Age- and sex-specific percentile curves for gross and fine motor skills in early childhood: an analysis from the SUNRISE International Study

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Motor skills during early childhood are shaped by biological maturation, environmental opportunities, and cultural contexts. However, most reference data on motor skills derive from high-income countries, limiting global comparability. The SUNRISE International Study was developed to address this gap by generating cross-cultural evidence on early child development. This study aimed to develop age- and sex-specific percentile curves for gross and fine motor skills, based on a cross-cultural and income-diverse sample of 3-4-year-old children included in the SUNRISE Study. In 6 countries, 3027 children completed the supine-timed up and go and the 9-hole pegboard test, as measures of gross and fine motor skills, respectively. The Generalized Additive Models for Location, Scale and Shape model, with the Box-Cox Power Exponential adjusted method was used to construct percentile curves within each 3-month age category, according to sex. Percentile curves were generated to offer a foundational reference for interpreting gross and fine motor skills development within the scope of the SUNRISE. The proposed curves may support tracking children's motor skills and inform context-specific strategies aimed at identifying and addressing potential motor skills delays, while maintaining comparability across countries using the harmonized protocols. Regular updates based on broader and representative datasets are encouraged to maintain their relevance and applicability across populations and countries. What is Known: • Motor competence (MC) assessment is essential for identifying developmental delays and guiding interventions in early childhood. • Existing reference values for gross and fine MC often have limited applicability across diverse populations due to cultural and contextual differences. What is New: • The percentile curves developed provide a robust framework for comparing gross and fine MC across different samples within the scope of the Sunrise International Study. • These curves, capturing a broader range of variability, offer guidance for comparing children´s motor development, supporting teachers, health professionals, and policy makers at promoting motor skill development.

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