Purpose: Survival of children with intestinal failure (IF) has improved; however, these children have multiple co-morbidities that can impact physical function. Motor delays may result in low levels of physical activity (PA), further influencing health outcomes. This study evaluates motor proficiency and generalized self-efficacy towards PA in children age 6-12 years with IF.

Methods: Observational, cross-sectional study of children followed in a multi-disciplinary intestinal rehabilitation program. Motor proficiency was assessed using the Bruininks-Oseretsky Motor Proficiency-2 Short Form (BOT-2 SF) and Scales of Independent Behaviour (parent report). Children completed the Children’s Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) and a questionnaire describing the type and context of their PA participation. Demographic and medical variables were correlated with assessment results.

Results: Thirty children (18 males), median age 7 years (interquartile range (IQR) 6-9) were assessed. Median gestational age was 35 weeks (IQR 32-39) and birth weight was 2.13 kilograms (IQR 1.68-2.77). Thirteen children (43%) were dependent on parenteral nutrition (PN) at assessment. Primary etiologies included necrotizing enterocolitis (23%) and gastroschisis (20%) with a median remnant small bowel length of 61% (IQR 15-100). Fifteen (50%) had below average standard scores on the BOT-2 SF. Lower motor proficiency was associated with lower PA self-efficacy (CSAPPA scores) (r= .480, p <.05). Nine (30%) did not participate in any organized sports or physical activities. Common barriers to PA participation included the presence of a central line or parental concerns that their child was smaller, weaker or easily fatigued. Motor proficiency (BOT-2 SF) was significantly (p <.05) correlated with the following medical variables: total septic events (r= -.488), height z-score (r= .443), total length of hospital admissions (r= -.362), and gestational age (r= .361). Linear regression, adjusting for birth weight, revealed total septic events and total PN days were significant predictors of lower BOT-2 SF scores.

Conclusion: Multiple medical variables related to IF may impact motor proficiency and self-efficacy towards PA, with potential for decreased PA participation. Developmental follow-up at school age is important to optimize motor skill development, and promote PA participation with family support to overcome IF-related barriers.