Positive changes in breastfeeding and complementary feeding indicators in Brazil are associated with favorable nurturing care environments.

OBJECTIVES: To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. STUDY DESIGN: Ecological time-series study. METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends. RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.

The impact of ever breastfeeding on children ages 12 to 36 months: A secondary data analysis of the standardization study of the Dominican system for evaluating early childhood development.

Extensive research has shown that breastfeeding offers many benefits to children, including advantages in lifelong health, physical development, cognitive function, behavior, and brain development, compared to those not breastfed. In the Dominican Republic, the prevalence of exclusive breastfeeding among infants aged 0-6 months remains low, and the lack of a surveillance system has made it challenging to measure the impact of breastfeeding on early childhood development (ECD). This study aims to address the effect of ever breastfeeding on ECD. We conducted secondary data analysis from the Dominican System for Measuring Early Childhood Development (SIMEDID), a screening tool adapted and validated to the Dominican context that measures four areas of development: gross-motor, fine-motor, language, and socioemotional development. The data from SIMEDID can be cross-analyzed with other datasets generated by the National Institute for Early Childhood Comprehensive Care (INAIPI) that include information about breastfeeding. The children were evaluated during the standardization study of SIMEDID. To determine the breastfeeding impact, we: 1) conducted an analysis of covariance using ECD scores as dependent variables and ever breastfed as the independent variable, with age and sex as covariates (previously confirmed with an analysis of variance indicating the relevance of age and sex at birth in ECD); 2) analyzed the relative risk (RR) of developmental delay by breastfeeding status. We studied a sample of 699 Dominican children aged 12-36 months who receive services at INAIPI (the government institution responsible for administering comprehensive early childhood services). The results show that ever breastfed children had higher scores in overall ECD than those who were not; higher scores in language and fine motor development primarily drove this effect. The never breastfed group had a greater risk of developmental delay in fine motor and socioemotional development. These findings underscore the importance of promoting and supporting breastfeeding to improve child neurodevelopmental outcomes. This is particularly relevant in low-resource settings, where mothers may need additional support. Moreover, the study's results provide evidence of SIMEDID's validation, which can help inform future research and evidence-based decision-making toward optimal ECD in similar contexts.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Association between persistent organic pollutants in human milk and the infant growth and development throughout the first year postpartum in a cohort from Rio de Janeiro, Brazil.

Persistent organic pollutants (POPs) are compounds that are recalcitrant and ubiquitous that bioaccumulate in human milk (HM) and can impact infant growth and development. We explore the association between POP concentration in HM at 2-50 days postpartum and infant growth and development trajectory throughout the first year of life. A cohort of 68 healthy adult Brazilian women and their infants were followed from 28 to 35 gestational weeks to 12 months postpartum. HM samples were collected between 2 and 50 days postpartum, and POP concentrations were analyzed using gas chromatography with mass spectrometry. Concentrations of POPs >limit of quantification (LOQ) were defined as presence, and concentrations ≤LOQ as an absence. Growth z-scores were analyzed according to WHO growth charts and infant development scores according to Age & Stages Questionnaires at 1 (n = 66), 6 (n = 50), and 12 months (n = 45). Linear mixed effects (LME) models were used to investigate the association of POPs in HM with infant growth and development. Benjamini-Hochberg (BH) correction for multiple testing was performed to reduce the false discovery ratio. P < 0.1 was considered for models with the interaction between POPs and time/sex. After BH correction, adjusted LME models with time interaction showed (1) a positive association between the presence of ß hexachlorocyclohexane and an increase in head circumference-for-age z-score (ß = 0.003, P = 0.095); (2) negative associations between total POPs (ß = -0.000002, P = 0.10), total organochlorine pesticides (ß = -0.000002, P = 0.10), and dichlorodiphenyldichloroethylene concentrations in HM (ß = -0.000002, P = 0.10) and fine motor scores. No statistical difference between the sexes was observed. Postnatal exposure to organochlorine pesticides in HM shows a positive association with the trajectory of head circumference-for-age z-score and a negative association with the trajectories of fine motor skills scores. Future studies on POP variation in HM at different postpartum times and their effect on infant growth and development should be encouraged.

Lead Exposure Can Affect Early Childhood Development and Could Be Aggravated by Stunted Growth: Perspectives from Mexico.

BACKGROUND: Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities. METHODS: Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth. RESULTS: Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (ß: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (ß: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (ß: -0.15, 95% CI: -0.36, 0.06). CONCLUSIONS: Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.

A Thousand Days-A programme for vulnerable early childhood in Argentina: Targeting, dropout risk factors and correlates of time to graduation.

BACKGROUND: Mil Días (A Thousand Days) is a programme for the first thousand days of life, from gestation to 2 years of age, targeted at highly vulnerable children and/or mothers and pregnant women. The programme was implemented in August 2015 in the municipality of San Miguel, in Argentina. Mil Días is designed in a holistic and intersectoral way. The main form of intervention is through home visits, but other benefits are available depending on the 51 vulnerability criteria by which participants are admitted to the programme, most of which are related to health issues. Exits of the programme occur when the mother and/or child have reversed the deprivation/s of the entrance-criteria. METHODS: This paper provides an analysis of the programme's primary data between August 2015 and May 2019, with a total of 1,111 programme participants. First, we perform a statistical analysis of the targeted population of the programme. Second, using a logistic regression, we study factors associated to the withdrawal from the programme. Third, using survival analysis, we study the correlates of time to graduation from the programme. RESULTS: We find that the programme is well-targeted, as participants exhibit higher deprivation levels than those exhibited by beneficiaries of social programmes in general in the same municipality. We also find that programme participants in situations of most extreme vulnerability are more likely to abandon the programme and that successful exits from the programme take longer for more complex cases. CONCLUSIONS: Mil Días-San Miguel is a programme for early childhood development in Argentina, which was pioneer when it was first introduced. It is well targeted and exhibits encouraging results despite complex cases taking longer to sucessfully exit the programme. In addition, the poorest poor participants are more likely to abandon the programme and so additional actions could be taken to retain them, as intended by the 'Leave No One Behind' 2030 commitment.

Maternal History of Adversity and Subsequent Mother-Child Interactions at Early Ages: A Systematic Review.

Adverse childhood experiences (ACEs) can negatively impact physical, emotional, cognitive, and social development, consequently affecting the next generation. The aim of the present study was to systematically review evidence from empirical studies on the association between maternal history of adversity in childhood (maltreatment and household dysfunction) and subsequent mother-child interactions at an early age. A search was performed in the PubMed, Web of Science, PsycINFO, EMBASE, Scopus, LILACS, and SciELO databases to identify studies, including measures of maternal childhood adversities and mother-child interaction, published between 2016 and 2022. Twenty-nine studies met the inclusion criteria. The results showed that in 90% of the studies, maternal childhood adversities negatively impacted subsequent mother-child interactions in early childhood, reducing maternal displays of affection, emotional availability, sensitivity, mother-child communication, and bonding. Biological factors (e.g., genetic and hormonal) and maternal emotional recognition moderated these associations. In addition, biological factors (i.e., neurobiological and hormonal) and psychosocial factors (e.g., depression, executive functioning, and violence) acted as mediators. Preventive interventions should be implemented to break out of the intergenerational cycle of violence that impacts mother-child interactions.

Validation of the Dominican system for measuring early childhood development.

Background: The purpose of the study was to determine the psychometric properties of the Dominican System for Measuring Early Childhood Development (SIMEDID, for its Spanish acronym), to adjust the sequence of item presentation, and to provide age-standardized norms for each item, to enable policy and program managers to make decisions based on specific and structured data. Methods: After approval from an ethics committee, a total of 948 children from 0 to 60 months participated in this study. Participants were evaluated on four early childhood development domains (gross motor, fine motor, language development, and socio-emotional development). The data were collected from November 2021 to February 2022, either at early childhood care centers or at home, using mobile devices that guided the evaluators through the screener. Data were later synced to a global database. Psychometric properties were calculated using Cronbach's alpha and split-half parallel reliability. For reorganizing item presentation and to obtain age-standardized norms, we conducted a logistic regression analysis for each item on dependent variable item success, and independent variable age. Results: The instrument showed excellent reliability and additional evidence of validity. The item presentation order was rearranged according to the probability of item success progression. In addition, the study characterized the expected evolution of item success probability across participants' age. Conclusions: SIMEDID is a valid and reliable instrument for depicting childhood development in national evaluations. Its integration with electronic platforms for national monitoring represents a cost-effective, time-efficient screening tool adapted to the Dominican sociocultural context. This represents a promising tool to strengthen strategies that support early childhood development.

Interaction Dynamics with Babies During Shared Reading Practices / Dinâmicas de Interação em Situações de Leitura Compartilhada com Bebês / Dinámicas de Interacción con Bebés durante Momentos de Lectura Compartida

Abstract This paper examines the triadic dynamics of baby-teacher-book during shared reading in an Early Childhood Education School to explain how educational teaching practices can enhance initial reading experiences and development processes in Early Childhood. A ten-months-old baby and a teacher participated in this study and, as an instrument for data collection, reading situations were registered and later these sessions were weighted through use of microgenetic analysis. From the analysis of the data present in the detailed case, it was identified the emergence of qualitative indicators that favoured the involvement of the baby in the activity, the mediation and educational actions of the teacher and the use of the book were more frequent. The effective use of the object book with that baby has contributed to qualitative changes in the baby's development and learning and emphasizes the incentive to share reading with other children.

Resumo Este estudo teve como objetivo examinar a dinâmica da tríade bebê-professora-livro durante a leitura compartilhada em uma Escola de Educação Infantil a fim de explicar como as práticas educativas de ensino potencializam experiências iniciais de leitura e processos de desenvolvimento na Primeira Infância. Uma bebê de dez meses e uma professora participaram desse estudo e como instrumento para coleta de dados foi utilizado a vídeogravação de momentos de leitura e posteriormente essas sessões foram ponderadas através da análise microgenética. A partir das análises dos dados presentes no caso detalhado, identificou-se a emergência de indicadores qualitativos que favoreceram o engajamento da bebê na atividade, sendo que a mediação e ações educativas da professora e do uso do livro foram mais frequentes. O uso efetivo do livro-objeto pode ter contribuído para mudanças qualitativas no desenvolvimento e aprendizagem da bebê e enfatiza a necessidade de incentivar o compartilhamento da leitura nessas idades.

Resumen Este artículo tuvo como objetivo examinar la dinámica de la tríada bebé-maestra-libro durante la lectura compartida en una Escuela de Educación Infantil con el fin de explicar cómo las prácticas docentes educativas pueden potenciar las experiencias iniciales de lectura y los procesos de desarrollo en la Primera Infancia. En este estudio participó una bebé de diez meses y una maestra y como instrumento de recolección de datos se utilizó la grabación en video de los momentos de lectura y posteriormente estas sesiones fueron ponderadas a través del análisis microgenético. A partir del análisis de los datos presentes en este caso, se identificó la emergencia de indicadores cualitativos que favorecen la participación de la bebé en la actividad, siendo más frecuentes la mediación y las acciones educativas de la docente, así como el uso del libro. El uso efectivo del libro objeto con la bebé ha contribuido a cambios cualitativos en el desarrollo y aprendizaje de los niños y enfatiza el incentivo de compartir la lectura con otros niños pequeños.

Bodyweight and human capital development: Assessing the impact of obesity on socioemotional skills during childhood in Chile.

This article analyzes the effect of bodyweight on socioemotional skills for children aged two to 12 years in Chile. Using an instrumental variable approach and a representative survey, we show that both BMI and obesity are causality related to children's socioemotional development, even after assuming that our instrument is imperfect. Although we did not find significant differences between boys and girls, we do identify heterogeneous effects by age: the weight penalty for girls starts earlier than for boys. Our findings suggest that early interventions for childhood obesity not only might generate positive impacts on children's health, but also a greater accumulation of non-cognitive human capital in the future.

Predictors of maternal knowledge on early childhood development in highly marginalized communities in Mexico: Implications for public policy.

INTRODUCTION: Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0-38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development. METHODS: We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0-38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge. RESULTS: The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs. CONCLUSION: Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.

Coparentalidade aos 24 meses da criança: um estudo qualitativo / Coparentalidad a los 24 meses del niño: un estudio cualitativo / Co-Parenting with 24-Month-Old Children: A Qualitative Study

O objetivo deste estudo foi investigar a coparentalidade aos 24 meses da criança. Trata-se de pesquisa qualita-tiva, da qual participaram 10 famílias nucleares, com um único filho. A mãe e o pai responderam entrevista sobre sua experiência de maternidade e paternidade, res-pectivamente. Essas entrevistas foram examinadas por análise temática dedutiva, considerando os temas com-ponentes do modelo de coparentalidade de Feinberg: divisão de trabalho, acordo nos cuidados, apoio versusdepreciação coparental e gerenciamento das interações familiares. Os resultados revelaram que cuidados bási-cos e tarefas domésticas estavam sob responsabilidade predominantemente materna, enquanto o envolvimento paterno se dava sobretudo em atividades de lazer, tais como brincadeiras e passeios. Houve predomínio de relatos de satisfação quanto à divisão de trabalho. So-bre acordo nos cuidados, os participantes enfatizaram especialmente os desafios de negociar e estabelecer limites apropriados à criança aos 24 meses, visando à promoção das novas habilidades e da autorregulação infantil, bem como à prevenção de acidentes. Relatos de apoio e de depreciação coparental coexistiram nas famílias. Assim, evidenciou-se respeito de um genitor às contribuições do outro, admiração e manutenção da autoridade, embora também culpabilização, crítica e competição entre a mãe e o pai. Quanto ao gerencia-mento das interações familiares, houve predomínio de estratégias construtivas para resolução de confli-tos, com destaque às conversações entre os genitores. Discutem-se aspectos gratificantes e desafiadores da coparentalidade aos 24 meses da criança, com ênfase aos estressores normativos nessa etapa do desenvolvi-mento infantil e às potencialidades dos genitores para enfrentá-los colaborativamente.

El objetivo de este estudio fue investigar la coparentalidad a los 24 meses del niño. La investigación fue cualitativa y participaron 10 familias nucleares con un solo hijo. La madre y el padre respondieron una entrevista sobre su experiencia de maternidad y paternidad, respectivamente. Estas entrevistas fueron examinadas por análisis temático deductivo, considerando los te-mas componentes del modelo de coparentalidad de Feinberg: división del trabajo, acuerdo en el cuidado, apoyo vs.depreciación coparental y manejo de las interacciones familiares. Los resultados revelaron que los cuidados básicos y las tareas del hogar eran predo-minantemente responsabilidad materna, mientras que la participación paterna se producía principalmente en actividades de ocio como juegos y salidas. Hubo predominio de relatos de satisfacción con respecto a la división del trabajo. En cuanto a la concordancia en el cuidado, los participantes destacaron los desafíos de negociar y establecer límites adecuados para el niño a los 24 meses, con el objetivo de promover nuevas habilidades y la autorregulación del niño, así como la prevención de accidentes. Coexistieron relatos de apoyo y desvalorización. Así, se evidenció el respeto de uno de los padres por las contribuciones del otro, la admiración y el mantenimiento de la autoridad, aunque también reproches, críticas y competencia entre la madre y el padre. En el manejo de las interacciones familiares, hubo predominio de estrategias constructivas para la resolución de conflictos, con énfasis en conversaciones entre padres. Se discuten los aspectos gratificantes y desafiantes de la coparentalidad de una crianza a los 24 meses de edad, con énfasis en los factores estresantes normativos en esta etapa del desarrollo y el potencial de los padres para enfrentarlos en colaboración.

The current study aimed to investigate co-parenting in children of 24 months of age. It was a qualitative study in which the participants were 10 nuclear families, each with an only child. The mother and father attended an interview about their experience of maternity and pa-ternity, respectively. These interviews were examined using the deductive thematic analysis, considering the component themes of Feinberg's co-parenting model: division of labor, childrearing agreement, support versus undermining, and joint family management. The results revealed that essential childcare and household chores were predominantly under maternal responsibility, while paternal involvement was mainly in leisure activities such as play and strolls. Reports on satisfaction regard-ing the division of labor were predominant. Concerning the childrearing agreement, the participants particularly emphasized the challenges of negotiating and setting appropriate limits for the child at 24 months, aiming to promote new skills and self-regulation in the toddlers, as well as to prevent accidents. Reports of support and undermining coexisted in the families. Thus, respect of one parent for the contributions of the other, admiration and sustaining of authority, on the one hand, and blaming, criticism, and competition between mother and father, on the other, were evidenced. Regarding joint family management, there was a predominance of constructive strategies for conflict resolution with an emphasis on conversations between parents. Rewarding and chal-lenging aspects of co-parenting at 24 months of age are discussed, highlighting the normative stressors at this stage of child development and the potential of parents to cope with them cooperatively.

Associations Between Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children.

Background. Haiti lacks early childhood development data and guidelines in malnourished populations. Literature shows that developmental interventions are crucial for improving developmental outcomes malnourished children. This study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy. Methods. We used cross-sectional data from 42 patients 6 months to 2 years old in Saint-Marc, Haiti. We assessed their developmental status using the Ages and Stages Questionnaire. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood development delays and high parental depression risk were calculated. Multivariable logistic regression analyses were used to test whether parental depression risk and low self-efficacy were associated with a higher risk for childhood developmental delays. Results. Among participants, 45.2% (SD = 7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD = 7.4%) of parents were at high risk for depression. 47.6% (SD = 7.7%) of parents reported relatively low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.1-270.0) after adjusting for socioeconomic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study. Conclusion. Parental self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed to design contextually appropriate interventions.

Using Retrieval Practice on Learning with Children: Systematic Literature Review / El uso de la práctica de recordar en el aprendizaje de los niños: una revisión sistemática de la literatura / O uso da prática de lembrar na aprendizagem de crianças: revisão sistemática da literatura

To improve education, it is necessary to use evidence-based techniques, that is, techniques based on the scientific method proven to be effective in improving educational practices. One of the strategies indicated by the science of learning is the retrieval practice (trying to remember the content learned, strengthening the memory traces). This study synthesizes the research developed on retrieval practice in the teaching and learning process of children from a systematic review system based on the prismamethod. For this, a biblio-graphic search was carried out in the databases of the capes/mec, eric, Scielo, PubMed, Web of Science, and Psycinfo. Forty-one articles were included in the qualitative synthesis. The studies converge on stating there is a beneficial effect of using retrieval practice from an early age (18 months of age). This practice can help both long-term learning and new learning in children, especially when feedback is provided. Thus, there is a need to expand the recommendations to educators so that this audience also benefits from the use of this strategy.

Para mejorar la educación es necesario utilizar técnicas basadas en la evidencia, es decir, basadas en el método científico, utilizar estrategias que demuestren su eficacia para mejorar las prácticas educativas. Entre las prácticas muy recomendadas por la ciencia del aprendizaje se encuentra la práctica de recordar, que consiste en tratar de recordar el contenido aprendido, fortaleciendo así las huellas de la memoria. Este estudio resume la investigación desarrollada sobre la práctica de recordar en el proceso de enseñanza y aprendizaje de los niños, a partir de una revisión sistemática basada en el método prisma. Para ello, se realizó una búsqueda bibliográfica en las bases de datos de las revistas capes/mec, eric, Scielo, Pubmed, Web of Science y PsycINFO. Se incluyeron 41 artículos en una síntesis cualitativa. Los estudios convergen en que existe un efecto beneficioso de utilizar la práctica de recordar con bebés a partir de los 18 meses de edad, es decir, esta práctica puede ayudar tanto al aprendizaje a largo plazo como a facilitar nuevos aprendizajes en los niños, especial-mente cuando se brinda retroalimentación. Por lo tanto, existe la necesidad de ampliar las recomendaciones a los educadores para que ese público también pueda beneficiarse del uso de esta estrategia.

Para melhorar a educação, é necessário utilizar técnicas baseadas em evidências, ou seja, com base no método científico, usar estratégias que são comprovadamente eficazes para aperfeiçoar as práticas educativas. Entre as práticas altamente recomendadas pela ciência da aprendizagem, está a prática de lembrar, que envolve tentar evocar o conteúdo aprendido, fortalecendo assim, os traços de memória. Esse estudo sintetiza as pesquisas desenvolvidas a respeito da prática de lembrar no processo de ensino e aprendizagem de crianças, a partir de uma revisão sistemática baseada no método prisma. Para isso, foi realizada uma pesquisa bibliográfica nas bases de dados do portal de periódicos capes/mec, eric, Scielo, PubMed, Web of Science e PsycINFO. Foram incluídos em síntese qualitativa 41 artigos. Os estudos convergem para o fato de que há efeito benéfico do uso de prática de lembrar com bebês a partir dos 18 meses de idade, ou seja, essa prática pode auxiliar tanto a aprendizagem de longa duração, quanto facilitar novas aprendizagens em crianças, especialmente quando o feedback é fornecido. Dessa maneira, há necessida-de de ampliar as recomendações a educadores para que esse público também seja beneficiado com o uso dessa estratégia.

Assessing the effect of an educational intervention on early childhood development among Mexican preschool children in the state of Oaxaca: a study protocol of a cluster randomized stepped-wedge trial.

BACKGROUND: Early childhood development (ECD) is essential in human capacity building and a critical element in the intergenerational process of human development. In some countries, social programs targeted at improving ECD have proven to be successful. Oaxaca is one of the States with the greatest social inequities in Mexico. Therefore, children in Oaxaca are at a high risk of suboptimal ECD. In 2014, the non-governmental organization (NGO) Un Kilo de Ayuda started to implement the Neurological and Psycho-affective Early Childhood Development Program in eighty marginalized communities of Oaxaca. In this article, we present the impact evaluation design to estimate the effect of this program on ECD. METHODS: We will use a cluster randomized stepped-wedge design with an allocation ratio of 1:1. Communities will be randomly assigned to each study group: four groups of twenty communities each. We expect that children from intervened communities will show better ECD outcomes. DISCUSSION: This study is one of the few rigorous assessments of the effect of an ECD program on the neurodevelopment of Mexican children recruited in their first 3 years of life from communities of high social vulnerability. Our study design is recommended when the way in which outcomes are measured and assessed depends on age, self-selection is present, and assignment is performed at an aggregate level. Implementation research will be conducted prior to study launch and quality control measures will be in place to maximize the fidelity of study design implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04210362.

Adaptation of the INTERGROWTH-21st neurodevelopment assessment (INTER-NDA) to the context of the English-speaking Caribbean.

BACKGROUND: Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings. METHODS: We report the cross-cultural adaptation of an international, standardized ECD instrument, the INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA), measuring cognitive, language, motor and behavioural outcomes in 2-year-olds, from a UK-based English-speaking population to the English-speaking Caribbean. Children aged 22-30 months were recruited from a pre-existing randomized controlled neurodevelopment intervention study in Grenada, West Indies. RESULTS: Eight of 37 INTER-NDA items (22%) were culturally and linguistically adapted for implementation in the Caribbean context. Protocol adherence across seven newly-trained non-specialist child development assessors was 89.9%; six of the seven assessors scored ≥80%. Agreement between the expert assessor and the non-specialist child development assessors was substantial (κ = 0.89 to 1.00 (95% CI [0.58, 1.00]). The inter-rater and test-retest reliability for non-specialist child development assessors was between κ = 0.99 -1.00 (95% CI [0.98, 0.99]) and κ = 0.76 - 1.00 (95% CI [0.33, 1.00]) across all INTER-NDA domains. CONCLUSIONS: The current study provides evidence to support the use of the adapted INTER-NDA by trained, non-specialist assessors to measure ECD prevalence in the English-speaking Caribbean. It also provides a methodological template for the adaptation of child developmental measures to cultural and linguistic contexts that conform to the cultural standards of the countries in which they are utilized to aid in the measurement of neurodevelopmental impairments (NDIs) in a variety of global clinical settings.

A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial.

The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.

El ensayo controlado aleatorizado analizó la eficacia de un un programa personalizado de parentalidad a distancia mediante feedback por vídeo dirigido a mejorar la parentalidad y el comportamiento de los niños. Se distribuyó aleatoriamente a 92 madres de niños de entre 2 y 6 años de edad en el grupo de intervención (n = 50) y un grupo control de lista de espera (n = 42). Para mejorar la parentalidad positiva se utilizó el programa preventivo Strengthening Bonds, en el que las madres participaron en una sesión de grupo presencial. Durante seis semanas recibieron por teléfono móvil feedback en vídeo personalizado sobre su interacción madre-hijo durante el juego. El resultado primario fue la conducta parental, y el resultado secundario la conducta del niño. Se llevaron a cabo mediciones preintervención y posintervención. El análisis de ecuaciones de estimación general no tuvo resultados significativos en los análisis por intención de tratar (AIT). En los análisis por protocolo (APP) hubo efectos significativos, reduciendo las prácticas parentales coercitivas de las madres y los problemas de conducta de los niños. El análisis de modelos de ecuaciones estructurales reveló que la disminución de los problemas de conducta de los niños producida por la intervención era mediada por la mejora en las prácticas coercitivas. La intervención tenía un efecto directo en la mejora del sentimiento de competencia parental. A pesar de la falta de resultados del AIT, el APP dio resultados prometedores en cuanto a la mejora de las conductas y creencias parentales positivas y en la reducción de los problemas de conducta de los niños.

Qualitative evaluation of a scalable early childhood parenting programme in rural Colombia.

BACKGROUND: Integrating early childhood parenting programmes into existing government services is a key strategy for reducing the loss of children's developmental potential in low- and middle-income countries. There is limited evidence of participants' perceptions of these programmes, especially when implemented at scale. We integrated an intervention into an existing government programme targeting pregnant women and mothers of children up to 2 years of age and their families in rural Colombia. METHODS: As part of a cluster randomized trial, 171 government workers (facilitators) implemented the intervention. The intervention included four components: (1) structured curricula, (2) play materials, (3) nutrition and (4) training and supervision. In this qualitative evaluation of the programme, we conducted semi-structured interviews with beneficiary mothers (n = 62), facilitators (n = 40) and supervisors (n = 8). Topic guides were developed to collect information on participants' perspectives of the acceptability, feasibility and effectiveness of the intervention and the enablers and barriers to implementation. All interviews were audiotaped and transcribed, and data were analysed using the framework approach. RESULTS: Participants' responses indicated that the intervention was acceptable, feasible and effective. Key enablers to implementation were (1) the use of evidence-based behaviour change techniques leading to interactive, fun and participatory sessions; (2) structured curricula with easy to use, simple activities and materials; (3) the focus on positive, supportive relationships; and (4) the perceived benefits of the programme to the beneficiary mothers, children and families, facilitators and programme supervisors. The main barriers were (1) facilitators took time to become comfortable and competent in using the new participatory methodology and (2) the logistics related to making and distributing the play materials. CONCLUSION: Providing structured curricula and play materials with training and ongoing supervision to enhance an existing programme targeting mothers, families and children was reported as acceptable, feasible and effective by beneficiary mothers and programme staff.