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Komakech JJ, Emerson SR, Cole KL, Walters CN, Rakotomanana H, Kabahenda MK, Hildebrand DA, Stoecker BJ. Care groups in an integrated nutrition education intervention improved infant growth among South Sudanese refugees in Uganda's West Nile post-emergency settlements: A cluster randomized trial. PLoS One 2024; 19:e0300334. [PMID: 38489346 PMCID: PMC10942045 DOI: 10.1371/journal.pone.0300334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda. METHODS A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms. RESULTS The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001). CONCLUSION Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs. TRIAL REGISTRATION Clinicaltrials.gov, NCT05584969.
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Affiliation(s)
- Joel J. Komakech
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, Mississippi, United States of America
| | - Sam R. Emerson
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Ki L. Cole
- Research, Evaluation, Measurement, and Statistics Department, Oklahoma State University, Stillwater, OK, United States of America
| | - Christine N. Walters
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Hasina Rakotomanana
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | | | - Deana A. Hildebrand
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
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Al-Mamari W, Idris AB, Al-Alawi K, Rashid N, Al-Araimi FAF, Siddeeg K. Enhancing Child Development in Oman: Applying global agenda into local context. Sultan Qaboos Univ Med J 2023; 23:143-147. [PMID: 37377824 PMCID: PMC10292597 DOI: 10.18295/squmj.1.2023.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Watfa Al-Mamari
- Developmental Pediatric Unit, Child Health Department, Sultan Qaboos University, Muscat, Oman
| | - Ahmed B. Idris
- Developmental Pediatric Unit, Child Health Department, Sultan Qaboos University, Muscat, Oman
| | - Kamila Al-Alawi
- Public Health Office, WHO Country Office for Sultanate of Oman, Muscat, Oman
| | | | | | - Khalid Siddeeg
- Department of Healthier Populations, WHO Regional Office for the Eastern Mediterranean, Muscat, Oman
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Lafave LMZ. Is the online 'creating healthy eating and active environments survey' (CHEERS) tool reliable for early childhood educators in Alberta, Canada: a randomized crossover trial. Arch Public Health 2023; 81:22. [PMID: 36782334 PMCID: PMC9926852 DOI: 10.1186/s13690-023-01036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The creating healthy eating and active environments survey (CHEERS) is an audit tool used to assess the nutrition and physical activity environment in early childhood education and care (ECEC) centres. Availability of the tool has been limited to paper-based versions. Digital health initiatives offer improved reach and immediacy of support for community-based clients through novel technology products. In order to provide increased access to the CHEERS tool, an online version was developed. The objective of this study was to assess the reliability of an online version of CHEERS. METHODS Utilizing a randomized crossover design, ECEC educators completed either a paper-based or online-based survey and then the opposite mode with a two to three-week interval. The intraclass correlation coefficient (ICC, with 95% confidence interval) was used to determine the reliability between test and retest. Absolute index of reliability in the original measurement was assessed through the standard error of measurement (SEM = SD × √1-ICC). The smallest amount of change not due to inherent variation was assessed by determining minimal detectable change at the 95% confidence level (MDC95 = SEM × 1.96 ×√2; MDC95% = MDC95/mean ×100). RESULTS Test-retest reliability was good to excellent for the online-based CHEERS total score (ICC = 0.86) and for each of the four subscales: food served (ICC = 0.82), healthy eating environment (ICC = 0.76), program planning (ICC = 0.76), and physical activity environment (ICC = 0.79). The SEM, MDC95, and MDC95% for the CHEERS overall score were 0.79, 2.19, and 9.6%, respectively. CONCLUSIONS The results of this study demonstrate that the online-based and paper-based versions of the CHEERS audit tool share comparable accuracy. The CHEERS tool can be reliably implemented in an online environment and this provides users an alternative means to complete the centre-based health assessment. The advantage of the online-based version includes user accessibility and the potential to develop a feedback response for participants using digitally collected data.
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Affiliation(s)
- Lynne M. Z. Lafave
- grid.411852.b0000 0000 9943 9777Department of Health and Physical Education, Mount Royal University, Calgary, AB T3E 6K6 Canada
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Camarata S, Liu XL, Lee W, Li T, Jiang F, Simms M. Adapting the UNICEF/WHO Nurturing Care Framework for speech-language pathologists to support Sustainable Development Goal 4. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:82-86. [PMID: 36412043 DOI: 10.1080/17549507.2022.2141327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The United Nations' Sustainable Development Goals and the UNICEF/WHO Nurturing Care Framework for supporting children's health and development present unique international opportunities for speech-language pathologists to contribute support to early childhood development and Sustainable Development Goals (especially SDG 4 and SDG 17) in diverse international contexts. The crucial role that parent/caregiver support plays in promoting Nurturing Care and sustainable education is often underappreciated, so the objective of this paper is to describe key concepts and importance of parent/caregiver support in the Nurturing Care Framework and the SDGs. This commentary focusses on SDG 4, which is foundational to individuals, communities and societies in creating an education framework that includes and harnesses family and community support. This paper also includes as an example a comprehensive program that has been developed and implemented in the People's Republic of China that includes speech and language skills as an explicit component. RESULT The results in China indicate that a program of universal developmental facilitators can be implemented within an educational and paediatrician/developmental paediatrician centred health care context. CONCLUSION Sustainable Development Goal 4 and UNICEF/WHO Nurturing Care Framework are important and innovative programs that explicitly harness parent education and training to identify and address the needs of children with developmental difficulties utilising paediatricians, speech language pathologists, allied health personnel, teachers, and community stakeholders proactively for implementation. The program's adoption and success in the China suggest that it provides a model which can be adapted internationally within the context of national health programs.
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Affiliation(s)
- Stephen Camarata
- Department of Hearing & Speech Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Xueman Lucy Liu
- Hainan Boao Bethel International Medical Center, Boao Medical Pilot Zone, China
| | - Wendy Lee
- Hainan Boao Bethel International Medical Center, Boao Medical Pilot Zone, China
| | - Tingyu Li
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Medical School of Shanghai Jiao Tong University, Shanghai, China, and
| | - Mark Simms
- Department of Medicine, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Paul P, Chandna J, Procter SR, Dangor Z, Leahy S, Santhanam S, John HB, Bassat Q, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Yanotti CS, Seedat F, Horváth-Puhó E, Hossain AT, Sadeq-ur Rahman Q, Jit M, Newton CR, Milner K, Gonçalves BP, Lawn JE. Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina. EClinicalMedicine 2022; 47:101358. [PMID: 35747160 PMCID: PMC9142788 DOI: 10.1016/j.eclinm.2022.101358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/04/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Data are limited regarding long-term consequences of invasive GBS (iGBS) disease in early infancy, especially from low- and middle-income countries (LMIC) where most cases occur. We aimed to estimate risk of neurodevelopmental impairment (NDI) in children with a history of iGBS disease. METHODS A multi-country matched cohort study was undertaken in South Africa, India, Mozambique, Kenya, and Argentina from October 2019 to April 2021. The exposure of interest was defined as a history of iGBS disease (sepsis or meningitis) before 90 days of age, amongst children now aged 1·5-18 years. Age and sex-matched, children without history of GBS were also recruited. Age-appropriate, culturally-adapted assessments were used to define NDI across multiple domains (cognitive, motor, hearing, vision, emotional-behaviour, growth). Pooled NDI risk was meta-analysed across sites. Association of iGBS exposure and NDI outcome was estimated using modified Poisson regression with robust variance estimator. FINDINGS Amongst 138 iGBS survivors and 390 non-iGBS children, 38·1% (95% confidence interval [CI]: 30·0% - 46·6%) of iGBS children had any NDI, compared to 21·7% (95% CI: 17·7% - 26·0%) of non- iGBS children, with notable between-site heterogeneity. Risk of moderate/severe NDI was 15·0% (95% CI: 3·4% - 30·8%) among GBS-meningitis, 5·6% (95% CI: 1·5% - 13·7%) for GBS-sepsis survivors. The adjusted risk ratio (aRR) for moderate/severe NDI among iGBS survivors was 1.27 (95% CI: 0.65, 2.45), when compared to non-GBS children. Mild impairment was more frequent in iGBS (27.6% (95% CI: 20.3 - 35.5%)) compared to non-GBS children (12.9% (95% CI: 9.7% - 16.4%)). The risk of emotional-behavioural problems was similar irrespective of iGBS exposure (aRR=0.98 (95% CI: 0.55, 1.77)). INTERPRETATION Our findings suggest that iGBS disease is on average associated with a higher risk of moderate/severe NDI, however substantial variation in risk was observed between sites and data are consistent with a wide range of values. Our study underlines the importance of long-term follow-up for at-risk neonates and more feasible, standardised assessments to facilitate diagnosis in research and clinical practice. FUNDING This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene &Tropical Medicine.
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Affiliation(s)
- Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Corresponding author.
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | | | | | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - A.K.M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles R. Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children's Research Institute
- Department of Paediatrics, University of Melbourne
| | - Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Oberklaid F. It's time to eliminate the mismatch between pediatric training and practice. Isr J Health Policy Res 2021; 10:70. [PMID: 34857054 PMCID: PMC8638363 DOI: 10.1186/s13584-021-00504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
The quality of pediatric clinical practice is dependent on the training received during residency. It is assumed that the content of the training will adequately prepare pediatricians for the sorts of problems and issues they will be asked to manage in community settings. While over the past several decades there have been major changes in pediatric morbidity, there is evidence that training and service delivery models have not evolved; there is a significant mismatch between training and evidence-based clinical practice. A recent paper published in this journal (1) drew attention to the inadequacy of pediatricians' training in child development. The reality of major gaps in the content and experiences of pediatric training in Israel are widely held, and there have been repeated calls for an increased focus on community child health and developmental and behavioural pediatrics. While it appears that finally there are some small initial steps to this end, it is strongly recommended that there be a long overdue, radical rethink of pediatric training programs.
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Affiliation(s)
- Frank Oberklaid
- Centre for Community Child Health, Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
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Rocha HAL, Correia LL, Leite ÁJM, Machado MMT, Lindsay AC, Rocha SGMO, Campos JS, Cavalcante E Silva A, Sudfeld CR. Screen time and early childhood development in Ceará, Brazil: a population-based study. BMC Public Health 2021; 21:2072. [PMID: 34763693 PMCID: PMC8582336 DOI: 10.1186/s12889-021-12136-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, children's exposure to digital screens continues to increase and is associated with adverse effects on child health. We aimed to evaluate the association of screen exposure with child communication, gross-motor, fine-motor, problem-solving, and personal-social development scores. METHODS We conducted a population-based, cross-sectional study with cluster sampling among children 0-60 months of age living in the state of Ceará, Brazil. Child screen time was assessed by maternal report and the World Health Organization (WHO) recommendations were used to define excessive screen time exposure. Child development was assessed with the Brazilian Ages and Stages Questionnaire. Generalized linear regression was used to determine the association of screen exposure with developmental outcomes. We also examined the potential non-linear relationship of screen time with development scores using spline analyses. RESULTS A total of 3155 children 0-60 months of age had screen time exposure evaluated and 69% percent were identified as exposed to excessive screen time. This percentage of excess screen time increased with child age from 41.7% for children 0-12 months to 85.2% for children 49-60 months. Each additional hour of screen time was associated with lower child communication (standardized mean difference (SMD): -0.03; 95% CI: - 0.04, - 0.02), problem solving (SMD: -0.03; 95% CI: - 0.05, - 0.02) and personal-social (SMD: -0.04; 95% CI: - 0.06, - 0.03) domain scores. CONCLUSIONS Excess screen time exposure was highly prevalent and independently associated with poorer development outcomes among children under 5 years of age in Ceará, Brazil.
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Affiliation(s)
- Hermano Alexandre Lima Rocha
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Maternal and Child Health, Federal University of Ceará, Rua Professor Costa Mendes, 1608 - 5th floor -, Fortaleza, Ceará, CEP: 60430-140, Brazil.
| | | | - Álvaro Jorge Madeiro Leite
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | | | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | | | - Jocileide Sales Campos
- Service, Education and Community Integration, University Center Unichristus, Fortaleza, Brazil
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Uchitel J, Alden E, Bhutta ZA, Goldhagen J, Narayan AP, Raman S, Spencer N, Wertlieb D, Wettach J, Woolfenden S, Mikati MA. The Rights of Children for Optimal Development and Nurturing Care. Pediatrics 2019; 144:peds.2019-0487. [PMID: 31771960 DOI: 10.1542/peds.2019-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
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Affiliation(s)
| | - Errol Alden
- International Pediatric Association and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida
| | | | - Shanti Raman
- International Pediatrics Association Standing Committee, International Society of Social Pediatrics and Child Health, Geneva, Switzerland.,Division of Community Pediatric, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Jane Wettach
- Duke Children's Law Clinic, School of Law, Duke University, Durham, North Carolina; and
| | - Sue Woolfenden
- Discipline of Paediatrics, School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamad A Mikati
- Division of Pediatric Neurology and .,Early Childhood Development Standing Advisory Group, International Pediatrics Association, St Louis, Missouri
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