life, though Indian infants lag behind those o f more advanced countries in physical growth, in behavioural develop-
Vo~. 45, N o ; ~ ment t},es, a:e ~,t par, and even a h e a d o f tht:tn. Upto age of six months, most i n f a l ~ ale breast fed, and therelore the advelll effect of I~overty and mainu,,'ition are tt0t evident in our ~!,dy. Both U k l o n s k ~ and .Jha found that the development;~o~ milestones was retarded ~ft.er the seventtl month. Phatak (!969), working with It group of infants from a better social elaH, reports Indian infants to be more advanced than American infants upto fifteen to . The earlier behavioural eighteen . ,.o. . , . ~~" development may well be a racial charac. teristic. T o observe the effect of factors like birth weight, quarterly ir.crement in weighr~ socio-economic conditions, education ot" mother and morbidity, on behavioural development, this was studied in relation to each factor separately. Much has been said about the effect of prematurity on mental development but very little work has been done on the effect ol birth weight on full term infants. Churchill.. e t a l . (1966) found a positive relationship between I . Q . and birth weight (when all cases with b i r t h weight under 2500 gm or with gestation under 38 weeks were deducted). In table Table 2 ;t is seen that in the present study only 11 infants had more than the overage birth, weight. Only 7 of these were studied in the second quarter. In neither of the quarters were any of these infants seen to have delayed milestones. 39 infants had below average birth weight. In the first quarter 15 (38.4%) o f these had delayed milestones, and only 2 (5.1%) developed early. During the second quarter, only 17 of these infants could be followed up. 8 (47%) were in the early group, and only 3 (17.6%) in the 'delayed'.
17t
r i j ~ o H I T E T AL~ ~ B E H A V I O U R A L D E V i Z L O P M E N T OF I N D I A N I N F A N T S
In Table No. 3, a positive relation between quarterly weight increments and attainment of behaviour manifestations was found in both quarters. In the first quarter the maximum number of infants showing delayed development of milestones were from the lower
Thus~ the delay seems to have been made up. Does the handicap of a lower birth weight, if at all there, become less with age, other influencing factors, especially racial characteristics, becoming more domii~a;i~ ? The subjects needs further investigation on a larger sample with a longer follow up.
T a b l e 2.
Relation of birth weight and behaviour manifestations Birth to three months No. of infants
Birth weight Behavi0ur manifestations
Below average
Average
Above average
Total
t
2
i3
2
17
Normal
22
52
9
83
Delayed
15
I0
0
25
Total
39
75
II
[25
Above average
Total
Early
(b)
Three months to six nzonths No. of infants Birth weight Behaviour manifestations
Below average
Average |
8
Early Normal
6
25 11
Delayed Total
3 17
4 40
7 0 0
7
40 17 7 64
172
m n x A N JOURNAL OY pIgDIATilOS
T a b l e 3.
VOL. 45, NO. I
Relation between quarterly weight increments and behaviour manifestations
(a) Birth to three months No. of infants Weight increments
Behaviour manifestation L
N
M
Total
Early
I
10
3
14
Normal
4
57
9
70
Delayed
3
13
1
17,
Total
8
80
i3
I0i
(b) Three months to six months No. o f infants Behaviour manifestations
Weight increments L
N
M
Total
I
Early
2
21
8
31
Normal
l
II
l
13
Delayed
4
I
0
5
Total
7
33
9
49 i
h
N-M-~
Less than normal increment. Normal increment. More than normal increment.
I
"
- -
IqJROHIT I~T A L . - - B E H A V I O U R A L
soclo-economic group (Table 4). The weight increment in the group was, however, fom~d to be equal to that of the middle wcio-economic group. This retarded development may be the result of lack of interest on the part of the parents due to
T a b l e 4.
173
D E V E L O P M E N T OF I N D I A N INFANTS
larger families, poverty, and lack of education leading to lack of training. In the second quarter more of these infants showed early development, perLaps due to the general trend towards eaHy development during the second quarter. Infants from the
Relation between socio-tconomlc groups and behaviour manifestations.
(~) Birth to three months
No. of infants Socic-ee~nomic groups
Behaviour
Total
manifestations Lower
Middle
Upper
||
3
9
5
17
Normal
30
43
10
83
Delayed
14
10
1
25
47
62
16
125
Early
Total
(b) Three months to six months
No, of infants Total
Socio-economic groups
Behaviour manifestations Lower
Middle
Upper
Early Normal
1l 8
23 6
6 3
40 17
Delayed
2
5
0
7
21
34
9
64
Total
174
VOL. 45, No. a
INDIANJOUgNAL OF PEDIATRICS
development of the infant. In Table 5 , ~ is seen that of the 50 infants belonging uneducated mothers, 12 (24%) had delayed development, 4 (8%) developed early, and the rest normally. 12 infants belonged to
upper Iocio-economic group attained the milestones early or normally during both quarters. I n the first quarter, education o f the mother seemed to play a positive role in the T a b l e 5.
Relation between mother's education, and behaviour manifeJlations. Birth to three months No. o f Infants Mother's education
Behaviour manifestations
Total UE l
MS
HS
i
C
!
4
4
6
3
17
34
. 22
19
8
83
Delayed
12
6
6
1
25
Total
50
32
31
12
125
Early 9N o r m a l
(b) T ~ e , month, to Jix months No. of Infants Mother's education Behaviour manifestations
Total US
MS
HS
15
9
8
40
Normal
9
3
5
17
Delayed
2
4
!
7
Total
26
1.6
14
64
I
C
I
Early
UE = MS = HS ---C =
Uneducated Middle school High school Collegeeducated
175
~LfROHI'I' I~T A L . ~ B E H A V I O U R A L DEVRLOPMENT O F I N D I A N I N F A N T S
cdlege tducated mothers. Of these 3 (35%) developed early, 1 (8.3%) had delayed development, and the rest developed nor-really, in the second quarter all the 8 infants belonging to college educated mothers showed early development. But the infants from the uneducated group seem to catch up with the others, and i 5 (57.7%)
T a b l e 6.
of the 20 infants from thisgroup developed early, and or.Iy 2 (7.7%) had delayed development, again showing a general tendency fer early development in the second quarter. The effect of minor and moderate illnesses suffered by the infants dining the presant study is shown in Table 6. In the
Relation betwun morbidity and behaviour manifestations.
(a) Birth to ~hr#e months
No. of Infants Grades of Illness
Behaviour manifestations
+
m
it
,
i
Early Normal Delayed Total
++
Total
+++
I
tam
9 41 II 61
4 12 8 24
4 20 2 26
17 83 25 125
0 10 4 14
(b) Three months to six months
No. of Infants Grades of Illness
Behaviour manifestations
Early Normal Delayed Total
23 7 0 30
+
++
7 3 3 13
8 5 2 15
Tota 1 §
I
2 2 2 6
L
40 17 7 64
176
INDIANJOURNI.L OF PEDIATRICS
first quarter, 14 infants were in the ' + + + ' group of illnesses. O . t of these~ l0 (7! 4~ d,~veloped normally, 4 (28.6%) showed delayed development, and none early. Of the 61 infants who had no illnesses, 41 (67.2%) developed normally, 9 (14.7%) were early, and 11 (18%) delayed. In the second quarter, of the 6 infants in the ' + + + ' group, 2 (33.3%) developed early, 2 (33.3%) normally and 2 (33.3%) were delayed. 30 infan~ were in the ~o illness group, and none of these showed delayed development. 23 (76.6%) showed early development and 7 (23.3%) showed normal development. Hence, illness seemed to have a some what adverse effect on the developmental milestones.
Summary Observations regarding behavioural growth of infants studied longitudinally from birth to six months, are reported. It was seen that the infants in our study were more advanced in behavioural development, than those of more advanced countries. None of the infants with above average birth weight had delayed milestones. The infants with less than average birth weight had delayed milestones during the first quarter, but caught up with the rest, during the second quarter.
VOL. 45, No.ql
A positive relation between quarter weight increments and attainment of ht haviour manifestations was found in b ~ quarters. Poor socio-economic conditions, and lack of education in the mother advers~ affected the behaviourai developrnel~ during the first quarter, but not in the second quarter. The minor and moderate illnessel recorded seemed to have a somewhat adverse effect on the developmental mile~ stones. Referescea
Churchill, J.A., Neff, J.W., Caldwell, D.F. ( 1 9 ~ Birth weight and intelligence. Obsttt. and Gyner 426.
Illingworth, R.S. (1968). The Normal Chl~ London. Ch~,rchill. Ed. 1968, p 162. lllingworth, R.S. (1972). The development ef the infant and young child--normal and abnormal, Edinburgh and London. Ed. 1972. p. 137. Jha, $.S. (1969). A longitudinalstudy of infams belonging to a sweeper community in Bombay city, Pedlar. Clin. India. 4, 49. Phatak, P. (1969). Motor and mental development of Indian babies from I month to 30 months. lndidn Pediatr. 6, 18. Uklonskaya, R., Purl, B., Chowdhari, N., Luthra, Dang and Raj Kumari, (1960). Development of static and psychomotor. Functions of infants in the first year of life in New Delhi. Indian 3. Chid. Hllg 9, 596.