Nurturing Care: Bringing Early Childhood Development and Nutrition Together for Greater Impact
In the nutrition community, we know that the 1,000 day window from pregnancy until a child turns two is a critical time for both physical growth and brain development. Vision, hearing, receptive language, and higher cognitive functions like decision-making and emotional and social regulation are all developing rapidly—or falling behind. To support children during this critical period, the 2016 Lancet Early Childhood Development (ECD) Series calls for the promotion of integrated programming and the concept of nurturing care: the “health, nutrition, security and safety, responsive caregiving, and early learning provided by parent and family interactions, and supported by an environment that enables these interactions.”
Unfortunately, our programming approaches to nutrition and ECD are typically siloed, and when the two sectors work separately they can derail the other’s efforts. For example, normal infant growth spurts around 3-4 months of age can lead to perceived milk insufficiency and early introduction of complementary foods. If the nutrition and ECD sectors work together, they can address misconceptions early to help caregivers understand developmental milestones and their child’s changing needs as they grow.
So how can those of us working in nutrition programs promote nurturing care, taking steps to integrate nutrition and ECD?
Through USAID’s multi-sectoral nutrition project, Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) and other leading implementing organizations, nutrition programs have begun to encourage the overlap of ECD and nutrition. At present, we see five opportunities for integrating ECD into nutrition programming:
- Promote responsive complementary feeding. When a child begins eating complementary foods after six months of age, we often focus on what a child eats, but not how a child is fed. Responsive (or active) feeding enhances the typical practice of complementary feeding in a way that draws clear connections between nutrition and ECD, incorporating positive parent-child interactions into feeding times throughout the day. Responsive feeding also helps caregivers ensure that children are eating the diversity of foods they are given.
- Define responsive feeding practices and develop a standard indicator to measure them. The World Health Organization’s 2001 complementary feeding guidelines includes one guideline specifically on responsive feeding practices, with recommendations such as: not forcing children to eat, finding creative food combinations to support picky eaters, and minimizing distractions. Still, and despite a growing body of supporting research, there is no agreed-upon standard definition of the term and does not have any standard associated indicators. Without a globally recognized indicator to measure progress, programs rarely prioritize or promote recommended behaviors, as is the case for responsive feeding.
- Incorporate role-modeling of positive interactions and stimulation into program materials and activities. It is a universal truth of parenthood that we are constantly learning from those around us, our communities, and our environment about how best to parent. Programs can make a big impact by making small changes to encourage positive caregiver interactions, especially during child feeding times. By incorporating scenes of positive interactions, stimulation, and play into counseling cards, job aids, and other graphics and multimedia that nutrition activities already use, programs can role-model what these practices look like. These tools can deliver precise messages on how to use good practices, such as the underlining the importance of clean play spaces to preserve good hygiene, which is critical for health when promoting play. Communication materials like these are often valued by community members—including fathers—as a source of new ideas for how to interact with their children.
- Work with mothers’ groups to reach caregivers in the first 1,000 days. Globally, these peer-to-peer support groups provide a unique opportunity not only to learn breastfeeding and infant feeding techniques and get encouragement from other mothers but, because mothers often bring their babies with them, also for early social development and positive interaction. Although the children are sometimes seen by group leaders as a distraction, they could easily provide local toys like spoons or cups and take advantage of opportunities throughout the session to demonstrate stimulation and explain the importance of spaces for clean play, free from animal feces and hazards. This small tweak can help teach mothers to practice positive stimulation and play not just in the meetings, but also at home.
- Incorporating stimulation, play, and nurturing care in health systems. The health system is a key touchpoint for ECD and nutrition-related interventions, such as when parents and children interact with health workers during routine immunizations and well-child visits. ECD-related interventions can be integrated into such routine health and nutrition services in a number of ways, such as incorporating child development screenings, adding topics on nurturing care practices into nutrition counseling, or by providing simple toys in the clinic facilities themselves to model a clean, nurturing environment with stimulation and provide inspiration for easy-to-make handmade toys at home.
While it is easy to get hung up on the challenges of integrating these ECD practices into nutrition programs, these challenges also present opportunities for us to see greater impact. We challenge you to think about what more we can do as a nutrition community to promote early childhood development. Share what your organization has done to integrate or what innovative ideas you have by leaving a comment below.
To learn how SPRING is supporting integration of nutrition and ECD, visit the SPRING website.