A new approach to childcare transforms the lives of children in Peru

From the Amazon region of Ucayali, the story of Silvia Hernández and her little girl Naomi is an example of the Care for Child Development (CCD) provided at a local health center.

Una madre cargando a su hija.
UNICEF/UN0503016/Rey de Castro
03 September 2021

After having her second child in May 2020, Silvia Hernández felt like a new mother. It had been 11 years since she gave birth for the first time, and she did not know how to react when the baby was restless or cried inconsolably. She couldn’t hold or bathe her without fearing she would hurt her. In this context, breastfeeding was the most challenging experience. Silvia could not get Naomi to suck correctly on her nipples, which led to a painful mastitis and caused her daughter health problems.

As she waited with her daughter to be treated at the Shirambari Health Post located in the Yarinacocha district in the Coronel Portillo Province, in Ucayali, the 28-year-old woman said: "Naomi almost died on me."

It is a sunny morning in July and Silvia and Naomi are waiting their turn for a check-up and follow-up visit. Hernández's eldest son keeps them company as he plays with his sister and feeds her small pieces of stuffed potato. Other moms are also waiting with their children.

Visitors at the Shirambari Health Post.
UNICEF/UN0503099/Rey de Castro
Despite the COVID-19 pandemic restrictions, there are many visitors at the Shirambari Health Post.
A father with his children seated, awaiting medical attention.
UNICEF/UN0503083/Rey de Castro
Mothers and also fathers visit the Health Post. One of the proposals of the CCD approach is to encourage the whole family’s participation in parenting.

“Ms. Berita helped me in those difficult moments. She taught me how to breastfeed correctly, showing me the correct positions and how to place my baby. She was very patient with me,” says Silvia. The young Pucallpa native refers to the care she received from Nurse Berita Sifuentes, one of the Peruvian CCD specialists trained by UNICEF and the Ministry of Health in a child development diploma course. Besides working at the Shirambari Health Post, she is currently a national CRED (“Control de Crecimiento y Desarrollo”) facilitator.

Thanks to Ms. Sifuentes’ guidance, Silvia overcame her mastitis and Naomi’s nutritional status improved in a few weeks. She and her daughter are now learning to communicate better and to play with love and joy.

Mother and daughter play inside the medical office.
UNICEF/UN0503040/Rey de Castro
During the check-up visit, Silvia Hernández and her daughter play inside the office. Unlimited eye contact and interaction are strongly encouraged.

A friendly learning process

Silvia and Naomi enter a room that does not look like a doctor's office: a blue mat lies on the floor with several toys nearby. The main difference is what happens inside, unlike anything in a traditional doctor’s visit. Ms. Sifuentes asks Silvia to place Naomi on the blue carpet, and they sit next to her as they talk.

“Every time you teach Naomi something, look into her eyes because that strengthens the affective bond between you. As you look at her, explain what you are doing,” says Ms. Sifuentes.

A mother plays hide and seek with her little girl.
UNICEF/UN0503039/Rey de Castro
During the check-up visit, Silvia Hernández and her daughter play hide and seek inside the office. Unlimited eye contact and interaction are strongly encouraged.

Silvia and her girl begin to play hide and seek using a cloth. She asks: "where is mom?" for Naomi to pull the fabric and find her mother with a look of surprise.

"You are doing it very well; this is how you should play with Naomi. You can use whatever you have at home, for example, even a new and clean dishwashing sponge, to let her feel the texture," says nurse Sifuentes.

Silvia Hernández and Berita Sifuentes talk about Naomi's growth and her diet.
UNICEF/UN0503044/Rey de Castro
Silvia Hernández and Berita Sifuentes talk about Naomi's growth and her diet.

The Care for Child Development activities that Ms. Sifuentes has integrated into her consultations are part of an approach that helps caregivers provide children with nurturing care based on play and communication.

“With our guidance, mothers learn how children understand, how babies respond with their eyes, with their smiles. The bond they develop in those first months is fundamental,” says Sifuentes.

a nursing professional applying the CCD approach.
UNICEF/UN0503026/Rey de Castro
Berita Sifuentes, a nursing professional, is one of six health professionals trained in the CCD approach in Ucayali.

“Before applying the CCD approach, we all thought that mothers came to check-ups to get their children vaccinated and to check how much they weighed and measured. But now they see, for example, how their child plays and they interact in the consultation room. The most important thing is that they notice that, from birth, the child can do so many more things than they thought possible”, says Berita Sifuentes.

Silvia's partner, Naomi's father, is a high school teacher and participates in raising his daughter, despite his time constraints due to his job. One of his favorite activities is playing endlessly with his baby.

“Her father makes her play a lot, and she likes it. They play like this, as we are doing now… she is very playful ”, says Silvia with a smile. Naomi also loves to watch the birds standing on the coconut, mango, and pacae trees in the family's small garden.

From UNICEF to Peru

Silvia Hernández recalls that more than a decade ago, her first child received a different type of medical care. Since then, Peru has started implementing actions in favour of early childhood development. UNICEF’s cooperation in the Ucayali region has supported intensive training in Care for Child Development (CCD).  There are currently 20 trainers from the health, education and Cuna Mas sectors and other professionals who work in early childhood issues. There are six regional trainers who are part of the health sector, including Berita Sifuentes who also helped train other health sector personnel. “Currently, there are 53 regional facilitators in CCD, in more than 30 health facilities in Ucayali,” says Neptalí Cueva, a UNICEF health consultant in Ucayali.

Una madre ve a su pequeña hija a quien están pesando durante una consulta médica. iátrica.
UNICEF/UN0503042/Rey de Castro
Silvia Hernández y la pequeña Naomi, durante la consulta pediátrica.

“UNICEF has set out to encourage early childhood development at the national level. We recognize the need to go beyond ensuring the availability of material resources at the local level; we know that developing policies is essential to guarantee that progress is maintained over time”, says Gisella Godier, UNICEF Regional Coordinator in Ucayali.

The visit ends, and Silvia Hernández and Naomi leave the Shirambari Health Post with new homework: diet changes, play on demand, make eye contact, and speak clearly. Silvia wants to do a good job: "I don't want her to get sick again; what happened last time scared me a lot," she says. Today, this young woman understood that motherhood requires constant learning, as she helps build Naomi’s present and future one day at a time.