by Dr Patrice Engle

People working to improve child health often focus on medical health, such as preventing and treating common childhood illnesses, and encouraging good nutrition. Physical health is very important, but a child’s mental, social and spiritual needs must also be met to ensure the full and healthy development of that child. Babies and young children need special attention because the care and attention a child receives in the first five years of life will influence a child’s whole development. People are capable of learning throughout life, but brain development is most rapid during the first few months and years.

The importance of care

Parents and other caregivers take care of children every day, but often do not realise how much they are doing, and how important it is. A child’s growth and development depend on the availability and quality of four things:

  • healthcare services
  • a healthy home environment
  • emotional care
  • healthy nutrition.

In difficult situations, where access to resources such as food or treatment is limited, good care at home is even more important to ensure the child’s survival, growth and development. Access to medical services at a local health centre is important, but what happens in the home is what really makes a difference. A health worker gives advice or a prescription, but it is the caregiver who has to obtain the necessary medicine and give it to the child each day, as well as take the child for immunisations. In the home, caregivers are responsible for creating a healthy environment by preventing accidents and teaching the child about hygiene and sanitation, such as handwashing and using a latrine. Caring for the child includes preparing and storing nutritional food, ensuring he or she receives education, and giving love and affection to the child. Children should be valued as people in their own right.

Emotional care and stimulation

About half of a child’s mental abilities will depend on the quality and consistency of social and emotional care, and opportunities for learning, that the child receives, especially in the first five years of life. Good care means:

  • giving children love, affection and attention. Caregivers should hold, touch, talk to and comfort children
  • protecting children from abuse, neglect and exposure to violence
  • encouraging children to play, explore and learn
  • responding to a child’s emerging abilities by encouraging new skills and stimulating the child by talking and playing with him or her.

This type of care does not require any resources apart from time. Good care and stimulation for pre-school children will improve their intelligence. The most important thing that a caregiver can do for a young child is to respond to what the child is trying to do – to follow the child’s lead. This means that the caregiver has to pay attention to what the child is learning to do, and help the child to take the next step. For example, if a child is beginning to make sounds, the caregiver can imitate the sounds and add some new ones. It is important to encourage all the child’s attempts, and praise the child for what he or she manages to do, not to criticise.

Healthy nutrition

Good nutrition is very important for child health, particularly in the early years. A child’s nutrition during the first five years of life will have a significant effect on the child’s mental and physical development. Improving the mother’s nutrition during the pregnancy is very important as development begins in the womb. Children who are born with low birth weight or who are malnourished are likely to develop more slowly, and perform less well at school because they are less able to learn and pay attention. If children are healthy and well-nourished, they are better able to learn and have the energy and curiosity to explore and respond to their environment.

Breastfeeding
Breast milk is the perfect food for babies, since it contains all the nutrients needed for healthy development of the brain. Mothers living with HIV have a difficult decision to make as HIV can be transmitted through breast milk. But the nutritional benefits of breast milk are so great, that in resource-poor settings, where access to safe water and sufficient breast milk substitutes cannot be guaranteed, it is recommended that mothers breastfeed exclusively for the first six months. Make sure that during this time the baby receives no other foods or liquids, such as tea or water. After six months stop breastfeeding as quickly as possible (Footsteps 52).

Encouraging a child to eat
Good feeding practices can stimulate learning and help to make sure a child gets enough to eat. Poor appetite is common and may be caused by illness or mouth infections, food that does not taste good, or the child being upset or unhappy. Here are some practical suggestions:

  • Feed the child when he or she shows signs of being hungry, rather than waiting for the child to start crying.
  • Feed the child at the same times each day, if possible.
  • Seat the child, give him or her your attention and try not to have any distractions during meal times.
  • Wash your hands before feeding a child. Give small amounts of food at a time – use your fingers or a small spoon or utensil that provides small mouthfuls.
  • Talk to the child during the meal – describe the food, the situation, the people around, and say how well the child is eating. Even if the child cannot answer, he or she is learning names and meanings of things.
  • Allow the child to eat in company with others, but make sure that the child has his or her own separate plate.
  • Eat the same food yourself and show that you like the food.
  • Encourage the child to try to feed him or herself, as this will develop their confidence and movement skills. Children under two years old can often manage a few mouthfuls using a spoon, but may also need to be fed. Children learn through their hands and senses, so allow the child to pick up food with their fingers, even if they may make a mess.
  • Offer a few more mouthfuls when the child has stopped eating, but do not force the child to eat – make mealtimes happy and peaceful.

Care for caregivers

Caregivers also need support and encouragement, especially if they are children themselves. Caregivers cannot give adequate care unless they have enough time, knowledge, motivation and control of resources such as money. Support from family members, particularly men, can make a big difference. Communities can also help by providing safe places for children to play, or alternative care.

It is very important that girls have the same access to nutrition and education as boys. This will also have a positive impact on the next generation, as women are usually the primary caregivers for children.

The information in this article is adapted with permission from articles which appeared in Child Health Dialogue, issue 20. (http://www.healthlink.org.uk/PDFs/chd20.pdf)

Dr Patrice Engle is Professor of Psychology and Child Development at Cal Poly State University and has worked for UNICEF in India as Chief of Child Development and Nutrition.

Cal Poly State University
San Luis
Obispo
CA 93407
USA
Email:
pengle@calpoly.edu


Activities to stimulate a child's development

Age Play Communication
Under six months
  • Provide ways for a child to hear, feel, see, touch and move
  • Have large colourful things for a child to reach for
  • Look at your child’s eyes and smile at him or her
  • Talk and sing to your child and have a conversation with sounds and actions
Six months to two years
  • Give your child things to stack up, to put into containers and to take out. Make sure these are big enough to prevent the child choking on them
  • Play simple games
  • Tell your child the names of people and things
  • Ask your child simple questions
Two to three years
  • Make simple toys for your child
  • Teach your child stories, songs and games
  • Encourage your child to talk and answer your child’s questions
  • Help your child to count, name things and compare things 


Developmental milestones for most children

Age Milestone
Three months
  • Wiggle and kick with legs and arms
  • Smile
  • Make cooing sounds
One year
  • Crawl on hands and knees
  • Sit without support
  • Get up to standing position with support
  • Say two or three words
  • Follow simple instructions
  • Pick things up with thumb and one finger
Two years
  • Carry an object while walking
  • Feed himself or herself
  • Repeat words that others say
  • Use two- or three-word sentences