Nurturing care: promoting early childhood development

Reducing childhood externalizing behavior: A feasibility RCT of the being a Parent program

OBJECTIVE

Rising rates of childhood behavioral problems are a global concern and in Portugal cases of behavioral problems in youth have been following international trends. Parenting interventions are widely regarded as one of the most effective ways to address externalizing behaviors early on, and thus their dissemination is crucial. This paper presents a feasibility randomized controlled trial (RCT) conducted in Portugal to evaluate the effectiveness of a parenting intervention for childhood behavioral problems. Our goals were threefold: a) assess feasibility parameters; b) evaluate program fidelity and acceptability; and c) examine the program's potential impact on child behavior, parenting skills, parental concern, and parental competence.

METHOD

A double-blinded, two-arm design was employed. Fifty-five families of children aged 2-11 years old who reported difficulties managing their child's behavior were included. Parents were randomly assigned to either the intervention group or a waitlist control group, and the intervention group participated in the eight-week "Being a Parent" program (Portuguese version: Ser Pai & Ser Mãe). Data were collected at two time points (pre- and post-intervention) using quantitative measures.

RESULTS

Findings confirmed the program's successful implementation in Portugal and demonstrated significant positive effects, particularly in reducing externalizing behavior, as well as aggressive behavior, and increasing parental competence, more specifically parental satisfaction.

CONCLUSIONS

This study represents the first trial of the Being a Parent program conducted outside the UK, and highlights its potential for broader international application. Key challenges and clinical implications are also addressed.

TRIAL REGISTRATION

ClinicalTrials.gov (nº NCT05626244).

"A word that describes it well is 'lonely'" - Experiencing preterm birth during the first COVID-19 lockdown in Germany: A qualitative study

BACKGROUND

During the first pandemic lockdown restrictive regulations were implemented in hospitals. Parents of preterm babies were particularly affected due to a long hospital stay. The aim of this study is to investigate how pandemic regulations during the first lockdown impacted the birth and perinatal experiences of parents of preterm babies.

METHODS

For this qualitative study, we interviewed ten parents who had a preterm baby (28 to 32 gestational weeks) during the first lockdown in Germany. The interviews were analysed using reflexive thematic analysis.

RESULTS

Five themes were identified 1) "Loneliness of pregnant mothers at risk at the maternity ward", highlights the lack of physical and emotional support, intensified by a tense atmosphere at the hospitals 2) "Losing out on meaningful moments" describes the feeling of being cheated of a 'real' birth experience and missing out on the 'normal life at home' with a newborn 3) "Fear as a constant companion" refers to the fear of a COVID-19 infection during the hospital stay and ambivalent feelings upon arriving home 4) "Medical care of preterm infants during the pandemic" emphasizes the gaps in medical care of preterm infants but also underscores what went well despite pandemic restrictions and 5) "Mothers taking action to change hospital regulations" portrays their agency.

CONCLUSION

It is crucial to include scientific, pediatric expertise in future pandemic response planning to rapidly visualize and prevent negative consequences of mitigations measures, such as those described in this study. Protecting elements of family-centered and integrated care should be a priority.

Autonomy and risk perception in Congo Basin developmental systems

This paper explores how cultural learning dynamics shape children's encounters with risk and, through developmental feedbacks, lead to stability or change in community-level risk perception and adaptation. I draw on cultural evolutionary theory to describe trade-offs communities face in shaping how children perceive and encounter risks: between social learning and individual learning; learning via teaching versus situated and collaborative learning; and inter- versus intra-generational social learning. After reviewing theoretical implications of these trade-offs, I examine how they manifest in intensive parenting in the Global North, which emphasizes teaching and vertical transmission (from parents) in children's learning about risk. This case study illustrates the potential for cultural evolution of maladaptive perceptions of risk in the face of environmental change. Then, I use the trade-off framework to analyze time allocation data from children (ages 4-16 years) from two small-scale societies in the Central African Republic, the Aka and the Ngandu. I show that Aka and Ngandu children spend more time with other children than with adults. Bayesian regression modeling further shows that adult availability decreases the probability children engage in risky activities, including work, which is consistent with respect for children's autonomy and an age-graded division of labor. Yet, when adults are available, risky work-but not play or other activities-increases probability of adult intervention, typically to guide children's work, not to avoid risks. Using these case studies, I discuss how autonomy is critical to balancing trade-offs inherent to conservative and rigid culture learning in contexts of local environmental change.

Parenting support in ECEC services: the views of practitioners implementing a model in the Irish context about parents' engagement and associated outcomes

Introduction

Providing parenting support in combination with Early Childhood Education and Care (ECEC) can positively impact children's and families' wellbeing. This study aimed to explore factors potentially affecting parents' engagement in a parenting support model in ECEC services and associated outcomes. This model involves a professional role dedicated to working with parents, the Parent Carer Facilitator (PCF).

Methods

Eight PCFs and seven managers of ECEC services in Ireland implementing this model were interviewed. Data were analysed through thematic analysis.

Results

Four themes were generated: factors related to parents' engagement, approaches to promoting engagement and responsiveness to families' needs, implementation drivers and relevance of the model.

Discussion

Findings indicated that a professional role dedicated to supporting parents within ECEC services, focusing on establishing trusting relationships and tailoring support according to families' needs, can foster parents' engagement in the support offered and positive outcomes regarding parenting and parents-ECEC service relationship.

Postpartum maternal bonding scale: Development and validation in a low- and middle- income country setting

INTRODUCTION

The World Health Organization's Nurturing Care Framework recommends promoting secure postpartum maternal-infant bonding practices through responsive caregiving for healthy child development. Various instruments exist to assess maternal-infant bonding, but they differ in theoretical foundations and constructs, limiting their broad application and comparability. Notably, there is a lack of bonding instruments developed for low- and middle-income countries (LMICs), where children under five are most at risk of not reaching their developmental potential. This paper describes the development and psychometric validation of a conceptually grounded postpartum maternal bonding scale in an LMIC context and highlights its potential applications in similar settings.

METHODS

Based on a literature review of bonding concepts and measurement processes, we developed a postpartum maternal bonding scale using a cultural adaptation model for psychometric instruments for children and adolescents. This involved identifying and reviewing existing bonding-related tools, generating items, iterative rounds of expert reviews, and pretesting with postpartum women. We then conducted a final survey with a large sample of women at 42 days postpartum to establish the scale's psychometric properties. The study was conducted in the Thatta and Sujawal districts of Sindh, Pakistan.

RESULTS

An initial pool of 44 items was developed following a literature review and interviews with postpartum women. After multiple rounds of expert review and cognitive pretesting, a 30-item tool was selected for field testing. Using data from 310 postpartum women, we examined the tool's structure through exploratory (EFA) and confirmatory factor analysis (CFA), leading to a refined 12-item tool. The EFA revealed three factors related to Emotional, Cognitive, and Behavioural bonding. Taking the four highest loading items from each domain, we performed CFA using three models: a first-order model with the three domains, a second-order model, and a bifactor model, which included an overall bonding construct. The bifactor model showed the best fit (comparative fit index =  0.951; root mean square error of approximation =  0.066; standardized root mean square residual =  0.045). This indicates that both an overall bonding construct and specific domains can be measured separately. Pairwise domain correlations were all below 0.67, and internal reliability statistics ranged from 0.63-0.72 (Cronbach's Alpha) and 0.64-0.77 (global omega). Regression analysis showed associations between bonding scores and factors such as cesarean delivery (reduced behavioural bonding score for mothers having caesarean: -0.94, 95% Confidence Interval -1.86 to -0.01, p-value 0.047), maternal disability (reduced overall bonding score for mothers with severe disability -1.54, 95% CI -3.12 to 0.03, p-value 0.054), and probable postpartum depression (reduced overall bonding score in mothers with probable PPD -1.57, 95% CI -2.70 to -0.45, p-value 0.006).

CONCLUSION

The 12-item postpartum maternal bonding scale (PMBS) is a conceptually grounded instrument. It is a brief, easy-to-administer tool with potential cross-cultural use in low- and middle-income settings after cultural adaptation.

Joint parental stimulation and early childhood development in 26 sub-Saharan African countries

BACKGROUND

Engagement in stimulation activities by both parents can have synergistic effects on early childhood development (ECD). While the role of maternal stimulation is well known, the association with paternal stimulation remains underexplored and inconsistent. The current study aimed to assess the distribution of different combinations of maternal and paternal stimulation and explore their associations with ECD in the context of sub-Saharan Africa (SSA).

METHODS

Using the Multiple Indicator Cluster Surveys and Demographic and Health Surveys from 26 SSA countries, we included 69 637 children aged 3-4 years in the analysis. The standardised ECD z-score was constructed using the ECD index. We estimated three-level linear regressions to assess its association with parental engagement in stimulation activities which was classified into four categories: mother low, father low (fewer than four activities); mother high, father low; father high, mother low; mother high, father high. Stratification analyses were conducted to examine whether the association differs by socioeconomic, geographic and learning-related variables.

RESULTS

Only 4% of parents provided high stimulation jointly (both high), which was associated with higher ECD z-score compared with both parents providing low stimulation (both low), after adjusting for covariates (b=0.04, 95% CI=0.01, 0.08). The association between joint parental stimulation and ECD was greater for children from wealthier households compared with their poorer counterparts (interaction p=0.012).

CONCLUSIONS

Children showed better developmental status when both parents jointly provided high stimulation. Policies and interventions should target both mothers and fathers, and transform traditional norms about parenting to achieve the most optimal development outcomes of children.

Bahir Dar Child Development Cross-Sectional Study, Ethiopia: study protocol

INTRODUCTION

Foundational preacademic skills are crucial for academic success and serve as predictors of socioeconomic status, income and access to healthcare. However, there is a gap in our understanding of neurodevelopmental patterns underlying preacademic skills in children across low-income and middle-income countries (LMICs). It is essential to identify primary global and regional factors that drive children's neurodevelopment in LMICs. This study aims to characterise the typical development of healthy children and factors that influence child development in Bahir Dar, Ethiopia.

METHODS AND ANALYSIS

The Bahir Dar Child Development Study is a cross-sectional study implemented in two health centres, Shimbit and Abaymado and in Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Bahir Dar, Amhara, Ethiopia. Healthy children between 6 and 60 months of age will be recruited from the health centres during vaccination visits or via community outreach. Young children aged 6-36 months will complete the Global Scale for Early Development. A battery of paper and tablet-based assessments of neurocognitive outcomes including visual and verbal reasoning, executive functions and school readiness will be completed for children aged 48-60 months. Caregivers will respond to surveys covering sociodemographic information, the child's medical history and nutrition, and psychosocial experiences including parental stress and mental health. During a second visit, participants will undergo a low-field MRI scan using the ultra-low-field point-of-care Hyperfine MRI machine at FHCSH. Analyses will examine relationships between risk and protective factors, brain volumes and neurocognitive/developmental outcomes.

ETHICS AND DISSEMINATION

The study is approved by the Institutional Review Boards of Addis Continental Institute of Public Health (ACIPH/lRERC/004/2023/Al/05-2024), Mass General Brigham Hospital (2022P002539) and Brown University (STUDY00000474). Findings will be disseminated via local dissemination events, international conferences and publications.

TRIAL REGISTERATION NUMBER

NCT06648863.

Economic returns on investing in early childhood development in Vietnam: a cost-benefit analysis

BACKGROUND

Economic evidence on the long-term benefits of investing in early childhood development is limited. This study aimed to estimate the potential long-term economic benefits of an early childhood development intervention 'Learning Clubs' in Vietnam.

METHODS

We conducted a cost-benefit analysis to estimate the costs and benefits of the intervention compared to the standard of care from a limited societal perspective. The intervention cost and child cognitive development outcome were derived from the published 'Learning Clubs' trial-based cost-effectiveness analysis. Benefits were monetised based on the gains in wages associated with improved cognitive development over a lifetime at the population level, using a life-table model. The benefit-cost ratio was estimated as the benefits in wages divided by the intervention cost with a 3% discount rate, assuming nationwide scale up to a hypothetical national birth cohort. Sensitivity, scenario, and threshold analyses were conducted to examine the uncertainty around the model.

RESULTS

The benefit-cost ratio was 5.52, indicating that the expected benefit for each US$1 invested would be US$5.52. The intervention would generate economic benefits of US$1,566 per child over their lifetime. Upon nationwide scale-up, the total benefit would amount to US$2.28 billion per national annual birth cohort. Probabilistic sensitivity analyses estimated the benefit-cost ratio to be 5.90 (95%CI 2.66 to 11.12). The findings were relatively robust as the benefit-cost ratios remained above 1 in all sensitivity and scenario analyses.

CONCLUSIONS

Our findings support greater investments in early childhood development. The Excel-based model is available for further use and adaption to other settings.

Development and validation of the Disrespect and Mistreatment during Childbirth Questionnaire: risk factors and effects on parenting stress

Introduction

A growing body of research indicates that disrespect and mistreatment during childbirth (obstetric mistreatment) are widespread globally. These experiences, along with their prevalence, risk factors, and impacts on maternal mental health, are often assessed using ad hoc tools, highlighting the need for psychometrically valid instruments. This study aims to develop and validate the Disrespect and Mistreatment during Childbirth Questionnaire (DMCQ) and explore factors contributing to negative childbirth experiences, as well as the relationship between mistreatment and parenting stress during the first two postpartum years.

Methods

An online survey was administered to 620 women, assessing sociodemographic and childbirth-related factors, experiences of disrespect and mistreatment during childbirth, postpartum posttraumatic stress symptoms related to childbirth, personality traits, and parenting stress.

Results

Exploratory factor analysis identified a 5-factor model with good internal consistency: negative interactions with healthcare providers, separation from the newborn, medical intrusiveness, verbal mistreatment, and pain experience. Confirmatory factor analysis supported this structure, showing positive correlations with perinatal stress (convergent validity) and no association with openness to experience (divergent validity). Higher scores on the DMCQ correlated with increased parenting stress, particularly distress related to the parental role. Women with higher education, low income, and births in Southern Italy reported greater obstetric mistreatment. Risk factors included primiparity, unplanned cesarean, instrumental delivery, episiotomy, anesthesia, labor exceeding 12 h, and delivery complications.

Discussion

In conclusion, the Disrespect and Mistreatment during Childbirth Questionnaire is a psychometrically valid tool specifically designed to address obstetric mistreatment in the early years postpartum.

Co-Occurrence of Stunting and Off-Track Early Child Development in Low- and Middle-Income Countries

Importance

Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children's potential to thrive.

Objectives

To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors.

Design, Setting, and Participants

This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024.

Exposure

Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics.

Main Outcomes and Measures

Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score <-2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither.

Results

In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only.

Conclusions and Relevance

This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.

Education for family-centred care: A qualitative study with educators of advanced practice child and family health nurses

AIM

Explore academics' perspectives of theoretical and practical education for family-centred care in postgraduate child and family health nursing courses.

BACKGROUND

Education for advanced nursing practice in child and family health relies on understanding underlying principles of care and application in practice. Family-centred care fosters engagement and promotes child and family health and wellbeing. Key to its implementation are principles of creating respectful relationships, ensuring effective communication, supporting autonomy and contextualising care in service provision. However, little is known about how these are addressed in advanced practice nurse education.

DESIGN

Qualitative descriptive study METHODS: Semi-structured interviews with academic coordinators from six Australian universities providing child and family health nurse education were conducted between December 2020-January 2021 and analysed using framework analysis.

RESULTS

Family-centred care was embedded throughout all curricula. However, differences existed in curriculum (entry requirements, duration, delivery mode, practical experience) and employer expectations (qualification requirements, practice scope). Educators aim to ensure students develop core skills for safe, appropriate and responsive care. Although professional standards support family-centred care, they do not routinely guide curriculum development.

CONCLUSIONS

Educational expectations for advanced practice in child and family health nursing reflect local differences. Education for family-centred care predominantly focused on strengths-based and partnership approaches. Aligning agreed practice standards with curriculum design and clinical oversight would enable more consistent practice across the country, even when service structures differ. We encourage educators to address the broader drivers of family-centred care in child and family health nursing education.

The undertold story: A leadership program to expand recognition of the importance of early childhood experiences

There are considerable data documenting the importance of early experiences for healthy human development. Though widely accepted amongst mental health clinicians, developmental researchers and early childhood policymakers, this information is not well known by much of the public. We describe a specialized program designed for established and emerging leaders in Louisiana, United States of America, to help them become better informed to take action to support young children and their families and to facilitate connections across sectors for greater impact. Conducted annually for 6 years, the program drew leaders from a variety of professional sectors working in every region of the state. To evaluate the effectiveness of the program, we conducted semi-structured interviews of program graduates and tabulated responses by thematic analysis. We conclude that translation efforts delivered in this kind of format can lead to gains in knowledge among leaders and action to support early childhood development and well-being.

Efficacy, Feasibility, and Acceptability of an Emotional Competence Tele-Intervention for Mandarin-Speaking Children Aged 5 to 7 Years With Developmental Language Disorder: Pilot Study With an Interrupted Time-Series Design

BACKGROUND

Children with developmental language disorder (DLD) often experience language difficulties that hinder their ability to acquire emotional competence. Poor emotional competence is associated with emotional and behavioral problems in young children.

OBJECTIVE

This research involved two studies focusing on (1) the emotional competence of Mandarin-speaking children aged 5 to 7 years with DLD and (2) the efficacy, feasibility, and acceptability of a tele-intervention designed to enhance their emotional competence in Taiwan.

METHODS

Five children with DLD from study 1 declined to participate in study 2, the emotional competence tele-intervention, and were excluded from the analysis. We compared the emotional competence of 20 Mandarin-speaking children with DLD to that of 24 children with typical language development (TLD). The children with DLD were, on average, aged 5.79 (SD 0.47) years, whereas the children with TLD were, on average, aged 5.93 (SD 0.31) years. We assessed the children's emotional competence, nonverbal ability, verbal comprehension, vocabulary acquisition, and expressive language skills. In study 2, all children with DLD included in study 1 engaged in an emotional competence tele-intervention. An interrupted time-series design was used to examine their emotional competence. In total, 20 children with DLD provided data on emotional competence evaluated using the Emotional Lexicon Test. These data were individually collected at 3 time points after study 1 (time 1). These phases included baseline (time 1 to time 2), during the tele-intervention (time 2 to time 3), and follow-up (time 3 to time 4), spanning approximately 18 to 20 weeks from time 1 to time 4. Recruitment, retention, and attendance rates were calculated to evaluate the intervention's feasibility, and participant mood was evaluated after each session to calculate the intervention's acceptability.

RESULTS

No significant changes in the children's ability to understand basic or complex emotional terms were observed during the baseline period. However, changes were observed during the tele-intervention period, and these changes remained throughout the follow-up period. With a recruitment rate of 80% (20/25), all participants completed 4 intervention sessions, with retention and attendance rates exceeding 95% (19/20). A total of 90% (18/20) of the participants deemed each session to be acceptable.

CONCLUSIONS

Mandarin-speaking children aged 5 to 7 years with DLD exhibited lower emotional competence compared with their counterparts with TLD. Tele-interventions are effective in enhancing the emotional competence of children with DLD, demonstrating feasibility and acceptability for these children and their parents in Taiwan.

Migrant parent-child separation in the first three years of life and mental health problems at preschool age: A cross-sectional study

Background

Parent-child separation is one of the adverse childhood experiences, becoming more common due to economic migration worldwide today. However, there is a lack of understanding of the association between this separation during the critical first three years of life and the development of mental health issues in early childhood. This study aimed to determine the association of parent-child separation in the first three years and its specific patterns with mental health problems that emerged at preschool age.

Methods

We conducted a kindergarten-based parent-reported questionnaire survey in Nanling, Anhui Province, from October 30 to November 3, 2023. Data on parent-child separation in the first three years and its specific patterns concerning parental number, gender, accumulated separation period, and present separation status at preschool age were collected. The parent version of the Strengths and Difficulties Questionnaire (SDQ) was adopted to assess outcomes of interest, including children's total difficulties, internalizing problems, externalizing problems, and pro-social behaviors.

Results

A total of 7487 children from eighty-one kindergartens were included, with a mean (SD) age of 4.2 (0.92) years, and 52.3 % were male. After adjusting for socio-demographic characteristics, compared to non-separation, parent-child separation within the first three years was significantly and positively associated with preschool-aged children's internalizing problems (β = 0.19, [95 % CI, 0.10-0.28]), externalizing problems (β = 0.24, [95 % CI, 0.12- 0.35]), and total difficulties (β = 0.42, [95 % CI, 0.25-0.59]), but not with pro-social behavior. The associations were significant when separated from either one parent or both parents, whether the separation lasted for less than or more than three years in total, and whether the separation occurred previously or persisted into preschool age.

Conclusions

Our findings illustrated the association between early parent-child separation and developing mental health in early childhood, indicating potential opportunities for cost-efficient prevention and intervention for the health and development of vulnerable children separated in the highly mobile society to achieve sustainable development.

Validation of the Global Scales of Early Development (GSED) tool in rural Western Kenya

BACKGROUND

Early childhood development (ECD) is a key determinant of long-term health, education, and wellbeing. However, one major global challenge is the lack of ECD assessment tools validated for use in low- and middle-income countries. To address this gap, the World Health Organization (WHO) launched in 2023 the Global Scales for Early Development, an open-access tool designed to generate reliable, valid, and internationally-comparable data on ECD for children aged 0-3 years globally. In this study, we examined the concurrent and convergent validity of the Global Scales for Early Development-long form (GSED-LF) for use with children aged 0-24 months in Kenya.

METHODS

We analyzed baseline data collected in October-November 2023 as part of a cluster-randomized controlled trial evaluating a parenting program for improving ECD in rural Western Kenya. Primary caregivers (91% mothers) with a child under 24 months were enrolled across 64 villages in Busia and Homabay counties. The GSED-LF was administered to all children (N = 647). In a randomly selected sub-sample of children (N = 116), the Bayley Scales of Infant and Toddler Development (Bayley-III) and the Caregiver Reported Early Development Instruments (CREDI) were also administered to compare their scores with those from the GSED-LF. Concurrent validity of GSED-LF was assessed in terms of its correlations with Bayley-III and CREDI. Convergent validity of GSED-LF was examined with respect to parenting outcomes, including parental stimulation, home caregiving environment, and maternal mental health.

RESULTS

GSED-LF scores had moderate associations with those on the Bayley and CREDI across the domains of cognitive, language, and motor development. GSED-LF had small associations with socioemotional development and relatively weaker concurrent validity for younger children under 12 months. GSED-LF also demonstrated good convergent validity in terms of showing moderate associations with maternal and paternal stimulation and the home caregiving environment.

CONCLUSIONS

Overall, this study demonstrated the feasibility and initial validity of the GSED-LF as a direct assessment tool for use in rural Western Kenya. Additional psychometric analyses across diverse settings are needed to strengthen the reliability and validity evidence of the GSED-LF and establish it as a robust, globallyapplicable tool for assessing ECD in resource-limited settings.

Development and validation of the Parent-Reported Indicator of Developmental Evaluation for Chinese Children (PRIDE) tool

BACKGROUND

Developmental delay (DD) poses challenges to children's overall development, necessitating early detection and intervention. Existing screening tools in China focus mainly on children with developmental issues in two or more domains, diagnosed as global developmental delay (GDD). However, the recent rise of early childhood development (ECD) concepts has expanded the focus to include not only those with severe brain development impairments but also children who lag in specific domains due to various social-environmental factors, with the aim of promoting positive development through active intervention. To support this approach, corresponding screening tools need to be developed.

METHODS

The current study used a two-phase design to develop and validate the Parent-Reported Indicator of Developmental Evaluation for Chinese Children (PRIDE) tool. In Phase 1, age-specific milestone forms for PRIDE were created through a survey conducted in urban and rural primary care clinics across four economic regions in China. In Phase 2, PRIDE was validated in a community-based sample. Sensitivity and specificity of both PRIDE and Ages and Stages Questionnaires (ASQ)-3 were estimated using inverse probability weights (IPW) and multiple imputation (MI) to address planned and unplanned missing data.

RESULTS

In Phase 1 involving a total of 1160 participants aged 1 to 48 months, 63 items were selected from the initial item pool to create 10 age-specific PRIDE forms. Our Phase 2 study included 777 children within the same age range. PRIDE demonstrated an estimated sensitivity and specificity of 83.3% [95% confidence interval (CI): 56.8%-100.0%] and 84.9% (95% CI: 82.8%-86.9%) in the identification of DD.

CONCLUSION

The findings suggest that PRIDE holds promise as a sensitive tool for detecting DD in community settings.

Effectiveness of a universal film intervention in reducing violence against children and increasing positive parenting among migrant and displaced caregivers from Myanmar: a community-based cluster randomised trial

Background

Parenting interventions have been shown to reduce violence against children and promote positive parenting, but evidence on interventions to achieve population-level reach and impact is limited in low-resource settings. We assessed the impact of a universal film intervention for migrant and displaced caregivers from Myanmar living in Thailand.

Methods

We implemented a two-arm, cluster randomised trial in Tak province, Thailand, on the border with Myanmar. 44 communities were stratified by district and randomly allocated to intervention or control (1:1) using a computer-generated list of random numbers. Intervention group participants received a screening of a 66-min narrative drama film about parenting, followed by a 30-40-min discussion and a 5-min video and poster summarising key messages. Control group participants received information about local health and social services. Eligible participants were primary caregivers aged 18 years or older with a child aged 4-17 years at enrolment. Participants were surveyed at baseline, endline approximately 4 weeks post-intervention, and follow-up approximately 4 months post-intervention. Primary outcomes were caregiver self-reported use of physical and psychological violence and positive parenting, analysed using both imputed and non-imputed multilevel models estimating differences between study arms at endline and follow-up. Due to the nature of the intervention, participants and assessors were not masked. The trial was prospectively registered with Thai Clinical Trials Registry TCTR20230222005.

Findings

Between February and June 2023, 2249 participants in 44 communities completed baseline assessments and were randomly assigned to intervention (n = 1116) and control (n = 1133). 2023 caregivers (n = 998 in intervention and n = 1025 in control) completed the four-week endline survey and 1909 caregivers (n = 961 in intervention and n = 948 in control) completed the four-month follow-up. Intention to treat analyses showed the intervention reduced physical violence (IRR 0.91, 95% CI 0.85-0.97) and increased positive parenting (β 0.46, 95% CI -0.03 to 0.95). No meaningful differences were observed for psychological violence between intervention and control groups, with imprecisely estimated effects close to zero (β 0.47, 95% CI -0.62 to 1.57). Small effects were observed for the secondary and exploratory outcomes of parenting knowledge, belief in the need for harsh punishment, engagement in early learning, family functioning, and social support. Subgroup analyses suggest that the intervention may be more effective at reducing physical violence among female caregivers and caregivers of female children and younger children. There were no reported adverse effects.

Interpretation

Universal parenting interventions using a film-based entertainment-education approach can effectively reduce physical violence against children and increase positive parenting, with potential for scalability in low-resource settings.

Funding

This study is part of the Global Parenting Initiative, which is funded by The LEGO Foundation, Oak Foundation, the World Childhood Foundation, The Human Safety Net, and the UK Research and Innovation Global Challenges Research Fund ((ES/S008101/1).

Parent-Child Interaction Therapy for Disruptive Behavior: A Systematic Review of Effectiveness in Different Settings

Background: Parent-child interaction therapy (PCIT) is an evidence-based intervention for children with behavioral problems. This systematic review assesses the efficacy of PCIT in reducing disruptive behavior problems (DBPs) by analyzing outcomes across diverse populations and settings. Methods: Studies were identified through an online search of the PubMed, Web of Science, Cochrane Library, and Embase databases, with a search period ranging from 2014 to 2024. This review was registered on Open OSF (n) TVFQ5. Results: Research studies demonstrate that PCIT is effective across a variety of DBP conditions, showing significant reductions in child behavioral problems and parenting stress. PCIT's adaptability, effectiveness, and potential for widespread use have been validated in both specialized and community settings, including diverse and high-risk populations. Conclusions: This systematic review highlights PCIT's overall effectiveness in reducing disruptive behaviors and improving parent-child relationships across diverse settings and populations. It emphasizes the need for further research into its long-term efficacy, adaptability in multicultural contexts, and potential integration with technology for enhanced dissemination and effectiveness.

Cultural foundations of global health: a critical examination of universal child feeding recommendations

There has been a rising call to decolonize global health so that it more fully includes the concerns, knowledge, and research from people all over the world. This endeavor can only succeed, we argue, if we also recognize that much of established global health doctrine is rooted in Euro-American beliefs, values, and practice rather than being culturally neutral. This paper examines the cultural biases of child feeding recommendations as a case in point. We argue that the global promotion of Responsive Feeding-a set of allegedly best practices for child feeding promulgated by the WHO and others-is based on a tacit conviction that certain Western middle-class feeding practices are universally best, along with a promise that future evidence will demonstrate their superiority. These recommendations denounce feeding practices that diverge from this style as Non-Responsive Feeding, thereby pathologizing the many valued ways of feeding children in communities all over the world without sound scientific evidence. Drawing on ethnographic research, we show that there is a wide variety in feeding practices around the world and these are closely interlinked with the understandings and priorities of caregivers, as well as with favored forms of relationships and ways of maintaining them. For global health nutrition interventions to be justified and effective, they would need to be based on more pertinent, culturally responsive research than they currently are. We suggest the use of ethnographic research as an important tool in building empirically grounded, epistemically inclusive, and locally meaningful approaches to improving nutritional support for children in communities around the world and to global health efforts more broadly.

Parenting in the Digital Age: A Scoping Review of Digital Early Childhood Parenting Interventions in Low- and Middle-Income Countries (LMIC)

Objectives

This scoping review examines the evidence and knowledge gaps regarding the effectiveness of digital early childhood parenting interventions in Low- and Middle-Income Countries (LMICs).

Methods

Using PRISMA-ScR and PICOS frameworks, we systematically reviewed studies published since 2010 from four databases, focusing on the impact of digital parenting interventions on Early Childhood Development and parent-level outcomes.

Results

Of 1,399 studies identified, 13 met inclusion criteria, evaluating digital interventions for parents of children aged 0-5 years. These interventions included digital-only and hybrid approaches, leveraging technologies for tasks such as sharing health and ECD information, reminders, group chats, or screening. Among ECD studies, three of four with parent-reported outcomes found positive effects, but none of three using direct assessments did. Parent-level outcomes, such as mental health and parenting behaviors, showed consistent positive impacts.

Conclusion

Digital parenting interventions are feasible in LMICs but face challenges in implementation and reaching vulnerable families. Most studies are small-scale with variable designs and outcomes. Rigorous, high-quality studies are needed to establish effectiveness and optimize implementation strategies before these programs are deployed at scale.

Serum metabolome indicators of early childhood development in the Brazilian National Survey on Child Nutrition (ENANI-2019)

Background

The role of circulating metabolites on child development is understudied. We investigated associations between children's serum metabolome and early childhood development (ECD).

Methods

Untargeted metabolomics was performed on serum samples of 5004 children aged 6-59 months, a subset of participants from the Brazilian National Survey on Child Nutrition (ENANI-2019). ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. The graded response model was used to estimate developmental age. Developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Partial least square regression selected metabolites with a variable importance projection ≥1. The interaction between significant metabolites and the child's age was tested.

Results

Twenty-eight top-ranked metabolites were included in linear regression models adjusted for the child's nutritional status, diet quality, and infant age. Cresol sulfate (β=-0.07; adjusted-p <0.001), hippuric acid (β=-0.06; adjusted-p <0.001), phenylacetylglutamine (β=-0.06; adjusted-p <0.001), and trimethylamine-N-oxide (β=-0.05; adjusted-p=0.002) showed inverse associations with DQ. We observed opposite directions in the association of DQ for creatinine (for children aged -1 SD: β=-0.05; pP=0.01;+1 SD: β=0.05; p=0.02) and methylhistidine (-1 SD: β = - 0.04; p=0.04;+1 SD: β=0.04; p=0.03).

Conclusions

Serum biomarkers, including dietary and microbial-derived metabolites involved in the gut-brain axis, may potentially be used to track children at risk for developmental delays.

Funding

Supported by the Brazilian Ministry of Health and the Brazilian National Research Council.

A community-based intervention (the Omama Project) improves neurodevelopment in impoverished 2-year-old Roma children: a quasi-experimental observational study

High rates of childhood neurodisability are reported among the Roma, Europe's largest ethnic minority community. Interventions targeting early child development (ECD) during the first 2 years of life can improve neurodevelopmental outcomes in vulnerable children; however, evidence from Roma preschoolers is scarce. In a quasi-experimental observational study, we compared neurodevelopmental outcomes at age 2 years, measured on the INTERGROWTH-21st Project Neurodevelopmental Assessment (INTER-NDA), between Roma children receiving a community-based ECD intervention (RI, n = 98), and age- and sex-matched Roma and non-Roma children (RC, n = 99 and NRC, n = 54, respectively) who did not receive the intervention in Eastern Slovakia. The intervention was delivered between 3 weeks and 20 months in weekly home-based sessions by trained Roma women from matched settlements to RIs. Compared with RC, RI had higher 2-year cognitive (B = 0.15; 95% CI, 0.04, 0.25), language (B = 0.25; 95% CI, 0.11, 0.38) and fine motor (B = 0.08; 95% CI, 0.01, 0.16) scores. After adjustment for covariates, cognitive delay decreased by 88% in RI compared with RC (aOR, 0.12; 95% CI, 0.03, 0.53). Linear growth at 24 months was a key predictor of developmental scores for both groups (range, B = 0.04-0.14; 95% CI, 0.01, 0.07 and 0.09, 0.20).

CONCLUSIONS

Our results highlight that, without directly intervening on nutritional and poverty status, a community-based ECD intervention, delivered by trained Roma women to Roma children, can significantly improve neurodevelopmental outcomes at age 2 years.

WHAT IS KNOWN

• The Roma are Europe's largest ethnic minority. High rates of neurodisability, malnutrition and poverty are reported in Roma preschoolers. • Optimal early child development (ECD) is foundational to lifecourse health and wellbeing. Early interventions improve ECD outcomes in vulnerable children; however, evidence from Roma communities is limited.

WHAT IS NEW

• The Omama project is a community-based ECD intervention, delivered by trained Roma women to Roma children aged 3 weeks to 20 months living in impoverished settlements in Eastern Slovakia. • Roma children receiving the intervention had (i) higher cognitive, language and fine motor scores and (ii) lower rates of cognitive delay compared with controls.

Constraints to Child Language Development in Peri-Urban and Rural Areas: A Mixed-Methods Analysis From Southwestern China

PURPOSE

This mixed-methods study examined how differences in parental time, knowledge, and economic constraints, as well as community socioeconomic contexts, may contribute to differences in home language environment and child language ability outcomes between peri-urban and rural households in China.

METHOD

We conducted an explanatory sequential mixed-methods analysis using data from 158 children aged 18-24 months among peri-urban and rural households with low socioeconomic status (SES) in southwestern China. Audio recordings were collected from each household and analyzed using the Language ENvironment Analysis system. The Mandarin version of the MacArthur-Bates Communicative Development Inventories was administered to each child's primary caregiver. We also conducted qualitative interviews with primary caregivers in 31 peri-urban and 32 rural households. Interviews were recorded, transcribed, and coded.

RESULTS

The quantitative results reveal that children in peri-urban households heard less adult speech and had lower language ability than children in rural households. Directed content analysis of interviews found that peri-urban caregivers faced more severe time constraints and less favorable community socioeconomic contexts than rural primary caregivers. Taken together, these findings suggest that differences in time constraints and community socioeconomic contexts between the two populations are the most likely factors contributing to the inferior language environment and language ability among children in peri-urban households.

CONCLUSION

The mixed-methods study indicated that parental time constraints and community socioeconomic contexts should be considered alongside SES for a comprehensive understanding of factors influencing parental investment in the home language environment in China.

Social vulnerability among Brazilian children in early childhood: a scoping review

OBJECTIVE

To identify, map, and describe studies involving Brazilian children in early childhood in situations of social vulnerability.

SOURCE OF DATA

A scoping review including full articles published in Portuguese and English up to March 2023, with no temporal restrictions. Searches were conducted in the MEDLINE/PubMed, Scielo, EMBASE, Cochrane, Scopus, CINAHL, Web of Science, PEDro, and LILACS databases. Journal metrics, sample characteristics, study area, characterization of the situation of social vulnerability, and study outcomes were extracted.

SUMMARY OF THE FINDINGS

Seventy-six articles involving a total of 107.740 children in early childhood were included in this study. These studies presented relevant findings, including the temporal publication trend, the variability of social vulnerability indicators, the scarcity of intervention studies, and the fact that 100% of eligible studies were from the health area. Negative outcomes were associated with the condition of social vulnerability in almost the entire sample, reinforcing the need for government policies capable of protecting early childhood from the effects of social vulnerability.

CONCLUSION

This scoping review mapped important findings involving Brazilian children in social vulnerability. It also identified literature gaps such as the need for intervention and multisectoral studies among health, education, and social protection.

Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources

BACKGROUND

An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families.

OBJECTIVE

This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions.

METHODS

We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale.

RESULTS

The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=-4.35, P<.001; digital resources; t67=-4.95, P<.001).

CONCLUSIONS

The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped.

Development and validation of the social determinants of health screening scale-parent form

BACKGROUND

The American Academy of Pediatrics recommends screening children for social determinants of health (SDOH).

PURPOSE

This study aimed to develop a valid and reliable tool for screening SDOH in children and adolescents aged 0-18 through their parents.

DESIGN AND METHODS

This methodological research was conducted with parents of 748 children admitted to a hospital in Turkey. An item pool was created from a literature review and interviews with 30 healthcare professionals. The scale's validity and reliability were tested through pilot and main applications.

RESULTS

The scale, with 33 items across five factors, explained 57.256 % of total variability. Confirmatory factor analysis showed significant model fit (RMSEA = 0.052, χ2/df = 2.013). Cronbach's Alpha ranged from 0.646 to 0.909 for sub-dimensions, and 0.886 overall.

CONCLUSION

The scale is a valid and reliable tool for screening SDOH in children and adolescents through their parents and can be used in academic research and clinical practice.

PRACTICE IMPLICATIONS

The scale provides healthcare professionals with a practical tool for assessing social determinants of health in pediatric populations, facilitating early identification and intervention in both clinical settings and research applications.

Using concept mapping to co-create implementation strategies to address maternal-child food insecurity during the first 1000 days of life

Food insecurity (FI) has short- and long-term effects on maternal and child health, with persistent inequities within under-resourced communities of colour (e.g., Hispanic and Non-Hispanic Black). Interventions to mitigate maternal-child FI must engage the voices of under-resourced communities of colour to improve implementation and tackle socio-ecological drivers of inequities, leading to positive maternal-child outcomes. This exploratory sequential mixed-methods study aimed to co-create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under-resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two-step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus-building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio-ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co-creation of a culturally sensitive intervention to reduce inequities in maternal-child FI during the first 1000 days of life requires multi-level strategies across three socio-ecological levels in under-resourced communities of colour in Las Vegas.

Effect of a youth-led early childhood care and education programme on children's development and learning in rural Sindh, Pakistan (LEAPS): a stepped-wedge cluster-randomised implementation trial

BACKGROUND

In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18-24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan.

METHODS

We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18-24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5-5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5-5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with ClinicalTrials.gov (NCT03764436).

FINDINGS

LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12-20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20-0·40]; p<0·0001) as compared with the control condition.

INTERPRETATION

LEAPS offers a scalable solution to expand access to high-quality ECCE and promote children's school readiness while providing employment for female youth in rural Pakistan and settings with similarly low ECCE participation.

FUNDING

Dubai Cares; and Saving Brains, Grand Challenges Canada.

TRANSLATION

For the Urdu translation of the abstract see Supplementary Materials section.

COVID-19 pandemic and the neurodevelopment of Brazilian infants: Analysis of predictors according to the Nurturing Care Framework

INTRODUCTION

Concerns have been raised about the potential negative impacts of the COVID-19 pandemic on child development; this issue can be analyzed using the Nurturing Care Framework (NCF).

OBJECTIVE

To analyze the predictors of neurodevelopment at 12 months in infants born during the pandemic in Brazil, according to the NCF.

METHODS

It is a longitudinal case-control study involving 284 infants born between April and August 2021. Mothers were interviewed at birth and at six months postpartum. At 12 months, the infants' neurodevelopment was assessed using the Bayley III Scale. The explanatory variables were grouped according to NCF components, and their association with Bayley III results was examined using hierarchical logistic regression, adjusting for socioeconomic status and gestational exposure to SARS-CoV-2.

RESULTS

Twenty percent of the sample exhibited delays in at least one Bayley III domain (3% cognitive, 16 % language, and 7 % motor). We found an increased risk of cognitive (OR = 5.78; 95 % CI 1.07-31.09) and motor delays (OR = 6.97; 95 % CI 2.17-22.38) for children who had not undergone regular well-child care in their first six months. The likelihood of a child showing some delay at 12 months was 2.23 times higher when the mother reported concerns about the child's development at six months (95 % CI 1.11-4.50).

CONCLUSION

Well-child care emerged as a protective factor against cognitive and motor delays, while the mother's concerns were predictive of future developmental issues.

Factors associated with early childhood development: results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

Introduction

The full achievement of early childhood development (ECD) is a human right and adhering to the nurturing care framework may facilitate it.

Objective

To evaluate the association between distal and proximal variables and developmental quotient (DQ).

Methods

Data from 14 159 children <5 years were evaluated in the Brazilian National Survey on Child Nutrition. The Survey of Well-being of Young Children-Brazilian version milestones questionnaire was used to evaluate ECD. The developmental age was estimated using the graded response models. DQ was calculated by dividing developmental age by chronological age. The expected age milestones are attained when DQ=1. DQ predictors were defined considering distal and proximal levels/variables using a multiple linear regression model and a hierarchical approach.

Results

The DQ mean was significantly lower among children aged 36-59 months (0.91 (0.88 to 0.93)), boys (1.03 (1.01 to 1.06)) and those from the North region (0.98 (0.93 to 1.04)) compared with children aged 1-35 months (1.18 (1.15 to 1.22)), girls (1.11 (1.08 to 1.13)) and from the Southeast region (1.11 (1.07 to 1.16)). For children aged 1-35 months, DQ was inversely associated with emergency C-section (β=-0.08; p<0.01), consumption of ultra-processed food (β=-0.33; p<0.01), and positively associated with attendance at daycare/school (private: β=0.09; p=0.02 and No: β=0.12; p<0.01). For children aged 36-59 months, attendance to private daycare/school (β=0.08; p<0.01) was positively associated with DQ, and small for gestational age at birth (β=-0.05; p=0.01) and access to public health services (no-primary care) (β=-0.07; p<0.01) were inversely associated with DQ.

Conclusions

Adverse health, nutrition and learning factors predicted the ECD, demonstrating an inequitable environment for Brazilian children. These findings indicate a need for public policies to ensure social and health equity in early childhood.

Assessing the impact of the Aarambh nurturing care model on the capacity & support structures for caregiver empowerment: A qualitative study

Background & objectives The provision of nurturing care during the crucial developing phase from pregnancy to three years is essential for enduring health. The Aarambh project, executed in specific districts of Central India, utilised existing Integrated Child Development Scheme (ICDS) and healthcare facilities to improve nurturing care. This study assessed the influence of loving care interventions on the skills, functionality, and support systems of anganwadi workers (AWWs) to enhance the capabilities of primary carers. Methods This qualitative study evaluated the competencies of AWWs by observing house visits and mothers' meetings in both control (Deoli, Wardha) and intervention blocks (Ralegaon, Yavatmal), Maharashtra. Comprehensive interviews were performed with AWWs, primary carers, ICDS supervisors, CDPOs, ASHAs, and parents. Results AWWs in the intervention group exhibited substantial enhancements in providing age-appropriate guidance, play, and communication activities along with effective community-based events. Interpretation & conclusions The findings of this study suggest empowerment of beneficiaries and child development through this discussed programme framework. In light of this, it is apparent that the soft skills of service providers hold paramount importance for achieving sustainable outcomes.

Parenting with nutrition education and unconditional cash reduce maternal depressive symptoms and improve quality of life: findings from a cluster randomised controlled trial in urban Bangladesh

BACKGROUND

Maternal post-natal depression is a global public health problem. Parenting interventions targeting children's development may also bring benefits to mothers, but few parenting interventions have been studied thoroughly.

OBJECTIVES

The study aimed to measure the effect of a parenting intervention using culturally appropriate and locally made toys, along with nutrition education and unconditional cash, on maternal depressive symptoms (MDS) and quality of life (QoL).

METHODS

The study was a cluster randomised controlled trial with two arms: i) intervention: parenting with nutrition education and unconditional cash and ii) comparison: unconditional cash in an urban setting in Bangladesh. Twenty clusters were randomised to either the intervention or control group. Community Health Workers (CHWs) delivered parenting and nutrition education sessions fortnightly in households for one year. The participants were mother-child (6-16 months) dyads. The MDS and QoL were measured using the Self-Reporting Questionnaire-20 and a brief version of the QoL questionnaire. Linear regression analysis was used to assess the treatment effects.

RESULTS

After one year of intervention, 547 mothers (93%) completed the study. The mothers in the intervention group had lower MDS [Regression coefficient (β)=-1.53, Confidence interval (95% CI)=-2.28, -0.80] and higher QoL scores in physical health [β = 4.21 (95% CI = 1.71, 6.73)], psychological health [β = 3.14 (95% CI = 1.10, 5.19)], social relationships [β = 3.21 (95% CI = 0.76, 5.66)] and environment [β = 3.40 (95% CI = 1.37, 5.44)] compared with the comparison group.

CONCLUSION

Parenting interventions including nutrition education and unconditional cash, aimed at improving children's development, resulted in a reduction in maternal depressive symptoms and improvement in quality of life.

Blueprint for Enhancing Implementation Quality of Criança Feliz Program in Brazil: A Combined Program Impact Pathways-ERIC Approach

Brazil's Criança Feliz Program is one of the largest early childhood development home-visiting programs globally. After seven years of scaling up, implementation barriers across diverse municipality settings prevented the program from achieving the intended impact on parenting skills and child development. We conducted a program impact pathway analysis to generate a blueprint to enhance implementation quality by (1) identifying the critical quality control points that need to be monitored throughout the scaling up and (2) specifying implementation strategies for enhancing implementation quality. The program impact pathway analysis consisted of inductive and deductive coding of pre-existing retrospective (e.g. reports, and codebooks from in-depth interviews) and workshop with national team to identify the critical quality control points and corresponding implementation barriers and facilitators. The Expert Recommendations for Implementation Change taxonomy was used to specify implementation strategies facilitating the scaling up or opportunities to address barriers across critical quality control points. We identified seven critical quality control points: hiring municipal workforce; staff training; home visits; complementary multisectoral actions; municipal supervision; technical assistance and monitoring; and funding. Implementation strategies facilitating the scale-up were "providing assistance" and "supporting teams;" opportunities for enhancing implementation quality were "financial strategies" and "evaluative and iterative strategies." Our analysis identified seven critical quality control points necessary to achieve the intended implementation and program outcomes. The combined use of the program impact pathway and the Expert Recommendations for Implementation Change taxonomy generated a meaningful blueprint of implementation strategies to enhance implementation quality, which may support the sustainability of a large-scale program.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43477-024-00141-7.

Division of childcare policy actors under health-oriented goals: thematic analysis of China's policy texts from the social constructionist perspective

Background

Ensuring child health, as a key objective of global childcare policies, requires coordinated efforts between the government, social organizations and communities, institutions, and families. Despite China's progress in comprehensive childcare policy development, rapid economic growth, and urbanization, challenges persist, such as urban-rural disparities and unequal resource distribution, highlighting the need for effective collaboration between policy actors.

Methods

To collect textual data, this study searched for prefectural-level childcare policy texts issued since 2019 on government websites and legal databases, ultimately identifying 224 documents for analysis. This study reviewed the literature on the impact of childcare policies on child health and identified the enhancement of childcare quality as a current research focus. This study then conducted a content analysis using Nvivo12 Plus software and coded and analyzed the childcare policy content. Finally, it applied social construction theory to interpret the policy documents.

Results

Childcare policies were centered around child health and formed a responsibility and accountability framework between the government, social organizations and communities, institutions, and families, whose action shares accounted for 38.9, 22.89, 29.05, and 9.16%, respectively. The development of childcare institutions was a key aspect of the defamilialization trend. Compared to other policy actors, institutions played a larger role in child health policy aspects such as safety management (12.97%), health and hygiene (8.56%), and scientific parenting (10.93%).

Conclusion

Within China's health-oriented framework, the refamilialization and defamilialization processes coexist in terms of childcare policies, and limited community-based childcare resources extend beyond the family. The participation of diverse policy actors in China's childcare system is expected to persist, underscoring the increased need to enhance the policy actors' negotiation skills and bolster community-based childcare services in the future.

The influence of early childhood education and care on the relation between early-life social adversity and children's mental health in the environmental influences for Child Health Outcomes Program

Early adversity increases risk for child mental health difficulties. Stressors in the home environment (e.g., parental mental illness, household socioeconomic challenges) may be particularly impactful. Attending out-of-home childcare may buffer or magnify negative effects of such exposures. Using a longitudinal observational design, we leveraged data from the NIH Environmental influences on Child Health Outcomes Program to test whether number of hours in childcare, defined as 1) any type of nonparental care and 2) center-based care specifically, was associated with child mental health, including via buffering or magnifying associations between early exposure to psychosocial and socioeconomic risks (age 0-3 years) and later internalizing and externalizing symptoms (age 3-5.5 years), in a diverse sample of N = 2,024 parent-child dyads. In linear regression models, childcare participation was not associated with mental health outcomes, nor did we observe an impact of childcare attendance on associations between risk exposures and symptoms. Psychosocial and socioeconomic risks had interactive effects on internalizing and externalizing symptoms. Overall, the findings did not indicate that childcare attendance positively or negatively influenced child mental health and suggested that psychosocial and socioeconomic adversity may need to be considered as separate exposures to understand child mental health risk in early life.

The paternal influence on early childhood development in Africa: implications for child and adolescent mental health

This commentary examines the influence of fathers in early childhood development in Africa and its implications for child and adolescent mental health. Historically overshadowed by maternal influence, research increasingly highlights the multifaceted impact of paternal involvement on children's cognitive, emotional, social, and behavioural development. Fathers contribute uniquely to children's mental growth through stimulating play and rich language interaction. Their emotional engagement fosters children's self-esteem and resilience. Moreover, fathers influence social skills by modelling interactions and encouraging exploration. Paternal involvement is linked to improved behaviour regulation. Beyond direct interaction, factors such as paternal mental health, economic stability, and co-parenting dynamics also shape child outcomes. Despite the impact of engaged fatherhood on children's cognitive, emotional, and social development, many fathers encounter barriers such as economic pressures, cultural norms, and migration. These challenges often hinder their ability to participate actively in their children's lives, resulting in a disconnect that can affect family dynamics and child well-being. Addressing cultural and societal barriers to father involvement is crucial to optimise child development. To address these issues, the paper outlines several key policy implications aimed at promoting paternal involvement. This commentary serves as a foundation for further exploration of fathers' complex and vital role in shaping children's lives.

Associations between sociodemographic exposures, growth and development during infancy with development at the age of eight years among children: Analysis of a maternal education trial in rural Uganda

Background

Links between early life exposures and child development later in life are not sufficiently explored in low- and middle-income countries. We studied associations between sociodemographic variables, growth and development at six to eight months with developmental outcomes at eight years.

Methods

We used data from a maternal education trial which included 511 mother-infant pairs at children's age of six to eight months (baseline). In this follow-up study, data from 361 mother-child pairs were available. Questionnaires were used to collect sociodemographic variables. Growth (anthropometry) was measured by study personnel and converted to z-scores according to the World Health Organization (WHO) growth reference. Child development (cognitive, motor and language) at baseline was assessed using Bayley Scales of Infant and Todler Development, third edition (BSID-III). Development at eight years was measured using two neuropsychological tools: Kaufman Assessment Battery for Children Second Edition (KABC-II) and Test of Variables of Attention (TOVA).

Results

Higher weight-for-age z-scores (adjusted odds ratio (aOR) = 0.74; 95% confidence interval (CI) = 0.53, 0.98; P = 0.04), better maternal education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03). and better household head education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03) at six to eight months of age were associated with lower odds of scoring below average on KABC-II categorical scores at eight years of age. Motor composite scores and maternal parity at six to eight months of age were positively associated with auditory and visual TOVA scores (all P-values <0.05) at eight years. Cognitive composite scores at six to eight months of age were positively associated with visual TOVA scores (P < 0.05). In contrast, weight-for-length z-scores and household head age were negatively associated with both auditory and visual TOVA scores (P < 0.05). Being a female child was associated with lower auditory and visual TOVA scores (P < 0.05).

Conclusions

At six to eight months of age, growth and development, gender, maternal education and parity, and household head age and education were associated with child development at eight years. Interventions emphasising improved growth and development in infancy, as well as parental educational attainment, may improve long-term developmental outcomes.

Collaborative extended home-visits as a key to facilitating early support within the frame of a family centre in Sweden

BACKGROUND

All children should have the possibility to be healthy during childhood, according to the Convention on the Rights of the Child. In Sweden, the Child Health Services (CHS) support all parents and children from birth until the age of six to promote children's health and development. Some Swedish regions have introduced an extended home-visit programme, with CHS nurses and social workers visiting first-time parents together to provide parental support in collaboration. The programme aims to expand the task of promoting the child's health and increase the possibilities of discovering risk factors in families earlier. The aim of the present study is to describe the professionals' experiences of collaboration when introducing the extended home-visit programme to a broader population within the frame of a family centre.

METHODS

The study used a reflexive thematic qualitative approach with focus group interviews. All staff at the family centre were invited to participate: CHS nurses, social workers, and managers who worked with the extended home-visit programme. Data were collected through focus group interviews with each profession separately and analysed through reflexive thematic analysis.

RESULTS

One overarching theme emerged: A key to facilitating early support. Three connected themes - Ease for everyone on the family's terms, From working alone to becoming a team, and A matter of supporting structures - illuminated the participants' experiences. Their driving force was early detection of risk factors or needs in the family, to be able to provide support. The collaboration was enhanced by the different professional competencies complementing each other. That all were located at the family centre together was also important to facilitate collaboration.

CONCLUSIONS

The extended home-visits were appreciated and experienced as useful by all participants. That a family centre organization already existed was one of the facilitators, functioning as a meeting point to expand the collaboration. The managers' support was essential, and it was experienced as positive that the organization invested resources to allow employees to participate in the development of the extended home-visit programmes. This way of working has the potential to add value for the children and families, and the CHS would benefit from using the extended home-visit programme further.

Emergence and evolution of developmental resilience science over half a century

This reflection on the history and future of developmental resilience science (DRS) highlights its co-emergence with developmental psychopathology (DP), as well as the roles of this journal and its founding editor, Dante Cicchetti, in the evolution of these intertwined domains of scholarship. A remarkable constellation of scholars at the University of Minnesota shaped the course of both conceptual frameworks and their dissemination. I describe fundamental assumptions common to DP and DRS frameworks that reflect their common roots and the pervasive influence of systems theory on developmental science. I describe four waves of DRS and key principles of DRS at the present time. In conclusion, I consider the possibility that a fifth wave of DRS is emerging with a focus on understanding patterns of multisystem, multilevel processes of resilience and their implications for interventions in the context of interacting, interdependent, and complex adaptive systems. I close this commentary with questions for future research and a hopeful outlook on the future of human resilience.

Engaging Family Members to Support Exclusive Breastfeeding, Responsive care, and Antiretroviral Therapy Adherence Among Families with Children who are HIV-Exposed and Uninfected

Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. To support families with CHEU, we assessed the acceptability of engaging family members to support women living with HIV (WLWH) with exclusive breastfeeding (EBF) and antiretroviral therapy (ART) adherence and to engage in responsive infant caregiving. We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors. We enrolled postpartum women in Lusaka, Zambia, who identified home supporters. At visit 1, WLWH were interviewed about current practices. At visit 2, WLWH and home supporters received tailored EBF, responsive care, and ART adherence counseling. At visit 3, WLWH and home supporters were interviewed about their experiences trying recommended practices for 2-3 weeks. Interview transcripts were analyzed thematically. Participants included 23 WLWH, 15 male partners, and 8 female family members. WLWH reported several barriers to EBF. The most common were fear of HIV transmission via breastfeeding-despite high ART adherence-and insufficient breastmilk. After counseling, WLWH reported less fear of HIV transmission and improved breastfeeding practices. Home supporters reported providing WLWH increased support for EBF and ART adherence and practicing responsive caregiving. Both male and female home supporters appreciated being included in counseling and more involved in caregiving, and WLWH valued the increased support. Families with CHEU need focused support. Tailored counseling and family support for WLWH show promise for improving EBF, responsive caregiving, and ART adherence.

Preventing malnutrition within the first 1000 days of life in under-resourced communities: An integrative literature review

This integrative review aimed to summarise existing best evidence practice for preventing malnutrition within the First 1000 Days of Life in under-resourced communities. BioMed Central, EBSCOHOST (Academic Search Complete, CINAHL and MEDLINE), Cochrane Library, JSTOR, Science Direct and Scopus were searched as well as Google Scholar and relevant websites for grey literature. Most recent versions of strategies, guidelines, interventions and policies; published in English, focussing on preventing malnutrition in pregnant women and in children less than 2 years old in under-resourced communities, from January 2015 to November 2021 were searched for. Initial searches yielded 119 citations of which 19 studies met inclusion criteria. Johns Hopkins Nursing Evidenced-Based Practice Evidence Rating Scales for appraising research evidence and non-research evidence were used. Extracted data were synthesised using thematic data analysis. Five themes were derived from extracted data: 1. Improving social determinants of health using a multisector approach; 2. Enhancing infant and toddler feeding; 3. Managing healthy nutrition and lifestyle choices in pregnancy; 4. Improving personal and environmental health practices; and 5. Reducing low-birthweight incidence. Further exploration regarding preventing malnutrition in the First 1000 Days in under-resourced communities is required using high-quality studies. Systematic review registration number: H18-HEA-NUR-001 (Nelson Mandela University).

Survive and Thrive: Outcomes of Children Enrolled in a Follow-Up Clinic for Small and Sick Newborns in Rural Rwanda

INTRODUCTION

Children born small or sick are at risk of death and poor development, but many lack access to preventative follow-up services. We assessed the impact of Pediatric Development Clinics (PDC), which provide structured follow-up after discharge from hospital neonatal care units, on children's survival, nutrition and development in rural Rwanda.

METHODS

This quasi-experimental study compared a historic control group to children receiving PDC in Kayonza and Kirehe districts. Study populations in both districts included children born preterm or with birthweight < 2000 g and discharged alive. Kirehe additionally included children with hypoxic ischemic encephalopathy (HIE). Home-based cross-sectional surveys were conducted in Kayonza among children with expected chronological age 11-36 months in 2014 (controls) and 2018 (PDC group) and in Kirehe among children with expected chronological age 17-39 months in 2018 (controls) and 2019 (PDC group). Outcomes were measured using anthropometrics and the Ages and Stages Questionnaires. We used weighted logistic regression to control for confounding and differential non-participation.

RESULTS

PDC children (n = 464/812, 57.1%) were significantly more likely to participate in surveys (83.0% vs. 65.5%), have very low birthweight (27.6% vs. 19.0%), and be younger at the survey (26.2 vs. 31.1 months). 6.9% (n = 56) died before the survey. PDC was associated with reduced odds of death (aOR = 0.49, 95% CI: 0.26-0.92) and reduced odds of developmental delay (aOR = 0.48, 95% CI: 0.30-0.77). In Kayonza, PDC was associated with reduced stunting (aOR = 0.52, 95% CI: 0.28-0.98). PDC was not associated with reduced underweight or wasting.

CONCLUSIONS

PDC was associated with improved survival and development among children born preterm, with low birthweight, or with HIE. Increased access to PDC, scale-up across Rwanda, and implementation of similar services and early intervention in other low-resource settings could support children born small or sick.

The next 1000 days: building on early investments for the health and development of young children

Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2-5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood development and the next 1000 days, focuses on the transition to the next 1000 days of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children's development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children's needs. Paper 2 focuses on the cost of inaction and the implications of not investing in the next 1000 days. In low-income and middle-income countries (LMICs), only 62 million children aged 3 and 4 years (25·4%) currently receive adequate nurturing care during the next 1000 days, leaving 181·9 million children exposed to risks that jeopardise their healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, although 86·2% of children have a healthy weight in this period, less than one in three children have access to developmental stimulation or are protected from physical punishment, and only 38·8% have access to early childhood care and education services. Intervention research in LMICs in the next 1000 days is scarce. The continuity of developmentally appropriate nurturing care, coordination across health, education, and protection sectors, and the implementation of interventions to support caregivers and improve the quality of education and care remain top priorities in this period. These sectors play key roles in promoting quality early care and education for this age group, which will help maximise developmental potential and opportunities of children globally and help progress towards the achievement of the Sustainable Development Goals.

The cost of not investing in the next 1000 days: implications for policy and practice

Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2-5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers. We show that a minimum package of 1 year of ECCE for all children would cost on average less than 0·15% of low-income and middle-income countries' current gross domestic product. The societal cost of not implementing this package at a national and global level (ie, the cost of inaction) is large, with an estimated forgone benefit of 8-19 times the cost of investing in ECCE. We discuss implications of the overall evidence presented in this Series for policy and practice, highlighting the potential of ECCE programming in the next 1000 days as an intervention itself, as well as a platform to deliver developmental screening, growth monitoring, and additional locally required interventions. Providing nurturing care during this period is crucial for maintaining and further boosting children's progress in the first 1000 days, and to allow children to reach optimal developmental trajectories from a socioecological life-course perspective.

The development and validity of the Early Learning Tool for children 0-3-year-old in rural Pakistan

Background

Research has demonstrated the critical role that early learning experiences play in shaping children's cognitive, social, and emotional development. Nevertheless, tools for assessing children's exposure to early learning experiences remain scarce. This paper describes the initial validation of the Early Learning (EL) tool, which captures the levels of stimulation with playthings and people available to children 0-3-year-old in low-resource, international settings.

Methods

We randomly sampled 200 mothers of children under 3-year-old in rural Sindh, Pakistan. We collected data on sociodemographic information, early learning, responsive caregiving, and child development. Psychometric analyses assessing the structural validity with confirmatory factor analysis and item response theory, criterion validity with Pearson correlation coefficients, and predictive validity with Ordinary Least Squares linear regression were conducted.

Findings

We found that the EL tool is valid in this setting, capturing two factors of early learning: stimulation with playthings and stimulation with people. Stimulation with playthings and people were strongly and positively correlated with responsive caregiving, maternal education, and wealth, indicating criterion validity. Stimulation with playthings and people were also strongly associated with child development, measured by the Bayleys Scales of Infant Development.

Conclusions

The EL tool is a promising instrument for measuring early learning in low- and middle-income countries, and its use can lead to more effective and inclusive monitoring and development of early learning initiatives.

Global development assistance for early childhood care and education in 134 low- and middle-income countries, 2007-2021

INTRODUCTION

Low- and middle-income countries (LMICs) often dedicate limited domestic funds to expand quality early childhood care and education (ECCE), making complementary international donor support potentially important. However, research on the allocation of international development assistance for ECCE has been limited.

METHODS

We analysed data from the Creditor Reporting System on aid projects to assess global development assistance for ECCE in 134 LMICs from 2007 to 2021. By employing keyword-searching and funding-allocation methods, we derived two estimates of ECCE aid: a lower-bound estimate comprising projects primarily focusing on ECCE and an upper-bound estimate comprising projects with both primary and partial ECCE focus, as well as those that could benefit ECCE but did not include ECCE keywords. We also assessed aid directed to conflict-affected countries and to ECCE projects integrating COVID-19-related activities.

RESULTS

Between 2007 and 2021, the lower-bound ECCE aid totaled US$3646 million, comprising 1.7% of the total US$213 279 million allocated to education. The World Bank led in ECCE aid, contributing US$1944 million (53.3% out of total ECCE aid). Low-income countries received less ECCE aid per child before 2016, then started to catch up but experienced a decrease from US$0.8 (2020) per child to US$0.6 (2021) per child. Funding for ECCE projects with COVID-19 activities decreased from a total of US$50 million in 2020 to US$37 million in 2021, representing 11.4% and 6.6% of annual total ECCE aid, respectively. Over 15 years, conflict-affected countries received an average of US$0.3 per child, a quarter of the aid received by non-conflict-affected countries (US$1.2 per child).

CONCLUSION

Although ECCE aid increased significantly between 2007 and 2021, its proportion of total educational aid fell short of UNICEF's suggested 10% minimum. Recommendations include increasing the share of ECCE aid in total educational aid, increasing aid to low-income and conflict-affected countries, and investing more in preparing ECCE programmes for future global crises.

Role of home nurturing environment on early childhood neurodevelopment: a community-based survey in Shanghai, China

BACKGROUND

Ages of 0-3 years are critical stages for children's neurodevelopment. However, the impact of the home nurturing environment on early childhood neurodevelopment remains unclear.

OBJECTIVE

To explore the role of the home nurturing environment on early childhood neurodevelopment and to provide evidence of an association between fostering quality home nurturing and achieving optimal neurodevelopment.

PARTICIPANTS AND SETTING

An online cross-sectional survey using the stratified sampling method was conducted from 16 June, 2021 to 18, February, 2022 in all 13 communities of Minhang District, Shanghai. A total of 2,402 children aged 0-3 years with balanced sex distribution were included.

METHODS

The quality of home nurturing environments was measured using validated Child Home Nurture Environment Scales. Neurodevelopment was measured using the Ages and Stages Questionnaire - Third edition (ASQ-3). Generalized Linear Mixed Modeling was used to analyze the association between the quality of home nurturing environments and neurodevelopment.

RESULTS

Among children aged 0-1, neglect or restriction was reported as the most prevalent problem (8.02%) among home nurturing environment dimensions, and was associated with an increased risk of suspected fine motor development delay (OR = 2.82, 95% CI: 1.18-6.69, P = 0.019). Among children aged 1-3, inadequate parental warmth, as the foremost (16.10%) problem, was associated with an increased risk of suspected gross motor development delay (OR = 4.12, 95% CI: 1.35-12.53, P = 0.013) and suspected personal-social development delay (OR = 12.50, 95%CI: 1.48-105.36, P = 0.020).

CONCLUSIONS

Poor home nurturing environments were associated with an increased risk of suspected early childhood neurodevelopment delay. There exists a need for services to guide for establishing a quality home nurturing environment.

Nurturing care: perceptions and practices of caregivers for children under five in the Ecuadorian highlands - a qualitative study

Introduction

The importance of nurturing care for child development is well-established, and parents play a central role in providing this care. However, cultural values and traditions can influence child-rearing practices, and there are gaps in child welfare in Ecuador. Two research questions delve into caregivers' definitions of nurturing care for children aged 0-5 and its alignment with World Health Organization's concept.

Methods

A qualitative methodology was applied to comprehensively explore caregivers' perspectives and application of nurturing care across diverse cultural contexts in rural areas of Cotopaxi and Loja in Ecuador. Using snowball sampling primary caregivers, healthcare professionals, childcare workers, and community leaders were interviewed and participated in focus groups, examining its congruence with WHO's Nurturing Care Framework for Early Childhood Development.

Results

While there is alignment with the WHO framework, the study reveals challenges such as a lack of awareness of the term "nurturing care" among participants. Findings also indicate issues in health communication, reliance on traditional medicine, and myths around nutritional practices. The role of technology in early learning is explored, noting both its advantages and disadvantages. Notably, preventive health activities were not mentioned, emphasizing a universal need for knowledge.

Conclusion

This study urges tailored interventions for nurturing care, emphasizing success tied to robust healthcare and child protection. Urgency lies in cultural sensitivity, local adaptation, and targeted training for implementation. These insights contribute significantly to the global discourse, stressing the importance of context-specific approaches. Implications are crucial for policymakers, practitioners, and researchers dedicated to elevating care quality for vulnerable populations worldwide.

Interplay of paternal caregiving and screen use habits on early childhood development and children's tantrums

BACKGROUND

This study aims to examine the association for paternal care and father-child screen use with early childhood development and children's temper tantrums.

METHOD

Study file included questions about paternal characteristics, child care, father-child screen habits, and utilized the UNICEF Early Childhood Development Index (ECDI). Factors influencing ECDI-on-track status and children's responses when screen use was restricted were investigated with Chi-square test and multiple logistic regression.

RESULTS

The study included 464 fathers having children aged 3-4 years. The findings showed that 89.7% of the children were on track in three out of the four ECDI subgroups. When screen use was restricted, 55.6% of the children engaged in another activity, while 44.4% reacted by crying. Multiple logistic regression analysis revealed that the father's education level, the child's age and gender, the starting age for screen usage, the child's reaction to screen restriction, and having three or more books were associated with ECDI. Furthermore, the child's reaction to screen restriction was related to the child's and father's screen time, the presence of three or more books, the adequacy of care, and being on track in the literacy-numeracy ECDI subgroup.

CONCLUSION

Screen usage habits significantly impact early childhood development and children's reactions to screen restrictions. These findings underscore the importance of educating fathers about the effects of their own and their child's media habits, the quality of fatherly caregiving, and the presence of books in fostering positive child development.