1. Early Childhood Care and Development
Moderator – Prof. S. S. Gupta
Presenter - Dr. Anil Koparkar
Department of community Medicine
MGIMS, Sewagram
Taking care of our future, today . . .

2. Framework Introduction
Major problem with estimating numbers of affected children
Why focus on early child development?
Brain development
Factors affecting growth & development of children
Factors-Underdevelopment-effects
Interventions in early childhood -Effect
Effect of ECCD
Components of ECCD and Education
Types of approaches in ECCD
Characteristics of successful ECD interventions
Initiatives in ECCD
ECCD in India
ICDS
Impact of ICDS
Challenges in implementing ECCD
Challenges faced in the present interventions
Summary
References
Dr. Anil K. ECCD

3. Introduction Do children just grow in size?
They develop, evolve, and mature, mastering ever more complex understandings of the people, objects and challenges in their environment.
In earliest years of life…
Fundamental for the future of every individual –
Survival,
Growth
Development
Dr. Anil K. ECCD

4. Introduction Early childhood –
India- 0-6years
ECCD consultative group /WHO/Internationally– Prenatal-8 years
Care - “the provision in the household and the community of time, attention and support to meet the physical, mental and social needs of the growing child and other household members”.
Development - The process of change in which the child comes to master more and more complex levels of moving, thinking, feeling and interacting with people and objects in the environment.
Dr. Anil K. ECCD

5. Introduction
Early Childhood Care Development (ECCD) Early Childhood Development (ECD) emphasizes a holistic approach dealing with the child’s, physical emotional, social as well as cognitive/language development - from birth to entry into primary school in formal and non-formal settings.
Meena Cabral de Mello. Department of Child and Adolescent Health and Development
World Health Organization. The Rationale for Early Child Development. WHO-UNICEF Meeting on Early Childhood Development . Colombo, Sri Lanka – July 13, 2009
Dr. Anil K. ECCD

6. Major problem with estimating numbers of affected children
Unlike growth, child development is much more complex to measure
Data on early cognitive ability for most developing countries to estimate prevalence is insufficient
Rough indication taken from school achievement data which is correlated to children’s development.
Thus,
Health system’s focus - >5 million preventable child deaths/year in developing countries.
Neglects - >200 million children <5 years fail to reach their potential in cognitive development. – Loss of potential
Dr Vikram Patel.ppt
Dr. Anil K. ECCD

7. Result of Neglect towards underdevelopment
Developmental level in nurturing environment with adequate stimulation and nutrition
Current developmental levels
Degree of loss of potential 2
Dr. Anil K. ECCD

8. Why focus on early child development?
Brain development is most rapid and vulnerable from conception to five years
The factors known to affect child development are common, especially in low/middle income countries
Impaired child development has life-long effects
Interventions in early childhood are more cost effective than at other ages
Dr Vikram Patel.ppt
Dr. Anil K. ECCD

9. Brain development is most rapid and vulnerable from conception to five years
Dr. Anil K. ECCD

10. Why focus on early child development?
Brain development is most rapid and vulnerable from conception to five years
The factors known to affect child development are common, especially in low/middle income countries
Impaired child development has life-long effects
Interventions in early childhood are more cost effective than at other ages
Dr. Anil K. ECCD

11. The factors...affecting child development......
Risks -
Poverty,
Malnutrition(Stunting)
poor health (Repeated deseases), and
unstimulating home environments
social emotional development.
motor, and
Cognitive,
Impairments -
Dr. Anil K. ECCD

12. Poverty-Malnutrition-Underdevelopment A Vicious circle
The factors...affecting child development......
Poverty-Malnutrition-Underdevelopment A Vicious circle
Poverty
Malnutrition
Underdevelo-pment
Dr. Anil K. ECCD

13. Dr Vikram Patel.ppt
national
economy
Dr. Anil K. ECCD

14. The factors...affecting child development......
Current Scenario
Prevalence and number (in millions) of disadvantaged children under 5 years by region in 2004
Population younger
Percentage living
Number living
Percentage
Number
Percentage stunted, living in poverty or both
Number stunted, living in poverty or both
than 5 years *
in poverty
stunted
Sub-Saharan Africa
117
46%
54.3
37%
43.7
61%
70.9
Middle east and north Africa
44.1 4%
1.6
21%
9.1
22%
9.9
South Asia
169.3
27%
46.3
39%
65.6
52%
88.8
East Asia & Pacifi c
145.7
11%
16.6
25.2
23%
33.6
Latin America and the Caribbean
56.5
10%
5.9
14%
7.9
19%
10.8
Central and eastern Europe
26.4 1
16%
4.2
18%
4.7
Developing countries
559.1
125.6
28%
155.7
128.7 2,
*Population and poverty source data from UNICEF State of the World’s Children,
percent living in poverty were obtained from UNICEF75
and data for stunting obtained from WHO.76
75UNICEF. State of the world’s children New York: UNICEF; 2005.
76 WHO. Global database on child growth and malnutrition. World
Health Organization
database/en/ (accessed March 18, 2006).
Dr. Anil K. ECCD

15. The factors...affecting child development......
Current Scenario
Regional distribution of the number of Disadvantaged children under 5 years in millions
(A)stunted,
(B) living in poverty, and (C) disadvantaged (either stunted, living in poverty, or both) in year 2004. 2
Dr. Anil K. ECCD

16. The factors...affecting child development......
Current Scenario
Percentage of disadvantaged children under 5 years by country in year 2004 2
Dr. Anil K. ECCD

17. Factors affecting growth & development of children
2. Environmental exposures
Lead
Pesticide exposure
3. Psychosocial risk factors
Cognitive stimulation
Caregiver sensitivity and responsiveness
to Child
4. Contextual risk factors
Maternal Depression
Exposure to violence
1. Biological
(A)Nutritional
Intrauterine growth restriction
Childhood under-nutrition
Iodine deficiency
Iron deficiency
Breast feeding
Zinc deficiency
(B) Infectious Diseases
Diarrheal diseases
Tuberculosis
Intestinal Helminthes
Malaria
HIV/AIDS
Dr. Anil K. ECCD

18. Why focus on early child development?
Brain development is most rapid and vulnerable from conception to five years
The factors known to affect child development are common, especially in low/middle income countries
Impaired child development has life-long effects
Interventions in early childhood are more cost effective than at other ages
Dr. Anil K. ECCD

19. Factors-Underdevelopment-effects..2
Dr. Anil K. ECCD

20. Factors-Underdevelopment-effects.... (Cont.)
Hypothesized relations between poverty, stunting, child development, and school achievement 2
Dr. Anil K. ECCD

21. Factors-Underdevelopment-effects.... (Cont.)
Effect of Diarrheal diseases in children
Weight gain-
D0-D4=240gms
D6-D10=240gms
T(8days)=480gms
Weight loss(2Days)–
D4-D6=590gms
Result on D10-
NET WEIGHT LOSS=110gms
CTC Kharangna (G)
Age in
IAP
Weight gain Gm/Day/Kg
months
Stunting
Wasting
Grade
D10
D15
Final 19
Severe
Mod II
-1.5
0.56
1.37
Dr. Anil K. ECCD

22. Responsiveness to child language affects language development
Factors-Underdevelopment-effects.... (Cont.)
Responsiveness to child language affects language development
Tamis-LeMonda et al 2001
- Dr. Patrice Engle, July 15, 2009, Sri Lanka
Dr. Anil K. ECCD

23. Factors-Underdevelopment-effects.... (Cont.)
Basic Care giving Skills: Sensitivity & Responsiveness
Sensitivity: The capacity of the caregiver to be aware of the infant, and aware of the infant’s acts and vocalizations that communicate needs and wants
Responsiveness: The capacity of the caregiver to respond contingently, appropriately to the infant’s signals
A caregiver must be sensitive and responsive:
To be effective in caring for a young child
And for a child to develop a secure attachment to the caregiver—the basis for healthy growth, and intellectual, social and emotional development.
In IMCI we help the mother or other caregiver improve the care she provides her child, e.g.: to improve feeding, give adequate liquids, recognize signs of illness, treat the sick child, stimulate the child’s development, and so on.
Two basic caregiving skills are particularly important in determining the effectiveness of care: sensitivity and responsiveness. They affect the quality of all caregiving.
.), The integration of a child into a social world. Cambridge, UK: Cambridge University Press
Dr. Anil K. ECCD

24. Mother and Child Protection Card
Dr. Anil K. ECCD

25. Homans’ Interaction Theory -influencing change-
Factors-Underdevelopment-effects.... (Cont.)
Homans’ Interaction Theory -influencing change-
Interactions
George Homans describes three components of social relationships:
1. Activities: what we do together.
2. Interactions: how we communicate together.
3. Sentiments: how we feel about each other, about our activities and about our interactions together.
4. Each of these components influences the others—as we can see by the arrows—in a system.
Homans proposed, and many others have since proved, that, if you change any one part of the system, you produce changes in the other parts. He also proposed that Activities are the easiest to change directly. [Ask: In contrast, what component would be the most difficult to change? (Sentiments)]
\\\\\
Homans, G.C. (1950) The Human Group. NY: Harcourt, Brace & World.
Activities
Emotions
Dr. Anil K. ECCD

26. Homans’ Interaction Theory: Improving Care for Development
Factors-Underdevelopment-effects.... (Cont.)
Homans’ Interaction Theory: Improving Care for Development
Interactions
Look into your child’s eyes and smile at him or her.
Respond to your child’s sounds and interests
Provide ways for your child to see, hear, feel, and move
Give your child clean, safe things to handle, bang, drop
The simple interventions in Care for Development are designed to improve the child’s health and development, AND to improve the human caregiving system: the activities, interactions and sentiments between caregiver and her child. Here are some examples:
We ‘treat’ or try to improve the activities the caregiver and child do together [read examples on diagram]. Most of us have found that it is easiest to engage the mother and child in doing the simple play activities.
But we also ‘treat’ their interactions [read examples].
If we can improve how the mother and child interact together around simple activities, we hope to improve the sentiments that develop. By now, in your clinical practice sessions, you have seen examples of this. [Ask: What examples have you seen?]
In the intervention Care for Development, the play and communication activities have been selected to help children to develop new skills. They have also been selected as satisfying activities that caregivers and their children can do together, to strengthen the emotional ties—bonding and attachment—that are key to sensitive, responsive caregiving. These support the basic qualities or skills that determine the effectiveness of caregiving.
Questions?
Activities
Emotions
Dr. Anil K. ECCD

27. Result of sensitive & responsive caregiver
Factors-Underdevelopment-effects.... (Cont.)
Result of sensitive & responsive caregiver
Bonding of mother to child,
attachment of child to mother
emotional outcomes of caring interactions
Dr. Anil K. ECCD

28. Why focus on early child development?
Brain development is most rapid and vulnerable from conception to five years
The factors known to affect child development are common, especially in low/middle income countries
Impaired child development has life-long effects
Interventions in early childhood are more cost effective than at other ages
Dr. Anil K. ECCD

29. Interventions in early childhood are more cost effective than at other ages...
DQ or IQ scores of stunted and non-stunted Jamaican children from age 9–24 months to 17–18 years 14
Dr. Anil K. ECCD

30. Interventions.....effect...(Cont..)
Jamaica Project: Effects of supplementation and stimulation on the mean development quotient of stunted groups compared with non-stunted groups
1 Care Opening Ceremony SEARO SL July 2009.ppt
Here are the results of that study showing the effects of supplementation and stimulation on the child’s development quotient (practical reasoning, eye and hand coordination, hearing and speech, and performance). You can see that the red line describes the children who were not stunted. The other three lines below are the children who were stunted at the baseline (first measure after birth).
Let’s look at the progress of the stunted children. The blue is the control group of stunted children who received no intervention. The children represented by the pink line received food supplementation only, and the green line stimulation only. The yellow line represents the stunted children who received both supplementation and stimulation. These interventions were delivered through regular home visits (weekly). Take a moment to look over these results.
[Ask participants, one by one: What do you see in these results? Make sure some of the following are stated:]
Initially the stunted groups' DQs were lower than those of the non-stunted group. Poor mental development in stunted children is at least partly attributable to undernutrition.
The Development Quotient of the control group declined during the study, increasing their deficit.
Stimulation and supplementation had significant independent beneficial effects on the children's development. Stimulation appears to have produce greater gains than supplementation—an important finding.
The treatment effects were additive. Combined interventions were significantly more effective than either alone. (Stimulation and supplementation produced an increase in 13 points.)
Early stunting can be reversed by supplementation and stimulation. And many children will catch up to children who were not stunted before the age of 24 months.
In this study, we see that supplementation and stimulation each have a strong effect on the psychosocial and motor development of stunted children. Together they are even more powerful.
[Notes to the presenter:
Sally Grantham-McGregor, the leader in this study, serves on the WHO CAH advisory group on child development.
This graphic summary of results is adapted from a presentation by Jacques van der Gaag at the World Bank Converence on Investing in Our Future, 2000.]
\\\\\
Grantham-McGregor, S.M., Powell, C.A., Walker, S.P., and Hines, J.H. (1991). Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaica Study, in The Lancet, 338, 1-5.
Development quotient includes practical reasoning, eye and hand coordination, hearing and speech, and performance. Grantham-McGregor, SM, et al. (1991).
Dr. Anil K. ECCD 30

31. Effect of ECCD
Increased human resource development (via better school achievement).
Cost-savings and increased efficiency of primary schooling (lower rates of grade repetition and remedial education).
Higher educational attainment.
Increased earning potential.
Reductions in juvenile delinquency and its associated costs.
Increased commitment to marriage.
Increased social mobilization and community involvement
Reduced social and economic inequalities in developing countries 1
Dr. Anil K. ECCD

32. Components of ECCD and Education
working with parents to strengthen parenting skills,
working with siblings and other family members to recognize the specific developmental needs of younger children and what they can do to support them,
working to provide or strengthen day care options,
developing preschools and other early childhood education programs that address the child’s needs in holistic ways,
Strengthening the community in its economic, physical, and moral support of families and young children
Dr. Anil K. ECCD

33. Types of approaches in ECCD
Dimensions of focus in early childhood care and development programs
Dr. Anil K. ECCD

34. Types of approaches in ECCD
Child-focused interventions that provide psychosocial stimulation directly to the child
Children who participate ECCD programs show -
stronger performance on IQ tests.
less likely to repeat grades
Parent-focused interventions to improve parenting skills and psychosocial stimulation in the home environment
Shows positive effects on parental care giving, such as
improved mother-child interaction and verbalization,
Improved parental attitudes toward children
Improved behavior management.
Dr. Anil K. ECCD

35. Types of approaches in ECCD
Joint-focused interventions to improve parenting skills & to provide psychosocial stimulation to children and supportive services to parents
Role of AWW should be given more importance to improve the effectiveness of ECCD program.
Interventions that are both child- and parent-focused are more effective than either one alone for children’s psychological development. 19
Dr. Anil K. ECCD

36. Interaction at three critical points
1. At the level of the child
2. Between child and his caregivers
3. In the design & delivery of programs.
Dr. Anil K. ECCD

37. Comprehensive programs
Apart from previously mentioned, these program prominently includes-
Nutrition education to improve breastfeeding and complementary feeding
Interventions to control disease
Interventions to increase maternal education
Dr. Anil K. ECCD

38. Characteristics of successful early child development interventions
Integration of health, nutrition, education, social, and economic development, and collaboration between governmental agencies and civil society.
A focus on disadvantaged children.
Sufficient intensity and duration and include direct contact with children beginning early in life.
Parents and families as partners with teachers or caregivers in supporting children’s development. 4
Dr. Anil K. ECCD

39. Characteristics of successful early child development interventions(Cont.)
Provide opportunities for children to initiate and instigate their own learning and exploration of their surroundings with age-appropriate activities.
Blend traditional child-rearing practices and cultural beliefs with evidence-based approaches.
Provide early child development staff with systematic in service training, supportive and continuous supervision, observational methods to monitor children’s development, practice, and good theoretical and learning material support
Dr. Anil K. ECCD

40. ECCD in India Integrated Child Development Services (ICDS)
As a sequel to the adoption of the National Policy for Children (1974), the Government of India evolved ICDS.
centrally sponsored scheme
Came into existence on 2nd Oct in selected 33 community developmental blocks of the country,
The largest public initiative in the world to offer the early childhood education and care services in an integrated way. 7
Dr. Anil K. ECCD

41. Integrated Child Development Services (ICDS), India
Objectives:
to improve the nutritional & health status of children in years;
to lay the foundation for proper psychological, physical and social development of the child;
to reduce the incidence of mortality, morbidity, malnutrition and school dropout;
to achieve effective co-ordination of policy & implementation amongst the various departments to promote child development &
to enhance capability of mother to look after the normal health and nutritional needs of the child through proper nutrition and health education
Dr. Anil K. ECCD

42. Integrated Child Development Services (ICDS), India
supplementary nutrition,
pre-school non-formal education and
Nutrition, growth monitoring & health education.
immunization,
health check-up,
referral services,
of these six services 1-3 delivered through Ministry of Women and Child Development (WCD). 4-6 delivered through Public Health Infrastructure under the Ministry of Health & Family Welfare,
Dr. Anil K. ECCD

43. Integrated Child Development Services (ICDS), India
Impact & coverage
Dr. Anil K. ECCD

44. Integrated Child Development Services (ICDS)- Impact & coverage
mothers receiving ICDS services in India
Dr. Anil K. ECCD

45. Challenges in implementing ECCD
Competing priorities
Unfinished agenda -
Child mortality continue to remain high
High prevalence of malnutrition
Variations among states
Subodh sir
Dr. Anil K. ECCD

46. Challenges faced in the present interventions
Poor quality of child development services
Overburden on the ICDS
Poor attention to age-group 0-3 years
Capacity of Child Care Workers
Not recognized as skilled work
Unavailability of trained manpower in ECCD
Involvement of the family and community
Subodh sir
All the programs at village converge at the level of Anganwadi center. However, this has resulted in an increased burden of tasks on the Anganwadi workers and consequently diluted the child development component which was main focus in the initial vision of ICDS.
A major problem is that ECE is not considered a skilled job. Even after 35 years of launching ICDS, the country does not have a pool of manpower trained in ECCD or ECE.
Absence of ECE as a subject in most of the Indian Universities.
There is a need to improve Intersectoral coordination needs and advocacy efforts with policy makers and planners.
Dr. Anil K. ECCD

47. Summary
Four key risk factors where the need for intervention -stunting, inadequate cognitive stimulation, iodine deficiency, and iron deficiency anemia.
Effective interventions are available to reduce the developmental loss currently estimated to affect more than 200 million children under 5 years of age in developing countries.
The most effective interventions are comprehensive programs
Emphasis should be given more towards 0-3 years age group. 4
Dr. Anil K. ECCD

48. References
WHO, Department Of Child And Adolescent Health And Development, A Critical Link-Interventions for physical growth and psychological development-A Review , 8,
Sally GM et al. Child development in developing countries-1. Developmental potential in the first 5 years for children in developing countries. Lancet. Jan 2007; 369: 60–70.
Walker SP, Wachs TD, Gardner JM et al. Child development in developing countries-2 Child development: risk factors for adverse outcomes in developing countries. Lancet Jan 2007; 369: 145–57.
Patrice L Engle*, Maureen M Black. Child development in developing countries 3 Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet. Jan 2007; 369: 229–42.
Working Group on Development of Children for the Eleventh Five Year Plan ( )- A Report.
Available online at URL:
Sub Group Report Early Childhood Education In The Eleventh Five Year Plan ( ) Ministry Of Women And Child Development Government Of India Shastri Bhawan New Delhi.
International Institute for Population Sciences (IIPS) and Macro International National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS.
Integrated Child Development Services (ICDS) Scheme. Available online at URL:http.wcd.nic.inicds.htm
Dr. Anil K. ECCD

49. References
10. Early Childhood Counts: Programming Resources for Early Childhood Care and Development. CD-ROM. The Consultative Group on ECCD. Washington D.C.: World Bank, 1999.
11. Adair LS, Pollitt E. Outcome of maternal nutritional supplementation: a comprehensive review of the Bacon Chow study. Am J Clin Nutr 1985; 41: 948–78.
12. Black MM. Micronutrient deficiencies and cognitive functioning. J Nutr 2003; 133: 3927S–31
13. Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anemia. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Vol 1. Geneva: World Health Organization, 2005: 163–209.
14. Gorman K, Pollitt E. Does schooling buffer the effects of early risk? Child Dev 1996; 67: 314–26. Copyright: Blackwell Publishing Ltd.
15. The consultative group on early childhood care and development. What is ECCD?. Available online at URL:
16. Kuruganti K. Eff ects of pesticide exposure on developmental task performance in Indian children. Child Youth Environ 2005; 15: 83–114.
17. Registrar General. Census of India: Population Projections for India and States, , India for figures from 2001 onwards.
18. WHO. World Malaria report 2008.
19. Govt. of India. Annual report Ministry of Health & Family Welfare. New Delhi
20. Ade A.,Subodh SS, Deshmukh PR, et al. Effect of Improvement of Pre-school Education Through Anganwadi Center on Intelligence and Development Quotient of Children. Indian Journal of Paediatric. Dec 2009.
Dr. Anil K. ECCD

50. Dr. Anil K. ECCD
Thank you………

51. Thank You
Dr. Anil K. ECCD