Growing and learning through play

Four key aspects of Care for Child Development implementation in Latin America and the Caribbean.

Una madre interactúa con su hija durante una visita al pediatra.
22 September 2021

After years of adapting and implementing the Care for Child Development approach in the region, it is a good time to take stock and share the main lessons learned.

Care for Child Development (CCD) is an intervention model developed by WHO Global, PAHO/WHO and UNICEF, aimed at strengthening caregivers’ and families’ capacities to promote children’s comprehensive development through recommendations based on state-of-the-art evidence on child development. CCD-trained professionals learn to support families by providing play and communication activities that encourage children’s learning and promote nurturing care.

One of CCD’s principles is that young children and their primary caregivers gain essential knowledge and skills through play and sensitive and responsive communication with their significant others. Therefore, it is critical to support parents and caregivers to promote play, playful interactions, and exploration in everyday home and community settings.

CCD implementation in Latin America and the Caribbean (LAC) began in 2012 when the approach was adapted to respond to the region’s challenges: coordinating multisectoral, comprehensive early childhood care services, including a gender approach in parenting, responding to the needs of children with developmental delays or disabilities, and preventing violence against children at home.

As a result of this work, the CCD resource package for LAC included recommendations and tools to: i) expand its use to various services and settings beyond the health sector; ii) explicitly highlight the participation of parents and other family members; iii) prevent violence, iv) support parents of children with developmental delays and disabilities through activities based on play and communication, and v) promote the use of everyday household materials and objects to support children’s exploration and play.

The adaptability of the approach has enabled CCD implementation in 11 countries in the region[1] through diverse and contextualized strategies that respond to each country’s challenges, including emergencies and humanitarian crises. The approach has been adopted by professionals in the health, nutrition, education, childcare, child protection, and family-oriented social services sectors. This process and the vast array of existing experiences help guide the way to continue strengthening and expanding CCD in the region.

In an effort to collect these lessons learned and share them with different actors that influence policies, services and programs for early childhood, UNICEF, with the support of the LEGO Foundation, prepared case studies in five countries in the region: Belize, Dominican Republic, El Salvador, Paraguay, and Peru. The main lessons learned are described below:

1. CCD has helped include a holistic approach in early childhood care, favoring intersectoral work and enriching the services where it has been adopted. CCD training events have provided an opportunity for different sectors to come together to build a common framework based on promoting play, communication and parental support. In turn, this has encouraged commitment and collaborative work in favour of early childhood and has helped enrich daily care services.

For example, in El Salvador, officials from the health, education, and protection sectors, community promoters and academic sector and NGO representatives were trained in the CCD approach. The training events were adapted to the needs of different sectors and services, which was critical for building multisectoral commitment and facilitated articulation between various programs and services.

“We have evolved from each sector doing its part to an idea where everyone understands comprehensive early childhood care from an integrated perspective and a little more work is carried out in favour of articulation. Now, our work will follow development standards. The health and education sectors are now speaking the same language regarding child development” (Ministry of Education officer. El Salvador).

2. As the lead actors in this strategy, CCD offers families concrete tools for nurturing care and underlines play as essential for child development. CCD highlights the importance of play as a critical activity to promote child development and strengthen emotional ties between caregivers and children. Paraguay’s Juguetes para toda la vida (Toys for life) is a concrete example of this effort. It promotes play-based interactions between parents and children using toys made from materials available at home. Likewise, CCD strengthens families’ leading role by reinforcing their interactions with their children and preventing professionals from intervening directly with the baby or the child.

“For me, [CCD] is a very powerful tool because I am merely a facilitator of the process that unfolds between babies and their families. In what sense? In creating an attachment bond, in the quality of communication (...) I encourage families to take those tools with them and continue to work regularly at home; I encourage the family to be in charge of the relationship”(Health professional of the Kangaroo Mother Programme, in the Dominican Republic).

Padre ngöbe carga a su bebé durante una visita de rutina al pediatra.

CCD adaptations in the region included ensuring fathers’ and males caregivers’ active engagement in parenting and childcare. Participating professionals were trained in the importance of children’s bond with their fathers and how to encourage fathers’ participation in play and communication activities to reinforce their own nurturing care skills.

3. CCD has increased the motivation of professionals and has transformed staff’s interactions with families. Professionals’ relationships with families are now based on providing sensitive, respectful, and loving support. The recommendations they offer emphasize caregivers’ achievements, strengths, and capacities for responsive caregiving and playful parenting. This, in turn, has inspired and motivated staff who can directly identify changes in families; these include observing how attachment bonds are created between caregivers and babies through eye contact and how children, parents and staff enjoy themselves when play is included in regular interactions.


 Bajo a atenta mirada de la especialista, una madre interactúa con su hija durante una vista al pediatra.
UNICEF Perú/Hildebrandt

“Responsive or perceptive caregiving is [one of] the components of the CCD approach, which for us was like a discovery, realizing that was what we were looking for, what we felt was missing. We realized [...] and didn’t know this is what we were missing. Being able to sensitize, train the mother, the father, the grandmother, the main caregiver, train them to develop skills, sensitivity and attention skills, to interpret what babies want to communicate or transmit regarding their needs and interests”. (Management staff at the Mother-Child Pastoral service, in the Dominican Republic)

4. In emergency contexts or humanitarian crises, CCD contributes by providing play-based learning opportunities in crises. One of the reasons behind CCD’s strong momentum in the region was its crucial role as part of the response to the Zika virus health emergency, which was associated with an increase in births of children with disabilities. The integration of the CCD approach in health and early childhood development services and/or services for children with disabilities,  enabled strengthening the capacities of service professionals, families, and caregivers to provide caring and protective environments. CCD also strengthened the response to other emergencies. For example, in an emergency caused by a hurricane in Belize, temporary learning and care spaces were set up to provide play-based support to children 0-3 years old.

In the current COVID-19 context, one of the main challenges is to ensure the continuity of CCD training processes and continue supporting families and children through learning opportunities based on play and communication. Some countries have adapted the training processes to virtual modalities and/or have enhanced their services by providing telephone or online support or using mass communication media such as radio and television to offer families recommendations on play and communication.

Una madre cargando a su bebé durante una visita rutinaria al pediatra.

To respond to some of these challenges, UNICEF Latin America and Caribbean Regional Office recently launched an online course that introduces the CCD approach and is available to professionals who work with families in areas related to health, nutrition, education, protection, gender, water and sanitation, social protection, and monitoring and evaluation, among others. This online course will be part of a mixed training strategy that will include practical in-person sessions to offer proper certification to interested personnel. Additionally, with the LEGO Foundation’s valuable contribution, UNICEF continues to support CCD dissemination and expansion in the region, favouring children’s survival, development, and quality of life.

Note: This text was originally published in Spanish and disseminated via the ECDAN Platform. It was produced with the support of the LEGO Foundation.

[1] Belize, Bolivia, Brazil, Dominican Republic, various Caribbean countries, El Salvador, Honduras, Nicaragua, Panama, Paraguay, and Peru.