CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
IMCI has well-tested tools to
support its implementation:
technical guidelines and
training systems for
improving health worker
skills, health system supports
for building capacity in
planning and supervising
health programmes, and
ways to work with families
and communities to improve
child health.
Many attempts to improve
child development have failed
the test of going to scale, of
being able to reach large
numbers of children across
geographical and cultural
lines. The IMCI strategy has
succeeded in providing a
delivery system to reach
many children and their
families with effective
interventions to improve their
Combining interventions on nutrition
and psychological development for the
greatest impact
The intimate
relationship between
physical growth and
psychological
development is
particularly evident in
the first years of life.
This helps explain why
prenatal and early
childhood nutritional
interventions can also
have an impact on
psychological development. Likewise, early psychosocial stimulation
programmes to improve cognition (one aspect of psychological
development) may also have effects on physical growth.
The most significant fact, though, is that children who receive
combined nutrition and stimulation programmes perform better than
those who receive either type of intervention alone.
For information on research leading to these conclusions see:
A Critical Link: Interventions for physical growth and psychological development,
WHO/CHS/CAH/99.3, Department of Child and Adolescent Health and
Development, World Health Organization, 1999.
Support for implementing
Care for Development within IMCI
■ Guidelines for feeding, play, and communication
(IMCI charts)
■ Adapted IMCI training materials
— Modules for health workers
— Facilitator and supervisor guidelines
— Mother’s counselling card
— Training video
■ Technical seminar for decision makers
These materials are being revised based on field tests with
health workers in Brazil, South Africa, and Syria. They will
be ready for wider use by the end of 2001. Several tools
are also being adapted to strengthen support for child
development in community education and outreach
activities.
health. It is now being
implemented in over eighty
countries. Care for
Development can build on
IMCI Care for
Development
For the healthy growth and
development of children
CHILDREN who are poorly
nourished and frequently ill
are in danger of dying. They
are often difficult to feed,
and are less effective in
communicating their needs.
They may be timid and easily
this success, while upset. Those who survive are
strengthening the efforts of less active in exploring the
IMCI to reduce childhood world around them than
illness and deaths. ▲ other children; they have
more difficulty learning.
Over time mothers—and other
For further information please
caregivers—feed, play with,
contact:
and communicate less often
Department of Child and with their poorly nourished
Adolescent Health and
children. They are less likely
Development (CAH)
to recognize signs of hunger,
World Health Organization
discomfort, and illness, and
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email cah@who.int
activities that help their
website http://www.who.int/child-
children develop socially and
adolescent-health
intellectually. Improving the
child’s care is important for
developing the potential of all
children; it is essential for
increasing the chance of
survival of the most
vulnerable young ones.
WHO guidelines
on Care for
Development
CAH
WHO now provides
comprehensive guidance on
counselling families on care: Interventions
to improve feeding practices to promote
and interactions with psychosocial
children, respond effectively development within
when a child is sick, health programmes
stimulate growth and
Supporting the growth and
development through play
development of children is
and communication
becoming a greater priority in
activities, and solve problems
health programmes. Three
in care. The guidelines,
main approaches are used:
produced by the WHO
monitoring the child’s
Department of Child and
progress on developmental
Adolescent Health and
milestones, screening for
Development, are designed
developmental delays, and
to train health workers on
counselling families on how
Care for Development and
to support the development
to strengthen community
of their children. A look at
efforts through the WHO/
the three approaches
UNICEF strategy, Integrated
clarifies the choice to
Management of Childhood
implement a counselling
Illness (IMCI).
approach within IMCI.
Families give their
children special care
for development by
giving them love,
responding to their
nutritional and other
needs, and providing
opportunities to
learn. Children learn
to communicate
their needs, solve
problems, and help
others by playing and interacting with persons who care for
them. Even at a very young age, children learn important skills
that will prepare them for life.
 Unfortunately, accurate ■ The counselling of ■ Limited resources can be Implementing Care
Elements of effective programmes developmental tests are mothers and other care- used to directly improve the for Development
WHO commissioned a review of effective programmes in improving difficult to design, especially givers, as recommended in care children receive within through the IMCI
the health, nutrition, and psychological development of children in for young children. The IMCI, has been proven their families. strategy
disadvantaged circumstances. A Critical Link (1999) concluded that standards—even for effective in improving feeding
■ Maintaining a large-scale IMCI is a strategy to reduce
the most effective programmes: mastering basic motor tasks, practices and growth, and
monitoring or testing childhood deaths, illness, and
■ Focus on the children who are in the “critical window” of life— such as when the child could also be effective in
programme to identify disability, and to promote
improvements before birth and during the first 2 to 3 years of life should roll over or begin to improving the child’s
severely delayed children improved growth and
have the greatest crawl—are affected by development.
impact on the child’s would divert training, development. The most basic
cultural and family practices.
future growth and ■ Building on the IMCI consultation time, and other supports for child
Most first level health clinics
development. counselling process, and the resources away from the development in IMCI are
are unable to provide suitable
■ Focus on children delivery system developed to many other children who those that reduce the assault
testing conditions, as well as
who are most at risk— implement IMCI, is an could benefit from improved of repeated illness during the
the high level of training
the greatest efficient way to implement nutrition and intellectual time children need good
improvements were required to make accurate
Care for Development for stimulation. health to grow, reach out,
seen in children who assessments. The resources
the children who need it and explore, and promote
were impoverished used to implement an
most: those who are poorly good health and nutrition.
and undernourished. effective screening
nourished and frequently ill.
■ Combine several programme can leave little to IMCI targets children most
interventions, for help even the few children at risk, especially children
example: to promote identified to receive intensive living in poverty, often with
good nutrition, improve mother-child interactions, stimulate Key features of IMCI multiple conditions of illness.
services.
psychosocial development, and improve the child’s health.
Care for Development Many are poorly nourished.
■ Involve parents and other caregivers in improving the child’s care. The choice for the IMCI These are also the children
■ Based on the model of IMCI
The results of this review influenced the design of the IMCI Care for strategy: Counselling nutrition counselling most at risk of suffering
Development intervention. families on how to developmental delays.
■ Targets children most at risk:
For more information, see A Critical Link: Interventions for physical growth and support the development
children with anaemia or low IMCI nutrition interventions
psychological development, WHO/CHS/CAH/99.3, Department of Child and of their children weight for age, and all children
Adolescent Health and Development, World Health Organization, 1999. are intended for children who
A counselling approach less than two years old would also benefit from
focuses on what caregivers ■ Improves the knowledge and skills improved care: children who
can do to respond to the of mothers and others who care are underweight for their age,
Monitoring progress on milestones may leave few
for children
developmental resources available to help needs of their children for and all children age less than
milestones families, resulting in little care. It provides guidance on — Strengthens active and Age 12 months to 2 years: Give your two years (in the ‘critical
responsive feeding to improve child things to stack up, and to put into
change in the child’s care activities to stimulate containers and take out. window’ for having the
Programmes that promote nutrition and growth
and little effect on the child’s physical growth and greatest impact). The
the use of milestones focus — Introduces activities to improve
development. intellectual and social potential of achieving a
on what the healthy child interaction with children, to
development. Counselling greater impact by combining
should be able to do at stimulate growth and learning,
Screening for helps families solve problems interventions for nutrition and
various ages or stages of life. and to promote responsive care
developmental delays in providing care for their for the child’s health
psychological development
The child’s progress through
children. Where specialized have been clearly
developmental tasks To identify children who are — Recommends specific play and
services are available, demonstrated.
(milestones) for each age developmentally delayed, communication activities to
children who have difficulty help children move to the next
may be plotted on child some health programmes IMCI also builds the skills of
learning can be referred for steps in their development
health cards, similar to administer special tests to families to provide nutritious
appropriate assessment and
plotting the child’s growth. children at different ages. ■ Helps families solve problems in food, feed the child more
expert help. providing care
Failure to complete age- effectively, seek care for sick
Monitoring developmental
specific tasks on the test Based on a review of the Here are two recommendations from children, and care for the
milestones, as with growth
indicates potential delayed three main approaches, the the guidelines on how families can sick child at home. These
monitoring, requires an help their children learn through
development and a need to choice to promote a elements of care
appropriate response when play.
refer the child and family for counselling approach in IMCI Age 2 years and older: Help your complement care for
the child’s progress falters. child count, name, and compare things.
special help. was a practical one: Make simple toys for your child. development.
Efforts to promote the use of