Peer-reviewed article

Conceptualizations of Child Development Benefit from Inclusion of the Nurturing Care Framework

Maureen M. Black, Angela C. B. Trude · 2 May 2019

Abstract

Over 250 million children under age 5 y in low-and middleincome countries are at risk of not reaching their developmental potential, resulting in long-term negative consequences that undermine subsequent health, well-being, and productivity (1).The loss of developmental potential is a global crisis that has led to calls for action from leaders of international agencies (2) and recommendations for the Nurturing Care Framework to serve as a model for the care and services that promote young children's healthy growth and development.The Nurturing Care Framework includes policies, programs, and services that create an enabling environment for families and communities to ensure that their children receive health care, adequate nutrition, responsive caregiving, opportunities for early learning, and safety and security (1).In this issue of The Journal of Nutrition, the Malnutrition and Enteric Disease (MAL-ED) study authors make a unique contribution by systematically examining how enteric pathogens, nutrition, and the home environment during the first 2 y of life relate to children's development at age 5 y across multiple low-income sites in Africa, Asia, and South America (3).A study conducted when the children were age 2 y found that they experienced high rates of adversities during the first 2 y of life, including monthly detection of enteropathogens in nondiarrheal stools, frequent illnesses, and low micronutrient intakes (4).Enteropathogens, mediated by frequent illnesses and low hemoglobin concentration, were associated with low cognitive skills at age 2 y, suggesting that the malnutritionenteric infection cycle, which has been associated with poor health and is exacerbated by oral-fecal contamination often found in unhygienic environments (5), extends to children's cognitive development.In the current study (3), cognitive development was measured by the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III), which was developed and normed in the United States (6).As recommended, the investigators addressed cultural and linguistic issues across sites through adaptations and excluding verbal subtests from the analysis.Using statistical procedures at the item level to examine measurement equivalence across sites, they identified 3 subtests Supported by National Institute of Diabetes and Digestive and Kidney Diseases grant R01 DK106424 (to MMB).