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Responsive caregiving is associated with secure attachment and positive child developmental outcomes. However, there is some debate on whether responsive caregiving is a universal construct. Few studies have researched responsive caregiving in diverse cultural settings, particularly in low‐ and middle‐income countries. In this study, we explore if and how responsive caregiving is conceptualized among mothers of children under 3‐years‐old in rural, Sindh Pakistan. A phenomenological qualitative study was implemented in Naushahro Feroze through in‐depth interviews with twenty mothers. Mothers were asked about their aspirations for their children and how they would respond in a variety of different scenarios. Data were analyzed using thematic content analysis with an inductive‐deductive coding scheme. There was substantial variation in mothers' described responsive behaviors and beliefs. Almost all mothers described using some form of responsive parenting. Responding to children's demands while the mother was preoccupied, using verbal responses to console children, and if mothers believed that children should be praised, lacked consensus. Most mothers described using breastfeeding for consolation and highlighted the importance of immediately consoling their crying child. The results suggest that there is a need for a more nuanced approach to understand caregiver behaviors across contexts. [ABSTRACT FROM AUTHOR]

Abstract This study examined whether maternal depression is related to Early Childhood Developmental (ECD) delay among children by quantifying the mediating contribution of responsive caregiving. We used data from 1235 children (Children’s mean age = 50.4 months; 582 girls, 653 boys, 93.9% were Han), selected through convenience sampling, in 2021. 4.7% of children had ECD delay, 34.3% of mothers had depression. Children with depressed mothers were less likely to receive responsive caregiving (OR 4.35, 95% CI 2.60–7.27), and those who did not receive responsive caregiving were more likely to experience ECD delay (OR 3.89, 95% CI 1.89–8.02). Responsive caregiving partly mediated the relationship between maternal depression and ECD. Early intervention for children with depressed mothers is worthy of further investigation.

This study examined whether maternal depression is related to Early Childhood Developmental (ECD) delay among children by quantifying the mediating contribution of responsive caregiving. We used data from 1235 children (Children's mean age = 50.4 months; 582 girls, 653 boys, 93.9% were Han), selected through convenience sampling, in 2021. 4.7% of children had ECD delay, 34.3% of mothers had depression. Children with depressed mothers were less likely to receive responsive caregiving (OR 4.35, 95% CI 2.60–7.27), and those who did not receive responsive caregiving were more likely to experience ECD delay (OR 3.89, 95% CI 1.89–8.02). Responsive caregiving partly mediated the relationship between maternal depression and ECD. Early intervention for children with depressed mothers is worthy of further investigation. [ABSTRACT FROM AUTHOR]

Research has shown the importance of responsive caregiving for fostering positive development early in life; however, tools measuring these interactions are often impractical for larger scale intervention trials and in settings with resource constraints. The present study provides reliability and validity evidence from Sindh, Pakistan for a tool developed to quantify responsive caregiving. Data were collected from 200 randomly selected households on responsive caregiving, sociodemographic characteristics, early learning, and early child development. The results indicated that the responsive care tool can be feasibly administered in less than 5 min in a low-resource setting. An exploratory factor analysis found that the tool's indicators reliably loaded onto two distinct factors, responsive interactions and caregiver-initiated interactions, accounting for 96.01% of the underlying variation in scores. A confirmatory factor analysis reflecting input from modification indices showed satisfactory fit statistics and adequate factor loadings (all above.70). Internal consistencies of the two factors were also high, with alphas of.93 and.83, respectively. Convergent validity of the responsive interactions factor was demonstrated by a strong and positive correlation with measures of psychosocial stimulation, early learning, maternal education, and household wealth. Predictive validity of the responsive interactions factor was demonstrated by a strong and positive association with child development. The caregiver-initiated interactions factor was significantly and negatively associated with psychosocial stimulation and child development. The resulting evidence provides programs with an open access, observational, reliable, and valid measure to quantify responsive caregiving at the program level in low-resource settings. [ABSTRACT FROM AUTHOR]

Abstract Background Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings. Methods We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey. Results Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16). Conclusion Our study findings suggest a strong positive link between maternal stimulation activities and children’s developmental outcomes among communities in poor rural settings. Trial registration NA (not a clinical trial).

Aims/BackgroundDesign/MethodsResultsConclusionThe United Nations Sustainable Development Goals (SDGs) has placed emphasis on improving early child development globally. This is supported through the Nurturing Care Framework which includes responsive caregiving. To evaluate responsive caregiving, tools to assess quality of caregiver-child interactions are used, however there is little information on how they are currently employed and/or adapted particularly in low- and middle-income countries (LMICs) where children have a greater risk of adverse outcomes. The aim of this review is to provide a comprehensive guide on methodologies used to evaluate caregiver-child interaction – including their feasibility and cultural adaptation.We conducted a systematic review of studies over 20years in LMICs which assessed caregiver-child interactions. Characteristics of each tool, their validity (assessed with COSMIN Risk of Bias checklist), and the quality of the study (Mixed Methods Appraisal Tool) are reported.We identified 59 studies using 34 tools across 20 different LMICs. Most tools (86.5%) employed video-recorded observations of caregiver-child interactions at home (e.g. Ainsworth’s Sensitivity Scale, OMI) or in the laboratory (e.g. PICCOLO) with a few conducting direct observations in the field (e.g. OMCI, HOME); 13.5% were self-reported. Tools varied in methodology with limited or no mention of validity and reliability. Most tools are developed in Western countries and have not been culturally validated for use in LMIC settings.There are limited caregiver-child interaction measures used in LMIC settings, with only some locally validated locally. Future studies should aim to ensure better validity, applicability and feasibility of caregiver-child interaction tools for global settings. [ABSTRACT FROM AUTHOR]

Global public health organizations such as The World Health Organization and United Nations Children's Fund have prioritized environmental support for infants in their first 1000 days of life, including interventions that target early childhood development (ECD) outcomes. Responsive caregiving practices and interventions that support parents in engaging in them have a positive effect on ECD outcomes. Behavioral research has identified a number of specific caregiver responses that influence infants' early language development, including contingent vocal imitation. This study examined the effects of a brief, asynchronous online parent training using the Cool versus Not Cool™ procedure to teach two mothers and one father to imitate their infants' vocalizations in their natural home settings. All three parents increased the percentage of contingent vocalizations with their infants and positive changes in vocal behavior were observed for all the three infants. [ABSTRACT FROM AUTHOR]

Background: Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings. Methods: We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey. Results: Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16). Conclusion: Our study findings suggest a strong positive link between maternal stimulation activities and children's developmental outcomes among communities in poor rural settings. Trial registration: NA (not a clinical trial). [ABSTRACT FROM AUTHOR]

Early childhood (ECC) is the main period of cognitive development, physical and mental health in children. The well-being of future generations depends on early childhood development and care. Poverty, malnutrition, violence, gender inequality, environmental pollution and caregiver mental health problems threaten the development of young children and prevent them from being physically and mentally healthy, being happy, having positive relationships and being productive adults. Nurturing Care (NC) is a policy framework proposed by the World Health Organization (WHO), UNICEF and other stakeholders, aimed at achieving national and global goals to help children survive and thrive, in order to transform health and human potential. Its components are health, adequate nutrition, responsive care, early learning opportunities and safety. NC aims to provide family-centered, holistic services to each child, especially in the first three years of life, starting from pregnancy. The aim of this review is to increase the awareness of NC in Turkey and to share studies from other countries. [ABSTRACT FROM AUTHOR]

Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6–18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was 13.0 (4.6) months, including 49% males, 32% who were stunted, 55% who were anemic, and 58% who were iron deficient. At the endline (n = 328/386, 85% retention), there was no synergistic effect on the fortified beverage and responsive caregiving intervention. Compared to the non-fortified beverage group, socioemotional development improved in the fortified beverage group. There were no intervention effects on other measures of child development, hemoglobin, or ferritin. In a setting with high rates of anemia and iron deficiency, a multiple micronutrient-fortified beverage improved infants' socioemotional development. [ABSTRACT FROM AUTHOR]

Many young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration # NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group (n = 151) on measures of cognition (p = .022), fine motor (p < .0001), gross motor (p = .015), and language development (p = .013). No difference in secondary outcomes, including CP, was detected.

A global goal for early childhood education and care is to ensure universal, "quality" provision that reaches all children. Achieving this goal requires a well-prepared workforce that is equipped to adapt to and deliver early childhood programs across the vastly diverse contexts and communities where children are growing up around the world. Yet currently there is a severe shortage of early childhood workers, particularly in "low resource" and complex communities. Evidence to support appropriate training for such workers is also lacking. In response, this paper presents findings from a case study of a large-scale training program for community-based early childhood workers in central-east India. A total of 650 community-based Village Communicators were trained to deliver a responsive caregiving package to parents of young children. Data collected over 3 months highlight how the unique contextually grounded, caring and reflexive approach to training resulted in profound personal and professional change among training participants. The findings are of significance in informing policy and practice associated with global goals for early childhood. First, they challenge the technical, programmatic approaches to training that are commonly adopted for preparing this workforce. Second, they evidence the potentially transformative, long-term impact of person-centered approaches to training that facilitate knowledge-sharing to understand local needs and attitudes. Third, they provide insight into ways in which training programs can support enhanced local relevance and effectiveness of early childhood services implemented for children and families across diverse contexts. Highlights: Caring, consultative approaches to training support transformative changes in knowledge and practice among community-based early childhood workers. Community-based workers comprise a crucial yet under-researched workforce globally. Active contribution to adapting early childhood interventions for greater local relevance empowers community-based workers as well as enhancing program content. Training for community-based workers in early childhood needs to shift away from overly programmatic, technical approaches. Meeting global goals for early childhood development requires localized responses. [ABSTRACT FROM AUTHOR]

BackgroundLittle is known regarding the role of responsive caregiving in the association between maternal psychological stress and child neurodevelopment. We, therefore, herein investigated the relationship between maternal psychological stress during pregnancy and children's neurodevelopment with modifications in responsive caregiving.MethodsA total of 3,603 mother–child pairs were recruited from the Shanghai Maternal-Child Pairs Cohort, and we assessed maternal psychological stress using the Life Events Scale for Pregnant Women (LESPW) during early and late pregnancy. Early neurodevelopment of infants at 6 and 12 months of age was also evaluated using the Age and Stage Questionnaire, Third Edition (ASQ-3). The 2-month-old infant nursing-care questionnaire was designed based on the Five Elements of Parenting Care Framework released by the World Health Organization (WHO) and used to evaluate the levels of early responsive caregiving for infants. Multivariate logistic regression analysis was then applied to determine the association between maternal psychological stress during pregnancy and child development.ResultsThe suspected developmental delay rate of infants aged 6 and 12 months ranged between 13.3% and 24.5%. After adjusting for confounders, we noted that high maternal subjective events stress during early pregnancy was associated with an increased risk of suspected developmental delay in problem-solving domains at 12 months of age [adjusted OR (aOR) = 1.51; 95% confidence interval (CI), 1.09–2.20]. High general negative objective events’ stress during late pregnancy also constituted a risk factor for development in the personal–social domain at 12 months of age (aOR = 1.57; 95% CI, 1.13–2.19). Remarkably, we noted in infants with insufficient responsive caregiving that there were greater associations between the risk of general maternal negative objective events during late pregnancy and personal–social domain at 12 months of age (aOR = 2.06; 95% CI, 1.15–3.68). Similarly, there was a greater association between the risk for maternal subjective events during early pregnancy and problem-solving at 12 months of age (aOR = 1.55; 95% CI, 1.11–2.34).ConclusionsMaternal psychological stress during pregnancy was predominantly associated with suspected developmental delay in infants at 6 and 12 months of age, and these associations were modified by early responsive caregiving.

Background: The association between school and home is fundamental to sustainable education: parents' understanding of the school's priorities and teachers' understanding of their pupils' home environment are both vital for children to remain in school and succeed academically. The relationship between parents and teachers is closest in preschool settings, providing a valuable opportunity to build bridges between home and school. In this protocol paper, we outline our planned methods for identifying beneficial home and school behaviors. Objective: Our project aims to identify culture-specific structures and behaviors in home and school settings, which influence the quantity and quality of child-directed speech and identify positive experiences that can help improve children's linguistic development and nutrition. Methods: Using a mixed methods approach and focusing on early language learning, nutrition, and responsive caregiving, we will video-record and analyze mealtime language and eating behaviors at home and in school, targeting 80 preschool children and their families in rural Kenya and Zambia. In addition, we will assess children's language skills through audio recordings and use questionnaire-based interviews to collect extensive sociodemographic and dietary data. Results: Between the start of our project in January 2020 and the end of December 2021, we had collected complete sets of sociodemographic, observational, and food recall data for 40 children in Kenya and 16 children in Zambia. By the end of May 2022, we had started data collection for an additional 24 children in Zambia and transcribed and coded approximately 85% of the data. By the end of September, 2022, we plan to complete data collection, transcription, and coding for the entire sample of 80 children across both countries. From September 2022 onwards, we will focus on analyzing our language data, and we hope to have results ready for publication in early 2023. By relating children's language outcomes and nutritional intake to the observed mealtime behaviors, we hope to identify practices that increase the quantity and quality of child-directed speech and improve children's nutritional intake. Conclusions: Good nutrition and the promotion of language learning are key issues in early childhood development. By using a cross-cultural approach, combining a variety of methods, and working closely with stakeholders and policy makers throughout the project, we hope to find and share best practices for improving children's linguistic outcomes and nutrition and lay the foundation for the development of practitioner networks and parent outreach programs. [ABSTRACT FROM AUTHOR]

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BackgroundInfant development shapes children’s health into adulthood. Although providing responsive caregiving and opportunities regarding early learning for infants have received increasing attention from the international community, few studies have been published on these topics thus far. The purpose of the present study, then, was to explore the influences of responsive caregiving and the opportunities for early learning on infant development.MethodsMother-child dyads (3,714 pairs) were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) for the present study, and the development of infants, responsive caregiving and opportunities for early learning were collected from three waves of follow-up (2-, 6-, and 12-month old) We used the cross-lagged model to analyze the longitudinal correlation between responsive caregiving or opportunities for early learning and development of infants. We used the generalized estimation equation (GEE) to evaluate the effect of responsive caregiving and opportunities for early learning on suspected developmental delay; we also conducted a hierarchical analysis to investigate the interaction between responsive caregiving or opportunities for early learning and annual family income.ResultsThere was a mutual prediction between responsive caregiving or opportunities for early learning and some developmental domains of the Ages and Stages Questionnaires, third edition (ASQ-3). Sustained high-exposure to responsive caregiving or opportunities for early learning significantly decreased the risk of suspected developmental delay in most domains of the ASQ-3. And For infants whose annual family income was < ¥200,000, sustained high-exposure (Adjusted Odds Ratio = 0.456, 95% CI, 0.325–0.638) and fluctuating-exposure (Adjusted Odds Ratio = 0.510, 95% CI, 0.414–0.627) to responsive caregiving significantly reduced the risk for suspected developmental delay.ConclusionResponsive caregiving or opportunities for early learning interacted with infant development. Infants’ early access to adequate responsive caregiving and opportunities for early learning exerted a sustained and positive impact on infant development, and this effect is more pronounced in relative low-income families.

Efforts to monitor and improve responsive caregiving for young children, because of its importance for child development, are part of the United Nations Sustainable Development Goals. Two brief observational measures of responsive caregiving have been developed and validated (Responsive Interactions for Learning--parent [RIFL-P] and educator [RIFL-Ed] versions), with the RIFL-P available in English, Portuguese, and Spanish. The aim of the current study was to present and evaluate two online training programs for the RIFL measures. These distance learning courses were designed as open-source and asynchronous to enable their use in low- and middle-income countries and remote areas. The following course components are used: readings, lectures, observation of interactions on video, coding practice with automated feedback on item coding, and quizzes. Of the 76 trainees who registered for one of the online courses, 58 (76%) completed all theoretical module components. Student performance was generally high. Marks on quizzes ranged between 83%-100%. Ninety percent of those who took the reliability tests passed (40/44). Student satisfaction during and after the course was high. The effective online training programs are available free of charge and the RIFL suite of measures is efficient to implement. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Efforts to monitor and improve responsive caregiving for young children, because of its importance for child development, are part of the United Nations Sustainable Development Goals. Two brief observational measures of responsive caregiving have been developed and validated (Responsive Interactions for Learning—parent [RIFL-P] and educator [RIFL-Ed] versions), with the RIFL-P available in English, Portuguese, and Spanish. The aim of the current study was to present and evaluate two online training programs for the RIFL measures. These distance learning courses were designed as open-source and asynchronous to enable their use in low- and middle-income countries and remote areas. The following course components are used: readings, lectures, observation of interactions on video, coding practice with automated feedback on item coding, and quizzes. Of the 76 trainees who registered for one of the online courses, 58 (76%) completed all theoretical module components. Student performance was generally high. Marks on quizzes ranged between 83%–100%. Ninety percent of those who took the reliability tests passed (40/44). Student satisfaction during and after the course was high. The effective online training programs are available free of charge and the RIFL suite of measures is efficient to implement. Implications for research and practice are discussed.

Abstract Background Responsive caregiving, or interactions in which caregivers give appropriate responses to a child’s signals, is linked to improved psychosocial, cognitive and physical outcomes in children. However, much remains unknown about how responsive caregiving affects child development across cultural and socioeconomic contexts. The purpose of this study is to examine predictors of maternal responsive caregiving and investigate how these interactions are associated with children’s development. Methods Data for the current analyses came from a longitudinal study designed to follow mothers from the third trimester through the first three years of the child’s life. To assess responsive caregiving, the Observation of Mother-Child Interaction (OMCI) measure was used to examine maternal and child behaviors during a 5-min picture book activity at 24 months. Outcomes included child height-for-age z-score and child socioemotional development, using the Ages and Stages Questionnaire-Socioemotional (ASQ-SE) in which lower scores demonstrated better development. Using mean comparisons, the effects of baseline sociodemographic factors and maternal depression on responsive caregiving were tested. Analyses utilized hierarchical linear regressions to examine cross-sectional associations between responsive caregiving and child development outcomes at 24 months. Additional analyses controlled for the Home Observation for Measurement of the Environment (HOME), a common measure in low-income contexts of caregiving, to assess whether OMCI was uniquely predictive of child outcomes. Results Higher maternal education attainment, lower number of children, greater socioeconomic assets, and lack of maternal depression were associated with higher levels of observed responsive caregiving behaviors. Higher total OMCI scores were associated with positive child socioemotional outcomes in adjusted models (β: -0.84, 95% CI [− 1.40, − 0.29]). The finding was statistically significant, even after controlling for HOME score (β: -0.83, 95% CI [− 1.38, − 0.27]). There was no association between OMCI scores and child linear growth. Conclusions Responsive caregiving is linked to positive child socioemotional development in rural Pakistan. Our findings suggest that incorporating responsive caregiving into child health interventions in LMIC may have valuable impacts on child socioemotional development. The OMCI may be useful in identifying important pathways for change to responsive caregiving behaviors and may be of service for future interventions that optimize child development through responsive caregiving. Trial registration NCT02111915 (09/18/2015); NCT02658994 (01/22/2016). Trials were prospectively registered.

The World Health Organization identified the promotion of "Nurturing Care Environments" as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population‐level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population‐level dissemination that targeted responsive caregiving. The self‐guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on‐line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior‐specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population‐level intervention design and evaluation. [ABSTRACT FROM AUTHOR]

Experts in infant health and development consider the rooting reflex a cue of a baby's hunger and recommend feeding the infant when this reflex occurs. However, the relation between rooting and infant feeding status has not been well established in the literature. In the current study, seven parents documented the occurrence of their newborns' rooting, crying, and a control reflex (palmar grasp) before, after, and between naturally occurring feedings. For all participants, rooting occurred during a greater percentage of reflex checks prior to feedings, whereas the palmar grasp occurred during a similar percentage of checks across these time periods. These results provide empirical support for the rooting reflex as a feeding cue. However, data for only one dyad suggested a high probability of the rooting reflex occurring without crying during prefeeding checks. Thus, our data do not provide evidence that feeding in response to the rooting reflex would preempt infant crying. [ABSTRACT FROM AUTHOR]

Using a grounded theory approach, this study explores the ways a diverse group of pre-service student caregivers, new to teaching and caring for infants, come to understand notions of ‘love’ during an infant practicum course in the United States. Through analysing weekly dialogue journals and course assignments produced by each of the 8 participants, we captured their unique and complex experiences of love and care in the infant room. Results revealed that for love and trust between student caregivers and babies to evolve, caregivers need to acknowledge babies as unique individuals, and commit to getting to know and understand them in depth. Further, student caregivers develop intimate caregiving connections and loving relationships with babies through shared time and space. Loving care for babies became an integral experience and an essential pedagogical tool for student caregivers as they developed their professional identities. Our exploration of the deep and complex connections between love, care, and education in childcare, which have been for the most part overlooked, silenced, or simply ignored, has important implications for re-envisioning the notion of love in non-familial infant care. [ABSTRACT FROM AUTHOR]

BackgroundGiven the positive influence of responsive caregiving on dietary habits in childhood, to raise awareness of caregivers regarding their behavior is crucial in multidisciplinary care on infant feeding.ObjectivesTo identify the most common responsive and non-responsive feeding practices in mothers of children with feeding complaints, as well as to seek associations between practices and caregivers’ profile.MethodsCross-sectional study with 77 children under 18 years old, with complaints of feeding difficulties. Data were collected during interviews with mothers: child age, gender, duration of exclusive breastfeeding, presence of organic disease, dynamics of bottle use, self-feeding practices and posture at meals, use of appropriate feeding equipment; basic information about the mothers (parity and level of education), caregiver feeding style, presence of coercive feeding, frequency and characteristics of family meals. Statistical analysis considered significance level at 5%.ResultsThe non-responsive profile predominated among mothers (76.2%, with the Authoritarian style being the most prevalent—39.7%). The responsive profile was characterized by absence of coercive feeding, stimulation of self-feeding practices, use of appropriate feeding equipment and meal environment, with interaction at meals. Non-responsive profile consisted of both inadequate environment and posture at meals, use of distraction and coercive feeding, lack of shared meals, and disregard for children’s hunger signals. Only the habit of sharing meals with children was associated with mothers’ profile, and considered a protection factor against non-responsive care (OR 0.23; 95% CI 0.06–0.88). Both Authoritarian (p = 0.000) and indulgent mothers (p = 0.007) breastfed exclusively for longer time than negligent ones. There was a higher level of interaction with children in “responsive” parental style (OR 0.056; p = 0.01) compared to other feeding styles.ConclusionResults highlight the need for educational interventions focused on caregivers’ behaviors.

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. [ABSTRACT FROM AUTHOR]

Objective: Digital interventions hold important potential for supporting parents when face-to-face interventions are unavailable. We assessed the feasibility and effectiveness of a digital parenting intervention in Zambia and Tanzania., Methods: Using a randomised controlled trial, we evaluated the Sharing Stories digital parenting intervention for caregivers of children aged 9-32 months with access to a smartphone in their household. Caregivers were stratified based on child age and randomly assigned to the intervention or waitlist control arm. The intervention was delivered via facilitated WhatsApp groups over 6 weeks to promote caregiver wellbeing and responsive caregiving through shared reading activities. Primary outcomes were caregiver-reported responsive caregiving, child language and socio-emotional development. Secondary outcomes were caregiver mental health and parental stress. Masked assessors conducted assessments at baseline and immediate follow-up., Results: Between October 2020 and March 2021, we randomly assigned 494 caregiver-child dyads to the intervention ( n  = 248) or waitlist control ( n  = 246) arm. Caregivers in the intervention group reported more responsive caregiving (OR = 2.55, 95% CI: 1.15-5.66, p  = 0.02), time reading or looking at books (β = 0.45, p  = 0.04) and telling stories (β = 0.72, p  = 0.002). Intervention caregivers reported significantly lower symptoms of depression (β = -0.64, p  = 0.05) and anxiety (β = -0.65, p  = 0.02). Child development and parental stress did not differ significantly between groups., Conclusions: Digital parenting interventions using WhatsApp can effectively promote responsive caregiving and caregiver mental health in low-resource settings, with great potential for scalability., Trial Registration: ISRCTN database, ISRCTN77689525., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2023.)

Background: Early childhood development is highly dependent on the sensitive care provided by caregivers, and interventions focused on supporting parents to improve their sensitivity have shown to be effective. The COVID-19 pandemic has had a significant impact on mental health, with pregnant women and mothers of infants being an especially vulnerable group and maternal sensitivity particularly affected. However, access to face-to-face interventions is restricted; thus, it is important to have remote interventions to support this group of mothers., Objective: The objective of this study is to evaluate the feasibility and acceptability of C@nnected, a group videoconferencing intervention to improve maternal sensitivity aimed at mother-infant dyads attending primary health care centers in vulnerable areas of Santiago, Chile., Methods: This is a randomized feasibility single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation ratio (with more people allocated to the intervention arm). The intervention consists of 4 group videoconferencing sessions adapted from a face-to-face intervention with proven effectiveness. The control group will receive treatment as usual, along with educational brochures. The feasibility and acceptability of this study will be quantitatively and qualitatively assessed. Changes in clinical outcomes relating to maternal sensitivity, depressive symptoms, postpartum maternal attachment, and infant socioemotional development will also be evaluated., Results: We finished adapting the face-to-face intervention to the videoconferencing format in July 2021. The study began recruitment in August 2021, and enrollment is expected to end in August 2022, with final study results expected in December 2022., Conclusions: This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial., Trial Registration: ClinicalTrials.gov NCT04904861; https://clinicaltrials.gov/ct2/show/NCT04904861., International Registered Report Identifier (irrid): DERR1-10.2196/35881., (©Victoria Binda, Marcia Olhaberry, Carla Castañon, Constanza Abarca, Catalina Caamaño. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.08.2022.)

Background: Responsive caregiving, or interactions in which caregivers give appropriate responses to a child's signals, is linked to improved psychosocial, cognitive and physical outcomes in children. However, much remains unknown about how responsive caregiving affects child development across cultural and socioeconomic contexts. The purpose of this study is to examine predictors of maternal responsive caregiving and investigate how these interactions are associated with children's development.Methods: Data for the current analyses came from a longitudinal study designed to follow mothers from the third trimester through the first three years of the child's life. To assess responsive caregiving, the Observation of Mother-Child Interaction (OMCI) measure was used to examine maternal and child behaviors during a 5-min picture book activity at 24 months. Outcomes included child height-for-age z-score and child socioemotional development, using the Ages and Stages Questionnaire-Socioemotional (ASQ-SE) in which lower scores demonstrated better development. Using mean comparisons, the effects of baseline sociodemographic factors and maternal depression on responsive caregiving were tested. Analyses utilized hierarchical linear regressions to examine cross-sectional associations between responsive caregiving and child development outcomes at 24 months. Additional analyses controlled for the Home Observation for Measurement of the Environment (HOME), a common measure in low-income contexts of caregiving, to assess whether OMCI was uniquely predictive of child outcomes.Results: Higher maternal education attainment, lower number of children, greater socioeconomic assets, and lack of maternal depression were associated with higher levels of observed responsive caregiving behaviors. Higher total OMCI scores were associated with positive child socioemotional outcomes in adjusted models (β: -0.84, 95% CI [- 1.40, - 0.29]). The finding was statistically significant, even after controlling for HOME score (β: -0.83, 95% CI [- 1.38, - 0.27]). There was no association between OMCI scores and child linear growth.Conclusions: Responsive caregiving is linked to positive child socioemotional development in rural Pakistan. Our findings suggest that incorporating responsive caregiving into child health interventions in LMIC may have valuable impacts on child socioemotional development. The OMCI may be useful in identifying important pathways for change to responsive caregiving behaviors and may be of service for future interventions that optimize child development through responsive caregiving.Trial Registration: NCT02111915 (09/18/2015); NCT02658994 (01/22/2016). Trials were prospectively registered. [ABSTRACT FROM AUTHOR]