The Nurturing Care Framework (NCF) calls for establishing a global monitoring and accountability systems for early childhood development (ECD). Major gaps to build low-cost and large-scale ECD monitoring systems at the local level remain. In this manuscript, we describe the process of selecting nurturing care indicators at the municipal level from existing routine information systems to develop the Brazilian Early Childhood Friendly Index (IMAPI). Three methodological steps developed through a participatory decision-making process were followed. First, a literature review identified potential indicators to translate the NCF domains. Four technical panels composed of stakeholders from federal, state and municipal levels were consulted to identify data sources, their availability at the municipal level and the strengths and weakness of each potential indicator. Second, national and international ECD experts participated in two surveys to score, following a SMART approach, the expected performance of each nurturing care indicator. This information was used to develop analytical weights for each indicator. Third, informed by strengths and weaknesses pointed out in the previous steps, the IMAPI team reached consensus on 31 nurturing care indicators across the five NCF domains (Good health [n = 14], Adequate nutrition [4], Responsive caregiving [1], Opportunities for early learning [7] and Security and safety [4]). IMAPI represents the first attempt to select nurturing care indicators at the municipal level using data from existing routine information systems.
Gabriela Buccini, Jéssica Pedroso, Stefanie Eugênia dos Anjos Campos COELHO et al.
ABSTRACT Objective: To understand the interfaces of family care for preterm infants at home with the domains of good health, adequate nutrition, responsive care, safety and protection, and early learning opportunities, from the Nurturing Care Framework (NCF). Method: This is a qualitative study guided by the theoretical framework of Nurturing Care Framework. Data were collected between August 2023 and March 2024, in the homes of 12 preterm infants, with 27 family members, followed by a high-risk newborn follow-up service. During the visits, dyadic or group family interviews were conducted, and records were kept in field diaries. In parallel, two researchers performed blind coding of the data and inter-coder verification, using software-assisted deductive thematic analysis guided by a code dictionary. Results: The results showed: prevention of illness and promotion of physical health in preterm infants; early introduction of solid foods and breastfeeding-related weaknesses; caregiver responsiveness to the needs of preterm infants; intrafamily safety and prevention of domestic accidents; Early learning opportunities, limited to motor stimulation. Conclusion: It became evident that caregivers have a limited understanding of the domains of Nurturing Care Framework (NCF), a reflection of the current healthcare model in the research setting. It is expected that families, upon receiving nursing care and guidance based on the NCF, will be able to broaden their understanding and applicability of the model in their daily lives, which would be aligned with the objectives for sustainable development.
Maria Luiza Cunha Da Fonseca, Bruna da Silva Calderaro, Larissa Alves de Souza et al.
Cultures of CareThe primary role of a teacher is to teach: to educate, impart knowledge and facilitate learning.It is what teachers are trained to do, and what they do best.And yet, the teachers who tend to stand out are those who see their role as something more than just to teach, but to nurture, care and protect those in their charge.This is the theme picked up in the first paper in this issue of Child Abuse Review.In a qualitative study based in 16 primary schools in Ireland, Margaret Nohilly (2019) explores the care practices and systems that support child protection work in the schools.Ireland differs from the UK in that all teachers (along with other professionals) are mandated to report child abuse, above a defined threshold, which comes to their attention in the course of their professional or employment duties.One of the most consistent findings from their interviews was a consensus 'that the ethos of a school, by its very nature, was one of caring and that attending to the pupils' needs was the priority' (p.267).This emphasis on nurture, care and protection was most prominent in those schools designated as disadvantaged and a special school, and it included providing meals, addressing other care needs, running before and after school activities, and programmes to support parents.This ethos of care seemed to permeate all areas of school life and was felt to contribute in a significant way to pupil safety and protection.And yet, these elements of nurture, care and protection appeared to fall outside the statutory interagency framework of child protection to the extent that it was perceived that the Child and Family Agency was not aware of the care practices established at the school level.This carries some important implications for the value and validity of such care, and raises some important questions for schools.First, to what extent should this aspect of the teaching role be recognised?If this forms a major part of a teacher's role, and yet is neither remunerated nor allocated time, and is not recognised in training, supervision or inspection, how sustainable is it?Second, should such work be subject to inspection as are other aspects of the teaching and management of schools?If it were, what implications would that have for the quality or spontaneity of the care provided?Would it enhance or stifle these elements of a school's ethos?Third, is the provision of care and nurture within a school setting always the most appropriate response to a child in need?Does such an approach merely provide a sticking plaster, patching over the problems and not
INTRODUCTION: Children who are HIV-exposed and uninfected (CHEU) are a growing population at potential risk of poor neurocognitive development. We tested a nurturing care intervention on children's neurocognitive development and maternal depressive symptoms (primary) with mediation through caregiving activities (secondary). METHODS: This study was conducted among six intervention and nine comparison antenatal-care/prevention of vertical transmission (ANC/PVT) HIV clinics in eSwatini. We enrolled pregnant women and measured infant development at 9 and 18 months. mothers2mothers (m2m) designed and implemented the clinic-home-community-based intervention. We measured infants' neurodevelopment, maternal depressive symptoms and caregiving activities with the Mullen Scales of Early Learning (MSEL), Edinburgh Postnatal Depression Scale, HOME Inventory and Family Care Indicators. We fitted linear mixed effects regression models with clinic random effects to compare intervention versus comparison arms, and generalised structural equation models to evaluate mediation, adjusting for confounders. RESULTS: Mother-infant pairs (n = 429) participated between January 2016 through May 2018. Socio-demographic characteristics were balanced between arms except for higher rates of peri-urban versus rural residence and single versus married mothers in the comparison group. The 18 month retention was 82% (180/220) intervention, 79% (166/209) comparison arm, with 25 infant deaths. Intervention MSEL scores were significantly, and modestly, higher in receptive language (55.7 [95% CI 54.6, 56.9] vs. 53.7 [95% CI 52.6, 54.8]), expressive language (42.5 [95% CI 41.6, 39.8] vs. 40.8 [95% CI 39.8, 41.7]) and composite MSEL (85.4 [95% CI 83.7, 84.5] vs. 82.7 [95% CI 81.0, 84.5]), with no difference in maternal depressive symptoms or in observations of mother-child interactions. Intervention book-sharing scores were higher (0.63 vs. 0.41) and mediated the effect on MSEL scores (indirect effect, p-values ≤ 0.024). The direct effects on visual reception and expressive language scores were significantly higher in the intervention compared to the comparison arm (coefficients 1.93 [95% CI 0.26, 3.60] and 1.66 [95% CI 0.51, 2.79, respectively]). CONCLUSIONS: Nurturing care interventions can be integrated into ANC/PVT clinic-home-community programmes. The intervention, mediated through interactive caregiving activities, increased language development scores among CHEU. Partnering with a local team, m2m, to design and implement a culturally relevant intervention illustrates the ability to impact parent-child play and learning activities that are associated with children's neurodevelopment.
Andrea Ruff, Xolisile Dlamini, Bareng A. S. Nonyane et al.
BACKGROUND: Zip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days (from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, security and safety, and responsive relationships) can contribute to supporting families and their communities, and ultimately reduce systemic barriers to food security. We aimed to identify and characterize nurturing care assets in under-resourced communities with moderate and high FI risk. METHODS: Four steps were used to conduct a Community Asset Mapping (CAM): (1) review of community documents across five zip codes in Clark County, Nevada (2), engagement of community members in identifying community assets (3), definition of the assets providing nurturing care services, and (4) classification of assets to nurturing care components, i.e., good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. The Food Insecurity Index was used to determine FI risk in each zip code. Analyses explored whether disparities in nurturing care assets across zip codes with moderate and high FI exist. RESULTS: We identified 353 nurturing care assets across zip codes. A more significant number of nurturing care assets were present in zip codes with high FI risk. The adequate nutrition component had the most assets overall (n = 218, 61.8%), while the responsive caregiving category had the least (n = 26, 7.4%). Most of the adequate nutrition resources consisted of convenience stores (n = 96), food pantries (n = 33), and grocery stores (n = 33). Disparities in the number and type of good health, early learning, and security and safety assets were identified within zip codes with high FI risk compared to moderate FI risk. CONCLUSIONS: The quantity and type of nurturing care assets can exacerbate existing demographic disparities across zip codes, which are tied to barriers to access to food in under-resourced communities in Clark County, Nevada. Co-creating a nurturing care asset-based zip code strategy to address high FI risk will require strengthening systems across existing nurturing care assets.
Gabriela Buccini, Kaelia Lynn Saniatan, Ana Paula Poblacion et al.
Background The Nurturing Care Framework (NCF), which has been emphasized by the World Health Organization (WHO) in recent years and is among the United Nations Sustainable Development Goals (SDGs), expresses the conditions created to promote early childhood development (ECD). These conditions aim to provide opportunities for children in the Good Health, Adequate Nutrition, Responsive Caregiving, Security and Safety, and Opportunities for Early Learning (5 Components) by caregivers, primarily from low and middle-income countries (LMICs). The aim of this study is to examine the knowledge and awareness of expectant mothers and fathers in Turkey, about the NCF. Methods In this study, a cross-sectional, analytical research design was used. Nurturing Care (NC) knowledge and awareness levels of expectant mothers and fathers in the 2nd and 3rd trimesters of pregnancy were determined via the online form of “The Knowledge of Nurturing Care Inventory (KNCI)” prepared by the researchers. This form consists of 60 questions describing the 5 components mentioned above. The sample contains a total of 103 people, 91 (88.3%) women, and 12 (11.7%) men. Results Among the findings, the highest mean of knowledge level (13.76 ± 1.22) was found in Responsive Caregiving, and the lowest mean of knowledge level (4.35 ± 1.83) was found in Opportunities for Early Learning. The general level of knowledge on NC was found to vary statistically significantly depending on gender in favor of the women [t(101) = 3.27, p < .05], depending on educational status in favor of those with university and graduate education [F(2, 100) = 3.481, p < .05], depending on participation in pregnancy school training in favor of those who attended [t(101) = 2.349, p < .05], and depending on knowledge on how to support development in favor of those who know how to support [t(101) = 2.370, p < .05]. Conclusions As a result, expectant parents need information and support about the period when children can acquire the basic developmental milestones and about the developmental risk indicators. More research is needed to implement the NCF starting from the preconception period, especially in LMICs, so that the opportunities in early childhood (which is the time period when the brain architecture is shaped, and development is the fastest) are not missed.
Dietary guidelines provide advice on what to eat to different subsets of the population but often do not take into account the "how" to eat. Responsive feeding is a key dimension of responsive parenting involving reciprocity between the child and caregiver during the feeding process and is characterized by caregiver guidance and recognition of the child's cues of hunger and satiety. Evidence indicates that providing responsive feeding guidance to mothers on how to recognize and respond appropriately to children's hunger and satiety cues can lead to improved feeding practices and weight status and developmental outcomes among infants and young children. In addition, early and nurturing exposures to foods with different tastes and textures and positive role modelling help children to learn to eat healthy foods. The importance of improving caregiver's responsive feeding behaviours to ensure the adequate introduction of complementary foods is becoming increasing recognized, but responsive feeding principles have not been taken into account in a comprehensive way in the development of dietary guidelines. The incorporation of all responsive feeding principles into dietary guidelines has a strong potential to enhance their impact on early childhood development outcomes for infants and young children but will require adaptation to the different contexts across countries to ensure that they are culturally sensitive and grounded in a deep understanding of the types of foods and other resources available to diverse communities.
Rafael Pérez‐Escamilla, Sofía Segura‐Pérez, Victoria Hall Morán
The nurturing care framework (NCF) for early childhood development (ECD) launched at the 2018 World Health Assembly opens a range of opportunities and challenges for child neurodisability professionals. The United Nations Convention on the Rights of the Child and Convention on the Rights of People with Disabilities frame these pathways for collaboration and progress. This overview of the NCF and its contexts in inclusive ECD identifies avenues for innovation and collaboration in harmony with the field's clinical, scientific, and advocacy agendas. One avenue involves enhancing the alignment between health systems and human rights. A second avenue involves neurodisability professionals engaging with nurturing care as leaders, partners, and implementers. WHAT THIS PAPER ADDS: Participation and leadership by neurodisability professionals can enhance quality and impact. A rights-based framework that includes young children with disabilities and their families is widely encouraged.
The next 1,000 days of a child's life (spanning from the age of two to five years) offer a crucial opportunity to build on early gains and sustain or improve trajectories of healthy development. This period is vital for cognitive, motor, and socio-emotional growth. Consequently, it emphasizes nurturing care, which refers to the conditions established by public policies, programs, and services that enable caregivers and communities to ensure good health, adequate nutrition, responsive caregiving, opportunities for early learning, and safety and security. While Early Childcare and Development (ECD) interventions are not new in the Philippines, the next 1,000 days underscore the importance of continuity of care, emphasizing that the responsibility for ECD extends beyond parent-child relationships and the silos of the health and nutrition sectors. However, research involving disaggregated data during this period is limited among low- to middle-income countries, including the Philippines. Additionally, efforts to promote development in the next 1,000 days are often inadequate or not effectively translated into policies. This report aims to provide a baseline assessment of relevant outcomes during this critical period through the lens of the nurturing care framework, using population-level data covering children under the age of five. This assessment will guide the formulation of policy recommendations to enhance and build on these efforts, maximizing this golden opportunity for early child development.
