Little Lías grows in the Peruvian Amazon

The Care for Child Development (CCD) approach promoted by UNICEF in the Lima, Loreto, Huancavelica, and Ucayali regions became a national policy in Peru.

A mother and her baby boy visit the Shirambari Health Post, Peru.
UNICEF/UN0503006/Rey de Castro
03 September 2021

Lías, a 4-month-old baby and his mother Yágoda Ruiz are on the ground surrounded by different-sized toys. They are in a consulting room at the Shirambari Health Post, Coronel Portillo district, in Ucayali, one of the Amazon regions in Peru.

This 31-year-old mother, who was born in the neighboring district of Callería, sits on a blue tablecloth across her son while she listens to nurse Berita Sifuentes’ recommendations encouraging her to make eye contact with Lías and ask him to play.

"Lías, Lías, Lías, Yágoda says, while her son plays with an orange plastic spoon.

Using clear language, Nurse Berita Sifuentes patiently explains to Yágoda key aspects of her son’s diet and development.
UNICEF/UN0503025/Rey de Castro
Using clear language, Nurse Berita Sifuentes patiently explains to Yágoda key aspects of her son’s diet and development.

As in 30 other health centers in Uyacali, the CRED consultation rooms at the Shirambari Health Post provide mothers, fathers, and caregivers guidance on child development in line with the CCD approach.

“Play is an important activity in children’s life since that is how they will develop their skills each day. During their visits, we teach mothers and fathers how to play with their children. We also give them advice on how to develop and strengthen their bond with the child, since it is critical for their growth,” says Nurse Sifuentes. Ms. Sifuentes is one of the six specialists in her region who has been trained by UNICEF and the Ministry of Health in the CCD approach.

Two mothers and their children engage in a conversation as they wait to be called into the consulting rooms.
UNICEF/UN0503011/Rey de Castro
Two mothers and their children engage in a conversation as they wait to be called into the consulting rooms.
A seated family with two babies awaits the pediatrician's attention.
UNICEF/UN0503035/Rey de Castro
According to the CCD approach, significant people in children's lives should be involved in parenting.

Guidance based on the CCD approach offers parents and caregivers additional tools to provide nurturing care while responding to their children’s needs. This helps encourage their child’s development and develop their capacities to the fullest.

This evidence-based approach is applied through play and communication activities. Hence, Nurse Sifuentes insists that Yágoda and Lías interact as much as possible.

"Some parents think that babies do not see, feel or think, but even before birth, children can feel love and communicate with their parents," says Sifuentes.

Yágoda and Lías are still learning. This young Ucayali woman had her first child when she was still a teenager. At that time, CCD had not yet been included in the practices of her town's pediatric offices. Today she continues to learn about how her baby develops and how she can use play and communication to strengthen her relationship with her son to best support this/his development.

Lías cries loudly.

"He wants to be in his hammock," his mother says, referring to Peruvian Amazon women’s habit of rocking their children in hammocks. "When we get home, I'm going to lay him so he can rest."

Nurse Sifuentes teaches Yágoda how to interact with her child.
UNICEF/UN0503018/Rey de Castro
Nurse Sifuentes teaches Yágoda how to interact with her child by looking into his eyes and speaking affectionately.

Play and communication

Nurse Sifuentes measures Lías’ head circumference at 42 centimeters. She also weighs and measures him.

"Here is the growth chart, and here is the head circumference chart," says Ms. Sifuentes as she points to a series of posters hung up on the office wall. Lías is fine for his age.

Ms. Sifuentes makes sure that Yágoda understands the measurement results and takes the time to answer her questions and clarify what she needs to do. Taking the time to do this is essential because, frequently, parents do not feel comfortable so quickly.

Berita Sifuentes and the other five nurses who work as CCD trainers at Ucayali have trained 53 facilitators. They are part of a team distributed across more than 30 health centers in Ucayali that work with the Care for Child Development approach.

Berita Sifuentes is one of the six CCD experts in Ucayali, Peru.
© UNICEF/UN0503036/Rey de Castro
Berita Sifuentes is one of the six CCD experts in Ucayali. With her colleagues, she has trained more than 50 people in this approach.

“During the visits, they evaluate the interactions and communication that take place between the mother or father and their child. There are large posters at the workstations where parents can see their child’s development and receive recommendations on what to feed the child; for example, complementary food after the 6th month”, says Gisella Godier del Castillo, UNICEF regional coordinator in Ucayali.

For now, Lías only drinks breast milk.

Practicing at home

Yágoda and her family’s house is in Vista Hermosa, about a five-minute drive from the Shirambari Health Post. It is a neighborhood formed by a long avenue with a series of wooden houses and natural materials. Yágoda’s house has a large front yard where one of Lías' hammocks hangs:

"He loves his hammock." I lay him there to rest - says Yágoda, feeling comfortable at home.

A mother talks to her baby who is resting in a hammock.
UNICEF/UN0503080/Rey de Castro
Local mothers usually place their children in hammocks to rest.

Ms. Sifuentes recommends that besides using the hammock, mothers also place their children on the floor to promote free movement, exploration, and play.

According to the CCD approach, the play area does not have to be a fancy place. Games don’t need to be expensive or elaborate. Many places and objects can be adapted to support children's learning; the important thing is that they are safe, and everything is clean. Cardboard or fabrics can be used instead of rugs, and games can include empty jars or containers or even dishwashing sponges to teach children about textures. There are many options.

“According to CCD, if you don't have a drum, you take a pot, a stick, or a spoon and use them to teach your child. You can use household items, and you don’t have to buy anything,” says Neptalí Cueva, a UNICEF health consultant in Ucayali.

At home, the Ruiz family has a front yard and a backyard where chickens and other birds raised by Lías' grandmother roam. Next door is the kitchen where the family prepares dishes, such as Zúngaro fish, pandisho (or "breadfruit"), and cocoa beans. Soon, all these areas will be part of little Lías’ environment, where he will learn about animals, the surrounding plants and the different smells, colors, and tastes of food.

His mother continues to practice everything she has learned:

–I help him do his exercises. I make him move his little legs, his tiny arms, like that, like that, as they have taught me, –said Yágoda, showing how he helps Lías stretch.

A mother holds her baby.
UNICEF/UN0503079/Rey de Castro
When he gets a little older, Lías will begin to play more freely in his backyard.

Lías lives with his mother, father, brother, uncles, cousins, and grandparents. His father works all day in a sawmill, but his other relatives keep him company and help care for the children and with the housework. Lías' cousin Jack likes to play with him.

“He also loves his older brother; he pays more attention to him,” says Yágoda.

Making eye contact, playing with whatever is available at home and talking are some of the activities they will practice together every day.