Key messages There is a dearth of indicators and management information systems to assess early childhood nurturing care environments. The Brazilian Early Childhood Care Friendly Municipal Index (IMAPI) is a robust tool to assess nurturing care environments at the local level. IMAPI was able to detect nurturing care inequities within and across regions. Further validation work is needed to confirm the utility of IMAPI for policymaking.
Rafael Pérez‐Escamilla, Sônia Isoyama Venâncio, Gabriela Buccini
This study examines the use of Beatrice Alemagna's picture book 'What is a Child?' as a tool for understanding and implementing nurturing care principles in perinatal healthcare settings. Through mixed-methods analysis of forum discussions among 42 perinatal professionals, including psychologists, midwives, physicians, nurses, pharmacists and early childhood educators, we explored how engagement with the book's metaphorical and visual elements facilitated professional reflection and development. Qualitative analysis revealed four primary themes: the power of metaphors in conveying complex caregiving concepts, the importance of collective care and community support, understanding the temporality of care and fostering transformative dialogue. Quantitative analysis showed significant differences in thematic engagement across professional groups, with medical professionals emphasising physical health (20.8%) and nutrition (32.1%), while psychologists focused more on early learning opportunities (28.3%) and responsive caregiving (21.0%). However, the picture book's narrative framework encouraged professionals to transcend their domain-specific perspectives, fostering a more holistic appreciation of nurturing care principles. These findings suggest that carefully selected picture books can serve as sophisticated tools for professional development in perinatal care, particularly in translating abstract theoretical concepts into actionable insights while honouring different professional perspectives and expertise.
BACKGROUND: The study objective was to determine if a nurturing care parenting intervention delivered in a humanitarian setting in Rwanda would benefit early development, learning, and care outcomes for young children under five years and their caregivers compared to standard care. METHODOLOGY: Rwanda's Mugombwa, Kansi, and Kigeme refugee camps and host communities implemented the parenting program. Via a quasi-experimental research design, the study assessed the effects of intervention delivered as a high dose (HD: 12 group sessions and four home visits) or low dose (LD: 6 group sessions and two home visits) on child and caregiver outcomes compared to the control group from similar settings receiving standard care. The Ages and Stages Questionnaires-3 (ASQ-3) assessed child development outcomes. The Multiple Indicator Cluster Survey questionnaire assessed parenting practices concerning early learning and stimulation. FINDINGS: The assessment included 733 children and families in total: HD = 314, LD = 240, control = 179. The researchers found no significant difference in child development scores between the intervention and control groups. Significantly higher proportion of caregivers exposed to HD and LD packages had engaged in early learning and stimulation practices compared to the control group, respectively, with 211(67.2%), 148 (61.7%) vs. 66 (36.9%), p < 0.001 caregivers engaged in 4 or more activities in the past three days. Similarly, on responsive feeding items, a higher percentage of HD and LD group caregivers were engaged in positive behaviours compared to the control group: 164 (52.2%), 108 (45%) vs. 62 (34.6%), p = 0.001. The study found no difference between the study arms regarding caregiver mental health. CONCLUSION: Parenting programmes in humanitarian settings can improve nurturing care practices, even with a low dose, which is essential to strengthening children's resilience in at-risk conditions. Further studies in humanitarian contexts are crucial to understand the implementation needs in sensitive contexts.
Viktoria Sargsyan, Ana Tenorio, Mediatrice Uwera et al.
Abstract The Nurturing Care Framework recognises infants’ embeddedness in broader networks. However, given gender norms and socio-structural features, key actors responsible for child well-being may misrecognise complex care dynamics and reinscribe parental (usually maternal) responsibility. The paper offers a South African example, tracing the emergence of ‘parenting’ as a remedy for colonial violence and its enduring social and affective infrastructures. Close assessment of several research trials for parenting interventions that seek to prevent violence raises questions about the methodological and conceptual assumptions that produce the evidence base. I argue that, given gender norms and the devastating and enduring effects of the colonial-apartheid shaping of family life, women are made responsible for inculcating the values presumed to reduce violence. Despite the potential of a culturally responsive idea of nurture, the Framework prioritises ‘universalist’ ideas about development, bypassing local ontologies and missing the opportunity to materialise a fully redressive model of social well-being.
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).
Adequate nurturing care behaviours, including feeding practices, health-seeking and psychosocial stimulation, are crucial for the optimal health, growth and development of young children. However, several factors, recognised as maternal 'capabilities for care', can influence a mother's capability to provide adequate care, namely knowledge/beliefs, physical health and nutritional status, mental health, autonomy, reasonable workload/time availability and social support. As part of the Khula birth cohort study, we aimed to investigate if maternal capabilities for care are associated with nurturing care behaviours among mother-child dyads in Malawi (n = 122) and South Africa (n = 206). When children were 10-16 months of age, mothers competed a series of self-reported sociodemographic, child diet and health and psychosocial questionnaires. Six maternal capabilities for care were considered: haemoglobin concentration, mental health, employment, decision-making autonomy, support for childcare and social support. The nurturing care behaviours were feeding practices, complete immunisation status appropriate to chid age and psychosocial stimulation within the home environment. Regression modelling assessed associations between maternal capabilities for care and each care behaviour, adjusting for child sex, maternal age and education level and household socioeconomic status. Associations between maternal capabilities for care and nurturing care behaviours differed by care behaviour and setting. Maternal employment and decision-making as measures of autonomy, support with childcare as a measure of reasonable workload and reported social support were the maternal capabilities most consistently associated with feeding practices, complete immunisation status and stimulation practices, although the direction of associations differed between settings. Maternal haemoglobin and mental health were associated with one care behaviour each (stimulation and feeding practices, respectively). Measuring and understanding how various maternal capabilities influence caregiving across contexts is essential for empowering caregivers to provide optimal care. Interventions, programmes and policies that seek to improve child health, growth and development through enhanced nurturing care practices should strengthen multiple maternal capabilities.
Taryn J. Smith, Emmie W. Mbale, Michal R. Zieff et al.
Globally, two in five children under the age of five are at risk of not reaching their full developmental potential. Investing in early childhood is essential to uphold every child’s right to survive and thrive. Nurturing care interventions have proven to be an effective means of improving early childhood outcomes. However, there is limited knowledge on how to enhance the integration and implementation of these interventions. This article explores interventions that enhance nurturing care during early childhood development, utilizing the RE-AIM framework review study design. The findings indicate that these interventions are a valuable investment in children’s health, well-being, education, and personal development, and they are highly effective in shaping children’s overall development.
The Brazilian Early Childhood Friendly Municipal Index (IMAPI) is a population-based approach to monitor the nurturing care environment for early childhood development (ECD) using routine information system data. It is unknown whether IMAPI can be applied to document metropolitan urban territorial differences in nurturing care environments. We used Brasilia, Brazil's capital with a large metropolitan population of 2,881,854 inhabitants divided into 31 districts, as a case study to examine whether disaggregation of nurturing care data can inform a more equitable prioritization for ECD in metropolitan areas. IMAPI scores were estimated at the municipal level (IMAPI-M, 31 indicators) and at the district level (IMAPI-D, 29 indicators). We developed a quantitative prioritization process for indicators in each IMAPI analysis, and those selected were jointly mapped in the socioecological model for the role of indicators in relation to the enabling environment for nurturing care. Out of 28 common nurturing care indicators across IMAPI analysis, only four were prioritized in both analyses: one from the Adequate nutrition, two from the Opportunities for early learning, and one from the Responsive caregiving domains. These four indicators were mapped as enabling policies, supportive services, and caregivers' capabilities (socioecological model) and Effort, Coverage, and Quality (indicator's role). In conclusion, the different levels of nurturing care data disaggregation in the IMAPI can better inform decision-making than each one individually, especially in metropolitan areas where municipalities and districts within metropolitan areas have relative decision-making autonomy.
Gabriela Buccini, Juliana Lopes Pimentel, Jéssica Pedroso et al.
OBJECTIVES: to list educational elements in nursing with a focus on monitoring child development in the context of the Sustainable Development Goals and Nurturing Care. METHODS: qualitative report on an educational perspective for nursing undergraduates. The following stages emerged: key conceptual dimensions, simulated situation, clinical field, case study and assessment. RESULTS: educational elements were listed regarding child development monitoring prioritizing home visits. Contents and practices were anchored in scientific evidence from Nurturing Care and Sustainable Development Goals in their peculiarities of promoting child development, health and well-being, eradicating poverty and hunger, early childhood education and reducing inequalities. FINAL CONSIDERATIONS: the educational perspective presents itself as a triangulation between theoretical knowledge, simulation and clinical environment, with challenges in the face of circumstances, strengths and weaknesses in simulated situations and with families with children, allowing us to recognize the potential of existing practices and the barriers to be broken.
Débora Falleiros de Mello, Flávia Azevedo Gomes-Sponholz, Luciana Mara Monti Fonseca et al.
to analyze maternal parenting practices aimed at the development of children under one year of age in the home context, from the perspective of the Nurturing Care framework. a qualitative study, grounded in philosophical hermeneutics and the conceptual approach of Nurturing Care. In-depth, semi-structured interviews were conducted with 27 mothers, followed by inductive thematic analysis. maternal parenting practices involved interaction and engagement in play activities with the child, socialization with other children, early exposure to screens, relative paternal participation, and occasional book reading. Uncertainties emerged regarding setting limits, early childhood education enrollment, and perceptions of child development. The findings indicated a partial interrelation with Nurturing Care domains related to responsive caregiving, opportunities for early learning, and child security and safety. maternal parenting practices, analyzed through the lens of the Nurturing Care framework, reflected the child's care environment, highlighting both strengths and vulnerabilities in promoting child development in the home context. The Nurturing Care domains are useful for child care within Primary Health Care, reinforcing the relevance of parental responsiveness and the child's daily routine for their full development. This suggests a potential strategy to promote nursing care in child health. BACKGROUND: (1) Daily home routine reflects parenting practices for child development. BACKGROUND: (2) Maternal reports express strengths and weaknesses of the child care environment. BACKGROUND: (3) A nurturing and interactive environment provides opportunities of child learning. BACKGROUND: (4) Daily constraints expose children to developmental vulnerabilities. BACKGROUND: (5) The Nurturing Care framework offers analytical domains of child care at home.
Jeniffer Stephanie Marques Hilário, Letícia Pancieri, Regina Aparecida Garcia de Lima et al.
