World Health Organization · 2026 · 22 pages
Framework-based guidance for policy-makers and programme designers on ensuring inclusive, family-centred services for children with developmental delays/disabilities.
- Issuer
- World Health Organization
- Edition
- 2026
- Audience
- Policy-makers, programme designers, health care providers, educators, social workers, child protection officers, community workers, organizations of persons with disabilities
- Evidence
- Expert consensus based on consultations with stakeholders across multiple countries, caregiver focus groups (India, Malawi, Sierra Leone), and desk review of peer-reviewed and grey literature; aligned with UNCRPD and rights-based approach
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This thematic brief applies the Nurturing Care Framework to children with developmental delays and disabilities (birth to 5 years), addressing how these children and their families are often deprived of the five components of nurturing care: good health, adequate nutrition, safety and security, responsive caregiving, and opportunities for early learning. It outlines how attitudinal, physical, and systemic barriers result in these children being 25% less likely to receive early stimulation and responsive care, 34% more likely to be stunted, 32% more likely to experience severe physical punishment, and only one in five attending early childhood education.
The brief recommends actions across four domains: enabling policies (inclusive laws, intersectoral coordination, child-tracking systems); supportive services (universal access, early childhood intervention [ECI] services, developmental monitoring integrated into routine care, assistive technologies, transdisciplinary teams); empowered communities (tackling stigma, community-based services, peer support); and caregiver capabilities (caregiver-mediated interventions, mental health support, dissemination of information on available services). Three guiding principles underpin all actions: individualized care, family-centred care, and coordinated care.
The document emphasizes that nurturing care can both prevent developmental delays in at-risk children and improve functioning and long-term outcomes for children with developmental disabilities. It calls for whole-of-government and whole-of-society approaches, with case examples from Rwanda (deinstitutionalization), Viet Nam (social benefits), India (developmental monitoring using GMCD), Kenya (Caregiver Skills Training), and other countries demonstrating practical implementation strategies.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Children with disabilities face substantially higher risks: 34% more likely to be stunted, 25% more likely to be wasted, 25% less likely to receive early stimulation and responsive care, and only one in five attend early childhood education
- Early childhood intervention (ECI) services should be multisectoral, integrated, transdisciplinary, family-centred, home-based, grounded in daily routines, with caregivers participating at every stage of planning and delivery
- Developmental monitoring (distinct from screening) should be integrated into routine well-child services from birth to 3.5 years, using tools like the Guide for Monitoring Child Development (GMCD) to assess expressive/receptive communication, gross/fine motor, relating, play, and self-help skills
- Universal newborn screening should detect vision and hearing impairment, hypothyroidism, phenylketonuria, and infectious diseases (HIV); careful newborn examination is critical as technological advances enable more small and sick newborns to survive
- Micronutrient deficiencies require prevention: iron, folate and iodine deficiencies in pregnant women lead to small-for-gestational-age babies, neural tube defects, and cognitive/behavioural impairments; vitamin A deficiency causes blindness; vitamin B, iron and iodine deficiencies cause neurological impairments and intellectual disability
- Service delivery should follow a twin-track approach: universal services for all children to promote optimal development and identify those at risk, plus targeted or indicated services tailored to individual needs requiring additional support across health, development, education and social care sectors
- Caregiver-mediated interventions (e.g. WHO Caregiver Skills Training for ages 2–9 years) delivered by trained non-specialists build confidence and skills to promote children's development through structured play and home routines, with evidence from Kenya showing decreased behavioural problems and enhanced family quality-of-life
- Governments should establish social benefits including monthly income support, health insurance, education assistance, travel subsidies, support allowances, and low-interest loans for caregivers of children with disabilities, as implemented in Viet Nam and over 50 countries worldwide
Increased risks of children with disabilities compared to other children (Facts and figures)
Table extracted from the guideline
| Nurturing care component | Specific risk | Magnitude of disparity |
|---|---|---|
| Good health | Missing vaccinations or access to services | More likely |
| Good health | Symptoms of acute respiratory infection | 1.5 times more likely |
| Good health | Diarrhoea | 1.7 times more likely |
| Good health | Improved sanitation facilities | 12% less likely |
| Good health | Improved drinking water sources | % less likely (unspecified) |
| Good health | Water and soap for handwashing | 8% less likely |
| Adequate nutrition | Stunting | 34% more likely |
| Adequate nutrition | Wasting | 25% more likely |
| Adequate nutrition | In institutions with limited access to nutritional programmes | Disproportionate share |
| Opportunities for early learning | Attend early childhood education | Only one in five (20%) |
| Opportunities for early learning | Reading or being read to at home | 16% less likely |
| Responsive caregiving | Receive early stimulation and responsive care | 25% less likely |
| Safety and security | Severe physical punishment at home | 32% more likely |
| Safety and security | Birth registration | 10 percentage points lower |
Source: World Health Organization, Nurturing care for children with developmental delays and disabilities: thematic brief. Reproduced in summary form.
From the guideline
Verbatim
“The requirement of a diagnosis should not delay access to family-centred services aligned with the needs of the children.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As we strengthen Georgia's universal health coverage programme and primary health care network, this WHO-UNICEF brief offers an essential roadmap for ensuring that children with developmental delays and disabilities—estimated globally at 58.9 million under age 5 in 2019—are not left behind. I would particularly stress to Georgian clinicians the recommendation to integrate developmental monitoring into routine well-child visits using validated tools, rather than waiting for specialist referral or formal diagnosis before supporting families. Our experience with the hepatitis C elimination programme since 2015 demonstrates that when we build capacity at the primary care level and remove barriers to access, we can achieve equitable coverage. The realistic implementation caveat is workforce: the brief's emphasis on task-sharing and training non-specialists (community health workers, peer caregivers) will be critical in Georgia where paediatric subspecialists are concentrated in Tbilisi, and we must invest in competency-based training and establish functioning intersectoral referral systems linking our health, education, and social protection sectors before we can fully operationalize family-centred early childhood intervention services nationwide.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is highly relevant given the region’s ongoing health system strengthening efforts and commitments to universal health coverage. National programmes would need to assess current prevalence of developmental delays and disabilities using validated caregiver-reported tools (Global Scales for Early Development for 0–23 months, Child Functioning Module for 24–48 months, ECDI2030 for 24–59 months) to establish baseline data. Implementation would require integrating developmental monitoring into existing maternal-child health services, expanding early childhood intervention capacity beyond tertiary centres to primary care and community settings, addressing workforce gaps through task-sharing and competency-based training of non-specialists (including community health workers and peer caregivers), and establishing intersectoral coordination mechanisms linking health, education, social protection and child protection sectors. The emphasis on family-centred, home-based approaches aligns well with community-oriented primary care models being strengthened across the region, though social protection schemes (cash transfers, parental leave, respite care) would need adaptation to local fiscal contexts and existing benefit structures.
Questions this guideline answers
Quick answers
What is the difference between developmental monitoring and developmental screening?
Developmental monitoring aims to continuously track and support each child's development through informed watching, enjoying, and supporting the child with the family, looking at biopsychosocial risk factors and assessing functioning across multiple domains. Screening has a predetermined timeframe and aims to detect aberrations. Monitoring enables interpretation of the child's functioning in context and does not require a diagnosis to provide family-centred support.
Should we wait for a diagnosis before providing early childhood intervention services?
No. The requirement of a diagnosis should not delay access to family-centred services aligned with the needs of children. With or without a diagnosis, all caregivers should be supported to provide their children nurturing care. Early identification enables timely interventions, but services should be provided based on functional needs, not diagnosis alone.
What are the three guiding principles for services for children with developmental delays and disabilities?
The three principles are: (1) Individualized care—tailoring support to each child's unique needs and helping caregivers develop skills and confidence; (2) Family-centred care—valuing caregivers' knowledge, involving them as partners, equipping them with skills, and connecting them to resources; (3) Coordinated care—ensuring case management, transdisciplinary teams, and unified referral systems across sectors to eliminate barriers.
What is the twin-track approach to service delivery mentioned in this brief?
The twin-track approach provides universal services for all children and caregivers (e.g., counselling on appropriate activities, growth and developmental monitoring) to promote optimal development and identify those at risk, plus targeted or indicated services with additional intensity tailored to individual needs for children requiring extra support. This creates multiple pathways across health, development, education and social care sectors.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
- Malaria in Infancy Linked to Delayed Development at Age 1 and 6, Benin Study ShowsSep 2026
- Specialized Sensory-Friendly Salon Model Transforms Care for Neurodivergent ChildrenOct 2026
- World-First Prenatal Surgery Saves Identical Twins from Life-Threatening Pregnancy ConditionOct 2026
- Autism Spectrum Disorder and Comorbid Schizophrenia: Clinical Practice GuidelinesJul 2026
- Autism Panel Promotes Controversial Telepathy-Based Spelling Therapy Despite Abuse WarningsJul 2026
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 2026
- Status
- Current
- Published
- 2026-03-02
- Languages
- English
- Scope
- Global; applicable to all settings with focus on strengthening systems in low- and middle-income countries
- Audience
- Policy-makers, programme designers, health care providers, educators, social workers, child protection officers, community workers, organizations of persons with disabilities
- Pages
- 22
- Licence
- CC BY-NC-SA 4.0
- ISBN
- B09617
- Evidence
- Expert consensus based on consultations with stakeholders across multiple countries, caregiver focus groups (India, Malawi, Sierra Leone), and desk review of peer-reviewed and grey literature; aligned with UNCRPD and rights-based approach
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
United Nations Children's Fund, World Health Organization. Nurturing care for children with developmental delays and disabilities: thematic brief. Geneva: WHO; 2025. (https://doi.org/10.2471/B09617).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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