Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis

Abstract

Background Parents are the primary caregivers of young children. Responsive parent–child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. Methods and findings We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent–child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = −0.13, 95% CI: −0.18 to −0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent–child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = −0.07, 95% CI: −0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent–child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. Conclusions Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: a systematic review and meta-analysis

“… 5 In contrast, stimulation interventions (n=21) were found to be more beneficial for cognitive ( d =0.43) and language ( d =0.47) development than nutrition interventions (n=18, d =0.09) in children younger than 2 years. 6 Furthermore, a recent review by Jeong et al 7 found that stimulation-based interventions have considerably larger effects on cognitive (standardised mean difference [SMD]=0.41), motor (SMD=0.26), language (SMD=0.35) and socioemotional (SMD=0.24) development of children under 3 years in LMICs.…”

Africa is not a museum: the ethics of encouraging new parenting practices in rural communities in low-income and middle-income countries

“…19 More recently, a systematic review of parenting interventions delivered during the first 3 years of children's lives included nine (of 102) studies in six African countries (of 33 countries globally). 20 The African programmes ranged from an adaptation of the 2-year Reach Up programme in rural Madagascar, 21 which was not found to change ECD outcomes, to an 8-week book-sharing training programme for caregivers living in a peri-urban settlement in South Africa, 22 which was shown to impact children's language development and sustained attention. In rural Uganda, a programme similar to the RPP in design was found to increase children's cognitive and language scores in the programme group compared with control.…”

“…1 4 14 In the recent systematic review of parenting programmes for children 0-3 years, a greater effect on cognitive development was found in LMICs compared with HICs. 20 An earlier review of a wide range of interventions in LMICs that targeted learning outcomes for children 0-8 years found that child-focused educational interventions had larger effects on the cognitive development of children from low-income compared with high-income families. 56 Preserving the status quo perpetuates and ultimately widens the inequality gap in child health and development between the educated rich and the uneducated poor, 54 raising ethical concerns of inaction when action is possible.…”

Developmental delay in a resource-constrained environment: An approach to early intervention

“…• Parent education on responsive caregiving in the first 3-years of life and parent strategies for home-based activities that can assist development across domains • This is with the understanding that early nurturing home environments protect young children against effects of early adversities 23 and interventions in the first 3 years of life improved early child cognitive, language, motor, socioemotional development, and attachment and reduced behavioural problems 24 • Strategies for baby-bonding and attachment that can be executed in the home setting, for example, infant massage. 25 • Including content on caregiver burden, maternal mental health and how to maintain the quality of life for caregivers of children with DD • Parent workshops on how to make and use low-cost stimulation toys or apparatus for developmental stimulation in the home • Strategies on how to integrate developmental stimulation into everyday tasks, routines and activities Early evaluation and intervention include not only management and treatment for the individual child but also provision of appropriate family and community-based support mechanisms 18 Parents of children with DD may be more likely to have lowquality parent-child interactions because of increased difficulty in parenting this population 19 Understanding what families' needs are and how families use and integrate strategies within the context of their daily lives provides practitioners with insights needed to support families' resiliency in promoting their children's participation 20 Parents could be intervention agents to facilitate their children's language and social communication outcomes 21 with parent-implemented interventions at time proving more effective than clinician-directed service provision 22 CHWs, community healthcare workers; DD, developmental delays; PHC, primary health care; EI, early intervention; MDT, multidisciplinary team; LMIC, low to middle-income country/ies.…”

“…This is with the understanding that early nurturing home environments protect young children against effects of early adversities 23 and interventions in the first 3 years of life improved early child cognitive, language, motor, socioemotional development, and attachment and reduced behavioural problems 24 …”