Care for Child Development: an intervention in support of responsive caregiving and early child development.

BACKGROUND: An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children. METHODS: In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities. RESULTS: The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services. CONCLUSIONS: Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children.

Training health care workers to counsel breastfeeding mothers.

PIP: WHO and UNICEF have designed a 40-hour counseling course for maternal-child health workers that aims to impart the skills needed to assist mothers to breast feed their infant. Course participants receive training in the following communication and counseling techniques: accepting what a mother feels as valid, recognizing and praising things a mother is doing right, giving practical guidance, using simple language, making suggestions rather than commands, and limiting the information provided so as not to overwhelm the mother. In addition, health workers are trained on the attachment and positioning techniques that promote successful breast feeding. Such techniques include having the infant's chin touch the breast, more areola exposed above than below the infant's mouth, close contact with the mother's body, and arrangement of the baby's head and body in a straight line. Common concerns, such as mothers' fears that they are not producing enough milk, sore nipples, and breast feeding practices when an infant is sick, are addressed. At the conclusion of the training, health workers apply the skills they have learned in maternity wards and maternal-child health clinics.^ieng