ERIC ED376934: Health and Learning. Coordinators' Notebook: An International Resource for Early Childhood Development.

58 Pages·1993·1.7 MB·English

by  ERIC

DOCUMENT RESUME
PS 022 619
ED 376 934
Health and Learning. Coordinators' Notebook: An
TITLE
International Resource for Early Childhood
Development.
Consultative Group on Early Childhood Care and
INSTITUTION
Development, Haydenville, MA.
93
PUB DATE
58
NOTE
P.
Judith L. Evans, 6 The Lope, Haydenville, MA
AVAILABLE FROM
01039.
Collected Works
Serials (022)
PUB TYPE
Coordinators' Notebook; n13 1993
JOURNAL CIT
MF01/PC03 Plus Postage.
EDRS PRICE
*Child Development; *Child Development Centers;
DESCRIPTORS
*Child Health; Child Welfare; Community Cooperation;
Developed Nations; Developing Nations; *Early
Childhood Education; Family Programs; Foreign
Countries; Integrated Services; Nutrition; *Young
Children
Family Support; *United Nations Development
IDENTIFIERS
Program
ABSTRACT
This theme issue deals with the topic of the
relationship between health and learning as it applies to the care of
the young child. It consists of three parts. The first part is a
lengthy article, "Health Care: The Care Required To Survive and
Thrive" (J. Evans), explains health and caring environments of young
child in the given economic conditions worldwide and provides ways
that early childhood programmers can strengthen all dimensions of
child care, including health, nutrition, education and family
support. The second part provides four case studies of programs in
India, Bolivia, Thailand, and Malaysia that use various strategies
for caring for young children and their families. The article in the
third part, "Attention by International Organisations to Early
Childhood Care and Development: An Analysis of United Nations World
Reports, 1993" (R. Myers), examines the current activities of
international organizations working in early childhood care and
development and analyzes the latest World Reports issued by
specialized agencies of the United Nations. This article notes that
international organizations are beginning to recognize the importance
of the integrated nature of children's development during the
preschool years and its relationship to larger social and economic
development questions. Activities of the Secretariat for the
Consultative Group on Early Childhood Care and Development, news from
various family organizations in the network, and a list of
publications and videos on related research and activities are
included.
(AP)
************************************************************ ,
Reproductions supplied by EDRS are the best that can be made
from the original document.
***********************************************************************
Coordinators'
note
An International Resource for I
"PERMISSION TO REPRODUCE THIS
MATERIAL HAS BEEN GRANTED BY
5%34 v17\-\
TO THE EDUCATIONAL RESOURCES
INFORMATION CENTER (ERIC)."
Health and Learning:
Network Notes, Page 37
into poverty and situations which threaten their
chances for optimal human growth and develop-
AND LEARNING
ment. The quality of the environment in which mil-
lions of children arc growing up is inadequate by
any number of criteria. Overcrowding, lack of
HEALTH
potable water and sewage face ities, lack of adequate
food, and inadequate caretaking characterise the
environments of many young children. Frequent
CARE:
infection (most commonly diarrhoea) and malnutn-
non account for over 50% of all infant mortality in
developing countries.
These statistics are likely to worsen as the num-
The Care
bers living in urban areas increase, which they will.
It is estimated that by the year 2000, urban popula-
tions in the developing countries will increase from
1 billion in 1980 to 2.1 billion. This represents a 110
Required to
percent increase, compared with a projected
increase in the world's population during that same
time period of 38 percent. A further expansion of
urban slum and squatter settlements is inevitable.
Survive
This situation is of concern to many. In recent
years there has been an attempt to focus the world's
attention on the needs of children, as evidenced by
and Thrive
the Summit for Children convened in September 1990,
and the fact that the Conoention of time Rigl* of the add
was brought to the General Assembly of the United
Nations in 1989. calling for universal standards for
children in relation to survival, protection and
Jumni
L. EVANS
.
development. But the Conoention and other docu-
ments can only articulate desirable outcomes. They
do not guarantee what will happen in the life of an
individual child. Therefore it is necessary to develop
What future would you like to see for your
policies and programmes at the regional, national
child: The way parents answer this question
and local levels to turn the wording of Conventions
may determine whether or not the child
into reality. The various United Nations organisa-
survives. When parents see a future for their
tions whose mandates include children have taken
child, they will do their best to provide the child
on the challenge, as have a wide range of non-gov-
with the care required for survival even in circum-
ernmental and donor agencies.
stances where very little food is available However,
With the year 2000 in mind, specific targets have
if parents arc hesitant or cannot give a response to
been set For example in terms of micro-nutrients'
the question, the child may not survive. The latest
the challenge is to eliminate vitamin A and iodine
research on the relationship between health, nutri-
deficiencies and to reduce by a third iron-deficient
tion and stimulation argues convincingly that an
anemia in women. (World Bank, 1993) The World
adequate food supply is not enough to assure a
Summit was not the only arena within which these
child's survival, neither is access to micro-nutri-
targets were discussed They were endorsed by the
ents, neither is education, nor absence of disease.
Ending Hidden Hunger Cortical:Le in October 1991, and at
Children's growth and development is fostered
the Intern ational Conferrn«' on Nutrition in December 1992.
when all these variables are present, within a car-
In terms of education one goal set forth was to
ing environment
achieve universal primary education by the year
In the following pages we will explore the dimen-
2000. This goal was endorsed at the Education For
sions of a caring environment, and look at ways that
All world conference in lomtien, and reinforced at
early childhood programmes can strengthen all
the follow-up EFA conference in New Delhi, where
dimensions of Care including health, nutrition, edu-
several related aims were proposed and debated.
cation, and family support.'
(These will be examined more fully in the next issue
of the ( 'oordinator." Notebook)
The Situation of
Are these goals realistic' Only if we take a good
Young Children
look at the complex realities of people s lives and
what we know about successfully meeting their
One and a halt billion c hildren will he horn in the
needs.
To begin with we know that survival and healthy
decade of the 1990s Given economic conditions
development cannot he achieved without significant
worldwide, these children will increasingly he horn
A woman breastfeeds her child while another mother holds her malnourished daughter who is no
longer breastfed, Sinkor, Monrovia.
attention to young children, from their conception
a greater understanding of the relationships between
nutrition, health, care, education and developmental
through age six. The basis for good physical health
and cognitive functioning in later years must be
outcomes for children. We begin with a look at the
key needs of young children in section I. This is fol-
established during the early years The dependence
lowed in section 2 with data on the importance of
and rapid growth typical of infancy and early child-
hood make children vulnerable to a variety of
the environment of Care that surrounds the child in
terms of the immediate family and in terms of the
health, nutritional, psycho-social and other environ-
wider culture. In section 3 we look at the health care
mental conditions. Those living in poverty are par-
requirements of young children, including reports
ticularly at risk of poor physical and psycho-social
on current research which identifies the powerful
development
relationship between micro-nutrients and cognitive
Second, we know that children cannot he viewed
functioning and development Section 4 provides
It is necessary to recognize that they are
in isolation
guidelines that should be followed when creating
part of an ever-changing society. By understanding
new programmes or introducing health, nutrition.
more about changes in the family and community it
Care and/or education components into existing
is possible to identify the impact of those changes
programmes that ;eek to support children's growth
on children's growth and development. Such an
understanding can then provide the basis for inter-
and development.
vention programmes that meet the needs of children
The Child: Key
and their families.
Third, we are able to identify programmes that
Needs from
are effective and those that are likely to fail.
Conception through
Successful programmes generally require an interac-
the Early Years
tive, integrated, culturally-sensitive approach and a
In terms of physical, intellectual, emotional and
breadth of understanding of people's beliefs, percep-
social well-being, the period from conception to age
tions, needs and concerns In contrast, mono-dimen-
6 is the key to subsequent growth, development and
sional programmes, which may meet short term
ultimate productivity Pre-natally through the sixth
goals, are not likely to he sustainable. It is rarely
year there are several distinct stages. They include:
helpful to impose a single solution which ignores
intra-uterine, intrapartum (the birth itself). postpar-
the need for individuals and communities to control
tum (birth to month), early infancy (the first six
I
their own destinies.
months) late infancy (6- 12 months), toddler (1 to 3
Building on what we already know this article
years), and the pre-school child (3-6 years of age).
examines the latest research which provides us with
loot dim, tot s' Notebook. Winter t uo t
HEALTH AND LEARNING.
Children's
Children have different needs, depending on
Requirements
where they are within these stages. The younger the
for Care
child, the more difficult it
is to disentangle the
physiological and psychological factors within the
The quality of Care the young child receives deter-
environment that govern health. The youngest chil-
mines hisiher development. Engle (1992), defines
dren are completely dependent on adults. As they
care as the provision nn the household and community of time,
become toddlers environmental cleanliness, encour-
attention, and support to meet the physical, mental and social
agement of eating and vigilance in terms of the
needs of the glowing child and other household members. Care
child's safety are of utmost importance. The pre-
includes much more than keeping the child safe and
school child is more self-reliant As noted by Engle
free from harm Caregiving behaviours include
;1992) these children "are initiated into the culture
breastfecding; providing emotional security and
of children, and may even become fledgling care-
reducing the child's stress; providing shelter, cloth-
givers themselves... they may have developed skills
ing, feeding, bathing, supervision of the child's toi-
to obtain food for themselves. and the wisdom to
let; preventing and attending to illness; nurturing
protect themselves a little from pathogens in the
and showing affection, interaction and stimulation;
environment." (pg. 25)
playing and socializing; protecting from exposure to
While the general desciptu n of differences
pathogens; and providing a relatively safe environ-
across tiiz ages is important, in order to create a pro-
ment for exploration. (Zeitlin, 1991, Myers, 1992) A
it is critical to have
gramme for young children
second set of caregiving behaviours includes the use
more specific information on their needs. A delin-
of resources outside the family, including curative
eation of developmental differences is provided by
and preventative health clinics, prenatal care, the
Donohue-Colletta (1992) for three age groups. She
use of traditional healers, and members of the
defines the needs as follows.
extended family network. (Engle, 1992) All of these
) NI I I),
behaviours are a part of supporting the development
AN'T s HUT! I
)
of young children
PI PrOtt'Cil0/1frnin physical danger
The type of caregiving behaviour which is
adu/Hate nuts awn
required depends to a large extent on the child's
ade/pate health (arc
developmental age and the health and nutritional
adults with whom to form audi blunts
risks the child is facing. For example, during the first
,idults who Cali Iindersidlld and icspomi to their cloak
null, and task
year of life the child is at the greatest risk of mortali-
thing: to look at, touch, hear,
ty During late infancy (or when complementary
opporholthes to explore the world
foods are introduced) and during the toddler period,
appropriate language stimulation
the child is at greatest risk of growth faltering.
I NI I I)
.\(
( 1-3 YI .116 (t1
Tt )1 )1
While growth faltering may be the result of inad-
AIR )VI ANI)
s(1 RI (.A111:I
Al I
FI II
support in ti( oft:Jig new motor, language and thinking :kills
equate nutrition, there is clear evidence to suggest
that it is also linked to the way young children are
ma chance to develop some 111,41'14km(
fed. Feeding is more than giving children food; it
help Oi hatnin# how to control their own hehavunn
includes the interactive process which accompa-
opportunities to begin to learn to (at( lot themselors
daily opportunities to play with a variety of obleds
nies the intake of food. The interactive caregiving
provided during the feeding process can have a pro-
0 III DRIN AL.1"ti 3.6 (AND AIR Al
\IR AT, \I ,( ) NI I
found effect on the child's later development.
IN AN ATI( on TO TI
I ):
oPPorfunthes to dcorlop fine motor skills
Studies comparing children who are well- and poor-
encoutagemoit of language through talking trading,
ly-nourished suggest that there are positive Caring
singing
practices associated with children with better nutri-
ac bribe: which will dt'i'rlop ti positwe sense of mastery
tional status, even though the children come from
/lope/a hon. helping, sharing
opportunities to learn
the same type of environment as their malnourished
experimentation will, pre-writnut and pre-rcadmg skills
peers. (Zeldin, 1993)
In the context of feeding, Caring practices
(hg 61)
include frequent physical contact, being consistently
A wide variety of inputs is required to support
responsive to the child's needs and showing affec-
children's growth and development. An important
tion to the child. Care also includes 'icilyc feeding
thing to note is that all the inputs require someone
which means being aware of how much the child is
to interact with the child Very young children are
eating, offering the child a second helping, assisting
not capable of obtaining what they need on their
the child in the use of a utensil instead of expecting
own. The importance of adult-child interaction is
complete self-feeding, and offering praise for eating.
underscored by the latest research which addresses
(Engle, 1992)
specifically the relationship between nutrition. care
The studies of feeding are but one example of
and development.
5
current research that indicates the powerful effect of
on women's ability to provide care. These have been
the interaction between the child and the environ-
outlined by Engle. (1992) They include:
1. Physical health Many women in developing
ment on growth and development. Another example
countries are chronically anemic and undernour-
conies from longitudinal studies of children growing
up in poverty In Hawaii, Werner (1982) was able to
ished. This necessarily affects both the health of the
identify children who were able to thrive even
newborn and the woman's ability to provide Care.
though the conditions under which they were raised
2 Mental health. This includes a woman's level of
suggested they would he malnourished and not
self-confidence and her status within the culture
develop well. She termed those children that did
When women are stressed and feel they have no
well resilient. Those characterised as resilient evi-
control over their lives, the sense of powerlessness
can debilitate them. The more they feel they can
denced greater autonomy and competence (pg. 158)
and clearly did better developmentally and over
control aspects of their lives, the more self-confi-
time than their non-resilient peers. They did better
dent they are and the more likely they are to be able
because they were able to "elicit predominantly pos-
to give to others.
In cultures where women are
itive responses from their environment." These chil-
3. Women's status
dren were also found to he "stress-resistant" com-
subordinated to others, they are frequently unable
pared to children who elicited negative responses
to take good care of themselves, and may well lack
from their environment.
the resources (physical and psychological) to care
In her research, Werner
for the child. When women
sought to identify what makes
are respected and have con-
some children more resilient.
trol over resources, they are
always played
Women have
She concluded, as have others.
more self-assured. This gener-
that the differences between ally yields positive benefits
multiple roles that compete for
children who thrive and those
for children.
their time and physical and
who falter are determined by
4. Women's income. The liter-
the type of interaction that
ature suggests that women's
emotional energy. Regardless of
work outside the home pro-
Occurs between the child and
the context within which child,.en
child's
the environment. The
duces direct benefits for chil-
ability to thrive
is greatly
dren, particularly if the salary
are raised, care of children,
enhanced by the amount of
level is reasonable and if the
particularly young children, is
woman has control of the
affective stimulation and the
monies that she earns. In
kind of care the child receives.
still the woman's responsibility.
This clearly supports the con-
these instances, children are
ht addition, the woman is
to have improved
likely
tention that it
is not enough to
health and participate more
merely provide food. The child
responsible for household
fully in education.
needs food and Care.
management and operations, and
Education and
Another important factor in a
5.
Reliefs.
child's ability to thrive is the
studies
Numerous
have
economic/productive activity,
level of support the caregiver
demonstrated the strong posi-
some of which takes her outside
tive relationship between a
(most often the mother) receives
from others in the family and
woman's education and child
the home. Demands on time and
health and nutrition out-
from society. This support plays
energy make it increasingly
comes. While all the com-
an important role in the kind of
plexities of this relationship
care the caregiver is able to pro-
difficult for women to provide the
vide. Recognizing thi.. fact,
have not been explored fully,
kind of Care their children need.
is clear that when women
it
UNICEF has included support
for the caregiver
are better educated, their
their
in
children do better.
Nutrition Strategy. Adopted by
6. Social Supports. Moving beyond the individual,
the UNICEF Board in 1990, the Strategy suggests
the sixth variable is the kinds of social supports
that in addition to food security, access to health
available to women. When women feel they are part
care and a healthy environment, programming must
of a community, alternative forms of child care can
address the care of children and women. Recent
he developed, agricultural production can be facili-
research supports the UNICEF position that all of
tated through the formation of work groups. and
these are necessary; one alone is not sufficient.
From the onset of conception, the child and
informal sharing of tasks is possible, relieving the
stress on an individual woman. Community support
mother are inextricably linked and this is maintained
allows women to carry out a number of tasks effec-
after birth through breast-feeding and psychosocial
nurturing. Therefore the understanding of the
tively. L,- :k of supports may mean that many of the
tasks are not done well.
health needs and problems of the young child starts
7 Time. Somewhat related to the issue of social
naturally with adequate health inputs and supports
supports is the time that women have available for
for the motile,. A range of variables have an impact
6
'oordiriatots. Noiebook, Winter 100 s
'HEALTH AND LEARNING
University. In live countries (Bangladesh, Indonesia,
Care. The many hours of labour that women spend
Nigeria, Nicaragua and Mexico), Zeitlin and a team
to accomplish a range of tasks during the day has
of researchers undertook an "intervention research"
been well-documented One legitimate question is:
approach which encompasses academic research,
if women had more time would it he devoted to
operational research and the development of a pro-
childcare' The answer to this question is unclear. As
ject. The particular focus of this study was on the
Engle notes, the lack of an answer is largely due to
relationship between family variables and children's
the fact that when women are asked the question
nutritional and developmental status
they find it hard to imagine having leisure time.
The study provides insights into the role and
These variables are not static They are changing
impact of traditional care practices on nutritional
all the time as the nature of women's work changes.
status and children's growth and development. It
New economic pressures on and possibilities pre-
also provides a view of what the future holds as tra-
sented to women mean they increasingly work Out-
ditional practices are lost and modern strategics are
side the home, often for long hours and following
introduced.
schedules that limit their availability and thus the
To represent the complexity of the data. Zeitlin
time they can devote to child care.
developed a conceptual model that is elaborated on
In rural areas women often work in the fields.
in her discussion of practices within the various cul-
While in many cultures women have historically
tures. The basic model posits that overall child
constituted a majority of the agricultural work force,
growth and development, while rooted in family
in other settings the out-migration of men who are
resources (material and social), is mediated by fami-
seeking employment elsewhere has increased
ly management, beliefs and caring behaviours
women's agricultural role. In addition, in sonic agri-
These include: hygiene and sanitary practices; feed-
cultural settings cash crop production and plantation
ing practices; affection and attention; and academic
economies have meant that women are increasingly
stimulation provided to the child, all of which arc
being exposed to demands of rigid time and work
components of Care. Zeitlin suggests further that
schedules similar to those common in urban envi-
for infants and toddlers it is difficult to differentiate
ronments. In both urban and rural environments
nutritional and developmental outcomes.
there is an increase in the number of women-headed
In traditional cultures care has been the purview
households. All of these variables have an impact on
of the entire family kinship unit. Thus Zeldin argues
women's work loads
that nutritional programmes need to address the
Zeitlin H9921 has studied the impacts the rapid
needs of the "family kinship unit, the human entity
pace of change is having on children and families.
that survives across generations." emphasising in this
She con:Aides that many of the previous roles of the
broader definition the family unit over time, rather
extended family are being taken on by society.
than the individual child or the family within one
Because of this, Zeitlin is concerned not only with
generation.
the families' ability to provide care. but the ability of
The ability of the mother (or the primary caregiv-
local institutions to take on this function as well. As
er) to provide care for the infant and young child
Zeitlin notes, Care is moving from the non-mone-
depends both on her nutritional status and the kinds
tized dependency relationships within a family to
of supports that she receives. The father and other
the monetized public realm, and money does not
family members have an important role to play in
buy love.
the child's survival Zeitlin found that no matter
Zeitlin provides rich insight into the relationship
whether the father's traditional role called for
direct involvement with the child or just sup-
port of the mother, in all cases, "the father's
In conditions where there are poverty, food insecu-
presence, commitment and contribution was
rity and a high risk environment, good child Care
associated with better child nutrition." Others
and the social health of the family and community
within the kinship unit also play an important
are the most important variables in determining
role in caring for, socialising and teaching the
children's nutritional success. (Zeitlin)
young child.
However, in many places the family kinship
network is no longer a stable source of Care.
This makes it more crucial that programmes which
between family variables and children's developmen-
wish to meet the needs of young ch6dren address
tal outcomes. The Positive Deviance Research
the many dimensions of Care directly, rather than
Project, conducted 'nom 1987 to 1992 was spon-
as a background issue, or assuming that
sored by UNICEF New York and Nigeria the
treating
i
good care is being provided just because the child is
WHO/UNICEF joint Nutrition Support Program
in the company of adults. The example of the Asha
(JNSP) of the Italian Government and Tufts
7
Sadan remand home and orphanage (at right)
demonstrates this poignantly.
Zeldin found that the kinds of Care provided by
traditional and more modern parents have different
outcomes. Looking at the relationship between Care
and children's psychological development in
Indonesia and Nigeria, the researchers found that
parents with more modern (i.e. Western) childrear-
ing practices produce children who are more cogni-
tively advanced and better nourished, and thus bet-
ter prepared to participate in the modern world. In
particular Zeit lin's researchers observed in modern
families:
A change m parental dicciplinc away from mina,' le physi-
cal punishment to tolorince Of slower obediencr There was
that the child would have an
also an expect
t
.he reasons for rules.
understanding
Prolonged parental protection. Parents accepted the
child's physical dependency up to an older age, and
they provided more attentive feeding and care.
Akre affection and intimacy. A more personal rela-
tionship existed between the children and the
father and there were more recreations shared by
parents and children
Asha Sadan
-
Inc teased verbal respoihmene, to an child. This included
the use of explanation in addition to physical
A Hope
demonstration in teaching (Zeldin, 1991, pg
I
While these findings are heartening, moderniza-
Fulfilled
tion has also had a negative impact on care provided
by the family. Those aspects noted specifically by
Zcitlin
Iclude
Asha Sadan is a home which affords shelter
A dehumanization of an late elll'110111nrni with increased
and protection for destitute and abandoned
use of the bottle rather than the breast and the
children, as well as serving as a remand home
reliance on mass media rather than human interac
for delinquent girls. This foundling home
tion for entertainment
receives children of all ages in different states
The disintegration of family and community 1111Ik and of
of health and nutrition. The children remain
commitment to each other. Smaller units of owner-
in care until they are adopted. The neonates
ship and residence lead to less sharing and more
and sick children are assigned to nursing staff
who tend and care for them.
A reduction in the ability of families and communities to
This is the story of the older children who
provide care given the changing demands of work out-
were relatively healthy, but little else.
side the home The nature of this work does not
The honorary managing committee mem-
nurture stable family formation.
bers had noticed that the children were apa-
The fentonzation of poverty When families dissolve,
thetic and sometimes unruly. They showed no
the woman and her children generally fall into
signs of normal growth and development. In
poverty and lack adequate resources lor child care.
the month of August '86 there were thirty-two
A reduction m children.c altruism Preparing children to
babies who needed help, but the managing
he autonomous tends to make them precocious, self-
committee could not fathom the reason.
centered and unruly. Those children reared in more
The children had been provided with a
traditional societies are more altruistic. As modern-
beautiful nursery with fancy cots and beds and
ization occurs they become more egotistical. (pgs.
plenty of toys, but were not really allowed to
11-12)
play with the toys except under supervision.
One interesting outcome of this research was the
There was a luxurious kitchen and a full-time
discovery that the same characteristics of families
cook who dished out nutritious meals at fixed
who exhibited positive nutrition in circumstances of
times. But she was strictly following instruc-
poverty. vere those that led to positive cognitive
tions, and being anxious by nature, would pre-
In other words,
and social development as well
pare the food well ahead of time, then leave it
good Care yields benefits across the board in the
on the counter until the specified time. The
physical, mental and emotional realms.
Zeitlin concludes that child care practices are
'evolving codes of behavior that embody a society's
8
A NOTE FROM THE FIELD
children spent most of their time looking
"children should be seen and not heard." They
longingly at the food, partly because they
had established the rules and nobody dared
question them. For example, at feeding time,
were hungry, but more importantly because
the children were seated on the floor. Bowlfuls
they had nothing better to do.
of mashed cereal mixed with egg were shoved
Mobile Crecbes was requested to help in run-
ning the childcare centre during the day. into their mouths mechanically by some
helpers, with not a word being spoken. At the
Consequently four trained staff members
end of the meal, they were given water from
arrived at Asha Sadan to assess and assist in
the same bowls. Then the children were lifted
tending the children. For the staff of Mobile
up and put to bed.
Creches who were accustomed to the dust and
After many laborious discussions the
rubble of construction sites and creches with
low roofs and little ventilation, this seemed
emphasis was shifted from feeding and dump-
like heaven! There were toilets with running
ing, to nurturing with love and care, as well as
to activities for cognitive development. More
water and a large kitchen. What luxury.
attention to the children's health problems
But the atmosphere was strangely discon-
and habit formation began to pay dividends.
certing. The place smelled of stale urine and
most of the children were either Dying or just
They were encouraged to play and to use the
toys. The children looked forward to the time
sitting. Some of the smarter ones were point-
allotted for outdoor play. Soon they were
ing to the food on the counter and begging.
The staff were flabbergasted. There was no dancing and singing, and the creche was
resounding with their laughter. The first fal-
time to be wasted in observing. They had to
tering words had been uttered, showing that
get down to work immediately.
the children were normal after all.
Two of them attended to the physical cleanli-
A fortnight after the entry of Shalini,
ness of the nursery as well as the care of the
Vasanti, Shakuntala and Saraswati of Mobile
children. The plastic panties were replaced with
comfortable cotton ones, and toilet training was
Cackles, there was a perceptible change in the
children. They were happier and healthier and
started. Almost all the children had head lice
looked forward to each day with enthusiasm.
and scabies These were immediately treated.
The creche was now vibrant with eager chil-
But the most important aspect of child care
was affectionate interaction, coupled with
dren wanting to talk, play, learn and sing all
stimulating activities. These brought about the time. Their social-emotional development
was beginning to take place.
perceptible changes in the behaviour of the
The children's recorded weights showed an
children in the short time of a week. The chil-
increase of 500 grams exactly one month after
dren responded to the love shown to them
intervention. They were now feeding them-
and began to communicate with the adults
selves from little gleaming plates and enjoyed
who cared for them. But when it was time for
the independence.
the caregiving staff to leave in the evening,
there were heartrending scenes. The children
For Mobile Creches the experience provided
mixed feelings. There was the frustration of
would cling to them and cry bitterly.
not being able to change the system drastical-
By the end of a fortnight all this had
ly, combined with the satisfaction of meeting
changed. The children felt more secure and
were willing to wave goodbye to the care-
the challenge and achieving success. The ini-
tial trials turned into triumphs. They had
givers, secure in the knowledge that they
brought joy and stability into the lives of
would come again the next morning. Slowly
many forgotten children.
they were accepting discipline without fear.
At the end of six months the children had
The routine of feeding children and keeping
graduated into balwadis (pre-school). But the
them in bed most of the time was slowly mod-
work is not finished yet. The staff of the
ified to include interactive, stimulating activi-
remand home need to be trained for quality
ties for cognitive development.
childcare, so that every child who enters the
Working with established practices that
home has a better chance of normal develop
were unimaginative and outmoded was not
merit and a bright future.
easy. There was tremendous resistance from
the senior nursing staff who believed that
Indu Balagopal
9
14
If&
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Children's
perceptions of what children need to survive... and
Health
what society needs from the next generation." These
Requirements
"codes of behavior" are not easily changed. Parents
are not very responsive to what she calls "shorter-
Understanding the health needs and problems
term vertical objectives" such as improved weight
the young child starts naturally with adequate heal
gain Programmes that focus solely on weight gain
inputs for the mother After birth
the health ca
without addressing the families codes of behavior
requirements vary depending on the age of t
are not likely to be very effective. She adds her
child. For example. nutrition is often a focus of pr
voice to the growing chorus of researchers who
grammes for children under three since malnut
argue that support of "nutrition", (often conceived of
tion in its various forms contributes to about or
by the health field as consisting solely of
third of all deaths of young children in developi
Knowledge. Attitudes, and Practices (KAP). must
countries. (Engle, 19q2) With children between t
also incorporate Care, for the child, the family and
ages of 3 and 6, more emphasis is given to the pi
the society.
motion of school-related skills and the developmt
She argues that programmes should he directed
of good health habits.
toward:
Over the last five decades much has been writt
"strengthening families, for whom child care is
about the effects of protein deficiency on childre
intrinsic to self-expression;
physical development Children who receive Mac
using screening criteria to select dedicated, gen-
quatc protein intake fail to grow normally, and Iv
uinely caring alternative child care providers;
develop kwashiorkor, marasmus and other mild
monitoring the emotional climate of alternative
moderate symptom' of malnutrition. Howev,
child care...; and
recent research on the long-term effects of Prot
empowering the formation of community-Insed
Energy Malnutrition (PEM) suggest there is also
advocacy and self-help groups...as these groups
linkage between adequate nutrition during t
affiliate and serve out of a sense of shared purpose."