Abstract

Objective

Parental knowledge of children鈥檚 developmental milestones is associated with more effective childcare practices and improved overall outcomes. Therefore, this study aimed to assess parents鈥� knowledge levels regarding their children鈥檚 developmental milestones and the information sources they use in the West Bank of Palestine.

Methods

This was a cross-sectional study using a questionnaire that had already been verified. Multivariable logistic regression and descriptive statistics were used to analyze the data. The study included parents aged 18 years or older who reside in the West Bank, Palestine and had at least one child under the age of 14. Participants were selected from ten West Bank cities. The data were collected between January and March 2024.

Results

This study included 619 parents aged 18 years or older residing in the West Bank of Palestine. Most respondents (76.0%) demonstrated a 鈥減oor鈥� level of knowledge in all four domains. There was a statistically significant association between gender and knowledge level (p鈥夆墹鈥�0.05), females demonstrated a higher proportion of acceptable knowledge (26.5%) than males (13.3%). Among the four domains of child development, parents had the highest level of knowledge of physical development (57.22%). This was followed by cognitive development (27.30%), emotional development (24.81%), and social development (18.83%). Only a few parents (9.2%) claimed that they always relied on health care professionals for information.

Conclusion

There is a significant gap in parents鈥� understanding of developmental milestones, raising serious concerns about children鈥檚 health in West Bank, Palestine. Currently, healthcare institutions and pediatricians play limited roles in health education. Implementing effective health education programs and strategies is essential to enhance child development outcomes in the community.

Background

Early infancy, particularly the first three years of life, is a crucial time in a person鈥檚 existence that shapes them into useful community members [1]. Rapid growth and development occur during this time as the body鈥檚 organs mature, mental capacities grow, and fundamental motor skills such as walking, talking, and manipulating objects are learned [2]. The ability of a child to perform specific tasks at specific ages, such as lifting their head, rolling over, crawling, standing, walking, and running, is considered normal physical development [3]. These milestones in neurological development are critical, and parents鈥� awareness of potential delays is essential to ensuring proper child development. Milestones are not set at a certain age and have a normal variance range because children鈥檚 development varies from person to person and place to place. For example, around six months of age, babies recognize faces, react to noises by wriggling, and can roll over in both directions [2].

Since parents are children鈥檚 primary caretakers during their early years, understanding the processes involved in a child鈥檚 development is crucial for distinguishing between normal and abnormal physical development inside the child [4,5,6]. Strong parental understanding of child development and parenting techniques also reduced the likelihood of reported child abuse three to five years later. It also aided in the identification of developmental delays that may have allowed for earlier interventions, which are crucial for promoting a child鈥檚 health and preventing diseases. Furthermore, it improves behavioral issues in children and reduces maternal anxiety and depression [25,26,27]. Finally, it helps parents better understand their child鈥檚 abilities, create a healthy environment, set reasonable expectations, and engage in positive interactions with their child [2].

However, parents with inadequate understanding of normal child development frequently overestimated the rate at which their children were developing. This causes them to become irritated and intolerant of their children鈥檚 misbehavior and engage in neglectful behaviors toward them, such as expressing frustration over how their standards don鈥檛 match their children鈥檚 development [7]. In addition, parents are frequently the primary source of developmental milestone information for pediatricians; when parents are aware of these developmental milestones, their interactions with pediatricians are more fruitful [8]. Abnormal functioning or development in two or more domains of childhood development, such as physical, cognitive, communicative, and emotional, can be used to identify developmental delays. Physical disabilities have a wide range of effects on children鈥檚 lives, including involvement in activities, relationships with family and friends, and disruptions to schooling [1].

According to a 2019 study, raising parents鈥� awareness of child development can help avoid misdiagnosing developmental delays in addition to fostering better parent-child relationships [9]. Understanding typical physical development is thought to be crucial for a doctor鈥檚 job, especially when it comes to spotting developmental disorders in children and determining when early intervention is needed [9]. The purpose of this study was to determine how much parental awareness there was on the developmental milestones of children in the West Bank. The findings of our study should hopefully serve as a foundation for developing public health initiatives that inform West Bank parents about their children鈥檚 developmental milestones.

Methods

Study design, setting, and period

A descriptive cross-sectional study was conducted to assess parents鈥� understanding of children鈥檚 developmental milestones and their sources of information. The study included parents aged 18 years or older who reside in the West Bank, Palestine, and have at least one child under the age of 14. Participants were selected from ten West Bank cities: Hebron, Jerusalem, Ramallah, Jenin, Tulkarm, Bethlehem, Nablus, Salfit, Qalqilya, and Jericho. Data collection was conducted from January to March 2024.

Participants

We enrolled Palestinian parents aged 18 years or older residing in the West Bank, Palestine, who had at least one child under the age of 14. Conversely, we excluded individuals under 18, those living outside of the West Bank, those without children under the age of 14, and participants who did not complete the survey.

A threshold of 14 years was chosen to ensure a comprehensive assessment of parental knowledge across key developmental stages from infancy to early adolescence. This age range is particularly relevant, as parents of children under 14 years of age are typically actively engaged in monitoring and supporting their child鈥檚 growth. By including parents with at least one child under the age of 14, the study ensured that participants had direct and recent experiences with childhood development, making their responses more reflective of current understanding and practices. Additionally, this age range aligns with critical periods of physical, cognitive, emotional, and social development, providing valuable insights into parental awareness and identifying potential knowledge gaps that could inform targeted educational interventions.

According to the United Nations Population Fund, the number of married Palestinians in 2017 was 1,745,676 persons [10]. Based on a 95% confidence level, a 4% margin of error, and a 50% response distribution, a sample size of at least 601 was required. In our study, the total number of parents included in the analysis was 619. The sample size was calculated using the Roasoft online calculator [11].

Research instruments

The English and Arabic versions of the questionnaire utilized in this research were obtained with authorization from Abdulrahman et al. [12]. This questionnaire was originally developed to measure the understanding of children鈥檚 developmental milestones among adults in Riyadh, Saudi Arabia.

Participants were provided with the Arabic version of the online questionnaire, which explicitly detailed the study鈥檚 objectives, withdrawal process, privacy assurances, and data confidentiality in its introductory section. At this stage, participants were asked for their informed consent, with the option to decline participation by selecting the 鈥楴o鈥� option. After obtaining consent, participants proceeded to complete the online questionnaire. Families were recruited using online questionnaires distributed on digital platforms. The survey was conducted through social media channels, community networks, and relevant online groups targeting parents in the West Bank, Palestine. This approach allowed for efficient and widespread dissemination of the survey to eligible participants, specifically parents aged 18 years or older who had at least one child under the age of 14 years. The online method facilitated convenient participation, enabling parents to complete the questionnaire at their own pace and ensuring accessibility across different regions of the West Bank.

The questionnaire consisted of four sections. The first section addressed the study鈥檚 aim and obtained participants鈥� consent. The second section collected demographic information through 16 items, including age, gender, educational level, city of residence, socioeconomic status, family size, and residence history. The third section consisted of 17 items assessing parents鈥� knowledge of children鈥檚 developmental milestones across four domains: physical development (four questions), cognitive development (three questions), social development (five questions), and emotional development (five questions). Additionally, the questionnaire included a fourth section with seven questions regarding parents鈥� reliance on specific resources and the frequency of their usage. The correct responses for developmental milestones were based on the study 鈥淕auging knowledge of developmental milestones among Albertan adults: a cross-sectional survey鈥� [6] chosen for its evidence-based approach in defining developmental milestones. To ensure transparency, a full list of developmental milestones and their corresponding 鈥渃orrect鈥� answers are included in Appendix A.

A pilot study involving 15 participants was conducted to ensure the survey鈥檚 reliability and validity, addressing any misinterpretations or discrepancies. Participants鈥� knowledge levels were categorized as follows: 鈥渆xcellent鈥� if they scored鈥夆墺鈥�75%, 鈥済ood鈥� for scores between 50% and 75%, 鈥渇air鈥� for scores between 40% and 50%, and 鈥減oor鈥� for scores鈥夆墹鈥�39%. Those who scored鈥夆墺鈥�50% for each developmental domain were considered to have an acceptable level of knowledge.

Data analysis

We used R Statistical Software (version 4.1.3; R Core Team, 2022) to carry out all our statistical analyses. First, we summarized the descriptive statistics by looking at frequency distributions and percentages. To understand how respondents鈥� demographic characteristics related to their knowledge levels, we used cross-tabulation and the chi-squared test at the bivariate level.

For a deeper analysis, we employed binary logistic regression at the multivariate level. This allowed us to identify and compare the odds ratios (OR) and adjusted odds ratios (aOR) of the significant variables in relation to knowledge levels.

We considered results with a p-value of 0.05 or less to be statistically significant.

Result

Demographics analysis

In total, 619 parents participated in the study, with mothers constituting 83% (n鈥�=鈥�514) and fathers constituting 17% (n鈥�=鈥�105) of the sample. Nearly all the participants were married (99%; n鈥�=鈥�614). The largest proportion of participants were from Hebron, which accounted for the largest share (177 individuals, 29%), followed by Jerusalem (96 participants, 16%), Bethlehem 88 (14%), and Nablus 76 (12%). Other contributing cities included Jenin (48 participants, 7.8%), Jericho 35 (5.7%), and Ramallah 34 (5.5%). Both Qalqilya and Tulkarm had 31 participants each (5.0%), whereas Salfit had the smallest representation with three participants (0.5%).

The majority (52%) were young adults aged 18 to 30 years (n鈥�=鈥�322), while the remaining 48% were aged 31鈥�55 years (n鈥�=鈥�297). Most parents had their first child between the ages of 15 and 26 (84%; n鈥�=鈥�517). The majority were unemployed (62%; n鈥�=鈥�381), had a middle economic status (45%; n鈥�=鈥�281), and had a stable residency for the past five years (75%; n鈥�=鈥�467). Regarding education, 68% had completed a university degree, 26% had completed high school or lower, and 6.5% had a master鈥檚 or doctorate degree. Further participant characteristics are detailed in [Table听1].

Table 1 Population characteristics

Knowledge level analysis

Most respondents (76.0%) demonstrated a 鈥減oor鈥� level of knowledge. Additionally, 19% exhibited a 鈥渇air鈥� level of knowledge, while only 5.5% achieved a 鈥済ood鈥� level, as detailed in [Table听2].

Table 2 Level of knowledge of population about child developmental milestones

There was a statistically significant association between gender and knowledge level (p鈥夆墹鈥�0.05): Females demonstrated a higher proportion of acceptable knowledge (26.5%) compared to males (13.3%). Moreover, there was a significant association between household size and knowledge level: 27.0% of participants residing in households with six or more members exhibited acceptable knowledge, whereas 23.0% of those in households with five or fewer members showed acceptable knowledge (p鈥夆墹鈥�0.05).

The analysis revealed that females were more than twice as likely to have an acceptable level of knowledge compared to males (aOR鈥�=鈥�2.28; 95% CI 1.18鈥�4.66, p鈥�<鈥�0.001). Additionally, participants living in households with 6 or more individuals were 1.86 times more likely to possess acceptable knowledge (aOR鈥�=鈥�1.86; 95% CI 1.03鈥�3.39, p鈥�<鈥�0.001) than those in households with 5 or fewer members [Table听3].

Table 3 Knowledge model table displays the cross-tabulation [table听4].d results of the chi-squared test [table听4].amining the relationship [table听4].tween demographic variables [table听4].d knowledge [table听4].vels. Also, presents [table听4].justed odds ratios for significant variable. In the four domains of child development, parents [table听4].hibited the highest [table听4].vel of knowledge of physical development, with 57.22% correct responses (n鈥�=鈥�1417). [table听4].is was followed [table听4]. cognitive development (27.30%, n鈥�=鈥�507), [table听4].otional development (24.81%, n鈥�=鈥�768), [table听4].d social development (18.83%, n鈥�=鈥�583) [Table听4]

Table 4 Population knowledge level in the four domains of child development milestones

Analysis of information sources

The most frequently used source of information among parents was a family relative, utilized by 20% of respondents (n鈥�=鈥�126). This was followed by Internet websites at 13% (n鈥�=鈥�83), medical physicians and pediatricians at 9.2% (n鈥�=鈥�57), books and parenting magazines at 6.3% (n鈥�=鈥�39), social media broadcasts at 4.0% (n鈥�=鈥�25), parenting courses at 1.8% (n鈥�=鈥�11), and TV shows at 1.3% (n鈥�=鈥�8). Additional information of 鈥渙ften,鈥� 鈥渞arely,鈥� and 鈥渘ever鈥� used sources can be found in [Table听5].

Table 5 The source of information of population about child development milestones

Discussion and conclusions

The current study assessed the knowledge of Palestinian parents in the West Bank regarding their children鈥檚 developmental milestones, focusing on the extent of their understanding and the sources they use for information. The findings indicated a generally low level of awareness among parents, particularly in the domains of social and emotional development. This discussion expands on these results by examining the implications, comparing them with findings from other studies, and discussing potential strategies for improvement.

Our research reveals that a significant number of parents in West Bank lack awareness of their children鈥檚 developmental milestones. Approximately 76% of the respondents scored poorly on the overall assessment, and correctly answered fewer than 40% of the questions. Interestingly, a comparable level of understanding was observed among adults in Saudi Arabia [12], whereas other Arab groups demonstrated higher levels of knowledge [13, 14]. These discrepancies in the findings may stem from several factors. For instance, Glascoe reported that parents often lack accurate information about typical child development, which can hinder their ability to recognize developmental delays early [15]. Similarly, a study by Ertem et al. found that parental knowledge varies widely and is often insufficient, especially in low-resource settings [16].

One possible reason for the finding that mothers in West Bank may not have sufficient knowledge about children鈥檚 developmental norms and milestones could be their limited interaction with specialists, such as pediatricians and developmental psychologists, as well as a lack of exposure to primary sources of information, such as advanced parenting classes. Interacting with healthcare professionals and child development specialists can provide a wealth of information about normative child development. Consequently, a lack of access to these sources may prevent mothers from acquiring valuable knowledge about typical child development stages [5].

Parents showed the most knowledge in physical development (57.22%) and the least in social development (18.83%). This aligns with the findings of Bornstein and Cote, who noted that parents generally have more knowledge about physical and cognitive milestones than social-emotional ones. The lower understanding of social and emotional milestones could be due to these aspects being less observable or discussed in public discourse compared to physical and cognitive milestones [5].

In this study, we explored how mothers鈥� sociodemographic characteristics influenced their knowledge. The significant gender differences in knowledge levels, with females being more knowledgeable than males (OR鈥�=鈥�2.299), reflect the traditional gender roles in childcare, as noted by Volling et al. [17]. This is particularly relevant in West Bank, where cultural norms may still assign primary childcare responsibilities to women. Efforts to educate fathers about child development are crucial, as involved fathers have been shown to positively impact children鈥檚 outcomes, including cognitive development and emotional regulation [18].

The correlation between parents鈥� age at the time of their first child鈥檚 birth and their knowledge levels is an intriguing finding. Older parents, particularly those with their first child aged between 39 and 50 years, demonstrated greater knowledge (50%). This could be attributed to greater life experiences, better access to information, or a higher likelihood of seeking information due to perceived responsibility. This finding is consistent with research by Guo et al., who found that older parents often have more extensive knowledge about child health and development due to increased resources and life experience [19].

Employment status also significantly influenced knowledge levels. Most participants in our study were unemployed and had a middle economic status. Additionally, participants considered their monthly income to be their families鈥� total income. Unemployed parents were more likely to have an acceptable level of knowledge, possibly because they had more time to dedicate themselves to parenting and seeking information. This finding supports the notion that time constraints faced by working parents can limit their opportunities to engage in educational activities related to parenting [20].

The study highlighted that family relatives were the most frequently used source of information, followed by internet websites and medical professionals. This reliance on familial advice is common in many cultures, especially where trust in healthcare systems or internet resources may be limited. However, the variability in the quality of information from these sources raises concerns. For instance, a study by Dahlem et al. noted that while family members can be valuable sources of practical advice, they may not always provide accurate or evidence-based information [21].

The increasing reliance on internet sources, which accounted for 13% of parents who always used this medium, is both a strength and a potential weakness. While the internet offers vast resources, the accuracy of the information varies significantly. A study by Nicole Meyers et al. (2020) found that parents often turn to the internet for developmental information but may encounter misleading or incorrect information if they do not critically assess the sources [22].

These findings underscore the need for comprehensive and accessible educational programs targeting parental knowledge of child development. These programs should particularly focus on less-understood areas, such as social and emotional development, which are crucial for the child鈥檚 overall well-being. Healthcare providers and educators should actively disseminate accurate and accessible information. For example, integrating child development education into regular pediatric visits could be an effective strategy, as suggested by the American Academy of Pediatrics [23]. Additionally, tailored interventions are needed to engage fathers more actively in child-development education. Programs that include both parents can help distribute childcare responsibilities more equitably and ensure that both parents are informed equally. This approach has been shown to improve child outcomes, as both parents uniquely contribute to their child鈥檚 development [24].

Several limitations of this study should be considered when interpreting its findings. First, reliance on self-reported data through online questionnaires may introduce response bias, where participants may provide socially desirable responses or misunderstand survey questions. Online administration could have introduced a selection bias, potentially excluding certain groups such as older parents who may be less familiar or comfortable with online platforms, families with limited access to the internet or digital devices, and parents with lower literacy levels or language barriers. This limitation may affect the generalizability of the findings, as these underrepresented groups could have different perspectives or experiences regarding children鈥檚 developmental milestones and sources of information.

Additionally, the study sample predominantly consisted of mothers (83%) compared with fathers (17%), which may not fully represent paternal perspectives on children鈥檚 developmental milestones. This imbalance could potentially skew results related to parental knowledge and information sources. Moreover, the study focused exclusively on parents residing in the West Bank, Palestine, which may not be generalizable to other regions or populations with different cultural, socioeconomic, or educational backgrounds. The geographical concentration within certain cities may further limit the generalizability of the findings to rural or less-represented urban areas. The presence of a diagnosed health condition or disability in the family was not considered as an inclusion or exclusion criterion. This may have excluded the perspectives of families with children who have special needs and who might have unique experiences, knowledge, or sources of information regarding developmental milestones. Future studies should explicitly include this population to provide a more holistic understanding of parental knowledge and experiences. Despite these limitations, this study provides valuable insights into parental knowledge and information sources regarding children鈥檚 developmental milestones in West Bank, Palestine.

This study provides important insights into the knowledge of developmental milestones among Palestinian parents in the West Bank, highlighting significant gaps in understanding, particularly in the areas of social and emotional development. The reliance on informal sources of information, such as family and the internet, combined with the observed demographic disparities, suggests a critical need for improved educational resources and outreach efforts. Future research should focus on evaluating the effectiveness of specific educational interventions and understanding the cultural factors that influence parental knowledge and practices.

The healthcare system in the West Bank encounters numerous obstacles that impede its ability to provide health education, including guidance for parents regarding child development. Ongoing conflicts intensify systemic problems such as disjointed infrastructure, insufficient funding, and limited access to services. Many health services fail to maintain consistent standards regarding training, equipment, and overall quality. This subpar care is partially attributed to restricted mobility, which hampers effective health-system operations, management, and accountability, along with the presence of inadequately qualified healthcare providers and a weak institutional capacity for monitoring and evaluation [28, 29]. These systemic barriers correspond with the study鈥檚 finding that only 9.2% of parents sought developmental information from health care professionals.

The findings from this study, along with previous research on parenting knowledge, strongly indicate the need for further investigation of maternal knowledge to better understand its connection to parenting behaviors and child development. Understanding parenting beliefs is particularly important, as research has shown that parents鈥� knowledge of child development affects their expectations and interactions with their children. In developing countries, a mother鈥檚 knowledge of their child鈥檚 development has been positively associated with her ability to promote her child鈥檚 growth and development [6].