Acknowledgements Care for Child Development

The Care for Development module of IMCI was first Atif Rahman (Professor of Child Psychiatry, University
developed in the late 90s to provide families with of Manchester, United Kingdom);
information and recommendations for cognitive stimu­ Tomris Türmen (Professor of Paediatrics, Ankara Uni­
lation and social support to young children as part of versity, and President of the International Children’s
the child health visit specified in the WHO/UNICEF Centre, Turkey) with the assistance of others from the ICC.
strategy Integrated Management of Childhood Illness
(IMCI). WHO prepared the Care for Development
The meeting participants concluded that the training
for workers in first-level health facilities was a valuable
Contents
recommendations as part of the Counsel the Mother tool to promote the healthy growth and development
Card along with advocacy materials, technical seminars, of young children. The available materials, however,
◾ Foreword – Acknowledgments
and training materials with the technical expertise of needed updating to be consistent with new research
◾ Care for Child Development:
Drs. Patrice Engle and Jane E. Lucas. evidence and WHO/UNICEF recommendations.
Improving the Care of Young Children

Photo J. Lucas
­Furthermore, if the training could be used beyond, as
The project was led and managed by Meena Cabral
well as within, the IMCI strategy and local health
de Mello, Senior Scientist, Department of Maternal, Course materials:
facilities, the intervention had the potential to reach
Newborn, Child and Adolescent Health in WHO, and Counsel the Family on Care for Child Development
many more children. The training could complement
Nurper Ulkuer, Chief, Child Development Unit in UNICEF.
other child survival and health, nutrition, and early
◾ Care for Child Development: Participant Manual

In 2007, a group of experts in health, nutrition, and child child-care interventions in resource-poor areas, ◾ Care for Child Development: Counselling Cards
development met at the International Child ­Development ­including programmes to meet the needs of children ◾ Care for Child Development: Facilitator Notes
Centre (ICC) in Ankara. They reviewed the Care for living in communities affected by HIV/AIDS. The group’s ◾ Care for Child Development: Guide for Clinical Practice
Development training materials and shared experiences valuable recommendations are incorporated in these ◾ Framework for Monitoring and Evaluation
in using the guidelines in Africa, the Central Asian revised materials for the course Counsel the Family on ◾ Poster: Recommendations for Care for Child Development
Republics, the Middle East, and South East Asia. Care for Child Development.

Photo Caitlin Chittenden /Kerala, India, 2007

Nurper Ulkuer, Senior Advisor and Chief, Child Devel­ We are grateful to the many international experts and CD-Rom: Technical, Advocacy and Training Resources
opment Unit, UNICEF, New York, Nune Mangasarayan, WHO and UNICEF regional and country based staff ◾ Care for Child Development: Guide for Monitoring and Evaluation
Senior Advisor Nutrition, UNICEF, New York, and Meena who contributed over the years to the development and Course Materials
Cabral de Mello, Senior Scientist, Department of Child use of the Care for Development materials. Presentations for Technical Seminars
and Adolescent Health and Development, World Health
We are especially grateful to Drs Jane E. Lucas and Reviews of the Evidence
Organization, Geneva convened the group which
Patrice Engle for donating much of their valuable time Training and Advocacy Videos
included:
and technical expertise that was needed to update and Other Resource Materials
Patrice Engle (Professor of Child Development, Cal Poly
revise the materials that are contained in Care for Child
University, United States);
Development. They were supported by Aisha K Yousafzai,
Ilgi Ertem (Professor of Paediatrics, Ankara University,
Assistant Professor, Department of Paediatrics and
Turkey);
Child Health, Aga Khan University, Karachi, Pakistan and
Jane E. Lucas (Consultant in child health and develop­
Oliver Petrovic, ECD Programme Specialist, Early Child­
ment, United States);
hood Development Unit/PDO, UNICEF, New York, USA.
Sally McGregor-Grantham (Professor of Paediatrics, Additional materials to support the implementation of Care for
University College London, United Kingdom); The assistance of Amy R. Borden, WHO intern, Des Child Development will be added to this set as they are finalized.
Sudhansh Mahotra (Regional Adviser, Child Health and Moines University, USA, in the finalization process is
Development, WHO SEARO); gratefully acknowledged.
Linda Richter (Executive Director, Child, Youth, and
Family Development, Human Sciences Research C
­ ouncil,
South Africa);
Foreword

Early childhood development (ECD) – including help to modify distressing socio-economic and To address this gap, WHO and UNICEF have We hope that these materials will be widely used
the sensori-motor, social /emotional and lan­ gender-related inequities. There is strong evi­ collaborated closely to strengthen their ­technical to optimize early psycho-social development and
guage /cognitive capacities – is indivisible from dence regarding interventions that can address support to regions and countries and have thereby reduce inequities and the global burden
the child survival, health and education agendas the causal factors and reduce the burden of poor extended partnership to national leaders and of poor development.
and represents one of the important stages for child development. governments, development agencies, ­researchers,
breaking the intergenerational cycles of poverty academics, non-governmental organizations,
and for promoting sus­tainable development. The health sector in countries has the capacity professional associations and advocacy groups.
Development during the early years lays the to play a unique role in the field of ECD because We have also developed the present evidence-
critical foundations for health, learning and the most important window of opportunity for based set of materials to help international staff,
behaviour across the life course. ensuring optimal development and preventing national governments and their partners promote
risk of long-term damage is from pregnancy Care for Child Develop­ment within all relevant
Poor development during childhood, unfortu­ through the first five years of life. Therefore health programme activities of the health sector.
Care for Child
nately, is widespread. Globally over 200 million care encounters for women and young children Development
children do not reach their developmental are important ­opportunities to help strengthen These materials guide health workers and other
potential in the first 5 years because they live in families’ efforts to promote children’s early counsellors as they help families build stronger Participant Manual
poverty, and have poor health services, nutrition development and may r­ epresent the only real relationships with their children and solve prob­
and psycho-social care. These disadvantaged chance for health professionals in developing lems in caring for their children at home. Care
children do poorly in school and subsequently countries to p
­ ositively influence parents of young for Child Development recommends play and
have low incomes, high fertility, high criminality, children. But between birth and five years of life, communication activities for families to stimulate
and provide poor care for their own children. there are relatively few investments made by the learning of their children. Also, through play
As a result, their countries suffer an estimated governments for promoting the development of and communication, adults learn how to be
20 per cent loss in adult productivity (McGregor young children, and ECD is currently not system­ sensitive to the needs of children and respond
et al., The Lancet Child Development Series, atically incorporated into initiatives to promote appropriately to meet them. These basic care
2007). and protect maternal and child health. Moreover, giving skills contribute to the survival, as well as
families are often not prepared or aware of the the healthy growth and development, of young
Investment in early childhood programmes is critical role they can play in promoting cognitive children.
essential because ECD programmes and inter­ and socio-emotional d
­ evelopment in the early
ventions can provide a “fair start” to children and years.
a variety of health and community workers to
provide age-appropriate guidance to caregiv-
Implemented on a wide-scale, Care for Child
Development will have significant public health Care for Child Development
Improving the Care of Young Children
ers of young children for stimulating cognitive, and social benefits.
language and social-emotional development
through play and communication. This guidance
is designed to benefit those children and families 7.6 million children under the age of 5 worldwide die each year. More than 25 times that
number – over 200 million children – survive, but do not reach their full human potential.1
who need it most. It has been shown to be effec-
As a result, their countries have an estimated 20 per cent loss in adult productivity. Health
tive in improving responsive care.
services, health workers and c­ ommunity providers have an important role in promoting
the development of young children.

The Care for Child Development package consists of: For every child – a good start – lasts a lifetime – builds our society
 Simple recommendations health workers can make to families to improve the ­development
of children.

 Training materials for health workers and community providers.

 Support for families to solve common problems in providing good care for young children.
 Advocacy materials.
 A monitoring and evaluation ­framework.

© WHO-3844025. WAAK A.
EVERY CHILD GOOD START
What happens during the early years is of crucial Good nutrition and health, consistent loving care
For more information contact: importance for every child’s development. It is a and encouragement to learn in the early years
period of great ­opportunity, but also of vulner- of life help children to do better at school, be
Early Childhood Development/PDO World Health Organization
ability ­to negative influences. ­healthier, have higher earnings and participate
UNICEF House Department of Maternal, Newborn,
more in socie­ty. This is especially important for
3 UN Plaza Child and Adolescent Health (MCA) Many children do not reach their full human
children in ­poverty.
New York, NY 10017 Avenue Appia 20 potential because they live in very poor families
USA CH-1211 Geneva 27 in d
­ eveloping ­countries. They do not receive ade- LASTS A LIFETIME
Switzerland quate nutrition, care and opportu­nities to learn. A good foundation in the early years makes a
Email: [email protected] Email: [email protected] These children and their families can be helped. difference through adulthood and even gives the
It is their right to develop as well as to survive. next generation a better start.

1
© World Health Organization 2012 “We have made a conservative estimate that more than 200 million children under 5 years fail to reach their potential in c­ ognitive development
because of poverty, poor health and nutrition, and deficient care”. Grantham McGregor S et al., and the International Child Development ­Steering
Group (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, 369:60-70.
BUILDS OUR SOCIETY brunt of parental violence. It identified the
Educated and healthy people participate in, and importance of improved care for young children

© WHO-342031. GAGGERO C.
contribute to, the financial and social wealth of in the overall reduction of violence.
their societies.
There is consistent and strong evidence which
The World Health Organization (WHO) and shows that:
the United Nations Children’s Fund (UNICEF),  Brain development is most rapid in the early
together with a wide range of partners, have years of life. When the quality of stimulation,  Efforts to improve early child development and to support families in the process. The CRC
developed a package of materials entitled Care support and nurturance is deficient, child are an investment, not a cost. Available cost- advocates for children’s rights to development in
for Child Development to support families in development is seriously affected. benefit ratios of early intervention indicate addition to s­ urvival. Thus, health-care systems
promoting the development of young ­children that for every dollar spent on improving early must aim for better growth and development
 The effects of early disadvantage on chil- among all children.
– through health services, health workers, child development, returns can be on average
dren can be reduced. Early interventions for
community providers and others working with 4 to 5 times the amount invested, and in some
­disadvantaged children lead to ­improvements There is now substantial information on how
­families and young children. cases, much higher.
in children’s survival, health, growth, and ­children’s development can be promoted through
Improving care for young children is ­fundamental cognitive and social development. The health system has health care-related activities in d
­ eveloping
to achieving the ­Millenium Development Goals. a unique opportunity ­countries.
 Children who receive assistance in their
A 2007 series on Early Child Development in
early years achieve more success at school. The importance of children’s early years has been Care for Child Development
the Lancet estimated that more than 200 m
­ illion
As adults they have higher ­employment recognized for a long time. Many actors play an
The Care for Development intervention is based
children in the developing world, over one third
and earnings, better health, and lower important part in improving the care of young
on the best available evidence of child develop-
of all children, do not fulfill their potential. The
levels of welfare dependence and crime children.
ment. It incorporates the most recent evidence
major reasons for their disadvantage are poor
rates than those who don’t have these early
In most countries, the health care system on the identification of critical caregiver skills
nutrition and few opportunities to learn, which
­opportunities.
reaches more young children and their families affecting the child’s healthy growth and develop-
occurs in families facing poverty. The WHO’s
than other services. Health services often have ment (sensitivity and responsiveness) and the
Commission on the Social Determinants of
home-visiting services. In a­ ddition, nutrition and research demonstrating that these important
Health recognizes the importance of early
good health are essential to ­children’s develop- skills can be taught to caregivers.
childhood development to equity, adult health,
wellbeing and productivity. The Education for ment. Health services and community activities
Caregivers and families are best placed to
All Global Monitoring Report 2007 advocates for health must use their unique opportunities to
support children’s growth and development
that better care in early childhood improves per- strengthen families’ efforts to promote children’s
through daily activities and interactions.
formance in primary school. The World Bank’s development.
­Families often need assistance to focus on the
poverty reduction strategies begin with early The United Nation’s Convention on the Rights most important activities for the development
© WHO-201208

childhood development. The United Nations of the Child calls for all countries to enable of young children – play and communication.
­Secretary-General’s Study on Violence against children to develop their full human potential Care for Child Development can be used by
Children found that young children bear the