Providing an enabling nurturing care environment for early childhood development (ECD) that cuts across the five domains of the Nurturing Care Framework (i.e., good health, adequate nutrition, opportunities for early learning, security and safety and responsive caregiving) has become a global priority. Brazil is home to approximately 18.5 million children under 5 years of age, of which 13% are at risk of poor development due to socio-economic inequalities. We explored whether the Early Childhood Friendly Municipal Index (IMAPI) can detect inequities in nurturing care ECD environments across the 5570 Brazilian municipalities. We examined the validity of the IMAPI scores and conducted descriptive analyses for assessing sociodemographic inequities by nurturing care domains and between and within regions. The strong correlations between school achievement (positive) and socially vulnerable children (negative) confirmed the IMAPI as a multidimensional nurturing care indicator. Low IMAPI scores were more frequent in the North (72.7%) and Northeast (63.3%) regions and in small (47.7%) and medium (43.3%) size municipalities. Conversely, high IMAPI scores were more frequent in the more prosperous South (52.9%) and Southeast (41.2%) regions and in metropolitan areas (41.2%). The security and safety domain had the lowest mean differences (MDs) among Brazilian regions (MD = 5) and population size (MD = 3). Between-region analyses confirmed inequities between the North/Northeast and South/Southeast. The biggest within-region inequity gaps were found in the Northeast (from -22 to 15) and the North (-21 to 19). The IMAPI distinguished the nurturing care ECD environments across Brazilian municipalities and can inform equitable and intersectoral multilevel decision making.
Gabriela Buccini, Stefanie Eugênia dos Anjos Coelho Kubo, Jéssica Pedroso et al.
In Malawi, 38% of children under five are stunted, and only 36% are developmentally on track. An ethnographic study using the Reality Check Approach was conducted in four villages in Ntcheu and Balaka districts in Malawi to understand caregiving-related drivers of malnutrition and poor child development. Researchers immersed themselves in 12 rural households with a pregnant woman or a child under 2 years for 4 days and nights, and gathered information through informal conversations, participation in daily activities, observations, and group sessions. They assessed current behaviours and the factors driving these behaviours in five recommended nurturing care domains essential for a child to both survive and thrive. The study revealed that children were not receiving the nurturing care they needed. Caregiving-related issues identified included poor maternal, child, and family diets; inadequate infant and young child feeding; poor hygiene environment and practices; low use of health and nutrition services; limited responsive care, stimulation and learning opportunities, and early pregnancies. Caregiving determinants included chronic poverty and food insecurity, climate and economic shocks, low access to quality health, nutrition and early childhood development services, poor maternal wellbeing, gender inequality and harmful social norms. The research underscores the need for a multi-sector approach to improve maternal and child nutrition and development. It also stresses the importance of understanding the contextual determinants of caregiving behaviours to inform multi-sector programmes and policies and meet Malawi's Sustainable Development Goals and World Health Assembly targets for maternal and child health, nutrition, and development.
In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children's ecology to provide nurturing care is needed, as is further testing of new ideas.
Constance Sibongile Shumba, Rachel Kimani, Sheila Shaibu et al.
This cross-sectional study examines whether provision of nurturing care in 31 countries over 10 years was associated with improvements in countries’ child development outcomes.
Dana Charles McCoy, Jorge A. Cuartas, Jonathan Seiden
Nurturing care encompasses five components that are crucial for supporting early childhood development: good health, adequate nutrition, opportunities for early learning, responsive caregiving, and safety and security. While there has been increasing attention in global public health towards designing and delivering programs, services, and policies to promote nurturing care, measurement has focused more on the components of health and nutrition, with less attention to early learning, responsive caregiving, and safety and security. We conducted a scoping review to identify articles that measured at least one nurturing care outcome in a sample of caregivers and/or children under-5 years of age in low- and middle-income countries (LMICs). We systematically searched five electronic bibliographic databases for peer-reviewed articles published from database inception until November 30, 2020. We first classified outcomes to their respective nurturing care component, and then applied an inductive approach to organize key constructs within each nurturing care component and the specific measures and indicators used across studies. We identified 239 total articles representing more than 50 LMICs for inclusion in the review. The majority of included studies reported a measure of nutrition (N = 166), early learning (N = 140), and health (N = 102), followed by responsive caregiving (N = 78) and lastly safety and security (N = 45). For each nurturing care component, we uncovered multiple constructs relevant to children under-5: nutrition (e.g., anthropometry, complementary feeding), early learning (e.g., stimulation practices, early childhood education), health (e.g., birth outcomes, morbidity), responsive caregiving (e.g., parental responsivity, parent-child interactions), and safety and security (e.g., discipline, inadequate supervision). Particularly for outcomes of early learning and responsive caregiving, there was greater variability with regards to the measures used, reported indicators, and analytic construction of variables than the other three nurturing care components. This study provides a comprehensive review of the current state of measurement of nurturing care. Additional research is needed in order to establish the most optimal measures and indicators for assessing nurturing care, especially for early learning and responsive caregiving.
Joshua Jeong, Lilia Bliznashka, Eileen Sullivan et al.
Abstract Background Training program for home visitors on early child development was developed and implemented within UNICEF supported projects involving 25 primary health centers. Training content was notably based on resource modules “Supporting Families for Nurturing Care”, adapted according to the local context. Health professionals are seen as the critical actors to support development of young children and their families. Family-centered approach that addresses social as well as medical dimensions of problems became priority in their practice with a special focus on working with children from socially deprived settings and children with disabilities. Objectives The main objective was to improve knowledge and practice of home visitors on early child development based on most recent scientific evidence. Broad spectrum of topics was covered including engaging fathers, early detection of postpartum depression, attachment, developmental monitoring, age-appropriate play, home safety, stigma and discrimination. Training were organized as interactive face to face sessions and online courses and attendees were actively engaged in reflection. Comprehensive check list with various assessment instruments was developed to provide guidance to home visitors in implementation of gained skills. Results Increase in knowledge of 150 home visitors was between 57.6% and 82.9%. Enhanced knowledge and skills have been applied in 14912 families of which socially deprived was 34.5% during 2-year period of implementation. Parent-child interactions, assessed by visiting nurses, were improved by 32.6%, responsive feeding practices by 27.4%, while age-appropriate play by 34.4% after interventions during home visits. Conclusions Well-developed monitoring system was crucial for implementation of gained knowledge and skills in practice of home visitors. Key messages Home visitors were empowered to take a strengths-based approach in their work with families. Developed tools facilitated prioritization of most vulnerable families and tailoring support according to needs.
Svetlana Mladenović Janković, Dušanka Matijević, Gordana Tamburkovski et al.
Research on early childhood development has focused on child health, nutrition and stimulation. However, less attention has been given to the role of caregiver nutrition in shaping caregiving behaviours. Suboptimal caregiver nutrition may impair the ability to provide responsive and nurturing care. This scoping review aimed to summarise the existing evidence on the link between caregiver nutrition and nurturing care, specifically responsive caregiving and early learning opportunities. Database (Medline) and citation searches yielded 23 articles meeting inclusion criteria (n = 17 observational; n = 6 randomised controlled trials [RCTs]). The majority (n = 15) were conducted in low- and middle-income countries. Observational studies measured caregiver anthropometry (n = 8), dietary intakes/diversity/quality (n = 6), anaemia (n = 6) and vitamin B6 status (n = 1). RCTs supplemented pregnant and/or postpartum women with iron (n = 2), multiple micronutrients (n = 2), fish oil (n = 1) and food-based snacks (n = 1). Most articles (n = 18) measured caregiving through live or videotaped observations of caregiver-child interactions; the remaining used caregiver self-reported measures of stimulation or caregiver-child bonding/relationship. Overall, suboptimal diets, food insecurity, caregiver under- and overnutrition, anaemia and low vitamin B6 status were associated with less responsive caregiving and fewer opportunities for early learning. Providing anaemic or food-insecure caregivers with iron or food-based supplements positively altered caregiver-child interactions. Supplementation trials that did not specifically target undernourished caregivers found no effects on caregiving behaviours. More research specifically targeting undernourished caregivers is needed to understand how nutritional interventions might benefit caregiving. Interventions aimed at enhancing nurturing care should consider both caregiver and child nutrition as potential targets to improve outcomes for both children and their caregivers.
Forced displacement worldwide is at its highest in decades and millions of young children are living in conflict zones, in transitional or enduring refugee contexts, and in demographically diverse marginalized and informal settlements. There is a huge unmet need for delivering early childhood development interventions to ensure the safety and continued development of young children in these vulnerable contexts. In this paper, we discuss nurturing care as an important entry point for multisectoral collaborations to support families and reach young children. Nurturing care is a basic right of every child and encompasses health, nutrition, security and safety, responsive caregiving, and early learning. We review key elements of the biological and psychological development of children important to nurturing care and illustrate their application in case studies of war and displacement in Angola and Kenya. Building on long-term benefits of early interventions, scaled up support is essential to improve the health, development, and well-being of young children in contexts of conflict, violence, and insecurity. Not only do early childhood development interventions support the development of young children, but they also provide a potential pathway to violence reduction and a way to achieve more peaceful families, communities, and societies.
Linda Marleine Richter, Stephen James Lye, Kerrie Proulx
ABSTRACT Introduction During the COVID-19 pandemic, there have been drastic changes in family life and programs and services that promote and protect early childhood development. Global stakeholders have raised concerns that the pandemic is putting enormous strain on parents and other caregivers, compromising capabilities and enabling environments for nurturing care of young children and therefore likely impacting children’s development. Methodology This rapid review takes stock of emerging research on nurturing care for young children during the COVID-19 crisis. Two databases were searched in addition to an extensive search for grey literature, drawing on 112 scholarly and scientific studies from more than 30 countries that have examined components of nurturing care during the pandemic, namely: responsive caregiving, early learning and play, and children’s safety and security. Results There are some reports of unexpected positive benefits of the pandemic on families, including increased father involvement in caregiving. But more commonly, the studies’ findings reveal numerous issues of concern, including parental and caregiver mental health difficulties and less responsive parent-child relationships, increased screen time among children, limited opportunities for outdoor play, and fractured systems for responding to potential child neglect and maltreatment. Evidence suggests limited access and challenges in the provision of remote learning for the youngest learners, such as those in early childhood education. Conclusion The findings can inform global stakeholders, who have advocated for increased support and funding to ensure young children and other caregivers are supported and protected during the COVID-19 pandemic. There is an urgent need for action-oriented implementation studies – those that go beyond identifying trends and begin to pinpoint “what works” to effectively promote and protect nurturing care during emergencies such as the COVID-19 pandemic. Key questions What is already known? The most fundamental promotive experiences in the early years of life to reach optimal development come from nurturing care and protection received from parents, family, and community, which have lifelong benefits including improved health and wellbeing. Health and other emergencies are detrimental to the provision of nurturing care. What are the new findings? Findings from this rapid review reveal numerous areas of concern, including families reporting mental health difficulties and less responsive parent-child relationships, increased screen time among children, limited opportunities for outdoor play, and fractured systems for responding to potential child neglect and maltreatment. As with other features of this pandemic, not all families are affected equally: financially vulnerable families are much more likely to experience negative ramifications. The pandemic is also disproportionately affecting parents and other caregivers with young children, particularly mothers, those with pre-existing mental health difficulties, and those caring for children with disabilities. What do the new findings imply? Findings highlight the need for action by governments, civil society, international and community-based organizations to improve support for families so that the pandemic does not break the provision of nurturing care and wipe out decades of progress, especially for vulnerable families and children.
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
Julie Uchitel, Errol R. Alden, Zulfiqar Ahmed Bhutta et al.
