Experts are assessing a program that enhances the cognitive, motor and behavioral skills of infants, as Jiang Chenglong reports from Qujing, Yunnan.

Li Binying held a toy cup out for her new toy bear and babbled, "Drink, drink the milk."

The 2-and-a-half-year-old girl from Zhanyi, Qujing city, Yunnan province, was playing with a toy designed to teach children about food. She was accompanied by her mother and an "aunt", who brings new toys every time she visits.

Like many parents in rural areas, Binying's mother, 35-year-old Li Jiamei, was initially unaware of the child care measures required to raise her daughter in a way that would promote healthy intellectual development, such as playing with toys together as often as possible.

"Most rural parents have a lower level of education than those in urban areas, so they don't know enough about child care," said Luo Renfu, project leader of the Rural Education Action Program, supported by Stanford University, the Chinese Academy of Sciences and Shaanxi Normal University.

In early 2015, the program began a two-year research project in seven national-level, poverty-stricken counties in Shaanxi province. The program focused on 648 infants ages 6 to 24 months and their main caregivers.

The study found that most rural caregivers could only answer 50 percent of the questions in a parenting test, and also noted that the greater a parent's child care skills, the better their infant's cognitive, motor and behavioral skills will be.

"Children in rural areas are more likely to be left behind by their urban counterparts in terms of study and future opportunities because of defective childhood care before the age of 3," Luo said.

According to a 2015 report published by the All China Women's Federation, more than 50 percent of rural children ages 6 and younger had a zinc deficiency, which can affect metabolism, and their rate of growth retardation was six to eight times higher than their urban peers, meaning many were severely malnourished.

In response, the National Health and Family Planning Commission and Save the Children International launched a pilot program called Early Childhood Care and Development, designed for families with children age 3 or younger, in three rural areas in Zhanyi.

Under the program, the Zhanyi health bureau and Save the Children trained village workers to visit the families twice a month.

During home visits, they carried workbags containing new toys, picture books, a tablet computer featuring an app related to child development, equipment to measure height and weight, and free boxes of nutrition powder.

The workers and their "magic" bags were a key element of the program.

Home visit

"Have you missed me, Binying?" asked Wu Lumei, the little girl's "aunt", who arrived in December carrying a full workbag.

Binying lives with her grandparents who are often ill, her parents and 14-year-old brother. The family earns about 20,000 yuan ($3,122) a year from farm and construction work.

Wu, 35, a part-time village worker, lives near Binying's home in Dapo, one of Zhanyi's poorest areas. When she took a set of building blocks from her workbag, Binying was immediately interested and grabbed a cylinder and a cone.

Li sat beside her daughter and helped her to pile the blocks higher.

"Binying, what shape is this?" Wu asked, holding up a block. "It's a rectangle!"

She told Li: "You and her father should help Binying play with the blocks as often as possible. They can help her to learn about shapes and are good for improving manipulative ability."

Whenever she visited a family, Wu brought new age-appropriate toys and collected old toys, which were disinfected and given to other infants.

After helping Binying play with the toys, and giving instructions, Wu weighed and measured her.

"Good! 85 centimeters, and 12.1 kilograms!" she said, inputting the data into the app, developed by the Capital Institute of Pediatrics in Beijing. The app showed Binying's height and weight according to a range of reference intervals, based on previous growth data and her age in months.

Later, Wu questioned Li, entering her answers into the app. The assessment consisted of seven questions about the child's diet and parental interaction, such as "How many times have you accompanied your child's play in the past two weeks?"

After each answer, the app provided feedback, such as "Good, please keep it up," or a negative comment and detailed advice.

Finally, Wu gave Li a box of nutrition powder, containing 30 packs, enough for a month, reminding her to give Binying a pack every day.

Benefits

Binying was monitored from the age of 4 months. "The program benefited Binying's growth a lot," Li said. "She is half-a-head taller than a relative's boy of the same age."

When the program's first period concluded at the end of last year－the second is being planned－Save the Children invited the Rural Education Action Program to assess the beginning, middle and end using the Bayley Scales of Infant Development, which measure mental and physical development, including cognitive, motor and language skills.

Contrasts of the first and middle evaluations indicated that infants aided by the program performed better in all three areas than children who didn't participate, but particularly their cognitive skills.

The assessments also suggested that the more they were visited at home, the better the children developed.

Zhan Jialu, a village worker in Dade, a small settlement in Zhanyi, visited 3-year-old Zheng Menghan for 28 months.

"Menghan often asked when 'grandpa', as she called Zhan, would come, because she loved the toys he brought. We can't afford to buy lots of toys," said Chen Qiurong, Menghan's mother, whose family earns about 70,000 yuan a year.

"I feel Menghan's memory has improved, and she quickly recognizes colors and shapes," Chen said, recalling her daughter's situation before the program began. "She is also more lively and willing to talk to others."

Expert appraisal

During the program's first period, the local government and Save the Children selected 45 people to become village workers. "We invited parenting experts to provide two-day training sessions for them twice a year," said Li Dan, program officer for Early Childhood Care and Development at Save the Children.

Li Cai, former director of the Zhanyi family planning bureau, said, "To guarantee the quality of the services the village workers provided, supervisors checked their home visits and provided assessments that affected their monthly allowance and annual bonus."

Cai Jianhua, Party chief of the official training center at the National Health and Family Planning Commission, said: "China's economic development will rely on the younger generation, so rural infants must receive adequate nutrition and child care. That's why we adopted the pilot program and hope to promote it nationwide."

Now, the experts are assessing what they learned during the program's first period, and plan to establish a care center in a community with a larger number of infants.

"Such a center would allow village workers to share their child care knowledge and skills with a larger number of caregivers, which would save time and money," Li Cai said.

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