FOLLOW - UP OF THE CHI LD’S MOTOR ABI LI TI ES I N
DAY- CARE CEN TERS AN D PRE- SCHOOLS
1Magda An dr ade Rezen de2 Viv ian César Bet eli3 Jair Lício Fer r eir a dos Sant os4
Rezende MA, Bet eli VC, Sant os JLF. Follow- up of t he child’s m ot or abilit ies in day- care cent ers and pre- schools. Rev Lat in o- am En fer m agem 2 0 0 5 set em br o- ou t u br o; 1 3 ( 5 ) : 6 1 9 - 2 5 .
Th e aim w as t o d escr ib e t h e r esu lt s of a d ev elop m en t al scr een in g t est in a coh or t of 3 0 ch ild r en
at t en d in g 3 d ay - car e cen t er s in t h e cit y of São Pau lo an d d ev elop h y p ot h eses ab ou t t h ese r esu lt s. Th ir t y childr en w er e evaluat ed t hr ee t im es, dur ing t w o year s, by using t he DDST. I n t he gr oss m ot or ar ea t he r esult s
im pr oved ( Test s of t he Signs, 1st t o t he 3r d evaluat ion, p= 0.038* ) . Ther e w as a r elat ionship bet w een t he age
of t he child ( 2 t o 3 year s) and w or st r esult s ( Fisher ’s Exact t est , p= 0.013* ) . I n t he fine m ot or ar ea t he r esult s
im pr ov ed ( Test s of t he Signs, 1st t o t he 2nd ev aluat ion, p= 0. 031* ) . So, t he dev elopm ent of m ot or abilit ies
im pr ov ed aft er t h e ch ildr en st ar t ed at t en din g t h e day - car e cen t er s. We m u st u n der t ak e m or e r esear ch es in or der t o at t r ibut e t he specific influences of each ar ea: day - car e cent er and/ or fam ily .
DESCRI PTORS: child day car e cent er s; child car e; child dev elopm ent
ACOMPAÑAMI ENTO DE LAS HABI LI DADES MOTORAS DE
NI ÑOS QUE FRECUENTAN JARDI NES I NFANTI LES
El obj et iv o fue descr ibir los r esult ados de las selecciones del desar r ollo m ot r iz de un gr upo de niños
que fr ecuent a t r es ( 3) j ar dines infant iles de la ciudad de San Pablo y lev ant ar hipót esis a r espect o de est os
r esult ados. Tr eint a niños fuer on evaluados t r es veces, a lo lar go de dos años, ut ilizando el Test de Selección de
Desar r ollo de Denver ll. En el ár ea m ot or a gr uesa los r esult ados m ej or ar on ( Test de las Señales, 1a. par a 3a.
aplicación, p= 0,038* ) . Hubo r elación ent r e la edad de los niños ( 2 a 3 años) y peor es r esult ados ( Test exact o de Fish er , p= 0 , 0 1 3 * ) En el ár ea m ot or a f in a los r esu lt ados m ej or ar on ( Test de las Señ ales, 1 a. par a 2 a.
aplicación, p= 0,031* ) El desar r ollo m ot r iz m ej or ó después que los niños com enzar on a fr ecuent ar los j ar dines
infant iles. Son necesar ias m ás inv est igaciones a fin de at r ibuir influencias específicas par a cada ár ea: j ar dines infant iles y / o fam ilia.
DESCRI PTORES: j ar dines infant iles; cuidado del niño; desar r ollo infant il
ACOMPANHAMENTO DAS HABI LI DADES MOTORAS DE CRI ANÇAS
QUE FREQÜEN TAM CRECH ES E PRÉ- ESCOLAS
O obj et ivo foi descr ever os r esult ados de t r iagens do desenvolvim ent o m ot or de um a coor t e de cr ianças
q u e f r eq ü en t a 3 cr ech es d a cid ad e d e São Pau lo e lev an t ar h ip ót eses a r esp eit o d est es r esu lt ad os. Tr in t a cr ianças for am avaliadas t r ês vezes, ao longo de dois anos, usando- se o Test e de Tr iagem de Desenvolvim ent o
de Denv er I I . Na ár ea m ot or a gr ossa os r esult ados m elhor ar am ( Test e dos Sinais, 1ª par a 3ª aplicação, p=
0 , 0 3 8 * ) . Hou v e r elação en t r e idade da cr ian ça ( 2 a 3 an os) e pior es r esu lt ados ( Test e ex at o de Fish er , p= 0,013* ) . Na ár ea m ot or a fina os r esult ados m elhor ar am ( Test e dos Sinais, 1ª par a 2ª aplicação, p= 0,031* ) . O
desenv olv im ent o m ot or m elhor ou depois que as cr ianças com eçar am a fr eqüent ar as cr eches. São necessár ias
m ais pesquisas a fim de at r ibuir influências específicas a cada ár ea: cr eche e/ ou fam ília.
DESCRI TORES: cr ech es; cu idado da cr ian ça; desen v olv im en t o in fan t il
1 Resear ch par t ially financed t hr ough Scholar ships of Scient ific I nit iat ion supplied by FAPESP ( Pr ocess 00/ 11890- 7) e CNPq ( Pr oj ect 248/ 2002) t o Vivian César
I NTRODUCTI ON
I
n f a n t i l e d e v e l o p m e n t o c c u r s w i t h t h e pr ogr essiv e incor por at ion of ideas, at t it udes, abilit ies and behav ior s and depends on t he full occur r ence of m any fact or s. These fact or s ar e r elat ed t o t he child’s dev elopm ent , it s genet ic const it ut ion, phy sical, social an d cu lt u r al en v ir on m en t in w h ich it is in ser t ed. An exam ple of t he int er act ion am ongst t hese com ponent s occu r s w h en t h e ch ild of alm ost on e y ear an d f ou r m ont hs old lear ns how t o dr ink w at er fr om a glass. To acqu ir e t h is beh av ior it n eeds t o sit , t o h old t h e glass and coor dinat e t he m ovem ent so as not t o spill a n y t h i n g . Mo r e o v e r, t h e ch i l d n e e d s t o b e i n a n environm ent w here t he pr act ice of offer ing w at er in a glass is m ore com m on t han in a nur sing bot t le or in a glass w it h a st raw .Consider ing t he com plexit y of fact or s t hat t he child needs t o develop, t here is a need t o periodically ev aluat e it , t o inst it ut e act ions unex pect edly needed. I t i s cal l ed “ i n f an t i l e d ev el o p m en t su p er v i si o n ”, a h e a l t h a c t i o n r e c o m m e n d e d b y n a t i o n a l a n d int er nat ional inst it ut ions( 1- 3). This act ion is needed in d a y c a r e c e n t e r s a n d p r e s c h o o l s s i n c e t h e s e i n st i t u t i o n s, i n Br a zi l , a ssi st a g r ea t er n u m b er o f ch ild r en . I n 2 0 0 3 , 7 6 6 , 9 1 4 Br azilian ch ild r en u p t o t h e age of t h r ee y ear s w er e bein g assist ed in day -care cent ers. The increase in r elat ion t o 2002 is 7.02% . I n São Paulo, t he difference is even gr eat er : t he St at e r epor t s 19% m or e st udent s in day - car e cent er s t han i n 2 0 0 3( 4 ). I t i s w o r t h em p h a si zi n g t h a t d a y - ca r e cent er s assist childr en fr om 0 t o 3 year s old and pr e-school fr om four t o six y ear s old.
Am ong t he differ ent pur poses and goals t hat d a y - c a r e c e n t e r s a n d p r e - s c h o o l s m u s t r e a c h , accor ding t o t he Br azilian Cur r iculum Refer ent ial for I n f an t ile Edu cat ion( 5 ), t h er e ar e m an y associat ed t o t h e f o u r a r e a s o f i n f a n t i l e d e v e l o p m e n t : s o c i a l per sonal, gr oss and fine m ot or abilit ies and language abilit ies.
Re g a r d i n g f i n e m o t o r a r e a , c h i l d r e n a r e ex pect ed t o hav e t he oppor t unit y t o ex plor e and use p r eh en sile m ov em en t s, t o h old an d t o t h r ow w h en u sin g d if f er en t ob j ect s. An d r eg ar d in g g r oss m ot or abilit ies, t he environm ent m ust be or ganized in a w ay children w ill be able t o develop abilit ies t o m ove w it h p r o g r essi v e sk i l l i n sp ace w h en w al k i n g , r u n n i n g , j um ping, developing a self- confident at t it ude r egar ding t heir ow n body.
I n sp i t e o f i t s i m p o r t a n ce, d ev el o p m en t a l super v ision has been per for m ed only occasionally in m ost of d ay - car e cen t er s an d Br azilian p r esch ools accor ding t o t he bibliogr aphy and our ex per ience. I t m u st b e p o i n t ed o u t t h at , i n Br azi l , t h er e ar e n o
lon g it u d in al st u d ies of t h e in f an t ile d ev elop m en t in d a y - ca r e ce n t e r s a n d p r e - sch o o l , a l t h o u g h so m e professionals of t he nursing area ( isolat ed or in groups)
have carried out som e st udies relat ed t o t his subj ect( 6-10)
, t his because super v ision of infant ile dev elopm ent belongs t o child healt h car e( 1- 3).
OBJECTI VE
To d escr ib e an d d ev elop hy p ot h eses of t h e
r esult s of a dev elopm ent scr eening of m ot or abilit ies in a child cohort enrolled in t hree high- qualit y st andard d ay - car e cen t er s.
METHODOLOGY
Scenar io of t he st udy
Th e sel ect ed d ay - car e cen t er s ar e cl o sel y locat ed t o each ot her in t he cit y of São Paulo and are c o n s i d e r e d o f h i g h - q u a l i t y s t a n d a r d a s s i s t a n c e
r e g a r d i n g t h e i r s t r u c t u r a l s i t u a t i o n ( s i z e o f t h e classr oom s an d adu lt / ch ild r at io) . On ly t h e ch ildr en of t he em ployees t hat w or k at t he inst it ut ion use t hem .
Sam p le g r ou p
Ch ild r en w er e ev alu at ed f r om t h e m om en t t hey st ar t ed going r egular ly t o t he day - car e cent er s
in 2001. Thr ee evaluat ions of 30 childr en had alr eady been per for m ed ( 17 boy s and 13 gir ls) . Ages r anged fr om 4 m ont hs up t o 2 year s and 4 m ont hs in t he fir st evaluat ion, fr om 10 m ont hs t o 2 year s and 10 m ont hs
in t he 2nd evaluat ion and fr om 2 t o 4 year s in t he 3r d ev alu at ion . Th u s, t h e in t er v al bet w een t h e t w o fir st ev alu at ion s w as of alm ost six m on t h s an d fr om t h e 2 n d an d t h e 3 r d of ap p r ox im at ely on e y ear. Th ese
childr en st ay ed in t he day - car e cent er fr om 8 t o 12 hour s per day.
Requir em ent s t o for m t he fir st sam ple gr oup w er e: k n ow n g est at ion al ag e ( f or t h ose u n d er t w o
y ear s old) ; absence of any congenit al m alfor m at ion; no pr ev ious st ay in a day - car e cent er.
Analy sis of t he socioeconom ic st at us
Socioecon om ic ev alu at ion w as assessed b y using anot her r esear ch t hat had been done w it h t he gr oup( 11) in w hich w as included t he fat hers’ or m ot hers’
Ev alu at ion Met h od : Den v er Dev elop m en t Scr een in g Test
Th e DDST w as u sed t o scr een dev elopm en t pr oblem s. I t m ay be applied t o childr en fr om bir t h up t o t he age of six year s( 12). This consist s of 125 it em s, dist r ibut ed int o four ar eas: social- per sonal, adapt iv e f in e- m ot or, lan g u ag e an d g r oss- m ot or. Som e it em s a r e a p p l i e d b y a sk i n g t h e ch i l d t o p e r f o r m so m e specific t ask s or by m eans of t he par ent s’ or child’s car eg iv er s/ ed u cat or s r ep or t s.
The gr oss m ot or ar ea of DDST consist s of 32 it em s r elat ed t o behavior such as: sit t ing w it hout any support , walking properly, r unning and clim bing st air s. The fine m ot or ar ea consist s of 29 it em s, as: dr aw ing spont aneously and building t ow ers w it h sm all building b l ock s.
A pr ev ious pr epar at ion of t he indiv idual w ho w ill apply t he t est is needed so t hat each it em as w ell as t h e f u ll t est m u st be st an dar dized an d cor r ect ly applied an d in t er pr et ed.
DDST applicat ion( 1 2 )
Pr ev iou s t o t h e t est applicat ion , t h e age of t he child is calculat ed on t he day t he t est is perform ed. Nex t , a v er t ical lin e is d r aw n cor r esp on d in g t o t h e age. I n t his st udy, t he it em s cr ossed by t he line w er e applied t oget h er w it h t h e ot h er t h r ee at t h e left , in each dev elopm ent ar ea t o det ect if som e delay w as o b ser v ed .
Transit or y fact or s of exclusion such as sleep, f at ig u e, sick n ess, f ev er or f ear w er e con sid er ed . I f t he child pr esent ed som e of t hese, w e w ait ed for it s r ecov er y, w h ich cou ld last sev er al day s. Du r in g t h e t est , if t he child felt t ired or had t o part icipat e in som e expect ed act ivit y in t he day car e cent er, t he t est was int errupt ed. Ot her inform at ion on t he DDST is det ailed in ot her st udy( 13).
For t his r esear ch ever y it em of t he DDST w as int er pr et ed as: nor m al, caut ion or delay.
Nor m al: w h en t h e ch ild p er f or m s on e it em
w hich is cr ossed by t h e age line, or w h en t he ch ild fails or r efu ses t o per for m an it em , w h ich is t o t h e ex t r em e r ight of t he age line.
Cau t ion : w h en t h e ch ild f ails or r ef u ses t o
perform an it em in w hich t he age line crosses bet w een 75% and 90% .
Delay : w h en t h e ch ild f ails or r ef u ses t h at
w hich is t o t he ext rem e left of t he age line.
Aft er int er pr et ing each it em or behav ior, t he t est , as a w hole, m ay pr esent t w o t ypes of r esult s:
Nor m al: w her e t her e ar e no delay s and at a
m ax im um of one suspect .
Suspect : w hen t her e ar e t w o or m or e suspect s
an d/ or m or e delay s.
I n t his st udy, t he t est was com plet ely applied; int er pr et at ion w as per for m ed in gener al and follow ed b y i n t er p r et a t i o n o f t h e i so l a t ed a r ea s ( p er so n a l -social, language, fine m ot or and gr oss m ot or ) . Each ar ea w as consider ed adequat e w hen t he child had no su spect an d/ or delay s.
Wh en t h e r esu lt of t h e t est w as su spect , a n ew ev a l u a t i o n w a s p er f o r m ed w i t h i n o n e o r t w o w e e k s.
Met hodology and analy sis of et hical car es
Analy sis w as per for m ed w it h non- par am et r ic t est s( 14), assum ing t he alpha risk of 5% and each child was com par ed t o it self, dur ing t he 3 evaluat ions.
Th e r e se a r ch r e sp e ct e d m a n d a t o r y e t h i cs effor t s accor ding t o Br azilian legislat ion. I t indicat es t hat t he pr oj ect w as appr oved by an Et hics Com m it t ee, in t his case t he Et hics Com m it t ee of t he Nursing School of Univer sit y of São Paulo ( r egist r at ion num ber s 136/ 2001, 248/ 2002 and 310/ 2003) .
The dir ect or of each inst it ut ion per m it t ed t he r esear ch . So did t h ose r espon sible f or t h e ch ildr en . Th ey w er e in f or m ed ab ou t t h e w or k an d ask ed t o ex pr ess t heir agr eem ent . I f t hey did so, t hey signed a Fr e e a n d Cl e a n Te r m o f Co n se n t , a cco r d i n g t o Resolut ion nr. 196/ 1996 of t he Nat ional Healt h Council.
RESULTS AND DI SCUSSI ON
Socioecon om ic ev alu at ion
I n t h e y ear of 2 0 0 4 2 2 . 5 % of t h e par en t s ear n ed 2 . 3 1 t o 3 . 8 4 m in im u m w ages ( MW)( 1 1 ), an d t h ese par en t s w er e t h e poor est of all. Fu r t h er m or e, accor ding t o t his st udy 49.7 % of t he par ent s ear ned 3.85 t o 5.76 MW. The ot her 27.8 % ear ned fr om 5.77 t o 26.91 MW. These am ount s didn’t com pr ehend ot her kinds of aids ( financial subsidies such as t ransport at ion an d m eals) , n or t h e spou ses’ salar ies. Th e av er age of t hese salar ies was 7.60 MW, so it was bet t er t han t he av er age salar y in t he m et r opolit an r egion of t he cit y of São Paulo at t he sam e t im e, w hich w as 4. 28 MW( 15).
Ev alu at ion of dev elopm en t
Gr oss m ot or ar ea
Table 1 – Result s of child’s evaluat ion r egar ding gr oss m ot or ar ea of childr en fr om 3 day car e cent er s. São
Paulo 2 0 0 1 - 2 0 0 3
n o i t a u l a v
E Adequate Caution(s) Delay(s) Caution(s)+Delay(s)l Total .
r
n % nr. % nr. % nr. % nr. %
1st(2001) 17 56.60 7 23.40 2 6.60 4 13.40 30 100.0
2nd(2001) 23 76.60 6 20.00 1 3.40 0 00.00 30 100.0
3rd(2002-2003) 24 80.00 6 20.00 0 0.00 0 00.00 30 100.0
d l i h
C 1J2 2J3 1J3
1 + Tie +
2 + Tie +
3 Tie Tie Tie
4 + Tie +
5 Tie Tie Tie
6 + Tie +
7 Tie Tie Tie 8 Tie Tie Tie
9 - + +
0
1 - + Tie
1
1 Tie + +
2
1 Tie + +
3
1 + Tie +
4
1 Tie Tie Tie 5
1 + - +
6
1 Tie -
-7
1 Tie -
-8
1 Tie -
-9
1 + Tie +
0
2 Tie -
-1
2 + - Tie
2
2 Tie Tie Tie 3
2 + + +
4
2 Tie Tie Tie 5
2 - + Tie
6
2 - + Tie
7
2 Tie Tie Tie 8
2 Tie Tie Tie 9
2 + Tie +
0
3 Tie Tie Tie I t w as obser ved t hat childr en im pr oved aft er st ar t in g t o at t en d d ay car e cen t er. Th e n u m b er of inadequacies dim inished as t im e w ent by, in t he 1st . t her e w er e 43.3 % caut ions and/ or delays, in t he 2nd. 2 3 . 3 % an d i n t h e 3 r d . 2 0 % . I t i s i m p o r t an t t o em phasize t hat in t he 1st child’s ev aluat ion, childr en w er e at t ending t he day- car e cent er appr oxim at ely t w o m ont hs befor e and in t he 3 r d, alm ost 1 y ear and 6 m on t h s bef or e.
Co n s i d e r i n g e a c h c h i l d ’ s d e v e l o p m e n t , com p ar ison s w er e p er f or m ed b et w een t h e 1 st an d 2nd evaluat ions, bet w een t he 2nd and 3r d and, finally b et w een t h e 1 st an d 3 r d . Wh en d ev elop m en t w as m aint ained, it w as consider ed as a “ t ie” ; w hen t her e w as a change fr om caut ion and/ or delay t o adequat e, a p osit iv e sig n w as in t r od u ced an d if t h e op p osit e occur r ed, a negat ive sign w as consider ed ( Table 2 ) . The r esult s w er e evaluat ed by t he Test of Signs w it h a significant ( p= 0.038) im pr ovem ent w hen com par ing t he 1st w it h t he 3r d ev aluat ion, t hat is, in t his ar ea, ch i l d r en ’ s d ev el o p m en t i n cr ea sed a s t i m e o f st a y i n cr eased .
Ta b l e 2 – Co m p a r i s o n o f t h e e v a l u a t i o n r e s u l t s r egar ding gr oss m ot or ar ea by t he DDST I I . São Paulo, 2 0 0 1 - 2 0 0 3
Test s of t he signs
1 → 2P= 0.090 no significant 2 → 3P= 0.500 no significant 1 → 3P= 0.038 significant
Consequent ly, it is believed t hat t he phy sical ar eas an d t h e day - car e cen t er s’ equ ipm en t allow ed
such r esult s since t hese w er e not so good w hen t he ch ild r en st ar t ed at t en d in g t h em . I t is k n ow n f r om r esear ch m ad e b y an ar ch it ect , in t h e cit y of São
Paulo( 16), aim ing t o check how t he childr en used t he urban spaces, t hat children of higher socio- econom ical
condit ions have a t endency of using m or e poor ly such places. I n gener al, t hey m ainly used t heir ow n r oom s f o r p l a y i n g . I n co m p a r i so n , f a m i l i es w i t h a l o w er
in com e u sed m or e of t en open spaces, specially t h e st r eet s. Thus t heir oppor t unit ies for m ot or developm ent
w er e bet t er.
I t is k now n t hat fr om t he age of 2 y ear s, a ch ild in it iat es t h e ph ase of fu n dam en t al m ov em en t s
p a t t e r n s , i n w h i c h i t d e p e n d s i n t e n s e l y o n t h e su r r o u n d i n g co n d i t i o n s. Th u s, “ o p p o r t u n i t i e s f o r
pr act ice, encour agem ent , inst r uct ion, and t he ecology ( set t ing) of t he env ir onm ent it self, all play im por t ant r oles in t he degr ee t o w hich fundam ent al m ovem ent s
pat t er ns dev elop.”( 1 7 )
I n t his w ay it should be found out w hich w er e
t he condit ions in t he day- car e cent er s t hat helped t he ch ild r en . Reg ar d in g t h e av ailab le ar ea f or ch ild r en , t h e t h r ee day - car e cen t er s h av e gr eat ex t er n al an d
int er nal ar eas, safet y and t oy s adequat e for t he age r an ge. Th e in t er n al an d ex t er n al ar eas av ailable t o
t h e ch ildr en m easu r ed 1 1 . 3 0 , 1 3 . 3 4 e 2 9 . 0 9 m 2 in each of t he day- car e cent er s. We draw t he at t ent ion t o t h e f a c t t h a t t h e r e i s n o c o n s e n s u a l f i g u r e
con cer n in g w h at cou ld b e con sid er ed as a b ar e or i n d i sp en sab l e m i n i m u m f o r t h e ad eq u at e i n f an t i l e
dev elopm en t in t h e gr oss m ot or ar ea. We t h er efor e p r e se n t t h e p r e v i o u s f i g u r e s a s ch a r a ct e r i st i ca l l y descr ipt iv e, n ot an aly t ical.
Childr en st ay out side w it h fr ee act iv it ies for appr oxim at ely one hour and a half/ day, except in rainy
day s. They play in gr oups or alone, as t hey w ish. Besid es, t h e in t er n al sp aces of t h e 3 d ay -car e cen t er s ar e or gan ized in cor n er act iv it ies su ch
as t o fav or t he infant ile dev elopm ent( 18- 19).
Th en , it w as obser v ed t h at ch ildr en t w o t o
t hr ee year s’ old seem t o pr esent a gr eat er num ber of su sp ect s. To an al y ze t h i s h y p o t h esi s, w e g r o u p ed
Table 3 – The ev aluat ion r esult s of t he gr oss m ot or ar ea accor ding t o age. São Paulo, 2001- 2003 n o i t a u l a v e e g A . d 9 2 . o m 1 1 . r y 1 o t . o m 4 s r a e y 4 o t 3 + o t . r y 2 d 9 2 . o m 1 1 . r y
2 Total
. r
n % nr. %
n o i t a u l a v e e t a u q e d
A 45 80.36 19 55.88 64
) s ( y a l e D r o / d n a ) s ( n o i t u a
C 11 19.64 15 44.12 26
l a t o
T 56 100.00 34 100.00 90
Fisher ’s Exact t est P= 0.013 significant
Of t he 34 ( 100% ) evaluat ions of childr en w it h
ages r anging fr om t w o t o t hr ee y ear s, 15 ( 44. 12% )
w er e caut ion and/ or delay. I n t he ot her age r anges,
only 11 ( 19.64% ) of t he 56 ( 100% ) w er e consider ed
not adequat e, w hich w as significant ( p= 0.013) , t hat
is, t h er e is a r elat ion sh ip bet w een age of t h e ch ild
and caut ion and/ or delay.
We t h er ef o r e st ar t an al y zi n g b eh av i o r s i n
w hich t he child pr esent ed caut ion and/ or delay s. Of
t he 15 childr en w it h suspect s, 14 ( 93.33% ) w er e not
consider ed adequat e in t he it em “ t hr ow ing t he ball”.
Accor ding t o t he m anual, t o apply t he DDST( 12) and t o
go t o t he next it em “ t hr ow ing t he ball”, t he child has
t o t hr ow t he t ennis ball dir ect ly above t he ar m and t o
r e a c h a d i s t a n c e f r o m t h e g r o u n d b e t w e e n t h e
ex am iner ’s k nees and head w it hout for m ing an ar ch.
The child is not supposed t o t hr ow t he ball sidew ay s
or dow n. Fir st , t he exam iner show s how t o do it and
af t er, h e/ sh e t ak es a posit ion appr ox im at ely 9 0 cm
aw ay fr om t he child and in fr ont of it . Thr ee at t em pt s
ar e per m it t ed an d if t h e ch ild m an ages t o t h r ow at
least one, it goes t o t he nex t it em . Accor ding t o t he
m an u al, 7 5 % per f or m ed t h is it em at t h e age of 2 3
m ont hs and 24 days and 90% w it h 2 year s, 10 m ont hs
and 24 day s.
We believ e t h at t h is ev en t occu r r ed du e t o
t h e f act t h at bot h t h e t en n is ball an d t h e u sage of
one’s ow n hands ar e not so com m on in envir onm ent s
su ch a s f o o t b a l l , f o r e x a m p l e . Th u s, t h e ch i l d i s
ex posed t o a lesser num ber of sit uat ions fav or ing a
dev elopm ent of t he abilit y of t hr ow ing a ball, w hich
int er fer es in it s acquisit ion( 17).
Regar ding sex , t he r esult s w er e div ided int o
b o y s a n d g i r l s i n t h e t h r e e e v a l u a t i o n s a n d n o
si g n i f i can t d i f f er en ce w as o b ser v ed w h en Fi sh er ’ s
Ex act Test w as per for m ed.
Fine Mot or Ar ea
Re g a r d i n g t h e f i n e m o t o r a r e a , c h i l d r e n
obt ained t he r esult s show n in Table 4.
n o i t a u l a v
E Adequate Caution Delay Total .
r
n % nr. % nr. % nr. %
) 1 0 0 2 ( t s
1 25 83.34 3 10.00 2 6.66 30 100.00 ) 1 0 0 2 ( d n
2 30 100.00 0 0.00 0 0.00 30 100.00 ) 3 -2 0 0 2 ( d r
3 29 96.66 1 3.34 0 0.00 30 100.00 Table 4 – Evaluat ion result s of t he fine m ot or area in
childr en of 3 day car e cent er s. São Paulo, 2001- 2003
I t w as obser ved t hat childr en im pr oved aft er
g oin g r eg u lar ly t o d ay - car e cen t er. Th e n u m b er of
ch ild r en w it h cau t ion ( s) , d elay ( s) an d cau t ion ( s) +
delay s( s) decr eased w it h t im e: in t he 1st ev aluat ion
t her e w er e 16.66 % of caut ions and/ or delays, in t he
2nd, none and in t he 3r d, 3.33 % .
Co n s i d e r i n g e a c h c h i l d ’ s d e v e l o p m e n t ,
com p ar ison s b et w een t h e 1 st an d 2 n d ev alu at ion s,
bet w een t he 2nd and 3r d and, finally bet w een t he 1st
a n d 3 r d w e r e p e r f o r m e d , a cco r d i n g t o t h e sa m e
cr it er ia used for t he gr oss m ot or ar ea ( Table 5)
Table 5 – Com par ison of t he evaluat ion r esult s of t he
fine m ot or ar ea using t he DDST I I . São Paulo,
2001-2 0 0 3
d l i h
C 1J2 2J3 1J3
1 Tie Tie Tie
2 Tie Tie Tie
3 Tie Tie Tie
4 Tie Tie Tie
5 Tie Tie Tie
6 Tie Tie Tie
7 Tie Tie Tie
8 Tie Tie Tie
9 Tie Tie Tie
0
1 + Tie +
1
1 Tie Tie Tie
2
1 Tie Tie Tie
3
1 Tie Tie Tie
4
1 Tie Tie Tie
5
1 Tie Tie Tie
6
1 Tie Tie Tie
7
1 + Tie +
8
1 Tie Tie Tie
9
1 Tie Tie Tie
0
2 + Tie +
1
2 + Tie +
2
2 Tie Tie Tie
3
2 Tie Tie Tie
4
2 + Tie +
5
2 Tie Tie Tie
6
2 Tie Tie Tie
7
2 Tie -
-8
2 Tie Tie Tie
9
2 Tie Tie Tie
0
3 Tie Tie Tie
I t w as o b ser v ed t h at i n t h e f i r st m o n t h s,
fr equency in t he day car e cent er, t hat is fr om t he 1st
t o t h e 2 n d ev alu at ion , a st at ist ically sign if ican t ( p= 0 . 0 3 1 ) im pr ov em en t in t h e f in e m ot or dev elopm en t
w as o b ser v ed an d i n t h e 3 r d ev al u at i o n , ch i l d r en
m ain t ain ed t h eir dev elopm en t .
Th er ef or e, su pposedly t h e day - car e cen t er s
helped t he children obt ain t hese result s. I f it w ere t he
opposit e, t he childr en w ould alr eady hav e ar r iv ed in excellent condit ions at t he day- care cent ers. We know
t hat t he day- car e cent er s have pedagogical and ludic
m at er ials in su f f icien t qu alit y an d qu an t it y, besides qualified educat or s( 20). The int er act ion it self bet w een
t h e c h i l d r e n f a v o r s t h i s d e v e l o p m e n t . Ev e n s o ,
dom est ic influence cannot be discar ded, w it hin w hich t here is easy access t o pedagogical m at er ial and w hich
cost is accessible t o pract ically any m iddle- class fam ily,
as w ell as gam es an d t oy s w h ose cost s h av e gon e dow n dur ing t he last few y ear s. Not ably, in t he case
of t he fam ilies of t his st udy, t his lim it at ion is pract ically
n on - ex ist en t , sin ce t h eir in com e is h ig h er t h an t h e average incom e in t he m et r opolit an r egion of t he cit y
of São Paulo.
Finally, r egar ding sex, gir ls and boys pr esent ed t he sam e r esult s.
CONCLUSI ON AND I MPLI CATI ONS
The developm ent of t he childr en’s gr oss m ot or
i m p r o v e d a f t e r t h e y s t a r t e d a t t e n d i n g d a y - c a r e
cent er s, how ev er t he r esult s of t his t ask don’t allow ack n ow led g in g w h et h er t h is im p r ov em en t occu r r ed
ex cl u si v el y b eca u se o f t h e f a m i l i es, t h e d a y - ca r e
cent ers, or bot h. This research w hen collat ed t o ot hers,
show s t hat t he act ual ur ban condit ions, av ailable t o
c h i l d r e n o f m o r e f a v o r a b l e s o c i o - e c o n o m i c a l
con dit ion s, can h am per t h e f u ll dev elopm en t of t h e
gr oss m ot or ar ea. I n t his sense, day - car e cent er s of
high qualit y st andar ds can be a good oppor t unit y for
t he child t o enj oy w ide and safe spaces in w hich t o
p lay, b esid es f in d in g com p an ion s of t h e sam e ag e,
s o m e t h i n g w h i c h a l s o i s u n c o m m o n d u e t o t h e
r educt ion of t he num ber of childr en and t he for m at ion
of nuclear fam ilies.
Th e sam e can be est ablish ed as r egar ds t o
t h e f in e m ot or ar ea. As t o t h ese, t h e ch ildr en also
ov er cam e t he ev ent ual difficult ies aft er at t ending t he
day - car e cen t er s. Nev er t h eless, t h e difficu lt ies w er e
lesser t han t hose of t he gr oss m ot or ar ea and w er e
also sp eed ily ov er com e ( f r om t h e 1 st t o t h e 2 n d .
evaluat ions) . I t is supposed t hat t his occur r ed because
t h e f a m i l i e s h a d a l r e a d y s u p p l i e d a f a v o r a b l e
backgr ound t o t he developm ent of t hese abilit ies even
befor e t he childr en st ar t ed at t ending t he cent er s.
Fin ally, t h er e ar e j ob n ecessit ies t o d elim it
t h e i n f l u e n ce s r e f e r r i n g t o f a m i l i e s a n d d a y - ca r e
cent ers, as w ell as est ablishing a pat t ern of m inim um
q u alit y in t h e d ay - car e cen t er s t h at f av or t h e f u ll
dev elopm ent of bot h gr oss and fine ar eas.
Besides t his, t he DDST has t o be analyzed in
v iew of and ev ent ual suit abilit y of it em s t o Br azilian
cult ur al st andar ds. Ther e is a t least one it em of t he
DDST ( ball t h r ow in g) t h at m ay n ot be adequ at e t o
t he Br azilian cult ur e, and t his m ust be v alidat ed.
REFERENCES
1. Minist ér io da Saúde ( BR) . At endim ent o int egr ado à saúde
e desenv olv im ent o da cr iança: m ódulo 1. Car t ão da cr iança.
Br asília ( DF) : MS; 1 9 9 5 .
2 . M i n i s t é r i o d a S a ú d e ( B R) . S a ú d e d a c r i a n ç a :
acom panham ent o do cr escim ent o e desenv olv im ent o infant il.
Br asília ( DF) : MS; 2002. ( Sér ie Cader nos de At enção Básica,
no. 11) .
3 . Or g an ización Pan am er ican a d e La Salu d . Pr om oción d el
cr ecim ien t o y d esar r ollo in t eg r al d e n iñ os y ad olescen t es:
m ódulos de apr endizaj e. Washingt on: OPS; 1 9 9 9 .
4. Cafar do R. Núm er o de at endidos em cr eches sobe 7% em
u m a n o . O Est a d o d e Sã o Pa u l o , 3 0 a g o st o 2 0 0 3 : Seçã o
Ger a l ; p . A- 1 1 .
5. Minist ér io da Educação e do Despor t o ( BR) . Secr et ar ia de
Edu cação Fu n dam en t al. Refer en cial cu r r icu lar n acion al par a
a educação infant il. Br asília ( DF) : MED; 1 9 9 8 .
6 . Br êt as JRS. Av aliação psicom ot or a de cr ian ças de 5 a 7
an os d e id ad e, q u e f r eq ü en t am a cr ech e “ Mar ia Ap ar ecid a
Car lini”, Jar dim Sabiá, Município de São Paulo. [ disser t ação] .
São Paulo ( SP) : Univ er sidade Feder al de São Paulo; 1991.
7. Br êt as JRS, Silva MG. A aplicação do t est e de t r iagem de
desenv olv im ent o de Denv er pelo enfer m eir o pediat r a: r elat o
de caso. Act a Pau l En f er m agem 1 9 9 5 ; 8 ( 4 ) : 9 - 1 6 .
8. Fer r eir a AMA. Av aliação nut r icional e do desenv olv im ent o
de cr ianças de 0 a 3 anos de idade que fr eqüent am cr eches
conv eniadas com a Secr et ar ia Municipal do Bem - Est ar Social
d e S ã o Pa u l o n a r e g i o n a l d a La p a . [ d i s s e r t a ç ã o ] . S ã o
Pau lo: Un iv er sidade Feder al de São Pau lo; 1 9 8 9 .
9 . Fisb er g M, Ped r em ôn ico MR, Br ag a JAP, Fer r eir a C, Pin i
SCC, Cam pos SO, et al. Com par ação do desem penho de pr
é-escolar es, m ed ian t e t est e d e d esen v olv im en t o d e Den v er,
an t es e após in t er v en ção n u t r icion al. Rev Assoc Med Br as;
1 0 . K a k e h a s h i S . A v a l i a ç ã o d e a l g u n s a s p e c t o s d o
d esen v olv im en t o m ot or g r osso e f in o, ad ap t at iv o, p essoal
social e de linguagem das cr ianças de 2 a 6 anos de idade da
cr eche “ Mar ia Apar ecida Car lini”, Jar dim Sabiá. [ disser t ação] .
São Pau lo: Un iv er sidade Feder al de São Pau lo; 1 9 8 7 .
1 1 . Ver íssim o MLÓR. Est u d o sob r e in f ecções r esp ir at ór ias
ag u d as em cr ech es. [ Relat ór io Pesq u isa] . São Pau lo ( SP) :
Escola de En f er m agem USP; 2 0 0 4 .
12. Frankenbur g WK, Dodds J, Ar cher P, Br esnick B, Maschka
P, Edelm an N, et al. Denver I I Training Manual. Denver : Denver
Dev elop m en t al Mat er ials; 1 9 9 2 .
13. Rezende MA, Lim a FG, Bet eli VC, Sant os JLF. Habilidades
de linguagem e pessoal social de cr ianças de 0 a 3 anos de
id ad e cu id ad as em cr ech es. Rev Br as Cr esc Desen v Hu m
2 0 0 3 ; 1 3 ( 1 ) : 4 0 - 5 2 .
1 4 . Sieg el S. Est at íst ica n ão- p ar am ét r ica p ar a as ciên cias
do com por t am en t o. São Pau lo: McGr aw - Hill; 1 9 7 5 .
15. I nst it ut o Br asileir o de Geogr afia e Est at íst ica [ Página na
I nt er net ] . Br asília: Minist ér io do Planej am ent o, Or çam ent o e
Gest ão; c2 0 0 4 [ acesso em 2 0 0 5 j u n h o 2 5 ] . Dispon ív el em
URL: ht t p: / / w w w . ibge. gov. br.
1 6 . Ol i v ei r a CMAS. O am b i en t e u r b an o e a f o r m ação d a
c r i a n ç a . [ d i s s e r t a ç ã o ] . S ã o Pa u l o ( S P) : Fa c u l d a d e d e
Ar q u it et u r a e Ur b an ism o/ USP; 2 0 0 2 .
1 7 . Ga l l a h u e D L, O z m u n JC. U n d e r s t a n d i n g m o t o r
dev elopm ent : infant s, childr en, adolescent s, adult s. 3 r d ed.
Madison: Br ow n & Benchm ar k ; 1995.
1 8 . M e n e g h i n i R, Ca r v a l h o M I C. A r r a n j o s e s p a c i a i s e
agr u pam en t os de cr ian ças pequ en as em cr ech es. Rev Br as
Cr esc Desen v Hu m . 1 9 9 7 ; 7 ( 1 ) : 6 3 - 7 8 .
19. Mont agner H, Gauffier G, Epoulet B, Rest oin A, Goulenit ch
R, Taule M. Alt er nat ive child car e in France: adv ances in t he
st u d y of m ot or, in t er act iv e, an d social b eh av ior of y ou n g
childr en in set t ings allow ing t hem t o m ove fr eely in a gr oup of
p eer s. Ped i at r i cs 1 9 9 3 ; 9 1 ( 1 ) : 2 5 3 - 6 3 .
20. Rezende MA, Bet eli VC, Lim a FG, Sant os JLF. Habilidades
m ot or as de cr ianças de 0 a 3 anos de idade que fr eqüent am
cr eches segundo o Test e de Tr iagem de Desenvolv im ent o de
Den v er I I . Rev SOBEP 2 0 0 3 ; 3 ( 2 ) : 7 5 - 8 4 .
