Implementation of Baby Gym to Cognitive Development of Stunting Toddlers

Sarah Fitria1*, Nevi Susianty2

1
Department of Midwifery, Faculty of Mathematics, Science and Health, Universitas
Muhammadiyah Riau, Indonesia
1
Department of Midwifery, Faculty of Mathematics, Science and Health, Universitas
Muhammadiyah Riau, Indonesia

*Corresponding Author:
Sarah Fitria, 1Department of Midwifery, Faculty of Mathematics, Science and Health,
Universitas Muhammadiyah Riau, Indonesia, E-mail: sarahfitria@umri.ac.id, Phone:
+6285272786724,

Abstract
Introduction: Stunted toddlers cognitive development is a stunted caused by
malnutrition chronicles that are not handled properly and promptly. One therapy
that can improve the cognitive development of stunted toddlers is baby exercise.
Objective: This research aims to see the effect of baby exercise on the cognitive
development of stunted toddlers. Method: The research design used in this
research is Quasi-experimental with non-randomized pre and posttest approach
with control group design. Technique Sampling was taken using non-probability
sampling, namely purposive sampling. The number of samples in this study was 15
stunted toddlers aged 3-5 years of intervenstion group andn control group. The
statistical test data obtained was the Wilcoxon test with a significance value of α =
0.05. The research results where the value of ρ = 0.000, this shows that the value of
ρ < α which means there is The influence of baby exercise on the cognitive
development of stunted toddlers. Conclusion: Baby gym is a companion therapy in
seeking cognitive development in stunted toddlers that can be carried out by
therapists and parents stunting toddler at home.

Keywords: Gym, Baby, Stunted, cognitive

Introduction the number of children with stunting.

Stunting is a stunted/short body
condition caused by chronic malnutrition
that is not treated properly and
immediately. Stunting is one of the
nutritional problems that occurs in the
world or in Indonesia. Globally, around
162 million children are stunted (short).
The prevalence of stunting in Indonesia
is higher than in other countries in
Southeast Asia, such as Myanmar (35%),
Vietnam (23%), and Thailand (16%).
Indonesia is ranked fifth in the world for
The 2016 National Health Survey noted
that the prevalence of stunting reached
33.6%, this is an important health
problem because the stunting problem is
above the 20% threshold. (Ministry Of
Health , 2016) .
Many factors can cause stunting.
Stunting in children under five is caused
by multifactors such as nutritional
consumption during pregnancy, maternal
knowledge about nutrition, limited
access to services and access to
sanitation. Apart from that, society does
not yet realize that short children are a
problem, because short children in
society are seen as children with normal
activities, not like skinny children who
need to be dealt with immediately. The
impact of stunting is a decrease in
intelligence (cognitive), vulnerability to
disease, inhibiting economic growth and
work productivity and exacerbating
inequality. (Health et al., 2020) Most
psychologists, especially cognitivists
(cognitive psychologists), believe that
the process of human cognitive
development begins when a new child is
born. (Hayati, Cholimah and Christianti,
2013 ) The main provisions and capital
for human development are motor and
sensory capacities which apparently can
also be influenced to a certain extent by
cognitive domain activities. (Azmita &
Mahyuddin, 2021)
The phenomenon that occurs in
society today is that there are still many
children who experience delays in their
development. This is because many
parents do not invite their babies to talk
or do not give their babies foot and hand
movement exercises. This period is very
dependent on parents in terms of
fulfilling basic needs for growth and
development. Stimulation is needed to
stimulate the growth and development of
babies. Baby gym is one of the activities
that can be done to stimulate the growth
and development of babies. (Sgandurra
et al., 2016) The results of another study
conducted by Inal and Yildiz showed
that healthy babies born at term who
received infant exercise had more
significant mental motor development
compared to those who were not given
action. (Febriyanti et al., 2020)
Meanwhile, research conducted by
Merineherta (2011) showed that there
was an effect of baby exercise on
increasing developmental delays in
babies aged 3-6 months, there was a
significant difference in the increase in
babies who did exercise compared to
those who didn't. (Apriluana & Fikawati,
2018) Baby gym is an effective
stimulation based on developmental
kinesiology and primitive reflexes
according to development stage. Baby
gyms have not been widely applied in
society as a means of stimulating
children's growth and development.
(Febriyanti et al., 2020)
Providing stimulation in the form of
a baby gym is one of the efforts to
optimize baby development, movement
stimulation which can stimulate the
formation of nervous tissue systems
between one another (synaptogenesis)
and encourage the intelligence of
complex nerve cells because movement
uses multimodal stimuli, namely
vestibular kinesthetic. So it can
strengthen and stimulate all the motor
and sensory systems. This stimulation
stimulates the mylinization process
(refinement of the brain and nervous
system). (Sgandurra et al., 2016) This
research aims to determine the effect of a
baby gym on the cognitive development
of stunted toddlers.
Method
This type of research is a quasi
experiment with a control group pre test
and post test design. To determine the
sample size in research, the sample size
formula is used. To determine the sample
size, the difference between the means of
two groups:
Information :
Zα : Standard deviation of alpha
Zβ : Standard deviation of beta
S : Combined standard deviation
X 1 – X 2 : The minimum
difference between the means
that is considered significant is 62
 1. Inclusion criteria and exclusion criteria
2 a. Inclusion criteria
2
2
2 length, weight scales and MEPQ
n1 = n2 = 2 (2.5425) 2 =
12.9286125 = 13
Based on the calculation results, a
minimum sample size of 13 people was
obtained for each group. Drop out is
estimated at 10% in each group as
additional data with the formula:
n '=
n '=
n ' = 14.4
Each group has a sample size of 15
people with a total sample size of 30
people.
The sample size was 30
respondents . This research was carried
out by looking at the development of
stunted toddlers before being treated
(pre) aged 3 years to 5 years and after
being given treatment (post) for 30 days
in the control group and intervention
group and then looking at the results of
the treatment obtained by the two
groups.
The sampling technique is by
non-probability sampling , namely
purposive sampling , namely taking
samples by determining special
characteristics that are in accordance
with the research objectives. and meet
the inclusion criteria in the study.
Inclusion criteria for this study:
1. Toddler stunting aged 3-5 years
2. Young women are willing to be
respondents
The variables in this research are
the baby gym and the development of
stunted toddlers aged 3-5 years. The
instruments used were the respondent's
identity sheet, a meter measuring body
(Mental Emotional Problems
Quesioner) questionnaire sheets for ages
3-5 years. Data is processed using
editing, coding, scoring and tabulating.
Next, univariate analysis was carried out,
then bivariate analysis was used to
analyze the relationship between two
variables, namely 1 independent variable
and 2 dependent variables. In this study,
t dependent and independent t tests were
used with parametric tests. Baby gym
equipment such as oil, mats, washcloths,
baby gym leaflets.
Research procedure
1. Data Source
a. Secondary data
Secondary data was obtained through a
preliminary study at posyandu RW 24
West Sidomulyo Village regarding the
highest prevalence of stunting in toddlers
b. Primary data
Primary data was obtained directly by
conducting research on research
subjects. This research uses stunted
toddler subjects aged 3-5 years,
researchers need to ask for approval as
permission to conduct research to
consider ethical aspects of the research.
2. Research flow
Data collection in this research was
collected by researchers. Before
collecting data on research respondents,
researchers will conduct a baby gym trial
on the subjects before giving the
intervention to the actual subjects.
The research procedures to be carried
out are as follows:
a. Preparation phase
1) Research permit procedures
2) Request a research permit from
Posyandu RW 24, West Sidomulyo
Village
3) Selection of enumerators
a) To assist the researcher in this
research process, the researcher chose to
be assisted by an enumerator who is
certified in baby gym training
b) The number of enumerators that
researchers need is 2 people, to simplify
the research process because the
enumerators chosen are experts who
have baby gym certificates
c) Enumerators who are selected and
willing to help researchers are then
compared in their perceptions regarding
the research process.
d) Activities carried out by the
enumerator will be included in the
enumerator's attendance sheet.
4) After receiving permission from the
Head of Posyandu RW 24 West
Sidomulyo Subdistrict to conduct
research, researchers first recorded and
recorded stunted toddlers aged 3-5 years
and filled in personal data.
5) Prepare research instruments and
equipment needed for research.
b. Research stage
1) If the parents/guardians of toddlers
agree to be used as samples, they need to
fill out an informed consent form. Height
and weight were measured using scales
and a meter that met the predetermined
inclusion and exclusion criteria.
2) After finding stunted toddlers aged 3-
5 years who meet the criteria to be used
as samples. Provide an explanation of
the objectives, benefits, risks and
research procedures first to
parents/guardians.
3) Researchers provide education about
stunting toddlers and alternative
treatments by doing a baby gym.
4) Researchers provide baby gym
intervention to stunted toddlers 3
times/week with a duration of 10-15
minutes for 4 weeks
5) Researchers provided an observation
sheet on the consumption of government
nutritional biscuits to the intervention
group to ensure that toddlers got the
biscuits that had been announced by the
government. Observations were carried
out for 30 days.
6) KMME questionnaire to assess the
cognitive development of stunted
toddlers
7) The intervention group is stunted
toddlers aged 3-5 years who receive
baby gym 3 times/week with a duration
of 10 - 15 minutes for 4 weeks and 30
government nutritional biscuits.
8) The control group is stunted toddlers
aged 3-5 years who only receive 30
government nutritional biscuits for 4
weeks.
9) After being given intervention for 4
weeks, a reassessment will be carried out
using the KMME questionnaire to assess
the cognitive development of stunted
toddlers. The assessment of hemoglobin
levels and physical fitness was carried
out by the researchers themselves and
assisted by 2 enumerators.
10) After each treatment received the
final results of the assessment, the
researchers carried out a comparison,
namely whether the intervention group
and the control group experienced an
influence on the cognitive development
of stunted toddlers.
11) Next, data processing and analysis
are carried out.
Results
Tabel 1. Distribution of Character Respondent
Characteristic Variable Intervension Group Control Group
Age
3 12 (73,3) 6 (40)
4 1(6,6) 8 (53,3)
5 2 (13,3) 1 (6,6)
15 (100) 15 (100)
Height (cm)
72-76 5 (33,3) 4 (26,6)
77-81 6 (40) 4 (26,6)
82-86 1(6,66) 2 (13,3)
87-91 1 (6,66) 1 (6,66)
92-96 1 (6,66) 2 (13,3)
>97 1(6,66) 1 (6,66)
15(100) 15(100)
Heavy Body (kg)
9 6 (40) 5 (33,3)
10 3 (20) 5 (33,3)
11 2 (13,3) 3 (20)
12 3 (20) 1 (6,66)
13 1 (6,66) 2 (13,3)
>14 0 0
15(100) 15(100)
Tall Body/Age (TB/U)
Short 4 (26,6) 12
Very Short 11 3 (20)
15(100) 15(100)
Heavy Body/Age (BB/U)
BB Normal 12 (73,3) 13 (86,6)
Bb Lebih 3 (20) 2 (13,3)
 15(100) 15(100)
Based on table 1, the highest age of
toddlers was 3 years old, in the intervention
group the height of toddlers with a height of
77-81 was 6 people in the intervention group
and 4 people in the control group. There were
6 people weighing 9 kg in the intervention
group and 5 people in the control group. Based
on the very short TB/U table, there were 11
people in the intervention group and 3 people
in the control group. Based on BB/U BB More
than 3 people in the intervention group and 2
people in the control group Total
2. The Effect of Baby Gym on the Cognitive Development of Stunted Toddlers

Table 2. Effect of Baby Gym on Cognitive Development of Stunted Toddlers

Average
Group n Mean SD p-value
Different
Intervension
Before 15 10.43 0.94 3.54 0.000
After 13.98 2.07
Control
Before 15 10.36 1.12 1.90 0.001
After 12.26 1.77
stunted
From table 2, it can be seen that the p
The majority of respondents in this study
value is 0.000, which means <0.05, so it
were babies aged 3 years (73.3%). An
can be concluded that there is a
important early developmental stage in
significant influence between baby gym
babies is cognitive development.
treatment on motor development in
Because at the age of 3-5 years the
babies
existing brain cells will strengthen the
connections between the nerves that
Discussion
have been formed. So this brain
Based on the result of research on 15
development causes cognitive
respondents, so can it was conclude that development in babies to develop faster
than in the previous month (Wong
before doing baby gym fine cognitive
2019).
development instunted toddlers is in the The influence of Baby Gym on the
cognitive development of stunted
failed category and after being carried
toddlers using KMME. From the
out intervention Baby Gym obtained that research results, it was found that after
treatment by providing management for
fine cognitive development is to a large
30 days with a baby gym, babies
extent being in the pass category shows experienced increased cognitive
development. In the cognitive
that there is an influence of baby gym on
development of babies using
development cognitive on toddler measurements using the Chi Square test
with the results of an increase between
baby gyms and cognitive development
abilities, an odds ratio (OR) value of 11
was obtained. This figure shows that
baby gyms are 11 times more likely to
improve toddlers' cognitive development
with KMME than who didn't get the
baby gym treatment.
In the development of cognitive
development abilities using KMME, the
results of measurements using the Chi
Square test showed that the increase in
ability between baby gyms and the
ability to lift the neck obtained an odds
ratio (OR) value of 10. This value shows
that baby gyms are 10 times more likely
to improve cognitive development
abilities than those who do not. get the
baby gym treatment. So it can be
concluded that the baby gym has an
effect on increasing development,
especially cognitive development in
babies.
Cognitive development is physical
movement that requires balance and
coordination between body parts, using
large muscles, some or all of the body
parts. In babies aged 3-5 years the body's
skeletal muscles are strong enough so
that the baby is ready to carry out these
cognitive development movements
(Suhartini, 2017). The results of this
research relate to the guideline
movements for baby gym for babies
aged 3-5 years, starting from finger and
hand movements for hand strength, then
the prone position which focuses on the
head, back and leg areas, these
movements can stimulate babies to lift
their heads with hand strength. Then lie
down in a half-sitting position by
holding both arms and bent legs, elbows
and knees, gently pulling until the head
is lifted from the base, so that the baby is
in a half-sitting position, this movement
stimulates the baby to raise his head.
The results of research on the influence
of baby gyms on the development of
babies aged 3-5 years, especially
cognitive development, are almost the
same as research conducted by Jin Jing,
et al (2017) which states that giving
massage and movement exercises can
improve the physical development and
intelligence of babies starting from birth
to babies aged 3-5 years with p=0.001
for body weight index. Babies who
receive regular and targeted stimulation,
such as with a baby gym, will develop
faster than babies who receive less
stimulation. Similar to exercise in adults,
a baby gym can increase blood
circulation so that oxygen supply
throughout the body is sufficient and
regular, apart from that, exercise also
increases the stimulation of muscle
development and body cell growth.
Baby gym has many benefits for
children, including optimizing
development, increasing endurance,
increasing contrast, improving sleep
quality, improving blood circulation,
increasing oxygen distribution in the
body, stimulating muscle development
and cell growth so that it can help
cognitive development in children. child
(Zaidah 2020)(Eka 2019). It is hoped
that parents will always pay attention to
the growth and development of their
children and provide stimulation to
increase growth and development in the
form of a baby gym for children under
five to minimize the occurrence of
developmental delays in children
Conclusion
Berdasarkan hasil penelitian terhadap
15 responden yang dilaksanakan pada tanggal
1 Maret sampai dengan 30 Maret 2023 maka
dapat disimpulkan bahwa sebelum dilakukan
baby gym perkembangan kognitif pada balita
stunting berada pada kategori gagal dan
setelah dilakukan intervensi baby gym
didapatkan bahwa perkembangan kognitif
berada sebagian besar berada pada kategori
lulus hal menunjukkan bahwa ada pengaruh
 baby gym terhadap perkembangan kognitif
pada balita stunting.
Abbreviations
KMME :
Consist of abbreviations mentioned in
the article (from Abstract to
Conclusion).
Ethics Approval and Consent to
Participate
Inform liscence obtained from institution
and research subject. Authors have to put
the number of ethical approvals from the
Ethical Research Committee provided
for all type of study both using primary
and secondary data.
Competing Interest
The authors declared that there are no
significant competing financial,
professional, or personal interests that
might have affected the performance
Availability of Data and Materials
Data used in this study are available
from the corresponding author upon
reasonable request.
Authors’ Contribution
SF and NS were responsible for
conceptualization and methodology. NS
collected data and investigated. SF wrote
the original draft. SF and NS critically
reviewed the manuscript. SF supervised
this study. All authors read and approved
the final manuscript.
Acknowledgment
The author would like to thank
RISETMu as the research grant provider
and the residents of RW 24 as
respondents and the cooperation of all
participants
during this research is also highly
appreciated.
. monitoring the development of
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