FACT SHEET

Motor Development Variations Across Cultures: Implications for Culturally Competent

and Family-Centered Pediatric Care

WHAT IS CULTURE?
The United States Department of Health and Human Services Office of Minority Health defines culture
as “integrated patterns of human behavior that include the language, thoughts, communications,
actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.”1 Culture
has also been defined as “the learned and shared beliefs, values, and life ways of a designated or
particular group which are generally transmitted intergenerationally and influence one's thinking and
action modes.” 2

Culture is one of the many variables known to affect motor development. These variables include but
are not limited to climate,3 sex,4 early postural experience,5,6 socioeconomic status,7 nutrition,8 physical
growth,9 childrearing practices,10 and parental expectations.11

Because the concept of culture is multifaceted, this fact sheet will focus on cultural variations in motor
development as they relate to culture-based caregiving practices, routines, and parental beliefs across
different racial/ethnic groups.

WHY IS THIS IMPORTANT?

• The child population of the USA is expected to experience the majority–minority crossover in
2020.12
• By 2030, children from racial/ethnic minorities will account for more than half of the US
population under the age of 18 years.13
• By 2060, 64% of children in the USA will belong to racial and ethnic minorities compared with
56% for the total population, and nearly one in five of the nation’s total population will be foreign-
born.12

As the US child population continues to grow increasingly diverse, pediatric physical therapists must
carefully consider the child/family’s cultural background and caregiving practices when assessing
infants and children, establishing a plan of care, developing goals, and administering skilled
intervention.

CULTURE AND MOTOR DEVELOPMENT

Evidence from cross-cultural research has challenged the assumption that motor development follows a
fixed and predictable sequence.14 Culture-based variations in gross motor development have been
documented in populations around the world. The following examples in Table 1 illustrate some of
these differences and encourage a more flexible view of motor development milestones. These
examples are not all-inclusive of the current body of cross-cultural studies and should not be used to
make generalizations regarding a family’s caregiving practices or expectations regarding their child’s
development.
2018
TABLE 1: Culture-Based Variations in Gross Motor Development*
What? Documented Reasons Why
Higher percentage of independent sitting in 5- Emphasis on upright positioning and opportunities
month-old infants living in Cameroon and Kenya for practicing sitting during daily activities15
compared to 5-month-old infants living in Argentina,
Italy, South Korea, and the US15

Gross motor acceleration in infants living in - Culture-based handling practices:

Jamaica,16,17 Kenya,18,19 Mali,20 Nigeria,21 and 1. Aggressive massage applied to infants with low
Uganda22,23 tone11
2. Traction applied to infants’ head and limbs for
stretching11
- Culture-based positioning practices:
1. Infants living in Africa carried in slings with little to
no head support while mothers work in the field14
2. African infants propped into sitting and walking
positions by parents19,20
- Cultural belief/value that walking promotes a child’s
integration into their society and fosters
interdependence11

Skipping of crawling by infants living in Jamaica16,17 Cultural belief/perception that crawling is primitive
and demeaning.16,17 In contrast, crawling on hands
and knees is valued in European and American
cultural groups as it promotes early independence
with mobility24

Delayed onset of gross motor milestones in infants - Predominance of supine positioning during wakeful
living in China and Japan as compared to infants moments in Eastern Asian countries25,26,27
living in Western countries25,26 - Practice of “sandbags” for infant toileting in
Northern China: infants spend more than 16 hours
per day lying supine inside a small sleeping bag
filled with fine sand26
- Infants tend to be dressed in heavy clothing, which
may limit movement exploration28
-
Infants living in Hong Kong learn to roll supine to Preference for supine positioning during the day,
prone before they roll from prone to supine, the resulting in decreased opportunities for practice of
opposite of what is observed in Western cultures27 antigravity postural control27

Slowest rate of human development in The Ache Independent mobility is perceived as dangerous
group in Paraguay, a hunter-gatherer society11,14 and is therefore discouraged by parents11,14

*not all-inclusive of cross-cultural research literature

2018 APTA Pediatrics Fact Sheets | 2

IMPLICATIONS FOR PHYSICAL THERAPISTS
• Infants from certain cultural groups may follow unique motor development trajectories due to culture-
specific caregiving practices or cultural values/beliefs.29
• Using standardized motor development screening and assessment tools to evaluate the motor
development of children in cultures other than those in which the normative samples were established
may lead to misinterpretation of results and erroneous labelling of young children a developmentally
delayed or “early achieving.” 29
o New population norms and cross-cultural adaptations for commonly used standardized motor
development screening and assessment tools are available for many cultural contexts. 29
• It is common for families to retain their culture-specific caregiving practices when they immigrate to a
different country. A child born in the US to parents raised in another country may be raised using
culture-specific handling and positioning practices of the parents’ country. 30

CULTURALLY COMPETENT CARE AND FAMILY-CENTERED PEDIATRIC CARE:

PUT ON YOUR THINKING CAP!

Evaluation
-Do the "delays" I identified
Examination during my examination
reflect a true developmental Diagnosis /
History delay or a culture- or family- Prognosis/ Plan of
-Do I know enough about this specific difference? Care
family's caregiving routines? -Can my client/patient's poor
-Do the family's caregiving
-Are there cultural values or performance on certain test
practices contribute to my
beliefs that may affect this items be explained by lack of
examination findings as they
family's perception of their familiarity with or exposure
relate to my client's motor
child's development? to testing objects?
development? Are these
-Do I know what is important practices strengths or potential
to this family? Do I know the barriers to my plan of care?
parents' priorities? -Have I considered using goal-
Tests and Measures setting tools to focus on what
Intervention is important to this
-Is the motor development
screening/assessment tool I Parent/caregiver child/family?
am using valid for children education: -Am I approaching goal setting
from this cultural background? -Have I explainted how as a collaborative effort
-Are there cross-cultural culture- and family-specific between myself, the
adaptations of standardized caregiving, handling and child/family and other
motor development positioning practices may disciplines involved in this
assessments appropriate for affect motor development? child's care?
this client/patient's cultural Treatment Strategies
background?
-Do my interventions
incorporate culture-specific
practices that are important
to the family and child?

DON’T ASSUME that family’s adhere to cultural norms

ASK PARENTS/CAREGIVERS: What do you consider important to your child/family?

2018 APTA Pediatrics Fact Sheets | 3

REFERENCES
1. US Department of Health and Human Services Office of Minority Health. Assuring cultural competence
in health care: recommendations for national standards and outcomes-focused research agenda.
Washington, DC: US Government Printing Office; 2000.
2. Pasick RJ, D'Onofrio CN, Otero-Sabogal R. Similarities and differences across cultures: questions to
inform a third generation for health promotion research. Health Educ Q. 1994;23(suppl):S142-61.
3. Tronick EZ, Thomas RB, Daltabuit M. The Quechua manta pouch: a caretaking practice for buffering the
Peruvian infant against the multiple stressors of high altitude. Child Dev. 1994;65:1005-13.
4. Goodway JD, Robinson LE, Crowe H. Gender differences in fundamental motor skill development in
disadvantaged preschoolers from two geographical regions. Res Q Exerc Sport. 2010;81:17-24.
5. Lobo MA, Galloway JC. Enhanced handling and positioning in early infancy advances development
throughout the first year. Child Dev. 2012;83:1290-1302.
6. Lee HM, Galloway JC. Early intensive postural and movement training advances head control in very
young infants. Phys Ther. 2012;92:935-47.
7. McPhillips M, Jordan-Black J. The effect of social disadvantage on motor development in young children:
a comparative study. J Child Psychol Psychiatr. 2007;48:1214-22.
8. Sudfeld CR, McCoy DC, Fink G, et al. Malnutrition and its determinants are associated with suboptimal
cognitive, communication, and motor development in Tanzanian children. J Nutr. 2015;145:2705-14.
9. Thelen E, Fisher DM, Ridley-Johnson R. The relationship between physical growth and a newborn
reflex. Infant Behav Dev. 2002;25:72-85
10. Kolobe TH. Childrearing practices and developmental expectations for Mexican-American mothers and
the developmental status of their infants. Phys Ther. 2004;84:439-53.
11. Cintas HL. Cross-cultural similarities and differences in development and the impact of parental
expectations on motor behavior. Pediatr Phys Ther. 1995;7:103-11.
12. Colby SL, Ortoman JM. Projection of the size and composition of the U.S. population: 2014 to 2060. US
Census Bureau 2015. Retrieved from:
https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf. Accessed
August 2015.
13. Perez DA, Hirschman C. The Changing racial and ethnic composition of the US population: emerging
American identities. Popul Dev Rev. 2009;35(1):1-51.
14. Adolph KE, Karasik L, Tamis-LeMonda CS. Motor skill. In Bernstein M, editor. Handbook of Cultural
Developmental Science. New York: Taylor & Francis, 2010:61-88.
15. Karasik L, Tamis-LeMonda CS, Adolph KE, Bornstein MH. Places and postures: a cross- cultural
comparison of sitting in 5-month-olds. J Cross Cult Psychol. 2015;46(8):1023-1038.
16. Hopkins B, Westra T. Motor development, maternal expectations, and the role of handling. Infant Behav
Dev. 1990;13:117-22.
17. Hopkins B, Westra T. Maternal expectations of their infants’ development: some cultural differences. Dev
Med Child Neurol. 1989;31:384-90.
18. Keefer CH, Tronick E, Dixon S, Brazelton TB. Specific differences in motor performance between Gusii
and American newborns and a modification of the Neonatal Behavioral Assessment Scale. Child Dev.
1982;53:754-9.
19. Super CM. Environmental effects on motor development: the case of African infant precocity. Dev Med
Child Neurol. 1976;18:561-7.
20. Bril B, Sabatier C. The cultural context of motor development: postural manipulations in the daily life of
Bambara babies (Mali). Int J Behav Dev. 1986;9:439-53.
21. Iloeje SO, Obiekwe VU, Kaine WN. Gross motor development of Nigerian children. Ann Trop Paediatr.
1991;11:33-9.

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 22. Geber M. The psycho-motor development of African children in the first year, and the influence of
maternal behavior. J Soc Psychol. 1958;47:185-95.
23. Geber M, Dean RFA. Gesell Tests on African children. Pediatrics. 1957;20:1055-65.
24. Benson, JB. The significance and development of crawling in human infancy. In: Clark JE, Humphrey
JH, editors. Advances in Motor Development Research, Volume 3. New York: AMS Press; 1990:91-142.
25. Werner EE. Infants around the world: cross-cultural studies of psychomotor development from birth to
two years. J Cross-Cultural Psychol. 1972;3:111-134.
26. Mei, J. The Northern Chinese custom of rearing babies in sandbags: implications for motor and
intellectual development. In: vanRossum, J.; Laszlo, J., editors. Motor development: Aspects of Normal
and Delayed Development. Amsterdam: VU Uitgeverij; 1994.
27. Nelson ES, Yu LM, Wong D, Wong HYE, Yim L. Rolling over in infants: age, ethnicity, and cultural
differences. Dev Med Child Neurol. 2004;46:706-9.
28. Fung KP, Lau SP. Denver Developmental Screening Test: cultural variables. J Pediatr. 1985:106:343.
29. Mendonça B, Sargent B, Fetters L. The cross-cultural validity of standardized motor development
screening and assessment tools: a systematic review. Dev Med Child Neurol. 2016; 58(12):1213-1222.
30. Inman AG, Howard EE, Beaumont RL, Walker JA. Cultural transmission: Influence of contextual factors
in Asian Indian immigrant parents’ experiences. J Couns Psychol. 2007; 54: 93–100.

ADDITIONAL CULTURAL COMPETENCY RESOURCES

• APTA Cultural Competence in Physical Therapy Available at: https://www.apta.org/patient-care/public-
health-population-care/cultural-competence
• APTA Resources for Teaching Cultural Competence in Physical Therapy Education Available at: https://
www.apta.org/patient-care/public-health-population-care/cultural-competence/teaching-cultural-
competence
• Campinha-Bacote J. The process of cultural competence in the delivery of healthcare services: a model
of care. Journal of Transcultural Nursing. 2002;13(3):181-184.
• National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health
Care Available at: https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf
• Setting the Agenda for Research in Cultural Competence in Health Care Available at:
https://archive.ahrq.gov/research/findings/factsheets/literacy/cultural/cultural.html

©2018 by the APTA Academy of Pediatric Physical Therapy,1020 N Fairfax St, Suite 400, Alexandria, VA
22314-1488, www.pediatricapta.org

Developed by expert contributor Bianca Mendonça, PT, DPT, Board-Certified Pediatric Clinical
Specialist. Supported by the Fact Sheet Committee of APTA Pediatrics.

The APTA Academy of Pediatric Physical Therapy provides access to these member-produced fact
sheets and resources for informational purposes only. They are not intended to represent the position
of APTA Pediatrics or of the American Physical Therapy Association.

2018 APTA Pediatrics Fact Sheets | 5