What Does Infant Participation Look like? An International Delphi Study of Maternal Caregivers and Health Professionals

Aims To gain consensus on the content and constructs of infant participation for infants with typical development.Methods An international three-round Delphi survey was conducted with primary caregivers of children aged <2 years and health professionals (HPs). In Round 1, all participants answered open-ended questions on Attendance (life situations between 0 and 12 months), Involvement (observable infant behaviors), and Caregiver role. HPs also addressed definitions of infant participation; Similarities/differences compared with older children; and Participation Assessments and Interventions. Items generated in Round 1 were rated for consensus in Rounds 2 and 3 using an agreement threshold of ≥85%.Results Sixteen maternal caregivers and 35 HPs participated. High agreement was achieved for caregiver roles in mediating infant participation, including providing access, support and a strong relationship. Participants agreed that infant Attendance diversity increases substantially between 0 and 12 months. Multiple observable indicators of Involvement reached consensus (7/10 HP-generated and 9/9 caregiver-generated items). HPs agreed that Attendance and Involvement underpin infant participation. Agreement was low for similarity and differences between age groups and for participation intervention approaches. No assessments reached consensus.Conclusion Caregivers play a central role in co-constructing infant participation. Infants demonstrate increasing Attendance over time and observable signs of Involvement. Infant-specific participation assessments are urgently needed.