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WHO Nurtures Adolescent Caregivers? Guest Post

This opinion piece reflects on two recommendations from WHO, UNICEF and the World Bank Group framework; “Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential.” It suggests that the framework does not go far enough in recognising the work that children (especially young adolescents) provide as caregivers. Surmising that by informing, recognising and praising older children this helps improve their own development, as well as the care for their younger siblings, and potentially the health education of their parents. A triple win.

WHO nurtures young adolescent caregivers?

Here at Children for Health we like to absorb and reflect upon the latest developments in childhood development and health education. Hence our eagerness to read through the latest framework from the WHO, UNICEF and the World Bank Group; “Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential.”[1]

There are certainly parts that chime with our work with regard to the education sector. In particular, there are two aspects that fit very much with our ‘across the ages’ approach to the work we do. The framework gives precedence to:

1. Putting ‘family engagement at the core’

The report goes onto say that “When families feel valued, and when they are involved in the programme’s design and delivery, they are likely to be more successful and to sustain their efforts… [thus] the importance of engaging families in education’ as part of a ‘family- centred approach’ is vital (p.38).

In our eyes, children and younger adolescents especially, often serve as a social glue in transmitting health messages/education – both upwards to parents, but also downward to younger siblings. Whilst we do not undervalue the work that adult mothers, grandmothers/mothers-in-law play, we are concerned (still) by the lack of acknowledgment in policy and programming for the work that younger adolescents (both boys and girls) provide as caregivers.

For us, the framework does not go far enough. There is no explicit recognition of the work that children (especially young adolescents) provide as caregivers. We know at Children for Health that, “In many countries this cohort of children (literally) carry a lot of responsibility for the well-being of younger children for whom they are at least partial caregivers. They are also at an age where they can be reached effectively as there are far more 10-14 years olds in primary schools across the developing world than there are older adolescents in secondary school.

Most children in young adolescence are developing abstract thinking (vs the concrete operational thinking of younger children); they are usually close to their families and can have a subtle but powerful influence on family habits and practices. Family members may be interested and accepting of ideas and questions that children in this age group come back with – especially if their ideas and questions originate with a teacher or someone whom the family member respects.

We have witnessed children in early adolescence (10-14) have been successful in:

  • Persuading their fathers to give up smoking (Kenya)
  • Persuading their fathers to store their guns safely (Yemen)
  • Adopting the consistent and ongoing use of insecticide treated bed nets and getting others to do the same (Mali)
  • Taking their younger siblings to clinics to be immunised or urging their parents to do the same (Vietnam)”[2]

2. Investing in education for adolescents and adults

The report recognises that ‘Integrating nurturing care into secondary school curricula can prepare future caregivers to promote and support the development of the next generation of children.’ This is an important policy objective, because it looks to the benefit of the investment on current generations, but also future generations, and has echoes of Karen Moore’s early work on investments in young people and the positive repercussions on poverty in wider society[3].

It is important to recognise this ‘aging out/upwards’, but actually if we stay in the presentit also means recognising that young people can teach their parents/adults, and that parents can learn from their children. This is something in dominant cultures that is ignored (either intentionally or not).

Did you realise for example that, “As many as 1.4 million American children from ages 8 to 18 care for a parent, grandparent or sibling with a disability or illness, the American Psychological Association (2016) says, but it remains largely a hidden problem.”[4] Probably not if you have been brought up in the global north: in western societies we don’t talk or write much about children as caregivers, perhaps because we are still largely stuck within models of attachment/caregiving theories that focus on mothers alone.

Why then do young caregivers in the US for example remain hidden from state support? Because parents (in western countries), as the New York Times article states, “are often too embarrassed to tell schools how much they depend on their children, and caregiving children fear being taken away from their parents”. Heartbreaking really, if you think about it.

As a parent you know that your child reciprocally shapes and moulds you; you learn how to be a parent, and perhaps even what kind of parent you want to be/become. There is always a reciprocal and symbiotic learning process between child and parent, and siblings, and potentially wider social networks.

As an anthropologist working in the development quagmire, understanding the social barriers/drivers that constrain or enable behavioural change is paramount. And this is certainly true of understanding caregiving and social relations; and ultimately how policy should be shaped around such relational dynamics. This is also perceptively explored in Jean Hunleth’s book ‘Children as Caregivers’ (2017), which examines how well intentioned practitioners in Zambia fail to realize that children take on active caregiving roles when their guardians become seriously ill (in relation to tuberculosis), and demonstrates why understanding children’s care is crucial for global health policy.

There is still much more that can be learnt around individual family members’ roles and key catalytic figureheads within a given community. Too often in development we still overly simplify, and refer to the ‘family’ or the community’: this is lazy programming and policy. Especially when there is evidence out there that is clear: “not only is multiple child care, with resulting multiple attachments, widespread and normal but it takes different forms that are adaptive to local environmental and cultural contexts.”[5]

The question no longer is: do children provide active caregiving support to their parents and siblings? But rather: how can we design better policy and programs to support those children and early adolescents that do?

Here at Children for Health we have some of the answers, but not all. We are always on the lookout for thinkers, do-ers, partners (old or young) who we can learn from and/or collaborate with. What we have learnt is that children can be supported to be good caregivers via learning our 100 messagesThe first 10 focus on caring for babies and young children: the messages, which have gone through a thorough process of collaborative development will be piloted via our Memory Palaces this year. This could have an exponential effect on young caregivers and their younger siblings, but also via transmission to their wider familial networks.

Children for Health’s 100 messages for children to learn and share

It’s great to see that the framework mentions ‘care givers groups’; it would be even better to see that these groups pro-actively seek and raise the voices of young adolescent care givers in particular. By informing, recognising and praising older children this helps improve their own development, as well as the care for their younger siblings, and potentially the health education of their parents. A triple win.

Sarah Huxley – Child/Youth development specialist and Children For Health Associate @AidHoover


[1]World Health Organization, United Nations Children’s Fund, World Bank Group. Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: World Health Organization; 2018.

[2]See our earlier blog on Every Woman Every Child | The Global Strategy for Woman’s, Children’s and Adolescent’s Health 2016-2020.


[4]Downloaded 10thSeptember 2018 from:

[5]“It Takes a Village to Raise a Child”: Attachment Theory and Multiple Child Care in Alor, Indonesia, and in North India.” Susan C. Seymour