Geliştiren Bakım: Erken Çocukluk Çağına Bütüncül Yaklaşım

Erken çocukluk çağı (EÇÇ); çocuklarda bilişsel gelişim, beden ve ruh sağlığı temellerinin atıldığı dönemdir. Gelecek nesillerin refah düzeyinin, EÇÇ dönemindeki bakım ve erken öğrenme fırsatlarına bağlı olduğu düşünülmektedir. Yoksulluk, yetersiz beslenme, şiddet, cinsiyet eşitsizliği, çevre kirliliği ve bakım verenin ruh sağlığı sorunları çocukların gelişimini tehdit etmekte, fiziksel ve zihinsel olarak sağlıklı olmalarını, mutlu olmalarını, olumlu ilişkiler kurmalarını ve üretken yetişkinler olmalarını engellemektedir. Geliştiren Bakım (GB); Dünya Sağlık Örgütü (DSÖ), UNICEF ve diğer paydaşlarca önerilen, ulusal ve küresel düzeyde ulaşılması hedeflenen, sağlık ve insani potansiyeli dönüştürmek için çocukların hayatta kalması ve gelişmesine destek olacak bir politika çerçevesidir. Bileşenleri sağlık, yeterli beslenme, duyarlı bakım, erken öğrenme fırsatları ve güvenliktir. Bu bileşenler doğrultusunda gebelikten itibaren yaşamın özellikle ilk üç yılında aile merkezli, bütüncül hizmetlerin sunulması ve her çocuğun yaşamına en iyi başlangıcı yapması hedeflenmektedir. Derlemenin amacı ülkemizde GB farkındalığını artırmak ve diğer ülkelerin çalışmalarının paylaşılmasıdır.

Anahtar Kelimeler:

Geliştiren Bakım, Çocuk Sağlığı, Beslenme, Erken Öğrenme Fırsatları, Duyarlı Bakım, Güvenlik, Çocuk Gelişimi

Nurturing Care: A Holistic Approach to Early Childhood Development

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.

Keywords:

Nurturing Care Early Childhood, Development, Health, Nutrition, Early Learning, Responsive Caregiving, Safety,

PDF

___

Shonkoff JP. Capitalizing on Advances in Science to Reduce the Health Consequences of Early Childhood Adversity. JAMA Pediatr. 2016 Oct 1;170(10):1003-7. google scholar
Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, et al. Early childhood development coming of age: science through the life course. Lancet. 2017;389(10064):77-90. google scholar
World Health Organization. Nurturing care for early childhood development: linking survive and thrive to transform health and human potential. Erişim adresi: www.who.int/maternal_child_ adolescent/child/nurturing-care-framework/en/. google scholar
Yousafzai AK. If not now, then when? The importance of intervening early to provide family-based environments for all children. Lancet Child Adolesc Health. 2020;4(8):565-566. doi:10.1016/S2352-4642(20)30187-5 google scholar
Richter LM, Daelmans B, Lombardi J, et al. Investing in the foundation of sustainable development: pathways to scale up for early childhood development. The Lancet 2017; 389(10064): 10318. google scholar
Ayyıldız E, Bilici Albayrak HS. Türkiye’de Zorunlu Okul Öncesi Eğitim, Güçlükler ve Fırsatlar. İlke Politika Notu; 2020: Yayın No:67. DOI: http://dx.doi.org/10.26414/pn015 google scholar
World Bank, Early Childhood Development. Erişim adresi: https:// www.worldbank.org/en/topic/earlychildhooddevelopment google scholar
Pagani LS, Fitzpatrick C. Children’s school readiness: implications for eliminating future disparities in health and education. Health Educ Behav. 2014 Feb;41(1):25-33. doi: 10.1177/1090198113478818. Epub 2013 Feb 27. PMID: 23445605. google scholar
Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet. 2008;371(9610):411-6. google scholar
Heckman JJ. Skill formation and the economics of investing in disadvantaged children. Science. 2006;312(5782):1900-2. google scholar
Fitzpatrick C,Boers E, Pagani LS, Kindergarten Readiness, Later Health, and Social Costs. Pediatrics. 2020 Dec;146(6):e20200978. google scholar
Survive, Thrive, Transform - The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016 - 2030). New York: United Nations; 2015. google scholar
OECD (2019), Education at a Glance 2019: OECD Indicators, OECD Publishing, Paris. Erişim adresi: https://doi.org/10.1787/f8d7880d-en. Erişim tarihi: 8 Mayıs, 2020 google scholar
UNICEF, Türkiye’deki Çocukların Durumu, Genel Değerlendirme ve Anahtar Bilgiler, Haziran 2021 google scholar
Türkiye UNICEF Ülke programı Belgesi 2021-2025. Erişim Adresi: http://www.sck.gov.tr/wp-content/uploads/2021/07/UNICEF-Ulke-Programi-2021-2025.pdf google scholar
Community Preventive Services Task Force. Recommendation for Center-Based Early Childhood Education to Promote Health Equity. J Public Health Manag Pract. 2016 Sep-Oct;22(5):E9-E10. doi: 10.1097/PHH.0000000000000354. PMID: 26672408. google scholar
UNICEF, Countdown to 2030. Thrıve Nurturıng Care For Early Chıldhood Development Country profiles for early childhood development. Erişim Adresi: https://nurturing-care.org/wp-content/uploads/2020/11/English.pdf google scholar
Erken Çocukluk Gelişimi Platformu (EGÇEP). http:// erkencocuklukgelisim.com/erken-cocuk-gelisim-platformu-platformu-ecgep/ google scholar
Buccini, G, Pedroso, J, Coelho, S, et al. Nurturing care indicators for the Brazilian Early Childhood Friendly Municipal Index (IMAPI). Matern Child Nutr. 2021;e13155. https://doi.org/10.1111/ mcn.13155)World Health Organization. Improving Early Childhood Development: WHO Guideline. Erişim Adresi: https://www.who. int/publications-detail/improving-early-childhood-development-who-guideline . google scholar
Buccini G, Coelho Kubo SEDA, Pedroso J, Bertoldo J, Sironi A, Barreto ME, Perez-Escamilla R, Venancio SI, Gubert MB. Sociodemographic inequities in nurturing care for early childhood development across Brazilian municipalities. Matern Child Nutr. 2021 Jul 6:e13232. doi: 10.1111/mcn.13232. Epub ahead of print. PMID: 34231320. google scholar
Urke HB, Mittelmark MB, Amugsi DA, Matanda DJ. Resources for nurturing childcare practices in urban and rural settings: Findings from the Colombia 2010 Demographic and Health Survey. Child Care Health Dev. 2018 Jul;44(4):572-582. doi: 10.1111/cch.12570. Epub 2018 May 1. PMID: 29717504. google scholar
Flynn EP, Chung EO, Ozer EJ, Fernald LCH. Maternal Depressive Symptoms and Child Behavior among Mexican Women and Their Children. Int J Environ Res Public Health. 2017 Dec 18;14(12):1566. doi: 10.3390/ijerph14121566. PMID: 29258221; PMCID: PMC5750984. google scholar
WHO, Improving early childhood development. ISBN: 978-92-4000209-8 6. Erişim Adresi: https://www.who.int/publications/i/ item/97892400020986 google scholar
Barboza M, Marttila A, Burström B, Kulane A. Contributions of Preventive Social Services in Early Childhood Home Visiting in a Disadvantaged Area of Sweden: The Practice of the Parental Advisor. Qual Health Res. 2021 Jul;31(8):1380-1391. doi: 10.1177/1049732321994538. Epub 2021 Feb 28. PMID: 33645337; PMCID: PMC8278558. google scholar
Olds DL, Kitzman, KR, Knudtson MD, Anson, MS E, Smith JA, Cole R. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. 2014 September; 168(9): 800-806. google scholar
Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr. 2014 Sep;168(9):800-6. doi: 10.1001/jamapediatrics.2014.472. PMID: 25003802; PMCID: PMC4235164. google scholar
Shi HF, Zhang JX, Wang XL, Xu YY, Dong SL, Zhao CX, et all. Effectiveness of integrated early childhood development intervention on nurturing care for children aged 0-35 months in rural China. Zhonghua Er Ke Za Zhi. 2018 Feb 2;56(2):110-115 google scholar
Wu T, Niu J, Yin X, Zhao C, Huang X, Wang X. China’s antenatal care promoting early childhood development: evidence from a cross-sectional survey. Ann N Y Acad Sci. 2021 Jun;1493(1):90-101. doi: 10.1111/nyas.14559. Epub 2021 Jan 17. PMID: 33455003. google scholar
Shi H, Li X, Fang H, Zhang J, Wang X. The Effectiveness and Cost-effectiveness of a Parenting Intervention Integrated with Primary Health Care on Early Childhood Development: a Cluster-Randomized Controlled Trial. Prev Sci. 2020 Jul;21(5):661-671. doi: 10.1007/s11121-020-01126-2. PMID: 32419119. google scholar
Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. Klingberg S, van Sluijs EMF, Jong ST, Draper CE. Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study. Pilot Feasibility Stud. 2021 Feb 27;7(1):60. doi: 10.1186/ s40814-021-00802-6. PMID: 33640007; PMCID: PMC7912559. google scholar
Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK: Ankara;2019.p.10-174. google scholar