Infants with single ventricle CHD commonly experience gross motor delays due to physiological and environmental factors, including increased risk for white matter injury, reduced aerobic capacity, restrictive post-operative protocols, and limited movement opportunities. These delays persist in adolescence, affecting physical and social development. This study examines a quality improvement initiative within the National Pediatric Cardiology Quality Improvement Collaborative to enhance gross motor development.

Fifteen centres participated. Gross motor skills were assessed using the Ages and Stages Questionnaires, Third Edition, at 6 and 12 months. A key driver diagram, Plan-Do-Study-Act cycles, baseline data, and ongoing process measures were collected. Interventions were implemented, including education, therapy support, and mobilisation protocols. Control charts were used to evaluate the data.

Scores from the Ages and Stages Questionnaires indicated delays in gross motor skills at baseline, with improvement over time. Participating centres showed a centerline shift from 41% to 89% of infants achieving on-target or improved motor scores, compared with 54% to 68% of infants at non-participating centres. Establishment of customised infant developmental plans increased from 62% to 74% for participating centres and from 53% to 61% for non-participating centres. Interventions included establishing processes for consistent screening, developmental plan administration, review of prone positioning, access to therapies, and early intervention referrals.

This targeted quality improvement project increased the use of inpatient practices to support gross motor development for infants with single ventricle CHD. Collaborative, interdisciplinary efforts remain critical for addressing neurodevelopmental challenges in this high-risk population.

Parental adverse childhood experiences have been associated with poorer health outcomes for children in the general population. This single-centre study examined the prevalence of parental adverse childhood experiences in a sample of young children with single ventricle CHD, the associations between parental adverse childhood experiences and child health outcomes, and the moderating effects of parental stress and social support on the relationship between parental adverse childhood experiences and child health outcomes.

Parents (N = 72) responded to questionnaires assessing demographic characteristics, parental adverse childhood experiences, social support, and stress. Child health outcomes (hospital admissions, length of stay, missed appointments) were assessed via parent-report and medical record review.

Half of parents (52.8%) endorsed exposure to at least one adverse childhood experience. In univariate analyses, children whose parents had a history of adverse childhood experiences were 1.78 times as likely to have more parent-reported hospital admissions (p = 0.002) and 2.22 times as likely to have more missed visits (p = 0.03) compared to children of parents without a history of adverse childhood experiences. Parental social support significantly moderated the relationship between parental adverse childhood experiences and total hospital length of stay (p = 0.03). Specifically, for each unit increase in parents’ social support total score, parents with a history of adverse childhood experiences were likely to have an 83% reduction in their child’s length of stay.

Parental adverse childhood experiences may be associated with poorer single ventricle CHD outcomes. Strengthening parental social support may improve health outcomes for children with single ventricle CHD in the setting of pre-existing psychosocial risk.