BACKGROUND: Nurturing care, encompassing early learning, responsive caregiving, safety, security, good health, and adequate nutrition, is vital for optimal early child development. The World Health Organization (WHO) has developed the Nurturing Care Framework, which health workers are advised to translate into practice. However, their role in the aspects of early learning, responsive caregiving, and safety and security have not been adequately mapped. This review synthesizes evidence on delivery mechanisms, strategies to strengthen health worker support, and barriers and enablers influencing implementation. METHODS: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched peer-reviewed and grey literature published before 23 April 2025. Inclusion criteria involved literature pertaining to various domains of nurturing care delivered by health workers. Data extraction focused on delivery mechanisms, promotion strategies, and enabling or hindering factors. Analysis was guided by the Nurturing Care Framework and socio-ecological model, using combined inductive and deductive thematic strategies. RESULTS: From 29,997 records, 99 peer-reviewed articles and 14 grey literature reports from 48 countries were included. Common delivery mechanisms were community-based platforms (e.g., home visits, group sessions), facility-based counselling, and blended community-facility based supports or technology-enabled methods. Interventions were primarily delivered by community and primary health workers through task-sharing approaches. Key strategies to enhance support included training and supervision, integration of nurturing care into routine maternal, newborn, child health and nutrition services, and caregiver coaching. Less frequent but influential drivers of scale-up were supportive policies, multi-sectoral collaboration, and digital technologies. Barriers included time constraints, workloads, inadequate training, limited supervision, and restrictive cultural and gender norms affecting caregiver engagement. CONCLUSIONS: Health workers are central to advancing early learning and responsive caregiving within health systems, yet safety and security remains the least institutionalized component of nurturing care. Effective integration requires strengthening frontline worker capacity while embedding interventions into routine services supported by policies, financing, and intersectoral platforms. Without systemic commitments, efforts risk remaining fragmented and unsustainable, limiting their long-term impact on child development.
INTRODUCTION: Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a 'critical window' for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma. METHOD: The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes. ANALYSIS: Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability. ETHICS AND DISSEMINATION: Approval granted from St Vincent's Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.
OBJECTIVE: This study used retrospective linked population data to investigate the impact of early childhood cancer on developmental outcomes. METHODS: Children aged <9 years with a recorded malignant neoplasm were identified in the South Australian Cancer Registry. They were then linked to developmental data recorded in the Australian Early Development Census (AEDC) for the 2009, 2012, and 2015 data collection periods; and assigned five matched controls from the same AEDC year. RESULTS: Between 2000 and 2015, 43 children had a malignant cancer diagnosis and also participated in the AEDC. Compared to controls, childhood cancer survivors exhibited greater developmental vulnerability in their physical health and wellbeing. Between survivors and controls, no significant developmental differences were observed in social, emotional, language and cognitive, and communication and general knowledge domains. Rural or remote location had a significant positive effect on developmental outcomes for childhood cancer survivors relative to controls, suggesting this was a protective factor in terms of physical health and wellbeing, social competence, communication, and general knowledge. Among all children, socioeconomic advantage was linked to better developmental outcomes on all domains except physical health and wellbeing. CONCLUSION: Following an early cancer diagnosis, children may require targeted care to support their physical health and wellbeing. Geographic variation in developmental outcomes indicates remoteness was a protective factor and requires further investigation. This study highlights the feasibility of using administrative whole-population data to investigate cancer outcomes.
Julia N. Morris, David Murray Roder, Deborah A Turnbull et al.
BACKGROUND: Children's early development plays a vital role for maintaining healthy lives and influences future outcomes. It is also heavily affected by community factors which vary geographically. Direct methods do not provide a comprehensive picture of this variation, especially for areas with sparse populations and low data coverage. In the context of Australia, the Australian Early Development Census (AEDC) provides a measure of early child development upon school entry. There are two primary aims of this study: (i) provide improved prevalence estimates of children who are considered as developmentally vulnerable in regions across Australia; (ii) ascertain how social-economic disadvantage partly explains the spatial variation. METHODS: We used Bayesian spatial hierarchical models with the Socio-economic Indexes for Areas (SEIFA) as a covariate to provide improved estimates of all 335 SA3 regions in Australia. The study included 308,953 children involved in the 2018 AEDC where 21.7% of them were considered to be developmentally vulnerable in at least one domain. There are five domains of developmental vulnerability-physical health and wellbeing; social competence; emotional maturity; language and cognitive skills; and communication and general knowledge. RESULTS: There are significant improvements in estimation of the prevalence of developmental vulnerability through incorporating the socio-economic disadvantage in an area. These improvements persist in all five domains-the largest improvements occurred in the Language and Cognitive Skills domain. In addition, our results reveal that there is an important geographical dimension to developmental vulnerability in Australia. CONCLUSION: Sparsely populated areas in sample surveys lead to unreliable direct estimates of the relatively small prevalence of child vulnerability. Bayesian spatial modelling can account for the spatial patterns in childhood vulnerability while including the impact of socio-economic disadvantage on geographic variation. Further investigation, using a broader range of covariates, could shed more light on explaining this spatial variation.
Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The 2012 Australian Early Development Census (AEDC), a population-wide measure of early childhood development, and the Australian Bureau of Statistics Socio-economic Index for Areas Index of Relative Socio-economic Disadvantage were used to select fourteen disadvantaged local communities in five Australian states and territories based on those performing better (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their socio-economic profile. Between 2015-2017, qualitative and quantitative housing data were collected in the local communities. In total, 87 interviews with stakeholders, 30 focus groups with local service providers and parents, and Australian Census dwelling information were analysed. A comparative case study approach was used to examine differences in housing characteristics (e.g., public housing, density, affordability, and tenure) between disadvantaged local communities performing 'better than expected' and 'as expected' on early childhood development. Perceived better housing affordability, objectively measured housing tenure (ownership) and perceived and objectively measured lower-density public housing were housing characteristics that emerged as points of difference for disadvantaged local communities where children had relatively better early childhood development outcomes. These characteristics are potential modifiable and policy sensitive housing levers for reducing early childhood development inequities.
Karen Villanueva, Hannah M Badland, Robert Tanton et al.
Congenital Zika virus syndrome consists of a large spectrum of neurologic abnormalities seen in infants infected with Zika virus in utero. However, little is known about the effects of Zika virus intrauterine infection on the neurocognitive development of children born without birth defects. Using a case-control study design, we investigated the temporal association of a cluster of congenital defects with Zika virus infection. In a nested study, we also assessed the early childhood development of children recruited in the initial study as controls who were born without known birth defects,. We found evidence for an association of congenital defects with both maternal Zika virus seropositivity (time of infection unknown) and symptomatic Zika virus infection during pregnancy. Although the early childhood development assessment found no excess burden of developmental delay associated with maternal Zika virus infection, larger, longer-term studies are needed.
Lorenzo Subissi, Timothée Dub, Marianne Besnard et al.
Music early learning programs (MELPs) that provide music services to parents and carers of children aged birth through 8 years are proliferating. Parents make significant financial and social investments in MELPs, yet little is known of their motivations and aspirations nor of the enduring outcomes of participation. This article reports the findings of an interview study with 10 parents, 1 grandparent, and 8 child former participants in a MELP program in regional Australia that investigated perceptions of MELP participation. Findings indicate that parents come from a range of musical backgrounds. Reasons and aspirations for MELP enrolment encompass developing both parents’ and children’s musical skills, providing social benefits for parent and child, exposure to musical experience, value-adding to their child’s education and expanding the family social circle. Enduring outcomes include developed music knowledge and skills, future investments, physical and emotional development, and new patterns of learning that are potentially transferable. Findings suggest that children arrive at formal schooling with a rich repertoire of music, a capacity to engage in embodied musical experience, and a set of expectations concerning their participation in music. Such knowledge holds implications for the ways in which music learning might be structured within the early childhood classroom.
The development of children’s strengths is essential for their success at school. Processes that assist children to recognise and act on their strengths, collectively referred to as “strengths-based approaches” in this study, are one aspect in the relatively new field of positive education that have been adopted enthusiastically by teachers for their reported constructive purpose and focus on improving student achievement and wellbeing outcomes. In recent years, however, the use of strengths-based approaches in New Zealand schools has moved beyond that warranted by the limited research base. In this study, qualitative data were collected to report on the perceptions and practices of common strengths-based teaching and learning approaches, as described by children, parents and teachers in a New Zealand primary school. Three separate sets of data were collected using a case study approach. The first data set involved 16 ten-year-old children; the second data set involved 15 parents of the child participants; and finally, five teachers of the children involved in the research were participants in the third data set. In light of the paucity of New Zealand studies in strengths-based teaching and learning approaches for children, this study aims to contribute to the knowledge in these areas and identify topics that warrant further investigation.
Enhancing executive function in children and adolescents can have significant positive impact on their current and future daily lives. Upregulation of executive function associated with motor skill acquisition suggests that motor learning scenarios provide valuable developmental opportunities to optimize executive function. The present systematic review aimed to identify key motor learning features that contribute to executive function enhancement in children and adolescents. A January 2024 database search identified 62 eligible studies, involving a total of 4,163 children and adolescents, aged 3–17 years, from developmentally typical (35 studies) and atypical or clinical (27 studies) populations. Schools (51%), sports (22%), laboratory (11%), or home (5%) settings with 8- to 12-week programs for primarily fundamental or perceptual-motor skills but also sport, dance, and musical instrument skills were implemented to evaluate executive function outcomes in domains including working memory (55%), inhibitory control (55%), attention (48%), and cognitive flexibility (41%). Enhanced executive function was most frequently associated with gross and discrete or serial motor skill characteristics, closed or stationary regulatory environments, and variable practice conditions. Studies frequently omitted the assessment of motor learning outcomes or lacked sufficient methodological detail needed to classify motor skill and practice design features that might contribute to executive function enhancement.
Madison Richter, Hassan Mohammad Ali, Maarten A. Immink
Abstract Attention training programs have demonstrated potential for improving select cognitive skills and behaviors in children, but reported benefits are inconsistent. It is unclear whether variability in training benefits can be attributed to differences in children’s learning trajectories on training tasks over the intervention period. This study examined the functional form of learning trajectories on adaptive attention training tasks in primary school children, and potential associations between these learning trajectories and (a) pre-training child characteristics (general cognitive ability, hyperactivity, inattention, age) and (b) outcomes on untrained tasks from pre- to post-training (attention, hyperactivity, inattention). A total of 38 children (5–9 years) completed a 5-week attention training program in class. The training sessions involved four tasks targeting selective attention, sustained attention, inhibition, or interference control. Assessments were conducted pre- and immediately post-training. Based on non-linear mixed-effects models, the learning trajectories were best described by asymptotic regression, where the largest rate of improvement occurred initially, followed by gradual flattening out as task difficulty approached the asymptote. For the sustained attention training task, lower asymptotes predicted larger reductions in hyperactive behaviour from pre- to post-training. For the sustained and selective attention training tasks, age was associated with the asymptotes of the learning trajectories. Collectively, these findings suggest that learning trajectories on certain attention training tasks are associated with select child characteristics and training outcomes. It is of interest for future cognitive training studies to examine the learning trajectories of tasks targeting different skills to contribute understanding of the processes associated with cognitive training outcomes.
Sally Richmond, Hannah Kirk, Kim M. Cornish et al.
