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Fauziah Fauziah; Muhammad Daud; Akmalia Akmalia

Jurnal Ventilator: Jurnal riset ilmu kesehatan dan Keperawatan 2024 Stikes Kesdam IV/Diponegoro Semarang, Indonesia

The good growth period for children aged 7-12 years can be determined by providing nutritional needs in terms of quality and quantity of food and drink consumption levels. Children aged 6-7 years are vulnerable to nutritional deficiencies with nutritional status that can interfere with their development and growth. The aim of the research is to determine the relationship between nutritional intake and the incidence of stunting among toddlers in Miruk Lamredeup Village, Baitussalam District, Aceh Besar Regency. The type and design of this research uses quantitative methods through a cross sectional approach. The population in this study were 64 children aged 1-5 years in Miruk Lamredeup Village, Baitussalam District, Aceh Besar Regency. The sample in this study used Total Sampling, so the sample in the study was 64 children and parents. This research was carried out in Baitussalam District, Aceh Besar Regency. This research was carried out from 01 to 14 May 2024. The results of the research were that there was a relationship between nutritional intake and the incidence of stunting in toddlers in Miruk Lamredeup Village, Baitussalam District, Aceh Besar Regency with a value of p = 0.035. Researchers hope that the parents of respondents can improve the health and quality of life of toddlers by providing appropriate nutritional intake

Liliek Pratiwi; Hutari Puji Astuti; Harnanik Nawangsari; Maharnani Tri Puspitasari

Journal of Health Sciences, Nursing and Nutrition 2024 International Forum of Researchers and Lecturers

Background: In Indonesia, the prevalence of anemia in pregnant women is 37.1%, the highest number in rural areas is 37.8%, the lowest in urban areas is 36.4%, in 2018 it increased to 48.9%. Pregnant women continue to experience the greatest rates of anemia in rural areas (49.5%) and urban areas (48.3%) (Ministry of Health of the Republic of Indonesia, 2019). In 2016, the Ministry of Health of the Republic of Indonesia reported that the three primary causes of direct maternal mortality in Indonesia during pregnancy and childbirth remain unchanged: 30.3% of the cases were connected to hemorrhage, 27.1% to hypertension during pregnancy, and 7.3% to infections.Objective: This study aims to identify risk factors for the incidence of pre-eclampsia and anemia in Indonesia.Methods: Uses the Study Literature Review method by taking data that has been published on trusted national research sites.Results: Based on research results through a review that had been carried out, researchers found 14 national studies that were included in the inclusion criteria.Conclusion: The most dominant risk factors for preeclampsia are history of preeclampsia, parity, pregnancy spacing and maternal age. Meanwhile, the most dominant risk factors for anemia in pregnant women in this study were: nutritional status, maternal age, parity and pregnancy spacing.    

Merry Maria Mote; Nur Susan Iriyanti Ibrahim; Bau Kanang

International Journal of Public Health 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

Background:Toddlerhood is the most central phase of a child because the growth and development of children can run quickly, precisely the age of 0-2 years is the golden period of children, because brain development reaches 80%. Cases of BB/TB nutrition at the Kalibobo Health Center UPTD, 6 cases of malnutrition, 3 cases of undernutrition, 12 cases at risk of overnutrition. The task of parents, especially mothers, in the practice of caring for toddlers so that the basic needs of nurturing patterns, loving patterns and parenting patterns affect the process of child growth and development. Objective: To determine the relationship between nurturing patterns, loving patterns and parenting patterns to the nutritional status of toddlers in the Kalibobo Health Center UPTD Work Area. Method: Quantitative research type with a cross-sectional approach. The population of 222 toddlers became 69 toddler samples using the slovin formula. The sampling technique is purposive sampling. Data analysis using Statistical Program for Social Science (SPSS) software version 16.0 with the chi-square test. Results: The test of the relationship between the sharpening pattern p-value 0.30 (>0.05), the affection pattern p-value 0.00 (<0.05), and the parenting pattern p-value 0.00 (<0.05). Conclusion: The sharpening pattern and the nutritional status of toddlers have no relationship, the affection pattern and parenting pattern have a relationship with the nutritional status of toddlers in the Working Area of ​​the Kalibobo Health Center UPTD. Suggestion: It is necessary to carry out counseling on the sharpening pattern, affection, parenting, types of activities and the importance of integrated health posts to mothers.

Levina Bless; Nur Al-Faida; Alfred Denius Lambey

International Journal of Public Health 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

Background:Supplemental Feeding (PMT) is an activity of providing food in the form of safe and quality snacks along with other supporting activities by considering aspects of food quality and safety. There are two types of supplementary feeding, namely supplementary recovery feeding and supplementary counseling (PMT). Supplemental feeding (PMT) of local food is one of the strategies for handling nutritional problems in toddlers. The PMT activity needs to be accompanied by nutrition and health education for behavioral change, for example with support for breastfeeding, education and counseling on feeding, cleanliness and sanitation for families. Nutritional status is a state of the body as a result of food consumption and use of nutrients, where nutrients are needed by the body as a source of energy, growth and maintenance of body tissues, and regulators of body processes. Nutritional status is greatly influenced by nutritional intake. Objective: To determine the effect of providing local supplementary feeding (PMT) on the nutritional status of toddlers aged 12-59 months. Method: This type of research uses quantitative research using a pre-experimental design pretest-posttest research design. Results: Based on the results of the study, it was shown that a p-value of 0.41 (> 0.05) was obtained. Conclusion: Provision of Local Supplementary Food (PMT) Has No Relationship with Toddler Nutritional Status at UPTD Siriwini Health Center. Suggestion: It is expected that mothers who have toddlers pay more attention to the growth and development of toddlers.

Aplena H Gane; Nur Al-faida; Bau Kanang

International Journal of Health and Social Behavior 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

Malnutrition in children under 5 years old is a condition when the child's weight is below the moderate range. Objective: to determine the factors that influence the incidence of malnutrition in toddlers aged 6-59 months in the Wiyega Health Center Working Area, Paniai Regency. Method: The type of research is quantitative with analytical observational cross-sectional approach. The population taken using total sampling of 30 samples who experienced malnutrition at the Wiyega Health Center, Paniai Regency. Data analysis using the computer release program (SPSS) version 16.0 and using chi square. Results: There is a relationship between the level of maternal employment and the incidence of malnutrition with a p-value of 0.00 (<0.05), there is a relationship between the level of maternal education and the incidence of malnutrition with a p-value of 0.00 (<0.05), there is a relationship between the level of maternal knowledge and the incidence of malnutrition with a p-value of 0.01 (<0.05) and there is a relationship between exclusive breastfeeding and the incidence of malnutrition. Conclusion: Based on the results of the study, it was concluded that there is a relationship between maternal employment, education, knowledge, exclusive breastfeeding and the incidence of malnutrition. Suggestion: To be input for mothers who have toddlers aged 6-59 months to be able to increase knowledge and be aware of the importance of paying more attention to toddlers regarding the nutritional intake they receive.    

Abdullah Azam Mustajab; Fibrinika Tuta Setiani

International Journal of Public Health 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

The study was to describe the nutritional status of participants in the Integrated Development Post for Non-Communicable Diseases. The method used was descriptive quantitative with 35 respondents. Respondents were measured anthropometrically including weight, height, waist circumference and body mass index (BMI) then descriptive analysis was carried out using SPSS. The results showed that respondents who had BMI in the obesity category were 15 (42.90%), normal 14 (40%) and obese 6 (17.10%) and based on the measurement of waist circumference, respondents who experienced central obesity were 30 (85.70%) and not central obesity were 5 (14.30%). Conclusion: Maintaining nutritional status is very beneficial because someone who is overweight is at risk of experiencing several diseases such as hypertension, diabetes mellitus and heart disease.

Sarina Sarina; Ester Simanullang

Inovasi Kesehatan Global 2024 Lembaga Pengembangan Kinerja Dosen

Hyperemesis gravidarum is excessive nausea and vomiting in pregnant women to the point that it interferes with daily work because it generally becomes worse, due to dehydration. The aim of this research is to analyze the relationship between nutritional status and hyperemesis gravidarum in pregnant women at BPM Sarina Banyuasin in 2023. This research is quantitative. The population in this study were all pregnant women who experienced Hyperemesis Gravidarum, totaling 26 pregnant women. The sampling technique used is total sampling. The instrument used was a questionnaire and bivariate analysis using the Chi Square test. The conclusion was that there was a relationship between nutritional status and the incidence of hyperemesis gravidarum in pregnant women at BPM Sarina Banyuasin. Pregnant women with poor nutritional status will experience hyperemesis gravidarum 7.5 times compared to pregnant women with good nutritional status in the Singkil Community Health Center UPTD Work Area in 2024.

Meliance Bria; Ni Made Susilawati

Jurnal Pengabdian Masyarakat 2024 Lembaga Pengembangan Kinerja Dosen

Stunting is a chronic nutritional problem in children that can occur from the womb to the beginning of a baby's life until they are two years old. Worms are an infectious disease caused by the STH (Soil Transmitted Helminths) worm parasite. The impact of worms on children is that it results in a decline in health and nutrition. One of the activities carried out is socialization about worm disease in stunted children as an effort to increase public awareness from an early age through monitoring children's growth and development at posyandu. The aim of PkM is to increase the knowledge of mothers of toddlers about preventing and treating stunting and worms. The method used is counseling through health education on how to prevent and treat worms early in stunted children. The PkM target is 28 mothers of toddlers. The implementation was carried out in Bone Village. The results of the outreach show that the education and knowledge of mothers of toddlers is still low so that the implementation of socialization activities can increase knowledge and build commitment among mothers with toddlers in the Bone Village area to monitor the nutritional status and growth and development of toddlers against worms at the Posyandu.

Meliance Bria; Ni Made Susilawati

Jurnal Pengabdian Masyarakat 2024 Lembaga Pengembangan Kinerja Dosen

Stunting is a chronic nutritional problem in children that can occur from the womb to the beginning of a baby's life until they are two years old. Worms are an infectious disease caused by the STH (Soil Transmitted Helminths) worm parasite. The impact of worms on children is that it results in a decline in health and nutrition. One of the activities carried out is socialization about worm disease in stunted children as an effort to increase public awareness from an early age through monitoring children's growth and development at posyandu. The aim of PkM is to increase the knowledge of mothers of toddlers about preventing and treating stunting and worms. The method used is counseling through health education on how to prevent and treat worms early in stunted children. The PkM target is 28 mothers of toddlers. The implementation was carried out in Bone Village. The results of the outreach show that the education and knowledge of mothers of toddlers is still low so that the implementation of socialization activities can increase knowledge and build commitment among mothers with toddlers in the Bone Village area to monitor the nutritional status and growth and development of toddlers against worms at the Posyandu.

Febriayanti S, Rika; Masfufah Masfufah; Ni Ketut Kariani

Jurnal ilmu Kesehatan Umum 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

Anemia is a condition experienced by the body when red blood cells have hemoglobin levels less than the normal limit (<12 gr/dl). Adolescent groups, especially young women, are susceptible to anemia because they menstruate every month. One of the factors causing anemia in adolescent girls is poor nutritional status. Wrong eating habits, such as being lazy about eating and liking to eat fast food instead of home-cooked food, cause insufficient nutrition, thus affecting the nutritional status of young women. The aim of this research is to determine the relationship between Body Mass Index (BMI) and hemoglobin levels in adolescent girls.  This type of quantitative research uses a cross sectional method. The population is 406 young women from the Mamboro Community Health Center Area High School. The sample was 89 female students with a sampling technique, namely cluster random sampling. Data analysis uses the Chi Square test. The results of the study showed that the majority of young women with BMI were thin at 56.2% and there was a relationship between BMI and hemoglobin levels of young women with a P-Value of 0.000 <0.1. The conclusion of the study is that there is a relationship between BMI and hemoglobin levels in adolescent girls.

Diana Putri

Jurnal Riset Rumpun Ilmu Kesehatan 2024 Pusat riset dan Inovasi Nasional

Chronic Energy Deficiency (CED) in pregnant women is a major nutritional challenge in Indonesia, including in Bukittinggi. Despite proper health service utilization, the burden of CED is relatively high and has a non-economic component that includes cultural and family social support.  The influence of the husband on the nutritional status of pregnant women is frequently overlooked by prevention and control strategies. This study sought to investigate husbands' thoughts and roles in the prevention of  CED  in pregnant women in  Bukittinggi.  The present study employed a qualitative phenomenological research design including 15 husbands of pregnant women (experienced and non-experienced  CED)  and  5–7  triangulation informants  (pregnant women and health workers).  Semi-structured interviews and non-participatory observations provided the data, while  NVivo  12  was employed for thematic analysis. Source triangulation and member checking validate the data. The results indicate that the majority of husbands do not understand CED scientifically and view their support solely as financial assistance. Although emotional and informational motivations can affect positive nutritional behaviors, they are still regarded as weaknesses. Among the external barriers are costs, long hours of work, and a patriarchal culture that severely restricts husbands' ability to be involved in their wives' nutritional problems. However, some informants have indicated a value shift that prioritizes emotional involvement over intellectual focus.  The  intervention strategies for future implementation should be family-based with a primary focus on couples' nutrition education, emotional  strengthening,  and  the  inclusion  of  males  in  maternal  health  programs  (e.g.,  paternity-readiness sessions  

ANATASYA HERYANI; Feri Catur Yuliani; Rizal Fajri

JURNAL ILMIAH KESEHATAN MASYARAKAT DAN SOSIAL 2024 CV. ALIM'SPUBLISHING

Data from RISKESDAS 2018 Indonesian adolescents aged 15-20 years, found that adolescents consume instant noodles or other instant foods with a prevalence of more than 1 time per day 11.2%, more than 1 to 6 times per week 67.6%, and less than 3 times per month 21.2%. This can cause health problems Objective: This study aims to determine the relationship of fast food consumption patterns with nutritional status in adolescents at SMP N 1 Ngawen. Research method: This research is a type of quantitative correlation. With a cross sectional approach. Sampling using simple random sampling obtained 89 respondents. The instrument used ffq questionnaire and tools using scales and microtoice. Data were analysed using spearman rank. Results: Characteristics of respondents in this study the majority of 14 years (36.0%), female gender 44 (49.4%), male 45 (50.6%), the majority of patterns 45 (50.6%) and consumption of the majority of nutritional status 57 (64.0%). Spearman rank results obtained a value of 0.772 (> 0.05). Conclusion: There is no relationship between fast food consumption patterns and nutritional status in adolescents at SMP N 1 Ngawen.

ANATASYA HERYANI; Feri Catur Yuliani; Rizal Fajri

JURNAL ILMIAH KESEHATAN MASYARAKAT DAN SOSIAL 2024 CV. ALIM'SPUBLISHING

Data from RISKESDAS 2018 Indonesian adolescents aged 15-20 years, found that adolescents consume instant noodles or other instant foods with a prevalence of more than 1 time per day 11.2%, more than 1 to 6 times per week 67.6%, and less than 3 times per month 21.2%. This can cause health problems Objective: This study aims to determine the relationship of fast food consumption patterns with nutritional status in adolescents at SMP N 1 Ngawen. Research method: This research is a type of quantitative correlation. With a cross sectional approach. Sampling using simple random sampling obtained 89 respondents. The instrument used ffq questionnaire and tools using scales and microtoice. Data were analysed using spearman rank. Results: Characteristics of respondents in this study the majority of 14 years (36.0%), female gender 44 (49.4%), male 45 (50.6%), the majority of patterns 45 (50.6%) and consumption of the majority of nutritional status 57 (64.0%). Spearman rank results obtained a value of 0.772 (> 0.05). Conclusion: There is no relationship between fast food consumption patterns and nutritional status in adolescents at SMP N 1 Ngawen.

Fibrinika Tuta Setiani; Heny Lestari; Abdullah Azam Mustajab

International Journal of Health and Medicine 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

toddlerhood is called the golden age where a person experiences rapid growth and development. However, in 2022 based on the results of the Indonesian Nutritional Status Survey (SSGI) showed that toddlers with stunting were 21.6%, toddlers with malnutrition were 7.7%, toddlers with undernutrition were 17.1% and toddlers who were obese were 3.5%. The purpose of this study was to describe the nutritional status of toddlers aged 0-59 years in Kedalon Village. The quantitative descriptive research method with observational analytics on data from nutritional status measurements in toddlers aged 0-59 years. The total sample was 192 toddlers in Kedalon Village, the data was subjected to descriptive analysis. The results of toddlers with normal height were 182 (94.79%), short height 7 (3.65%) and very short height toddlers 3 (1.56%). Toddlers with normal weight 164 (85.42%), underweight toddlers 18 (9.37%), overweight toddlers 7 (3.65%) and very underweight toddlers 3 (1.56%). Toddlers based on weight according to height with normal results 163 (84.90%), undernutrition 10 (5.21%), overnutrition 3 (1.56%) and obesity 2 (1,045) and severe malnutrition 2 (1.04%). Toddlers who are identified as having nutritional problems can be given adequate nutritional interventions so that growth and development problems do not occur in the future.

Iiz Roizul Fahmi; Shinta Arviana; Imelda Puspitasari; Vika Safitri Rahmayuniar; Alicia Safina Rahma

Pandawa : Pusat Publikasi Hasil Pengabdian Masyarakat 2024 Asosiasi Riset Ilmu Pendidikan Indonesia

Maahad Tahfiz Al-Qur’an Darul Falah, Selangor, Malaysia, is an institution focused on Qur’an memorization for female students. Due to their intense activities, including memorization requiring high concentration, balanced nutrition is essential for supporting their academic performance and health. However, their nutritional intake has not been fully optimized. Initial observations indicated that some students have limited knowledge of balanced nutrition, which may affect their health and nutritional status. This community service program aimed to raise awareness about the importance of balanced nutrition through education, nutritional status checks, and counseling. The program included three main activities: (1) Nutrition education through lectures and interactive sessions, covering basic concepts of balanced nutrition, the food pyramid, and guidelines from the Ministry of Health Malaysia; (2) Nutritional status checks through height and weight measurements to calculate Body Mass Index (BMI), identifying students' nutritional categories and related issues; and (3) Nutritional counseling, conducted after the status checks, teaching students how to achieve or maintain an ideal weight and offering advice on healthy eating and lifestyle habits. The program, which involved 40 students, found that 60% of them had a normal nutritional status, while some were underweight (12.5%), overweight (20%), and obese (7.5%). The education and counseling sessions helped improve the students' understanding of the importance of balanced nutrition and provided guidance on how to maintain or achieve a healthy weight, supporting their overall health and academic.

Nadia Selli Putri Utami; Devita Mayaningrum; Ika Widya Ning Tias; Irma Mustika Sari; Supanti Supanti

Jurnal Pelaksanaan Pengabdian Bergerak bersama Masyarakat 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

: Background: Nutrients are obtained from food and fluids which are then assimilated by the body. Nutrition itself is one of the factors that can support the wound healing process, there are things that are no less important that must be considered as well, namely the nutrients from the food we eat during the wound healing process. Objective: The purpose of postoperative diet is to strive for the patient's nutritional status to return to normal immediately to accelerate the healing process and increase the patient's immune system, by providing basic needs (fluids, energy, protein), replacing the loss of protein, glycogen, iron, and other nutrients, correcting electrolyte and fluid imbalances, preventing and stopping bleeding. Methods: The media used in health education activities is leaflets. Through leaflets we hope that the delivery of material can be understood by participants and can be delivered well.Results: The results of observations from this health education activity, that the majority of participants are active in asking questions and answering questions given by the health education team and can explain the essence of the material that has been delivered by the speaker Conclusion: Of the 20 patient families who attended 15 people had understood the fulfillment of nutritional needs for the correct post op wound healing process.

Ahmad Fauzi; Budi Al Amin; Doddy Satrya Perbawa; Galih Setiawan Nurohim

Jurnal Pengabdian dan Keberlanjutan Masyarakat 2024 Lembaga Pengembangan Kinerja Dosen

Integrated Service Posts (Posyandu) are important facilities for monitoring children's nutritional growth and development, but there are still many posyandu that use manual methods for recording data. This results in obstacles such as inaccurate data, delays in decision making, and difficulty in accessing information. To overcome this problem, the E-Posyandu information system was implemented at the Posyandu, Mojosongo Village, Surakarta. E-Posyandu is a digital platform designed to facilitate automatic and structured recording, storage and processing of children's nutritional data. This research aims to examine the effectiveness of implementing the E-Posyandu system in improving monitoring of children's growth and nutritional status in Mojosongo Village. By using this technology, the monitoring process becomes more efficient, data is easier to access, and the potential for recording errors can be minimized. Apart from that, this system also offers reminders and notification features to parents regarding the posyandu schedule and necessary health measures.The results of the implementation show an increase in the accuracy and speed of collecting child nutrition data, as well as increased parent participation in monitoring their child's health. It is hoped that E-Posyandu can become an innovative model to be applied in other posyandu in Indonesia.

Saputra, Wahyu Dwi; Saputra, Adrian Dwi; Triwitono, Priyanto

JITIPARI (Jurnal Ilmiah Teknologi dan Industri Pangan UNISRI) 2024 Universitas Slamet Riyadi Surakarta

Previously, germination was reported in many studies that could improve the nutritional status and bioactive compounds in brown rice. However, the change of those functional properties was randomly different in diverse varieties. This study aimed to evaluate the change in chemical composition and functional properties of germinated brown rice from the Mentikwangi variety, one of the local paddy rice in Indonesia. Brown rice was germinated using the soaked and aeration method for 48 h. After that, the proximate compositions were analyzed including the change of total phenolic compounds and radical scavenging activity. We observed that germination in Mentikwangi brown rice significantly increased the crude protein content, but reduced the lipid and total carbohydrate contents. Moreover, the antioxidant activity was improved in germinated Mentikwangi brown rice sample due to the improvement of total phenolic compounds. These results affirm the previous studies which concluded that germination attenuated the functional properties of brown rice, so that has the potential to be developed as a future functional food.

Orpa Irianti Bonsapia; Nur Al-faida; Gandhi Pratama

International Journal of Public Health 2024 Asosiasi Riset Ilmu Kesehatan Indonesia

A child's life is very important, and parental attention is also important. Babies need to get nutrition from food every day in the right amount and good quality every day. One way to optimize child growth and development is by giving formula milk. Objective: To determine the effect of formula milk consumption on the nutritional status of toddlers in the Working Area of ​​the Yaro Health Center UPTD, Jaya Mukti Village, Nabire Regency. Method: This type of research is quantitative research using observational analysis research design and cross-sectional study design. The population in the study was 65 toddlers and the selected sample consisted of 65 toddlers using total sampling. The research instruments included questionnaires, anthropometric measuring instruments (digital scales and length boards), stationery and documentation tools. The analysis used the Release Statistical Program For Science (SPSS) type 16.0 application. Results: The study showed that the BB/TB index p-value was 0.00 (<0.05), the BB/A index p-value was 0.00 (<0.05) and the TB/A index p-value was 0.00 (<0.05). Conclusion: There is an effect of giving formula milk on the nutritional status of toddlers based on anthropometric measurements using the Body Weight/Height (BW/TB), Body Weight/Age (BW/U) and Height/Age (BH/U) indices. Suggestion: For parents to pay attention to the appropriateness of the dosage, frequency of giving and sanitation of serving formula milk to achieve optimal nutritional status.

Eka Afrika; Arie Anggraini; Adelia Rahma Dhini; Alfina Fitria

Journal of Educational Innovation and Public Health 2024 Pusat Riset dan Inovasi Nasional

Approximately 5-10% of children worldwide experience impaired motor development. Disrupted child development will contribute to morbidity that occurs throughout the child's life cycle, the transmission of poverty between generations, and in the long term can hold back the pace of a country's development. The purpose of this study was to determine the factors associated with motor development in toddlers aged 2-3 years at the Nagaswidak Health Center, Palembang. The research design used observational analytic with a cross-sectional approach. The population was all mothers who had toddlers aged 2-3 years in the Nagaswidak Health Center working area in January - March 2024, totaling 32 people. Sampling used the total population technique . Data analysis used the Spearman rank test. The results of the study obtained a relationship between knowledge and gross motor development (p value 0.080) and fine motor (p value 0.135), a relationship between gender and gross motor development (p value 0.144) and fine motor (p value 0.135), a relationship between nutritional status and gross motor development (p value 0.000) and fine motor (p value 0.003). There is a relationship between nutritional status and motor development, there is no relationship between knowledge and gender and motor development. It is expected that all related parties will increase stimulation for children related to motor development.