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OF PUBLIC
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NURSING
AND
MEDICAL
RESCUE
● No.3/2014
(25-29)
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The identification of postural defects in preschool children
(Identyfikacja wad postawy u dzieci w wieku przedszkolnym)
M Grzegorczyk 1,A,D,E,F, B Mroczek 1,B, W Grzegorczyk 2,C, B Karakiewicz 1,B
Abstract - Introduction: The changes in the physical development of children occurring between 3 and 6 years of age are
characterised by an increased exercise capacity of the whole
body and its various organs. Bad habits and low activity may
be the cause of irregularities in body posture.
Aim of the study: The identification of postural defects in
preschool children.
Material and methods: The examination was carried out in a
group of 50 preschool children from a private nursery (52%,
26) and a state nursery (48%, 24), aged 3-6 years (mean age
4.5 ± 0.9 years).
Results: In the group from the state nursery, there were 12
(50.0%) children with a tendency to valgus foot. In the group
of children from the private nursery, there were
5 (29.2%) cases of this defect. In the group from the state
school, this irregularity occurred significantly more often (Chi2
= 5.27, p = 0.0218). Other studies show certain differences, yet
statistically insignificant.
Conclusions: There is a need for the early monitoring of the
correct posture of children at this stage of development when
their osteo-musculo-articular system changes.
Wnioski: Istnieje potrzeba wczesnego monitorowania prawidłowej postawy ciała dzieci w tej fazie rozwoju, kiedy ich
układ kostno- mięśniowo- stawowy podlega zmianom rozwojowym.
Słowa kluczowe - stopa płasko-koślawa, postawa ciała, wady
postawy.
Author Affiliations:
1. The Department of Public Health at the Pomeranian Medical
University of Szczecin
2. Social Insurance Institution in Szczecin
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Key words - valgus flat foot, body posture, postural defects.
Streszczenie – Wstęp: Zachodzące w rozwoju fizycznym
dziecka zmiany między 3 a 6 rokiem życia charakteryzują się
zwiększona wydolnością całego organizmu oraz poszczególnych jego organów. Złe nawyki, niewielka aktywność mogą
być przyczyna powstawania nieprawidłowości w postawie
ciała.
Cel pracy: Identyfikacja wad postawy u dzieci w wieku przedszkolnym.
Materiał i metody: Badanie przesiewowe postawy ciała przeprowadzono w grupie 50 dzieci przedszkolnych z przedszkola
niepublicznego (52%, 26) i publicznego (48%, 24), w wieku 36 lat, średnia wieku 4,5±0,9 lat.
Wyniki: W grupie dzieci z przedszkola publicznego 50% (12)
było z tendencją do koślawienia stóp, a w grupie dzieci z
przedszkola prywatnego 29.2% (5) dzieci. W grupie dzieci z
przedszkola publicznego ta nieprawidłowość występowała
istotnie częściej(wartość testu Chi2=5,27,p=0,0218). Pozostałe
wyniki badań wykazują pewne różnice, ale statystycznie nieistotne.
Correspondence to:
Maria Grzegorczyk Department of Public Health, Pomeranian
Medical University in Szczecin, Zabużańska 35a Str., Pl-71051 Szczecin,e-mail: [email protected]
Accepted for publication: July18,2014.
I.
INTRODUCTION
he preschool period is the period of a child’s development between 3 to 6-7 years of age and it precedes
the compulsory school age. Most children go to
nurseries at that time and they are subject to the educational system [1]. The influence of this system is related
to instruction, shaping positive emotional and social attitudes but also to the psychophysical and motor develop-
T
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ment. The changes in the physical development of a child
occurring between 3 and 6-7 years of age are characterised by an increased exercise capacity of the whole body
and its various systems [2-5]. Participation in preschool
activities provides the necessary conditions for the need
of children to move related to their development, through
the fulfilment of physical activity programme tasks
whose purpose is to promote a good health, appearance,
manner of movement, and shape a proper body posture
[2]. It is a time when children develop their skills and
abilities, when the physical appearance is moulded, body
proportions change, the process of growth becomes intensified and motor features are shaped [6]. Bad habits
and low activity may be the cause of irregularities in
body posture, scoliosis or dysfunctions and defects of the
lower limbs and feet. The early detection of irregularities in body posture may prevent the child from developing them further and it guarantees effective treatment.
A postural defect recognised too late becomes permanent, which may have serious consequences in adulthood. Childhood is undoubtedly the best period for the
prevention of postural defects and the promotion of a
healthy behaviour. One of the main factors preventing
the development of postural defects in this period is
spontaneous movement and the natural need of preschool
children to move. Therefore, natural forms of activity
must be fostered and the development of motor characteristics must be modulated. Tasks in this scope should
be fulfilled in the nursery with the active participation of
parents. Low, purpose-oriented physical activity and passive forms of spending free time increase the probability
of developing postural defects, which are common in
preschool children. [6]
Body posture is a person’s individual feature. It changes
depending on age, health condition, eating habits and
lifestyle [7]. Changes in the body posture of a preschool
child are slow; in the preschool period from 4 to 7 years
of age, the posture tends towards deepening lumbar lordosis, the angle of the anterior pelvic tilt increases and
the stomach flattens. From 4 years of age, the fad pads
which were in the flat, weak and poorly arched feet of a
three-year-old, begin to disappear. The concavity of the
sole becomes apparent, in a five-year-old the foot becomes visibly longer, and a six-year-old child already has
distinct longitudinal and transverse arches. The assessment of proper foot shape is of crucial importance in
terms of prevention and correction of potential deformations [8].
A proper shaping of spine curves in the sagittal and coronal plane, a proper tension of postural muscles, and the
nervous system in charge of it all, help to maintain a
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healthy posture [9]. The following features characterise a
proper standing position: a straight head position, level
shoulders, shoulder blades pulled back, a symmetrical
position of the pelvis (level iliac spines), a slight protrusion of the stomach, a proper arch of the feet and proper
weight distribution on feet [10]. An improper body posture occurs when the shape of the body resulting from the
structure and habitual position of particular parts of the
body is not beneficial to the body as a whole. A considerable protrusion of the stomach, a rounded back,
a winging of the scapula, shoulders and head pulled forward are indicative of an improper posture [11]. Deviations from the generally accepted features of a healthy
posture are described in the literature of the subject as
postural defects – they may deepen as the child grows
and develops due to insufficient movement and lacking
prevention [12].
The aim of the study was to identify postural defects in
preschool children.
II. MATERIALS AND METHODS
The assessment of body posture was conducted in a
group of 50 children aged 3-6 from randomly selected
nurseries. In the examined group, 52% (26) children
were from a private nursery and 48% (24) from a state
nursery. In the assessed group, there were 56% (28) boys
and 44% (22) girls. The average age of children from the
state nursery was 4.0±0.1 (range of 4.0-4.5 years), and
from the private nursery - 4,5±0,9 years (range of 3,0-6,0
years). Children from the private nursery were older than
children from the state nursery (Z=2.00, p=0.04). It was
found that children from the state nursery stayed longer
in the nursery during the day than children from the private nursery (Z=3.11, p=0.01), they also spent more time
outdoors during the day (Z=3.58, p=0.001), and they
spent much more time outdoors during the week
(Z=2.19,p=0.03). Children from the private nursery
watched TV longer than children from the state nursery
(Z=-5.99, p=0.0001). The data have been presented in
table 1. The study plan covered a careful observation of
the children in a relaxed standing position, without shoes
on, only in underwear. The examination proper consisted
of a visual assessment of posture from the front, back,
side and top in a forward-bending position as well as of
the position of knees, the foot arch bearing and not bearing body weight while standing on both feet, one foot
and while walking. All children were examined for body
weight and height, using medical scales, and also the
BMI (Body Mass Index) was calculated. When assessing
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the position of the body in the coronal plane from the
front and back, attention was paid to the position of the
head, level position of the shoulders and shoulder blades
as well as the course of the spinous processes, the shape
and symmetry of waist triangles, the position of the knees
and feet. The plane started from the occipital protuberance and it went across: the line of iliac spines, the intergluteal cleft and to the floor in the place where feet
touched each other. When assessing body posture in the
sagittal plane, it started from the level of the mastoid
process of the temporal bone, it went across the centre of
the shoulder joint, the greater trochanter of the femur,
somewhat to the front of joint lines: knee joint and hock
joint, and to the centre of the sole. Before the examinations began, each parent had read the examination protocol and consented in writing to the child’s participation.
The examination was conducted by a doctor specialising
in motor rehabilitation. During each examination, a
nursery physical education teacher was present. The criteria according to which children qualified for the examination were: the consent of parents and nursery principals to conducting examinations and the lack of diagnosed developmental anomalies in the assessed children.
A specially prepared questionnaire for parents was also
used in the study. The questions concerned the age of the
child, the Apgar score at birth, medical history, participation in corrective gymnastics, the manner of spending
free time at home as well as the lifestyle preferred in the
family and the time which parents spent at work.
Statistical methods
The statistical analysis was conducted using the statistical package StatSoft. Inc. 2011 STATISTIKA version
10.0 and an Excel spreadsheet. Quantitative variables
were characterised using the arithmetic mean, standard
deviation, the median, the minimum and maximum value
as well 95% CI confidence interval. Qualitative variables, in turn, were presented using number and percentage values. To verify whether the quantitative variable
came from a normally distributed population, the W
Shapiro-Wilk test was used. The significance of differences between the two groups (model of independent
variables) was examined with tests of difference significance: Student’s t-test or the Mann-Whitney U test. Chisquare tests for independence were used for qualitative
variables. In all calculations, the significance level was
adopted as p≤0.05.
dency to foot deformity was confirmed, more often this
irregularity occurred in children from the state nursery,
and the differences were statistically significant
(Chi2=5.27, p=0.02). In 14% (7) children no irregularities in body posture were found. In a group of 32% (6),
a slight winging of the scapula was found, although the
difference was not significant. Children with properly
arched feet stayed outside significantly longer
(Z=2.39,p=0.02).
Table1. Group characteristics
State
N=24
Private
N=26
Together
N=50
p
value
mean±SD
4.0±0.1
4.5±0.9
4.3±0.7
Z=-2.00
range
4.0-4.5
3.0-6.0
3.0-6.0
p=0.04
median
4.0
4.5
4.0
95%CI
(4.0 – 4.1)
(4.1 - 4.8)
(4.1 - 4.4)
female
10 (41.7%)
12 (46.2%)
22 (44.0%)
Chi2=0.10
male
14 (58.3%)
14 (53.8%)
28 (56.0%)
p=0.75
Variables
Age
Sex
Weight
mean±SD
17.1±2.4
18.0±3.8
17.6±3.2
Z=-0.63
range
12.0-22.0
12.0-30.0
12.0-30.0
p=0.53
median
16.8
18.0
17.0
95%CI
(16.0 – 18.1)
(16.5 - 19.6)
(16.6 - 18.5)
mean±SD
1.1±0.1
1.1±0.1
1.1±0.1
t=-0.77
range
1.0-1.2
0.9-1.3
0.9-1.3
p=0.44
median
1.1
1.1
1.1
95%CI
[1.1;1.1]
[1.1;1.1]
[1.1;1.1]
Height
BMI
mean±SD
14.4±1.7
14.8±2.2
14.6±2.0
Z=-0.79
range
11.8-19.6
10.4-19.8
10.4-19.8
p=0.43
median
14.0
14.3
14.1
95%CI
(13.7 - 15.1)
(13.9 - 15.7)
(14.0;15.2)
Standards
obesity
1 (4.2%)
1 (3.8%)
2 (4.0%)
Z=0.85
overweight
0 (0.0%)
5 (19.2%)
5 (10.0%)
p=0.39
normal
11 (45.8%)
8 (30.8%)
19 (38.0%)
underweight
considerable
underweight
Apgar
score
median
7 (29.2%)
8 (30.8%)
15 (30.0%)
5 (20.8%)
4 (15.4%)
9 (18.0%)
10.0
10.0
10.0
Z=0.09
range
Stay i
n the
nursery
mean±SD
6.0-10.0
7.0-10.0
6.0-10.0
p=0.93
7.9±0.8
7.1±1.0
7.5±1.0
Z=3.11
range
5.0-9.0
4.0-8.0
4.0-9.0
p=0.002
median
95%CI
III. RESULTS
In more than one-third of children - 34% (17) a ten-
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8.0
(7.5 -8.2)
7.0
(6.7- 7.5)
8.0
(7.2 - 7.7)
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IV.
DISCUSSION
Changes occurring in the physical, psychological and
emotional development of children have an influence on
the proper body posture [13,14]. It is a time when the
child develops its body, motor skills and abilities [15].
Limited movement in favour of entertainment, e.g. television, video games, may lead to irregularities in the
shaping of body posture in children in the development
period [10,15-17].
The study has shown that children from the state nursery
stayed longer outdoors during the day and during the
week, while children from the private nursery watched
television longer and spent less time on spontaneous play
outdoors. The results point to a low awareness of parents
of children from the private nursery concerning the fulfilment of the need for outdoor movement, which is natural at that age, and the need to limit passive forms of
spending free time. In the study by Rotter et al. [18]
conducted among preschool children, it has been found
that parents are aware of the necessity to examine and
assess body posture and of the importance of prevention,
but they do not understand the role of exercise at home.
Postural defects in children in development age occur in
approximately 50-60% of the population and are mostly
caused by a firmly rooted bad habit or a forced load on
the body. [18-20]. Such a load may be related to overweight and obesity. In the author’s own research, neither
overweight nor obesity was confirmed in the examined
group of children. Puzder et al., in turn, have found a
positive correlation of the Body Mass Index and knee
valgus and valgus flat feet in children aged 9 [20-22].
In the author’s own examinations, only seven children
did not have any defect, and these were mostly children
attending the private nursery, whereas 43 were found to
have various irregularities related to flat and valgus feet
and the tendency to a rounded back. The most frequent
irregularity among the examined group was the tendency
to valgus feet, a slight winging of the scapula and internal rotation in the hip joints. Properly shaped and arched
feet were found in children who spent much more time
outdoors. Leszczewska and Czaprowski have presented
functional correlations in the kinematic chain of the lower limbs, pelvis and spine and they have demonstrated a
correlation between flat feet and deformations of lower
limb axes [23]. Similarly, in studies by Walczak and
Misterska, valgus knee was found in 10% of the examined children, and valgus foot in 36% [24,25]. Moreover,
the authors have demonstrated a correlation between flat
foot and valgus knee, but they have not established
a correlation between excessive body weight and a val-
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gus flat foot. An analysis conducted by DemczukWłodarczyk demonstrated that transverse flat foot is visible in girls from 3 years of age and in boys from 4 years
of age [26].
The improper position of shoulders and scoliosis have
been presented by Widłak as postural defects occurring
in 84,1% of children from a rural background [26].
The causes of postural defects and their consequences in
the motor system cause unfavourable changes and chain
reactions [16] and they may also serve to predict potential deviations appearing during further development. In
the analysed literature of the subject, postural defects
among schoolchildren during the so-called developmental milestones are discussed most frequently; perhaps an
earlier observation could effectively prevent the progress
of irregularities. When a postural defect is detected in a
child, an orthopaedic examination is necessary as well as
a relevant correctional treatment. The active participation
of parents in exercising at home is crucial, as well as the
awareness of the purpose and general rules of conducting
such exercises. Undoubtedly, a regular health-oriented
instruction contributes to limiting the frequency of postural defects, because acquired habitual defects are related to certain activities can be initially corrected easily.
The early detection of changes in body posture enables
their early correction.
V.
CONCLUSIONS
1. In the examined group, most children were found to
have irregularities in body posture. Therefore, it is
reasonable to conduct a control assessment of body
posture in the same group in order to monitor the irregularities.
2. A relatively small group of patients and subjective
measurement methods create the risk of error in the
assessment of changes, and therefore another assessment should be made by the same examining person.
3. It is useful to assess body posture in preschool children in order to diagnose irregularities early and
commence a correctional treatment.
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