Balance, Ball Games and Busy Hands: Movement Skills at Age 12 in Children Born Very Early

A plain-language guide to Örtqvist and colleagues' 2026 Swedish study of children born before 27 weeks of pregnancy who do not have cerebral palsy

Children born more than three months early who do not have cerebral palsy can still find movement skills such as balancing, catching a ball or careful hand tasks harder than their classmates do. A large Swedish study found that about 3 in 10 of these children had significant movement difficulties at age 12, compared with about 3 in 100 children born at full term. According to their parents, fewer than 1 in 10 of the children with difficulties had seen a physiotherapist in the past year.

Why movement skills matter long after the newborn unit

A full-term pregnancy lasts about 40 weeks. Babies born before 28 weeks are called extremely preterm, and many of them now survive and grow up to go to school. When families leave the newborn unit, one of the first things doctors watch for is cerebral palsy, a condition caused by injury to the developing brain that affects muscle control and movement. Most children born extremely early do not develop cerebral palsy, and it is natural for parents to feel that, once their toddler is walking and running, movement is no longer a worry. Yet some children who seem to be doing well find it harder than their friends to ride a bike, play team sports, stay steady on one leg or manage fiddly hand tasks. These problems are less obvious than cerebral palsy, but they can matter a great deal in everyday life. A new Swedish study by Maria Örtqvist and colleagues set out to measure how common such difficulties are by the age of 12, and which children are most likely to have them [1].

What doctors and researchers knew before this study

Over the past few decades, far more extremely preterm babies have survived, but a review of many studies found no clear sign that their development at school age, including their movement skills, has improved over the same period [2]. In Victoria, Australia, researchers compared groups of children born very early in the early 1990s, in 1997 and in 2005. At age 8, the share with cerebral palsy stayed at about 11–12 in every 100, but the share with other movement problems doubled, from 13 to 26 in every 100 [3]. A large review combining 41 studies showed that children born very early or very small score lower on movement tests than other children and that the gap does not simply close as they grow [4]. Doctors call some of these ongoing problems developmental coordination disorder (DCD), a condition in which a child's coordination is well below what is expected for their age; formally diagnosing it takes more than one test score, because doctors also need to check that the difficulties get in the way of everyday life and are not explained by something else, and international experts have written recommendations on how to assess and help these children [5].

Sweden has followed one special group of children closely. The Extremely Preterm Infants in Sweden Study (EXPRESS) includes every baby born alive before 27 weeks of pregnancy anywhere in Sweden between April 2004 and March 2007 [6]. Of the 707 babies born alive, 491 were still alive at 2.5 years, and 73 in every 100 of those children had mild or no disability [7]. When the children were 6.5 years old, researchers found that 37 in every 100 of those without major disabilities had DCD, compared with about 6 in 100 children born at term, and that parents often did not realise how much their child was struggling [8]. A study of children born extremely early in 11 European countries found significant movement difficulties in about 32 in every 100 five-year-olds without cerebral palsy [9], and in the same European group, fewer than half of the children with significant movement difficulties were getting help such as physiotherapy [10]. What nobody knew well was what happens later, as children move towards their teenage years, when sports, schoolwork and independence ask more of their bodies [1].

How the Swedish study worked

Maria Örtqvist and colleagues invited the EXPRESS children back when they were about 12 years old [1]. Children with cerebral palsy, or with severe problems with learning, hearing or sight, were not included, because the researchers wanted to study movement difficulties in children who do not have cerebral palsy or other severe disabilities. They also invited a comparison group of children born at full term, chosen to live in the same areas, be the same sex, share the same birthday and have mothers from the same country of origin.

In total, 268 children born extremely early, between 22 and 26 completed weeks of pregnancy, and 196 children born at term completed a standard movement test. The test, called the Movement Assessment Battery for Children (second edition), was run by experienced children's physiotherapists at six university hospital clinics across Sweden. It has eight short tasks in three areas: hand skills, ball skills (aiming and catching) and balance. Each child's score was compared with what is usual for their age, and children scoring in the lowest 5 in every 100 were counted as having significant movement difficulties. Parents also answered a few questions about their child's movement and whether their child had seen a physiotherapist, a health professional who helps people improve movement, in the past year [1].

What the researchers found

About 3 in every 10 children born extremely early (79 of 265 with a full score) had significant movement difficulties, compared with about 3 in every 100 children born at term (5 of 195) [1]. Hand skills, ball skills and balance were all affected, but compared with children born at term, the extra risk was greatest for balance: 19 in 100 children born early had real difficulty with balance, compared with just 1 in 100 term-born children.

Two things made movement difficulties more likely. The earlier a baby was born, the higher the chance: about half of the children born at 23 or 24 weeks had significant difficulties, compared with about 1 in 7 of those born at 26 weeks. Boys were also affected more often than girls (36 in 100 boys compared with 23 in 100 girls) [1]. This fits a long-standing pattern in which boys born very early tend to face more developmental challenges than girls [11]. Interestingly, the family's circumstances, such as the mother's age, education or country of birth, did not make a difference in this study at age 12.

Movement difficulties often came together with other conditions. Among children born early who had movement difficulties, about 1 in 4 had a diagnosis of autism and more than 1 in 3 had attention deficit hyperactivity disorder (ADHD), a condition affecting attention and impulse control. Among those without movement difficulties, the figures were about 1 in 20 and about 1 in 8 [1]. Doctors have known for some time that children born very early are more likely to have attention and social difficulties [12].

One finding stood out. Only about a third of parents of children with movement difficulties said their child had problems with movement, and only 7 of 74 of these children (fewer than 1 in 10) had seen a physiotherapist in the past year, about the same proportion as children without difficulties [1]. That does not mean parents are not paying attention. The researchers suggest these difficulties may simply be hard to recognise in everyday life when a child has no obvious neurological problem, which is why regular checks by professionals matter.

What this means for families

If your child was born extremely early and does not have cerebral palsy, this study should not cause alarm. Seven in every ten children in the study did not have significant movement difficulties. But it does suggest that it is worth keeping an eye on movement skills right through primary school and into the early teenage years, not only in the first few years. Signs that might be worth mentioning to your child's doctor include frequent falls, trouble with balance, avoiding sports or playground games, or difficulty with hand tasks that classmates manage easily.

The good news is that help exists. A large review found that movement-based therapy programmes can improve coordination in children with DCD, although the studies varied in quality [13]. Getting support matters, because movement difficulties in children born early have been linked with how well they do at school, their emotional wellbeing and how active they are [14], and with their quality of life [15]. A Norwegian study found that, in 23-year-olds born preterm with a very low birth weight, poorer movement skills went together with more mental health problems [16].

How confident can we be?

This was a careful national study with expert testers, but it has limits. More than a quarter of the children who could have taken part did not do the test, and those children may have been more likely to have difficulties, so the true number could be a little higher [1]. The test scores were compared with British standards because Swedish ones do not exist, which makes direct comparison with the earlier 6.5-year results difficult. The physiotherapy question was short and not formally tested, so it may not capture all the help children received. And because the study observed children rather than testing a treatment, it shows links, not causes.

What researchers are working on next

The Swedish team plans to follow how each child's movement skills change over time, to understand who improves and who does not [1]. They also want to find out whether short questionnaires could flag children who need a full assessment when testing is not available. Earlier research in another group of children born extremely early suggests that some early warning signs may be visible even in the first months of life [17]. In[Neo]Sight has also covered why boys born early face extra risks.

The bottom line

Children born extremely early who do not have cerebral palsy are still much more likely than their full-term classmates to have movement difficulties at age 12, with the biggest extra risk for balance, and especially if they were born at the earliest weeks or are boys. These difficulties are easy to miss and often go untreated. Regular check-ups of movement skills into the middle school years, and asking about them when something seems harder than it should be, can help children get support that works.

References

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  2. Cheong JL, Spittle AJ, Burnett AC, Anderson PJ, Doyle LW. Have outcomes following extremely preterm birth improved over time? Semin Fetal Neonatal Med. 2020;25(3):101114. doi:10.1016/j.siny.2020.101114 ↩
  3. Spittle AJ, Cameron K, Doyle LW, Cheong JL. Motor Impairment Trends in Extremely Preterm Children: 1991-2005. Pediatrics. 2018;141(4):e20173410. doi:10.1542/peds.2017-3410 ↩
  4. de Kieviet JF, Piek JP, Aarnoudse-Moens CS, Oosterlaan J. Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis. JAMA. 2009;302(20):2235-2242. doi:10.1001/jama.2009.1708 ↩
  5. Blank R, Barnett AL, Cairney J, et al. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Dev Med Child Neurol. 2019;61(3):242-285. doi:10.1111/dmcn.14132 ↩
  6. Fellman V, Hellström-Westas L, Norman M, et al. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009;301(21):2225-2233. doi:10.1001/jama.2009.771 ↩
  7. Serenius F, Källén K, Blennow M, et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA. 2013;309(17):1810-1820. doi:10.1001/jama.2013.3786 ↩
  8. Bolk J, Farooqi A, Hafström M, Åden U, Serenius F. Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm. JAMA Pediatr. 2018;172(8):765-774. doi:10.1001/jamapediatrics.2018.1394 ↩
  9. Aubert AM, Costa R, Ådén U, et al. Movement Difficulties at Age Five Among Extremely Preterm Infants. Pediatrics. 2022;149(6):e2021054920. doi:10.1542/peds.2021-054920 ↩
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