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La Educación
Número: (134-135) I,II
Año: 2000

Some Implications for Policy and Programming

1. Combine program actions

The review of the literature has tried to show that satisfying social and psychological needs can have an effect on both nutrition and health. It should not be surprising, then, that the first implication for programming to be drawn from the evidence is that nutritional and health actions should be combined with other actions designed to improve the social and psychological well-being of the child. Doing so takes advantage of the synergistic relationships that have been identified.

2. Support caregiver and child, not just the child or the mother

Researchers have emphasized that satisfying a child’s psychosocial needs requires mutually satisfying caregiver-child interactions within a supportive and stimulating environment. Thus, programming should be directed towards the caregiver-child dyad (using the word “dyad” captures the reciprocal nature of the interaction between caregiver and child) as well as to the caregiver (usually the mother) and to the child, viewed individually. Improving the nutritional and health condition of both is obviously important but, again, needs to be supplemented by attention to the kind of interaction occurring between caregiver and child.

What can be done to improve the interaction? Caregivers can be helped to interact better with their infants, toddlers and preschoolers by at least two kinds of action — strengthening the supporting environment and providing information to caregivers within a supportive structure.

3. Improve the supporting environment

The first, and probably most important, type of action is one that will help to remove limiting conditions that prevent natural interaction from occurring. Most caregivers will be loving and attentive and responsive and stimulating if they are given the chance. But there are many pressures on resources, time, and psyche that produce stress in caregivers, affecting their interaction — other than stress induced by under-nutrition. As suggested by Zeitlin, et al., there is an important need to look at the social support systems caregivers can count on — at whether there are additional hands and hearts available. Are there ways in which time taken for other tasks can be reduced? These concerns are in addition to efforts to improve the larger environment through changes in water systems, sanitation and other features of the physical environment. They are, in addition to providing opportunities for general education, an action which has many indirect benefits for caregiving.

4. Work with caregivers to improve childrearing practices

A second set of actions would focus more directly on the caregiver. Without underestimating the natural parenting abilities of most caregivers or disregarding the many traditional practices that help foster a positive interaction between caregivers and their children, it is possible to see important ways in which working with caregivers could improve interaction and foster child development. Many mothers, for instance, are not aware of the ability of their newborns to hear and see and respond at birth, do not value play, see no harm in “bottle propping” (leaving the child alone with the bottle instead of interacting during the feeding with a bottle), or are unaware of the importance of stimulating the child through touch, talking, and eye contact. (Kotchabhakdi 1988) In urban conditions, a teenage girl may not have had the socialization to child care she would have had in a rural area. She is in need of help with her parenting skills. In short, programs of parental support and education that include discussions of ways to satisfy psychosocial as well as nutritional and health needs will be appropriate.

5. Treat feeding as a social and developmental process

Feeding is a childrearing practice that varies considerably from place to place and family to family. From the review of evidence emerges a natural link between nutrition and psychosocial development related to the fact that feeding is a social and developmental as well as a nutritional process.

In nutrition programs, how a child is fed would be attended to — along with attention to screening for malnutrition and to what a child is fed. Feeding is at once a social activity with psychosocial development purposes as well as a nutritional activity with nutritional and growth proposes. The quality of the social and psychological interaction during feeding affects nutritional status both through a physiological effect on the child and through its influence on the amount of food the child demands and ingests. These considerations are seldom included in nutrition manuals (Myers, 1992, Appendix to Chapter 9).

Interactions during breastfeeding or bottle-feeding, during the weaning process, and at meal times can encourage or discourage proper feeding while helping to satisfy important developmental needs.