539
JOURNAL OF SCIENCE, Hue University, N
0
61, 2010 STUDY ON PHYSICAL AND PSYCHOMOTOR DEVELOPMENT AND SOME
RELATED FACTORS OF INFANTS IN HUE CITY - VIETNAM, 2009-2010
Hoang Thi Bach Yen, Hoang Anh Tien , Nguyen Van Dat, Dinh Thanh Hue
College of Medicine and Pharmacy, Hue University

SUMMARY
Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. For children, good health is very important because it is the
foundation for physical, psychomotor development. Nutrition for children in the first years plays
an important role in the development process and quality of life of each individual. Insufficient
nutrition in this period can lead to poor physical and mental development, and even diseases.
This study was conducted with two objectives: To assess the physical, psychomotor development
of infants in Hue City in 2009-2010; and to identify factors relating to physical, psychomotor
development of infants. Methodology: A cross-sectional study was implemented with a
combination of quantitative and qualitative methods. Results: The prevalence of underweight,
stunting, and wasting malnutrition were 2.07%, 1.55% and 4.39%, respectively. Prevalence of
delayed psychomotor development was 8.27%. There was a correlation between the time of
having complementary feeding and weight-for-length (r= - 0.156, p<0.01) and length-for-age
(r=0.108, p<0.05). Conclusion: Physical, psychomotor development of children should be
assessed and monitored regularly, using WHO Anthro software and Denver 2 test.
Key words: physical, psychomotor development, breastfeeding, complementary feeding

1. Introduction


With the 95% confidence level, Z
2/

=1.96
p =0.9: Estimated prevalence of normal physical and psychomotor development
of infants.
e = 0.03
Then n = 385. The sample size in this study is 387 infants and 387 mothers.
2.3.2. Sampling method: cluster random sampling
Classify 27 precints of Hue city into North and South of Perfume River, then
select randomly 4 clusters for sampling (2 precints from the North and 2 precints from
the South). The selected four precints were Huong Long, Phu Thuan from the North and
Phu Hoi, Thuy Xuan from the South. All of the infants within each cluster (about 80-
110 infants/precint) were study subjects.
2.4. Measurement procedures
- Quantitative method: Interview mothers using questionnaire, measuring weight,
length, head circumference of the infants. Assess psychomotor development by Denver
2 test.
2
2
2
)1(
e
pp
Zn





Total 31 100.0
There were 31 (8.01%) infants were malnutrition of 3 classifications, detailed as
table 5.1. 542
4.1.2. Psychomotor development
Table 2. Psychomotor development of infants
Classification n % p
Normal 355 91.73
< 0.0001
Delayed 32 8.27
Total 387 100.0
Table 3. Number of delayed domains of psychomotor development by gender
Gender

Number
Male (1) Female (2) Total
p (1,2)
n % n % n %
1 12 37.50 12 37.50 24 75.00 >0.05
2 3 9.38 2 6.25 5 15.63 >0.05
3 2 6.24 1 3.13 3 9.37 >0.05
Total 17 53.12 15 46.88 32 100.0
Among 4 domains, gross motor and language accounted for the highest
prevalence of the delay (51.16% and 23.26% respectively). Except for the personal –
social domain, the rest ones showed the delay on male rather than female. A
statistically-significant difference was observed between genders for all delayed
domains.
4.2. Factors relating to physical and psychomotor development of infants

Severe jaundice 10 22.73
Neonatal infection 7 15.91
Others 24 61.36
Total 41 100.0
Weight at birth
There were 24 (6.20%) of infants with a birth weight under 2500gr. Among of
them 9 (2.33%) was pre-term. The weight at birth was 3100 ± 400 grams.
4.2.2. Feeding practice
4.2.2.1. Breastfeeding
Table 5. Breastfeeding practice
Breastfeeding practice n %
The first food after
birth
Breast milk 205 52.97
Liquorice 8 2.07
Sugar 6 1.55
Infant formula 152 39.28
Others 16 4.13
Total 387 100.00
Breast feeding Yes 378 97.67
No 9 2.33
Total 387 100.00
Reasons for not breast
feeding
Insufficient supply of milk 7 77.78
Mother using Insulin 1 11.11
Non – protractile nipple 1 11.11

(months)

<4 10 47.63
4 – 6 6 28.57
>6 5 23.81
Total 21 100.0
Reasons for stopping
breast feeding
Mother do not know feeding
technique
1 4.76
Infants stopped themselves 12 57.14
Insufficient breast milk 7 33.33
Mother gone away 1 4.76
Total 21 100.00
- Prevalence of breastfeeding and exclusive breast feeding for the first 4-6
months for the children according to head of Huong Long and Phu Hoi CHCs’
estimation were 95% - 40% and 30% - 0%, respectively. The results from quantitative
data was 97.67% and 9.52%.
- There were some local conceptions that can be barriers to breastfeeding such as
early complementary feeding, and hard-work of mother, as reported by head of CHCs.
- Time of first breast feeding was within 2 hours after birth (females, 36,39,23
years old -Huong Long; female, 24 years old, Phu Hoi), “I breastfed my daughter right
after I came back to postnatal room, I did not care the time” (female, 34 years old,
Huong Long), “ Breastfeeding after 2 hours because the mother is very tired after 545
delivery, she need time to rest before giving breastfeeding” (female, 35 years old, Huong
Long). “Infants of mothers who had caesareans were often breast-fed after 1 day as the

Cereals 59 23.69
Others 1 0.40
Total 249 100.0
How to feed By bottle 11 4.44 546
By spoon, cup 237 95.56
Total 248 100.0
About the half of mothers introduced complementary food when their infants
were 4-5 month-of age (Huong Long, Phu Hoi). Some others were at 6 month-age as
suggested by mothers-in-law (Huong Long). A few infants were fed with
complementary food before 3 months because “my baby cried all day and all night
because he was starved” (female, 22 years old, Huong Long; female, 29 years old, Phu
Hoi) or “The economical status of family did not allow us to buy infant formula milk, we
have to feed him complementary food when breast milk is not enough for him” (female,
24 years old, Phu Hoi).
- Most of mothers used cereals as the first complementary food.
- Preparation of complementary foods: stewing bones, beef, pork or boiling fish
and mixing with rice; most of mothers added salt, red onion, fish sauce, and oil. Some
of them also added monosodium glutamate, or dehydrated broth . However, some other
mothers were against adding monosodium glutamate as “the food will be taste enough if
we stew many things, the only thing to do is to add some salt” (female, 34 years old,
Huong Long)
4.2.4. Knowledge of mothers about delayed psychomotor development
Some mothers gave attention to the psychomotor development of their baby.
“The delay means not to pronounce as fluently as usual. It will be good if the baby can
repeat what the mother said” (female, 28 years old, Phu Hoi) or “The delay means not
to reach some standards, based on the time. For instance, if a one year old baby can not
walk, he is considered as having delayed development. These are applied for the height,

Hoi) Sometimes but it was very rare that the child was fed by his father as “he came
home late after work”, “My husband said that I can ask him to do everything except for
feeding the baby” (female, 24 years old, Phu Hoi) Mothers also were the one who
played and chatted to the infants. The others sometimes played with them.
4.2.6. Gender issue
Table 5.7. Influence of gender issue on caring of the infant
Gender issue n %
Discriminating between boy
and girl
Yes (Male priority) 3 0.78
No 384 99.22
Total 387 100.0
Know gender of fetal before
birth
Yes 371 95.87
No 16 4.13
Total 387 100.0
Gender of fetal as desired
Yes 286 77.09
No 66 17.79
Do not care 19 5.12
Total 371 100.0
Family’s reaction

Happy 226 59.79
Sad, disappointed 17 4.50 548
No reaction 135 35.72

Comparing our results to other study
549
Classification
Our results
(n=387)
Tu Ngu et al (Phu Tho -
2006) (n=150)
p
Underweight 25.81 27.6 >0.05
Stunting 51.61 41.4 <0.05
Wasting 22.58 15.1 >0.05
There was a statistically difference (p<0.05) of stunting between our study and
Tu Ngu et al.
5.1.2. Psychomotor development
Prevalence of delayed psychomotor development in our study was 8.27%. A
statistically significant difference (p< 0.0001) was showed between normal and delayed
infants. Among 4 domains, gross motor and language accounted for the highest
prevalence of the delay (51.16% and 23.26%).
According to Han Nguyet Kim Chi et al (1999), the psychomotor development
of children from 0 to 24 months follows common rules but is not the same for all
children and all domains. During the first year, the infants had delayed gross motor and
language but the development of all 4 domains would be good in the second year. Our
study showed the same characteristics as this author for the first year.
5.2. Factors in the relation with physical and psychomotor development of
infants
91.73% infants of our study were delivered at full-term and 6.46 % were
delivered pre-term. Low birth weight of pre-term infants might be a risk factor for

Some of the mothers who attended focus group discussions added monosodium
glutamate when preparing food for infants. The National Institute of Nutrition suggest
that monosodium glutamate should not be added to the food of children under 3 as it
artificially sweetens the food, the infants will depend on that sweet and deny other foods
that are necessary for their development. Moreover, toxicity can occur with overuse.
There were 0.78% of families who discriminated between boy and girl children
(son preference). A few of mothers felt sad knowing that they were having a girl. The
two heads of CHCs confirm that gender discrimination was still a problem. According
to Han Nguyet Kim Chi et al, gender discrimination, especially from mothers will
affects psychomotor development of the child.
6. Conclusion
This study showed the prevalence of undernutrition was 31 (8.01%) and delayed
psychomotor was 32 (8.27%). A negative statistically significant correlation between
mother’s level of education and breastfeeding practice was found (r=-0.15; p<0.01).
The time of introducing complementary food was significantly correlated with weight-
for-length (r= - 0.156,; p<0.01), and length-for-age (r=0.108’ p<0.05). There were no
significant differences between: Weight at birth and physical development, diseases of
infants during neonatal period, breast feeding, gender discrimination and psychomotor
development
WHO Anthro and Denver 2 test are useful tools for detecting and following
physical, psychomotor development of children that should be used widely.
Acknowledgement
This paper is one part of the results of a Master of Public Health thesis (Hue 551
College of Medicine and Pharmacy, Vietnam). The study was suported by the Project
for capacity building for Public Health, Hue College of Medicine and Pharmacy-QUT.

REFERENCES