Intervenções precoces para a redução de vulnerabilidades e melhora do desenvolvimento infantil

Abstract

This article is published in Open Access under the Creative Commons Attribution license, which allows use, distribution, and reproduction in any medium, without restrictions, as long as the original work is correctly cited. In high-income countries, children born in socioeconomically underprivileged environments tend to lag behind on indicators of social capital and life advancement when compared to their better-off peers. These children, who are already born with intrauterine growth restriction or suffer malnutrition in the first year of life, show higher school dropout and repetition rates, worse scholastic performance, more involvement in violence and crime, and lower intelligence quotient (IQ) 1. Few such studies have been performed in low-and middle-income countries, where the most vulnerable children live. In 2010, an estimated 43% of children in low-and middleincome countries were malnourished or lived in extreme poverty 2. This is a huge number of children at risk of being left behind over the life course, having their development jeopardized, and failing to achieve their full potential. To address this situation, programs have been implemented to benefit early development of these children. One such program aims to conduct home visits with interventions targeted to reduce such vulnerabilities 3. Studies that seek to verify the effectiveness of these programs are extremely important. A systematic review in 2013 based on experimental studies, the majority of which in the United States, concluded that programs with home visits conducted by paraprofessionals (the equivalent of community health agents) were associated with small improvements in childhood neuropsychomotor development. Better results were obtained when the intervention was longer, beginning in the prenatal period, the health agents were properly trained to perform designated interventions to meet the families' needs, and the program focused on certain aspects rather than attempting to solve several problems at the same time. The interventions were also more effective when combined with programs that included nutritional improvements 4. This issue of CSP focuses on childhood developmental health in the context of a program of early childhood intervention through home visits, called "Primeira Infância Melhor" [Better Early Childhood] 5,6. This program aims to promote comprehensive development in early childhood through weekly community and home visits to families in situations of risk and social vulnerability. The objective is to develop family skills based on the families' own culture and experiences in educating and raising their children.