Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. e124-e131 (doi:10.1542/peds.2005-2704)
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Promoting Child Development at Sick-Child Visits: A Controlled Trial

Ilgi Ozturk Ertem, MD, Gulsum Atay, MD, Bahar Emine Bingoler, MD, Derya Gumus Dogan, MD, Asuman Bayhan and Dolunay Sarica

Developmental-Behavioral Pediatrics Unit, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey

OBJECTIVE. In developing countries, the health care system often is the only existing infrastructure that can reach young children, and health care encounters may be the only opportunity for professionals to have a positive influence on child development. To address the discrepancy between Western and developing countries related to the information that is available for caregivers on how to support their child's development, the World Health Organization Department of Child and Adolescent Health and Development and United Nations International Children's Education Fund have developed the Care for Development Intervention. The Care for Development Intervention aims during acute health visits to enhance caregivers' play and communication with their children. For facilitation of its delivery worldwide, the Care for Development Intervention was developed as an additional module of the Integrated Management of Childhood Illness training course. The purpose of this study was to determine the efficacy and the safety of the Care for Development Intervention when implemented during a young child's visit for acute minor illness.

METHODS. The study design is a sequentially conducted controlled trial, with the comparison arm completed first, Care for Development Intervention training provided for the clinicians next, followed by the intervention arm. At the Pediatric Department of Ankara University School of Medicine, 2 pediatricians who were blinded to the study aims and hypotheses before Care for Development Intervention training provided standard health care to the comparison group; they then received Care for Development Intervention training and provided standard health care plus the Care for Development Intervention to the intervention group. Compliance with treatment and the outcome of illness were determined by a follow-up examination in the clinic 1 week later. One month after the clinic visits, an adapted Home Observation for Measurement of the Environment was administered in the homes by researchers who were blinded to study aims and hypotheses.

RESULTS. Children who were aged ≤24 months and attended the clinic with minor or no illnesses were recruited for the study: 113 in the comparison group and 120 in the intervention group. At the 1-month home visit, significantly more families had optimal Home Observation for Measurement of the Environment scores (17.5% vs 6.2%), more homemade toys were observed (42.5% vs 10.6%), and more caregivers reported reading to their children (20.0% vs 3.5%) in the intervention than in the comparison group. Three independent predictors of optimal Home Observation for Measurement of the Environment score emerged from the logistic regression analysis: being in the intervention group, child ages >6 months, and maternal education greater than secondary school. Compliance with medical treatment and illness outcomes were not significantly different between the 2 groups.

CONCLUSIONS. The Care for Development Intervention is an effective method of supporting caregivers' efforts to provide a more stimulating environment for their children and can be used by health care professionals during visits for acute minor illness.

Key Words: child development • developing country

Abbreviations: WHO—World Health Organization • UNICEF—United Nations International Children's Education Fund • CDI—Care for Development Intervention • IMCI—Integrated Management of Childhood Illness • HOME—Home Observation for Measurement of the Environment Inventory • RR—relative risk • CI—confidence interval

Accepted Feb 6, 2006.




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