Parenting for Lifelong Health for Toddlers

PLH for Toddlers is a parenting programme that facilitates caregivers stimulation of young children’s cognitive and social development through focused engagement with picture books. Aimed at caregivers with children aged 1 – 5 years, caregivers are encouraged to engage the child in an active exchange about a picture book, following the child’s interest and cues. This practice of shared reading has been shown to dramatically enhance children’s language development. Working with Stellenbosch University, Oxford University, the University of Reading, and University College London, we have evaluated the programme through randomised control trials (RCTs) in Khayelitsha, South Africa and in Mokhotlong, Lesotho. These studies have shown benefit to both the quality of the parent-child relationship and to child developmental progress.

PLH for Toddlers is delivered to parents through trained facilitators over eight weekly 1,5 hours sessions. Delivered in a group setting, with up to 8 caregivers per group, the trained facilitators use a combination of interactive discussions on the theory, video demonstrations, and practical demonstrations to train parents in sensitive shared reading techniques. In each session, each caregiver is given the opportunity to practise the skills learnt, with the facilitator providing coaching and mentorship to encourage the caregiver to continue the practice at home, with the “book of the week” provided to them. In the following session, caregivers share their experiences with the group, where they teach and learn from each other. Separate shared reading programmes for caregivers with younger children (ages 12-30 months) and for caregivers with older children (31-60 months) have been developed in order to speak to the different developmental needs of children of different ages. PLH for Toddlers is currently being evaluated or implemented in several countries, including the UK, Brazil, Colombia, India, Italy, Sicily, Greece, Lesotho, and South Africa.

Following an initial successful pilot randomised controlled trial, PLH for toddlers was tested in an RCT in Khayelitsha in 2014. A sample of 91 mothers of 14-16 month old children participated in the trial. After the 8-week intervention, compared to the no intervention control group, the intervention group showed medium to large beneficial effects. The mothers became significantly more sensitive to their infants, during both shared reading and play; and there was a significantly greater reciprocity between the mother and child. These relationship changes were associated with large benefits to the children’s development, in terms of language and attention. PLH for toddlers was tested in an additional RCT in Khayelitsha, to evaluate the intervention for caregivers of children between 21-28 months, with a specific focus on children’s socio-emotional development. In a sample of 140 children and their caregivers (with 70 assigned to the intervention condition), the intervention benefited parenting and child development outcomes. Specifically, the intervention had positive effects on child language and attention.

In Lesotho, the PLH for toddlers programme was delivered to caregivers with children ages 1-5 as part of an integrated community-based parenting programme with a focus on improving HIV testing,  general health and nutrition. The integrated programme was tested in a cluster RCT which included 1040 children and their caregivers across 34 villages. Analysis of the primary outcomes showed a significant effect on child HIV testing, child receptive language at 3 months and 12 months post-intervention. The intervention also had a significant effect on child expressive language at 12 months post-intervention.

Dowdall, N., Melendez-Torres, G.J., Murray, L., Gardiner, F., Hartford, L., & Cooper, P. (2019) Shared picture book reading interventions for child language development: a systematic review and meta-analysis. Child Development, in press. Link

Dowdall, N., Cooper, P.J., Tomlinson, M., Skeen, S., Gardner, F. & Murray, L. (2017). The Benefits of Early Book Sharing (BEBS) study: protocol of a randomised controlled trial conducted in South Africa of a book sharing intervention to improve child cognitive and socio- emotional development. Trials, 18, 118-131. Link

Tomlinson, M., Skeen, S., Marlow, M., Cluver, L., Cooper, P., Murray, L., ... & Esterhuizen, T. (2016). Improving early childhood care and development, HIV-testing, treatment and support, and nutrition in Mokhotlong, Lesotho: study protocol for a cluster randomized controlled trial. Trials, 17(1), 538. Link

Murray L, De Pascalis L, Tomlinson M, Vally, Z, Dadomo, H, MacLachlan, B, Woodward, C, Cooper, P.J. (2016). Randomized controlled trial of a book-sharing intervention in a deprived South African community: effects on carer–infant interactions, and their relation to infant cognitive and socioemotional outcome. Journal of Child Psychology and Psychiatry, 57(12): 1370-9. 109. Link

Vally Z, Murray L, Tomlinson M, Cooper PJ. (2015). The impact of dialogic book-sharing training on infant language and attention: a randomized controlled trial in a deprived South African community. Journal of Child Psychology and Psychiatry, 56(8): 865-73. 108. Link

Cooper PJ, Vally Z, Cooper H, Radford, T, Sharples, A., Tomlinson, M. & Murray, L. (2014). Promoting Mother–Infant Book Sharing and Infant Attention and Language Development in an Impoverished South African Population: A Pilot Study. Early Childhood Education Journal, 42(2): 143-52. Link