Gill et al.

BMC Pediatrics 2013, 13:29

http://www.biomedcentral.com/1471-2431/13/29

RESEARCH ARTICLE Open Access

Birth and developmental correlates of birth

weight in a sample of children with potential
sensory processing disorder
Simone V Gill1*, Teresa A May-Benson2,3, Alison Teasdale2,3 and Elizabeth G Munsell1

Abstract
Background: Most research examining birth history (i.e. related birth complications) and developmental milestone
achievement follow outcomes for infants at-risk with very specific birth weight categories and gestational age
classifications. The purpose of this study was to examine how birth weight relates to infants’ birth histories and
developmental milestone achievement when they fall into a variety of birth weight and gestational age categories.
Methods: In the current study, we examined birth histories and onset ages for developmental milestones by
analyzing a convenience sample of anonymous existing data from 663 developmental histories completed by
parents at the time of an initial evaluation at a pediatric outpatient occupational therapy clinic. Infants fell into 3
birth weight categories; low birth weight (LBW), normal birth weight (NBW), and high birth weight (HBW) and 3
gestational age classifications considered with birth weight; small for gestational age (SGA), appropriate for
gestational age (AGA), and large for gestational age (LGA).
Results: NBW, AGA, and SGA infants with related birth complications had lower birth weights than infants without
birth complications. Larger birth weights were associated with earlier ages for independent sitting for HBW infants,
earlier ages for eating solids for NBW infants, and earlier walking onsets for LBW and NBW infants. Higher birth
weights were also linked with rolling at a younger age for LGA infants, earlier walking and speaking words for AGA
infants, and sooner independent sitting for SGA and AGA infants.
Conclusions: Our findings suggest that birth weight and gestational age categories provide unique insights into
infants’ birth history and developmental milestone achievement.
Keywords: Development, Birth weight, Child

Background LBW, NBW, or HBW respectively. Weights that are

Infants’ weight at birth is a strong predictor of neonatal ELBW, VLBW, or LBW are associated with complications
health outcomes such as chances of survival, risk of med- such as hypothermia, hypoglycemia, perinatal asphyxia,
ical complications, and timing for the achievement of de- respiratory distress, anemia, impaired nutrition, infection,
velopment milestones [1]. The health risks associated with neurological trouble, and hearing deficits [3-6]. Neonatal
birth weight depend upon classifications defined by the complications increase markedly depending on infants’
Centers for Disease Control [2]; extremely low birth birth weight classifications; the less infants weigh, the
weight (ELBW), very low birth weight (VLBW), low birth higher the chances of encountering health difficulties.
weight (LBW), normal birth weight (NBW), and high birth When determining neonatal health outcomes, it is im-
weight (HBW). Infants < 1,000 g, < 1,500 g, < 2,500 g, portant to consider infants’ gestational age along with
< 4,000 g, and > 4,000 g are classified as ELBW, VLBW, birth weight. For example, ELBW infants’ survival chances
are related to gestational age: fewer weeks of gestation cor-
* Correspondence: simvgill@bu.edu relate with lower chances of survival [7]. Also, it is possible
1
Department of Occupational Therapy, Boston University, College of Health
and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue,
for infants with LBW to be either appropriate or small for
Boston, MA 02215, USA their gestational age. Infants can be classified according to
Full list of author information is available at the end of the article

© 2013 Gill et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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how typical their weights are for their gestational age completed the developmental/sensory histories at home
compared to infants of the same sex [2]. Infants below the and returned them to OTA-Watertown via mail prior to
10th percentile are small for gestational age (SGA), those the evaluation session or in person on the day of the evalu-
between the 10th and 90th percentile are appropriate for ation. In the current study, we analyzed parents’ anonym-
gestational age (AGA), and infants above the 90th percent- ous, de-identified responses to questions related to their
ile are considered to be large for gestational age (LGA). children’s birth history and developmental milestones.
Some health risks for SGA infants include perinatal as- Milestones for children born at LBW and ELBW were
phyxia, sepsis, hypothermia, apnea, and risks of infection corrected for prematurity. Gestational age classifications
[8] whereas risks for LGA infants are shoulder dystocia were based on growth charts. Inclusion criteria were that
[9], brachial plexus injuries [10], or hypoxic injuries [11]. the developmental/sensory histories be completed between
Premature births are usually associated with related health July 2001 and October 2010 and that children be between
outcomes [12-14] in addition to birth weight category or 4 and 12 years old. All developmental histories during this
gestational age classification. Even late pre-term infants time period were considered for inclusion in this study. Ex-
(LPT) born between 34 and 36 weeks gestation have re- clusion criteria were that children not be diagnosed with
cently been earmarked as having difficulty with executive Autism or Downs Syndrome. See Table 1 for specific
function in their preschool years [15]. questions used in the current study. Parents’ responses to
Most research examining health and developmental questions on the developmental/sensory history forms were
outcomes based on birth weight and gestational age follow coded (i.e. Parents’ responses were converted to numerical
outcomes for infants at-risk with very specific birth weight values to be entered into statistical software) and analyzed
categories and gestational age classifications (i.e. ELBW, to quantify parents’ responses. Oversight for this study was
VLBW, LBW or SGA infants) into infancy [3-5,8-11]. Few provided by the Spiral Foundation and Boston University
have looked at outcomes with a group of infants that fall Institutional Review Boards.
into varied birth weight categories and gestational age
classifications. The purpose of this study was to examine Analyses
possible associations between birth weight and birth his- All statistical analyses were conducted using SPSS 16.0
tory (i.e. related birth complications) as well as develop- statistical software. Birth weight was the main dependent
mental milestone achievement in a sample of children variable. The independent variables were: 1) birth weight
with or suspected of having sensory processing disorder.
Table 1 Questions from developmental/sensory histories
Method
I. Child’s birth history: Parents II. Developmental milestones:
Data for this study were collected as part of a larger study were asked to check a box labeled Parents were asked to provide
with a total of 1,000 responses, which examined the inci- yes, no, or don’t know to answer ages for the following:
dence of pre-, peri- and post-natal factors in children iden- “Was or did the child”:
tified with sensory processing problems. In the current 1) Full term? Here they also wrote 1) rolling over
retrospective study, participants were a convenience sam- down the child’s birth weight.
ple of 663 children between 4–12 years of age who 2) Premature? Here they also wrote 2) walking
down the number of weeks.
received a comprehensive sensory integration-based occu-
pational therapy evaluation at a private pediatric out- 3) Small for gestational age (SGA)? 3) saying words
patient occupational therapy clinic (OTA-Watertown). 4) Breech (feet first)? 4) sitting alone
This study is unique in that it examines the issue of birth 5) Require forceps for delivery? 5) chewing solid food
weight and related milestone development in a population 6) Require suction for delivery? 6) saying sentences
of children with sensory processing problems.
7) Have any birth injuries? Here 7) crawling
In the current study, we only included participants parents were asked to provide
with recorded birth weights. Participants were primarily a description.
Caucasian and from a middle to upper-middle socio- 8) If known, Apgar score at 1
economic status. The sample included 74% boys and 26% minute and at 5 minutes.
girls. This study had a disproportionate number of boys 9) Require intensive care
because boys are significantly more likely to have sensory hospitalization? Here they also
answered if yes, for how long?
processing problems and thus seek clinical services. Note that intensive care
Data for this study were responses to questions hospitalization was the neonatal
on the OTA-Watertown Developmental/Sensory History intensive care unit (NICU).
completed by parents at the time of the participants’ evalu- NOTE: The variable that coded whether children required suction for delivery
was excluded from the analyses to avoid ambiguity about whether parents
ation. The developmental/sensory histories were mailed to were responding with regard to suction as a clearing of the mouth and airway
parents generally two weeks prior to the evaluation. Parents or as vacuum assisted delivery.
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category, 2) gestational age classification considered with Table 3 Birth weight means and standard deviations by
birth weight, and 3) birth history. The results were gestational age classification considered with birth weight
presented as means and standard deviations. Independent Gestational age classification Means in grams
t-tests were conducted to analyze the influence of the in- considered with birth weight (standard deviations)
dependent variables on the dependent variable. Separate SGA 2300.94 (532.90)
Pearson’s correlations for birth weight categories and ges- AGA 3500.68 (365.39)
tational age classifications considered with birth weight LGA 4403.77 (308.53)
were conducted to examine relationships between the age
at which developmental milestones were achieved and excluded from the analyses to allow for exact ages to be
birth weight. To test whether parents’ responses differed used rather than qualitative estimations of milestone
according to their children’s age when developmental his- achievement. Similar to related birth complications, ELBW
tories were completed, a Pearson’s correlation was run to and VLBW infants were excluded because of the small n
examine the relationship between children’s age at evalu- for those groups. Related birth complications that were
ation and each variable. All tests were subjected to reported by birth weight category were: for LBW children
Bonferroni corrections to reduce experiment-wise errors. a swollen head, for NBW children head bruises, face or
head abrasions, broken clavicles, shoulder dystocia, a swol-
Results len head, umbilical cord around the neck, minocin, low
Descriptive information muscle tone, dislocated hip, effusion of the forehead or
Our sample of 663 included ELBW (n = 3), VLBW (n = 8), nose, cranial bleeding, eye irritation, a benign mass on the
LBW (n = 39), NBW (n = 513), and HBW (n = 100) chil- neck, or a hernia, and for HBW children head bruises, face
dren. Of the 663 in our sample, 91 were SGA, 509 were or head abrasions, broken clavicles, shoulder dystocia, low
AGA, and 63 were LGA. Tables 2 and 3 show infants’ muscle tone, or cyanosis. According to gestational age clas-
average birth weights based on birth weight category and sification considered with birth weight, reported related
gestational age classification considered with birth weight. birth complications included for SGA head bruising, a
Although the total sample included 663, a variable swollen head, and the umbilical cord around the neck, for
number of responses were gathered due to missing data. AGA head bruises, face or head abrasions, broken clavicles,
Missing data occurred because parents sometimes left shoulder dystocia, a swollen head, umbilical cord around
items blank on the mailed developmental histories. If the neck, minocin, low muscle tone, dislocated hip, effu-
items were left blank for a particular dependent variable, sion of the forehead or nose, cranial bleeding, eye irritation,
those infants were omitted from the analyses for that a benign mass on the neck, or a hernia, and for LGA head
variable. For birth history, ELBW and VLBW groups bruises, face or head abrasions, broken clavicles, shoulder
were excluded from the analyses due to small n’s (n = 3 dystocia, low muscle tone, or cyanosis.
and n = 8 respectively). However, all LBW, NBW, and
HBW infants contributed data for birth history. For de- Birth history
velopmental milestones, responses varied based on how We examined whether birth weight is associated with
many parents provided a specific age at which the mile- related birth complications. Tables 4 and 5 show birth
stone was achieved. For example, instead of listing the weight means for children with and without related birth
exact age at which the milestone was achieved or leaving complications based on birth weight category and gesta-
the item blank, some parents wrote whether their infant tional age classification considered with birth weight. With
achieved the milestone at an early, normal, or late age. birth weight category as the independent variable, results
For rolling, walking, saying words, independent sitting, were only significant for NBW infants; NBW infants with
eating solids, speaking sentences, and crawling this birth complications had lower birth weights than infants
accounted for 11%, 4%, 11%, 10%, 11%, 12%, and 10% without complications; t(511) = 3.92, p = .0001. Of the
of the responses respectively. These responses were infants with normal birth weights and birth complications
16% were premature, 5% were breech, 25% required for-
Table 2 Birth weight means and standard deviations by ceps, 6% sustained birth injuries, 24% had jaundice, and
birth weight category 8% spent time in intensive care. Analyses with gestational
Birth weight categories Means in grams (standard deviations) age classification considered with birth weight as the inde-
ELBW 831.57 (182.26)
pendent variable showed that infants who were SGA had
lower birth weights if they had related birth complications
VLBW 1268.55 (169.37)
compared to SGA infants with no birth complications;
LBW 2208.68 (252.60)
t(89) = 2.47, p = .016. Of the SGA infants with birth
NBW 3391.02 (380.50)
complications 73% were premature, 8% were breech, 25%
HBW 4302.95 (283.58) required forceps, 8% sustained birth injuries, 46% had
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Table 4 Birth weight means and standard deviations by birth weight category and related birth complications
Birth weight categories Birth complications factors Prevalence of birth complications Means in grams
(Y or N) (standard deviations)
ELBW Yes 100% 831.57 (182.26)
No N/A N/A
VLBW Yes 100% 1268.55 (169.37)
No N/A N/A
LBW Yes 95% 2205.48 (259.96)
No N/A 2267.92 (200.46)
NBW Yes 52% 3329.19 (408.73)
No N/A 3459.19 (334.53)
HBW Yes 44% 4305.50 (278.86)
No N/A 4300.95 (289.73)

jaundice, and 42% spent time in intensive care. We also p = .001). Heavier birth weights for NBW was linked with
found that AGA infants with birth complications had eating solids sooner (r(222) = −0.56, p = 0.018). Higher birth
lower birth weights than AGA infants with none; weights were associated with earlier walking onsets for
t(507) = 2.35, p = .019. For AGA infants who had birth LBW (r(28) = −0.58, p = .001) and NBW (r(455) = −0.11,
complications, 11% were premature, 5% were breech, 24% p = 0.021) children. No significant relationships were found
required forceps, 5% sustained birth injuries, 23% had between birth weight category and rolling, crawling, saying
jaundice, and 7% spent time in intensive care. Pearson’s words, or speaking sentences (all p’s > .05). Birth weight
correlations between birth weight and children’s age at was not correlated with age at evaluation for any develop-
evaluation were not significant for children with and with- mental milestones (all p’s > .05).
out related birth complications (all p’s > .05). We also ran Pearson’s correlations for each gestational
age classification considered with birth weight on birth
Developmental milestones weight and developmental milestone achievement. We
We examined the relationship between the age at which found significant relationships between birth weight and
children achieved developmental milestones (i.e. rolling, sit- rolling, independent sitting, walking, and saying words.
ting independently, crawling, walking, eating solids, speaking Higher birth weights for LGA children was associated
words, and speaking sentences) and their birth weight as with rolling at a younger age (r(31) = −0.36, p = 0.048)
infants. Tables 6 and 7 shows means for age at onset for whereas higher birth weights for AGA children was
milestones based on birth weight category and gestational correlated with walking (r(451) = −0.12, p = 0.01) and
age classification considered with birth weight and the num- saying words (r(340) = −0.13, p = 0.019) at younger ages.
ber of infants that contributed to the findings for each. Higher birth weights were also associated with sitting in-
Pearson’s correlations for each birth weight category dependently at a younger age for SGA (r(51) = −0.36,
showed relationships between birth weight and ages at p = 0.009) and AGA (r(325) = −0.13, p = 0.023) children.
which children achieved independent sitting, walking, and No relationships were found between gestational age
eating solids. Larger birth weights for HBW children was classification considered with birth weight and crawling,
correlated with earlier independent sitting (r(61) = −0.42, eating solids, or saying sentences (all p’s > .05). The only

Table 5 Birth weight means and standard deviations by gestational age classification considered with birth weight
and related birth complications
Gestational age classification considered Birth complications factors Prevalence of birth complications Means in grams
with birth weight (Y or N) (standard deviations)
SGA Yes 88% 2251.26 (542.87)
No N/A 2667.23 (253.71)
AGA Yes 50% 3462.68 (379.44)
No N/A 3538.54 (347.45)
LGA Yes 43% 4430.32 (289.54)
No N/A 4383.86 (324.64)
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Table 6 Birth weight means and standard deviations for each developmental milestone onset age by birth weight category
Birth weight Developmental Mean onset age in months # Premature; # late pre-term Birth weight means in grams
category milestone (standard deviations); n (34 to 36 weeks) (standard deviations)
ELBW Rolling 5.50 (3.53); 0 2; 0 765.42 (200.46)
Sitting 8.00 (1.41); 0 2; 0
Crawling 10.50 (0.71); 0 3; 0
Walking 13.00 (1.73); 0 3; 0
Solids 10.50 (2.12); 0 2; 0
Words 24.00 (8.49); 0 2; 0
Sentences 54.00 (0); 0 1; 0
VLBW Rolling 3.80 (0.84); 0 5; 1 1264.37 (157.33)
Sitting 8.00 (2.16); 0 4; 0
Crawling 9.58 (2.29); 0 6; 1
Walking 14.75 (2.25); 0 7; 1
Solids 9.67 (1.15); 0 3; 0
Words 15.79 (8.64); 0 6; 1
Sentences 24.60 (12.80); 0 4; 0
LBW Rolling 5.55 (2.34);19 16; 8 2309.70 (193.98)
Sitting 7.62 (1.62); 23 19; 10
Crawling 9.79 (2.64); 23 19; 9
Walking 15.17 (3.48); 28 24; 13
Solids 11.24 (4.25); 17 14; 8
Words 14.04 (7.08); 24 20; 9
Sentences 25.28 (12.08); 21 16; 6
NBW Rolling 4.86 (2.20); 269 36; 13 3414.71 (369.67)
Sitting 6.65 (1.60); 326 47; 14
Crawling 8.68 (2.56); 329 46; 15
Walking 13.39 (3.63); 455 71; 20
Solids 9.07 (3.73); 222 26; 6
Words 14.05 (6.89); 346 53; 15
Sentences 22.11 (9.80); 299 45; 10
HBW Rolling 4.32 (1.73); 48 0; 0 4315.54 (280.37)
Sitting 6.61 (1.89); 61 0; 0
Crawling 8.40 (1.86); 62 0; 0
Walking 13.05 (2.75); 85 0; 0
Solids 8.87 (3.84); 39 0; 0
Words 12.61 (5.23); 64 0; 0
Sentences 18.01 (7.74); 49 0; 0
NOTE: n’s for ELBW and VLBW are 0 because they did not contribute to the analyses.

significant correlation for age at evaluation was with convenience sample from a clinic population identified
rolling for LGA infants (r(30) = 0.45, p = 0.013); older as or suspected of having sensory processing disorder.
ages at evaluation were associated with rolling later. Our results showed that infants with related birth
complications who had lower birth weights than infants
Discussion without birth complications were NBW, AGA, or SGA.
The purpose of this study was to examine the possible Ages of achievement for developmental milestones and
relationship between birth weight, birth history, and de- birth weight were linked with birth weight and gesta-
velopmental milestone achievement in a retrospective, tional age considered with birth weight category. Earlier
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Table 7 Birth weight means and standard deviations for each developmental milestone onset age by gestational age
classification considered with birth weight
Gestational age classification Developmental Mean onset age in months # Premature; # late pre- Means in grams
considered with birth weight milestone (standard deviations); n term (34 to 36 weeks) (standard deviations)
SGA Rolling 5.08 (2.58); 42 35; 0 2258.47 (582.89)
Sitting 7.28 (1.90); 51 38; 13
Crawling 9.34 (2.35); 47 44; 14
Walking 14.30 (4.12); 72 55; 21
Solids 10.26 (3.46); 33 25; 9
Words 14.73 (7.04); 60 45; 14
Sentences 25.68 (11.85); 50 35; 8
AGA Rolling 4.79 (2.12); 270 25; 12 3502.65 (357.95)
Sitting 6.58 (1.53); 325 35; 11
Crawling 8.61 (2.53); 295 31; 11
Walking 13.34 (3.48); 451 51; 13
Solids 9.07 (3.88); 222 21; 5
Words 13.99 (6.97); 340 37; 11
Sentences 21.79 (9.81); 291 32; 8
LGA Rolling 4.58 (1.73); 31 0; 10 4415.12 (304.64)
Sitting 7.14 (2.18); 40 0; 0
Crawling 8.76 (2.02); 39 0; 0
Walking 13.17 (2.62); 56 0; 0
Solids 8.75 (3.01); 28 0; 0
Words 12.50 (4.26); 43 0; 0
Sentences 17.84 (7.75); 34 0; 0

ages for independent sitting in HBW infants, eating milestone achievement varied according to birth weight
solids in NBW infants, and walking onsets in LBW and category and gestational age classification considered with
NBW infants were associated with larger birth weights. birth weight. For gestational age classification considered
Rolling at a younger age in LGA infants, earlier walking with birth weight, we found that heavier SGA and AGA
and speaking words in AGA infants, and sooner inde- infants sat earlier and that heavier AGA infants walked and
pendent sitting in SGA and AGA infants were also said words earlier. Previous studies have shown that SGA
linked with higher birth weights. infants tend to have less body fat than LGA infants and
Our results showed that birth history was associated some AGA infants [17], and that LGA infants have lower
with lower birth weights for AGA, NBW, and SGA lean body mass than AGA infants [18]. Less body fat in
infants. We hypothesized that birth history would be SGA infants and more lean body mass in AGA infants
linked with lower birth weight for SGA infants because may have allowed them to achieve some motor milestones
of medical complications (e.g. respiratory distress) re- sooner than the LGA infants in our sample. One of the
quiring professionals to deliver infants expediently. most difficult tasks for infants is to hold their bodies up
Lower birth weight may have been related to birth his- against gravity due to uneven body proportions [19,20].
tory for AGA and NBW infants in our sample because Until 24 months old, infants and toddlers are top heavy,
these infants also had complications necessitating a swift which makes their center of mass high [19,21,22]. During
delivery that required assistance (e.g. forceps). Also, our forward progression, a high center of mass requires
sample consisted of children who were being evaluated toddlers to work hard at mitigating the forward movement
for sensory processing disorder, so there may have been their center of mass [23,24]. When older children and
a higher incidence of birth complications in this sample adults walk, they use active plantarflexion of the stance
even for AGA and NBW infants [16]. limb to propel themselves upward. Therefore, they keep
We found that larger birth weights were associated with the acceleration of their center of mass positive when each
earlier onset ages for some developmental milestones. foot contacts the ground [23,25,26]. But, toddlers lack ad-
However, the relationship between birth weight and equate muscle strength and coordination to control the
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forward movement of their center of mass when they walk. gories relate to birth history and developmental milestone
Instead, at foot contact, the acceleration of new walkers’ achievement.
center of mass is negative, which means that they fall
downward into their steps [23,25,26]. Therefore, LGA Conclusions
infants may be at a disadvantage for sitting and walking be- Our findings suggest that birth weight and gestational age
cause of high fat and low muscle mass, but at an advantage considered with birth weight categories provide unique
for rolling because it does not require holding themselves insights into infants’ birth history and developmental mile-
up against gravity. Although we do not have body compos- stone achievement. Future studies may help to examine
ition data for these infants, it could be that the HBW and how information about birth weight category and gesta-
NBW infants in our sample have body composition tional age considered with birth weight can assist health
characteristics (e.g. high muscle mass) that allowed them professionals to predict and to treat impairments down
to achieve earlier sitting and walking. Also, children with the road for children.
sensory processing disorder commonly have low muscle
Competing interests
tone, poor postural control and stability, and decreased The authors declare that they have no competing interests.
vestibular functioning [27]. Thus, early motor skills devel-
opment may be impacted by these factors as well. Authors’ contributions
SG participated in data analyses, project conceptualization, and manuscript
Increased weight may be an advantage for them, but too writing. TMB and AT participated in project conceptualization and
much may result in poor milestone development because manuscript writing/editing. ES entered, processed, coded, and analyzed
of the above factors. It is important to further examine the participants’ responses. All authors read and approved the final manuscript.
relation of sensory processing disorder to these areas. Acknowledgments
Mastering postural control sooner with independent This research was supported by Boston University start-up funds. The original
sitting and walking may predispose children to achieving study was funded by the Maxwell Hurston Charitable Foundation and the
Spiral Foundation.
other developmental milestones sooner; we may have
found a relationship between birth weight and eating for Author details
1
NBW infants as well as saying words to AGA infants be- Department of Occupational Therapy, Boston University, College of Health
and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue,
cause their ability to be upright (i.e. earlier walking for Boston, MA 02215, USA. 2The Spiral Foundation, Newton, MA, USA. 3OTA The
NBW and earlier sitting and walking for AGA infants) Koomar Center, Newton, MA, USA.
allows for eating solids earlier and for engaging in
Received: 25 February 2012 Accepted: 9 January 2013
interactions with others sooner. Meeting motor milestones Published: 25 February 2013
earlier has been shown to foster meeting other develop-
mental milestones earlier. For instance, the beginning of References
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doi:10.1186/1471-2431-13-29
Cite this article as: Gill et al.: Birth and developmental correlates of birth
weight in a sample of children with potential sensory processing
disorder. BMC Pediatrics 2013 13:29.

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