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Early Childhood

Care for Child Development

For every child – a good start – lasts a lifetime – builds our society

What is Care for Child Development (CCD)? 

Care for Child Development (CCD) is a landmark and holistic Early Childhood Development intervention based on the best available evidence of child development. It incorporates the most recent evidence on the identification of critical caregiver skills affecting the child’s healthy growth and development (sensitivity and responsiveness) and the research demonstrating that these important skills can be taught to caregivers.  7.6 million children under 5 die each year, over 200 million children – survive, but do not reach their full human potential

Caregivers and families are best placed to support children’s growth and development, but families often need assistance to focus on the most important activities for the development of young children – play and communication. Thus, CCD aims to support families to care for their children and help them survive, grow and develop to their full potential. The intervention provides information and recommendations strengthening sensitive and responsive caregiver-child interactions. CCD guides health workers and other counselors as they help families build stronger relationships with their children and solve problems in caring for their children at home.

The CCD package focuses on building primary caregiver skills such as sensitivity- being aware of the infant and her or is acts, and responding appropriately to the infant's signals.

The package consists of: 

  • recommendations that health workers can make to families to improve the development of children 
  • training materials for health workers and community providers 
  • support for families to solve common problems in providing good care for young children 
  • advocacy materials
  • a monitoring and evaluation framework

How does Care for Child Development work?

Care for Child Development is a flexible, adaptable training package. Originally developed in the 1990s (by UNICEF WHO and other partners) as part of the regular child health visits as specified in the Integrated Management of Childhood Illnesses (IMCI). Good nutrition and health, consistent loving care and encouragement to learn in the early years of life help children to do better at school, be healthier, have higher earnings and participate more in society.The training package, geared towards people and organizations who work with children, has been designed to benefit those children and families who need it most and provides caregivers with information and guidance for clinical or home visits.

In the last decade, CCD has trained health services, health workers, nutrition workers, family planning workers and various other community providers and volunteers in over 40 countries. The freely available package has been updated to ensure that it can be used through more delivery platforms and has been integrated into initiatives such as Accelerated Childhood Survival and Development (ACSD), Infant Young Child Feeding (IYCF), Maternal and Newborn Health Care (MNHC) and Every Women, Every Child

The Pakistan Early Child Development Scale-up (PEDS) Trial demonstrated that the  Care for Child Development intervention had significantly greater results such as better cognitive, language and motor development outcomes at 12 and 24 months of age compared with the control group and with greater effect size than the stand-alone Enhanced Nutrition intervention.

The PEDS process included a cost-effectiveness evaluation, designed to measure which interventions provided the highest impact at the lowest cost. The four-phase evaluation found the cost of integrating the CCD with existing health and community services was US$4 per month per child. The monthly cost per child is reduced as activities go to scale. 

How is Care for Child Development Implemented? 

CCD fits easily with a range of child care services. It has been successfully integrated into child survival and health, nutrition rehabilitation, infant care and early education, services to families with children with developmental disabilities, and prevention of violence and child abuse. The approach builds on the skills of existing providers; it is not a separate programme and does not require new types of workers. Current professionals learn how to use play and inclusive communication to promote child development through the work they already do.  

In Pakistan, CCD was integrated into a community-based, government supported, Lady Health Worker Programme. Children under 2 years of age living in a highly disadvantaged rural district received the CCD intervention for 3 years. CCD was part of the routine monthly home visits and group meetings combining child development counseling with health care and basic nutrition education.

The outcomes were assessed for each child at two years old. Given the duration of the programme, both short and longer term outcomes were achieved. The findings showed children who received the CCD approaches had a significantly better learning environment and significantly greater caregiver involvement in play. The caregiver-child interaction scores were significantly higher in the intervention group than in the comparison group.

In Turkey, CCD was integrated into an outpatient clinic in an urban setting targeting children less than 2 years old. The patient population was largely from a poor socio-economic background. A pediatrician delivered counseling to children and their caregivers, who attended the clinic for treatment. A follow-up meeting was held one week later.

Outcomes were assessed 1-month after the second clinical visit. Given the low intensity of the intervention (2 contacts), short-term benefits were expected. The proportion of children with an enriched learning environment was significantly higher in the intervention group than in the comparison group, and the proportion of parents engaged in promoting learning.

How to monitor and evaluate 

The purpose of monitoring and evaluation (M&E) is to find out how well a programme is doing. In this case, does the integration of the approaches recommended in the CCD package in a health service benefit the intended recipients- young children and their primary caregivers? Ideally, an M&E framework should be planned from the outset, and build upon a Theory of Change (TOC).

A comprehensive M&E framework will measure the effectiveness of a programme, and how well the programme is implemented (process) to inform service providers and programme planners about how to make quality improvements in the implementation of programmes.

CCD Partners

This site provides materials to support the adoption and adapting of the training in many countries around the world.




Care for Child Development Training Package

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