{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:37:26Z","timestamp":1789263446267,"version":"build-2803163510"},"reference-count":70,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Brazilian Ministry of Health [Grant\/Award Number: Not Applicable]"},{"name":"Brazilian National Research Council","award":["440890\/2017-9"],"award-info":[{"award-number":["440890\/2017-9"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,1,17]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The full achievement of early childhood development (ECD) is a human right and adhering to the nurturing care framework may facilitate it.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the association between distal and proximal variables and developmental quotient (DQ).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from 14\u2009159 children &lt;5 years were evaluated in the Brazilian National Survey on Child Nutrition. The Survey of Well-being of Young Children\u2014Brazilian version milestones questionnaire was used to evaluate ECD. The developmental age was estimated using the graded response models. DQ was calculated by dividing developmental age by chronological age. The expected age milestones are attained when DQ=1. DQ predictors were defined considering distal and proximal levels\/variables using a multiple linear regression model and a hierarchical approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The DQ mean was significantly lower among children aged 36\u201359 months (0.91 (0.88 to 0.93)), boys (1.03 (1.01 to 1.06)) and those from the North region (0.98 (0.93 to 1.04)) compared with children aged 1\u201335 months (1.18 (1.15 to 1.22)), girls (1.11 (1.08 to 1.13)) and from the Southeast region (1.11 (1.07 to 1.16)). For children aged 1\u201335 months, DQ was inversely associated with emergency C-section (\u03b2=\u22120.08; p&lt;0.01), consumption of ultra-processed food (\u03b2=\u22120.33; p&lt;0.01), and positively associated with attendance at daycare\/school (private: \u03b2=0.09; p=0.02 and No: \u03b2=0.12; p&lt;0.01). For children aged 36\u201359 months, attendance to private daycare\/school (\u03b2=0.08; p&lt;0.01) was positively associated with DQ, and small for gestational age at birth (\u03b2=\u22120.05; p=0.01) and access to public health services (no-primary care) (\u03b2=\u22120.07; p&lt;0.01) were inversely associated with DQ.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adverse health, nutrition and learning factors predicted the ECD, demonstrating an inequitable environment for Brazilian children. These findings indicate a need for public policies to ensure social and health equity in early childhood.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001516","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T22:45:14Z","timestamp":1738881914000},"page":"e001516","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Factors associated with early childhood development: results from the Brazilian National Survey on Child Nutrition (ENANI-2019)"],"prefix":"10.1136","volume":"3","author":[{"given":"Nathalia Cristina","family":"Freitas-Costa","sequence":"first","affiliation":[{"name":"Nutritional Epidemiology Observatory, Institute of Nutrition Josu\u00e9 de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayana Rodrigues","family":"Farias","sequence":"additional","affiliation":[{"name":"Nutritional Epidemiology Observatory, Institute of Nutrition Josu\u00e9 de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadya Helena","family":"Alves-Santos","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Federal University of Par\u00e1, Bel\u00e9m, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Scincaglia","sequence":"additional","affiliation":[{"name":"Faculty of Nutrition, Federal University of Goi\u00e1s, Goiania, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Normando","sequence":"additional","affiliation":[{"name":"Nutritional Epidemiology Observatory, Institute of Nutrition Josu\u00e9 de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Rugani","sequence":"additional","affiliation":[{"name":"Institute of Nutrition, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa Maria","family":"de Aquino Lacerda","sequence":"additional","affiliation":[{"name":"Institute of Nutrition Josu\u00e9 de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Crispim","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Federal University of Paran\u00e1, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Valeria Maria","family":"Brentani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Pediatrics, University of Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Regina Lindgren","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8603-9077","authenticated-orcid":false,"given":"Gilberto","family":"Kac","sequence":"additional","affiliation":[{"name":"Nutritional Epidemiology Observatory, Institute of Nutrition Josu\u00e9 de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"key":"2025083110201591000_3.1.e001516.1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0366"},{"key":"2025083110201591000_3.1.e001516.2","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1016\/S0140-6736(18)30312-X","article-title":"Origins of lifetime health around the time of conception: causes and consequences","volume":"391","author":"Fleming","year":"2018","journal-title":"The Lancet"},{"key":"2025083110201591000_3.1.e001516.3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)31389-7"},{"key":"2025083110201591000_3.1.e001516.4","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)31698-1"},{"key":"2025083110201591000_3.1.e001516.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31390-3"},{"key":"2025083110201591000_3.1.e001516.6","unstructured":"WHO Guidelines Approved by the Guidelines Review Committee . Improving early childhood development: WHO guideline. Geneva: World Health Organization, 2020."},{"key":"2025083110201591000_3.1.e001516.7","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)30266-2"},{"key":"2025083110201591000_3.1.e001516.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002034","article-title":"Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling","volume":"13","author":"McCoy","year":"2016","journal-title":"PLoS Med"},{"key":"2025083110201591000_3.1.e001516.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-026449","article-title":"Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low\/middle-income countries","volume":"9","author":"Sania","year":"2019","journal-title":"BMJ Open"},{"key":"2025083110201591000_3.1.e001516.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002314","article-title":"Inequalities in early childhood care and development in low\/middle-income countries: 2010-2018","volume":"5","author":"Lu","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025083110201591000_3.1.e001516.11","unstructured":"Costa MA , Marguti BOE . Atlas da vulnerabilidade social nos munic\u00edpios brasileiros. 2015."},{"key":"2025083110201591000_3.1.e001516.12","unstructured":"IBGE . Desigualdades Sociais por Cor ou Ra\u00e7a no Brasil. 2022."},{"key":"2025083110201591000_3.1.e001516.13","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311x00037221","article-title":"Sampling plan of the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey","volume":"37","author":"Vasconcellos","year":"2021","journal-title":"Cad Saude Publica"},{"key":"2025083110201591000_3.1.e001516.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2013.07.001"},{"key":"2025083110201591000_3.1.e001516.15","doi-asserted-by":"publisher","DOI":"10.7322\/jhgd.145001"},{"key":"2025083110201591000_3.1.e001516.16","doi-asserted-by":"crossref","first-page":"e614","DOI":"10.1097\/DBP.0000000000001133","article-title":"Survey of Well-Being of Young Children (SWYC): Preliminary Norms for Screening for Developmental Delay in Brazilian Children Younger than 65 Months","volume":"43","author":"Guimar\u00e3es","year":"2022","journal-title":"J Dev Behav Pediatr"},{"key":"2025083110201591000_3.1.e001516.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajcnut.2023.04.026"},{"key":"2025083110201591000_3.1.e001516.18","doi-asserted-by":"crossref","unstructured":"Samejima F . Handbook of modern item response theory. New York, NY: Springer New York, 1997:85\u2013100.","DOI":"10.1007\/978-1-4757-2691-6_5"},{"key":"2025083110201591000_3.1.e001516.19","unstructured":"Muth\u00e9n LKaM BO . Mplus user\u2019s guide. 7th edn. Los Angeles, CA, 1998."},{"key":"2025083110201591000_3.1.e001516.20","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2019-0374","article-title":"Establishing New Norms for Developmental Milestones","volume":"144","author":"Sheldrick","year":"2019","journal-title":"Pediatrics"},{"key":"2025083110201591000_3.1.e001516.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2007.00787.x"},{"key":"2025083110201591000_3.1.e001516.22","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project","volume":"384","author":"Villar","year":"2014","journal-title":"The Lancet"},{"key":"2025083110201591000_3.1.e001516.23","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311x00293320","article-title":"Methodological aspects of the anthropometric assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey","volume":"37","author":"Anjos","year":"2021","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"2025083110201591000_3.1.e001516.24","unstructured":"World Health Organization . WHO child growth standards: length\/height-for-age, weight-for-age, weight-for-length, weight -for-height and body mass index-for-age: methods and development. Geneva: World Health Organization, 2006."},{"key":"2025083110201591000_3.1.e001516.25","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311x00301420","article-title":"Methodological aspects of the assessment of dietary intake in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey","volume":"37","author":"Lacerda","year":"2021","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"2025083110201591000_3.1.e001516.26","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980018003762"},{"key":"2025083110201591000_3.1.e001516.27","unstructured":"IBGE . Coeficiente de varia\u00e7\u00e3o. 2024. Available: https:\/\/ftp.ibge.gov.br\/Indicadores_Sociais\/Sintese_de_Indicadores_Sociais\/Indicadores_Sociais_2018_tabulacoes_especiais\/documentacao\/Coeficiente_de_Variacao.pdf2024"},{"key":"2025083110201591000_3.1.e001516.28","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/26.1.224"},{"key":"2025083110201591000_3.1.e001516.29","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3434"},{"key":"2025083110201591000_3.1.e001516.30","article-title":"Factors associated with early childhood development in municipalities of Cear\u00e1, Brazil: a hierarchical model of contexts, environments, and nurturing care domains in a cross-sectional study","volume":"5","author":"Venancio","year":"2022","journal-title":"Lancet Reg Health Am"},{"key":"2025083110201591000_3.1.e001516.31","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-59034-y","article-title":"Poor maternal nutritional status before and during pregnancy is associated with suspected child developmental delay in 2-year old Brazilian children","volume":"10","author":"Neves","year":"2020","journal-title":"Sci Rep"},{"key":"2025083110201591000_3.1.e001516.32","doi-asserted-by":"crossref","DOI":"10.1111\/mcn.12864","article-title":"Early childhood development and stunting: Findings from the MAL\u2010ED birth cohort study in Bangladesh","volume":"16","author":"Nahar","year":"2020","journal-title":"Maternal & Child Nutrition"},{"key":"2025083110201591000_3.1.e001516.33","doi-asserted-by":"crossref","DOI":"10.3389\/fnhum.2020.00244","article-title":"Gender Differences Are Encoded Differently in the Structure and Function of the Human Brain Revealed by Multimodal MRI","volume":"14","author":"Zhang","year":"2020","journal-title":"Front Hum Neurosci"},{"key":"2025083110201591000_3.1.e001516.34","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ridd.2015.01.009","article-title":"Gender and geographic differences in the prevalence of reportable childhood speech and language disability in Taiwan","volume":"40","author":"Tseng","year":"2015","journal-title":"Res Dev Disabil"},{"key":"2025083110201591000_3.1.e001516.35","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1750-8606.2012.00247.x","article-title":"Sex Differences in Early Infancy","volume":"6","author":"Alexander","year":"2012","journal-title":"Child Dev Perspectives"},{"key":"2025083110201591000_3.1.e001516.36","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.1002\/hbm.26238","article-title":"Sex differences, asymmetry, and age-related white matter development in infants and 5-year-olds as assessed with tract-based spatial statistics","volume":"44","author":"Kumpulainen","year":"2023","journal-title":"Hum Brain Mapp"},{"key":"2025083110201591000_3.1.e001516.37","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3325\/cmj.2019.60.141","article-title":"Sex differences in early communication development: behavioral and neurobiological indicators of more vulnerable communication system development in boys","volume":"60","author":"Adani","year":"2019","journal-title":"Croat Med J"},{"key":"2025083110201591000_3.1.e001516.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2016.03.001"},{"key":"2025083110201591000_3.1.e001516.39","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-065936","article-title":"Associations between sociodemographic and behavioural parameters and child development depending on age and sex: a cross-sectional analysis","volume":"12","author":"Schild","year":"2022","journal-title":"BMJ Open"},{"key":"2025083110201591000_3.1.e001516.40","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/jnr.24914","article-title":"Gender differences in early stages of language development. Some evidence and possible explanations","volume":"101","author":"Rinaldi","year":"2023","journal-title":"J Neurosci Res"},{"key":"2025083110201591000_3.1.e001516.41","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1017\/S0305000918000089","article-title":"Self-reported parental vocabulary input frequency for young children","volume":"45","author":"Bleses","year":"2018","journal-title":"J Child Lang"},{"key":"2025083110201591000_3.1.e001516.42","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0215343","article-title":"Prevalence and socioeconomic determinants of development delay among children in Cear\u00e1, Brazil: A population-based study","volume":"14","author":"Correia","year":"2019","journal-title":"PLoS One"},{"key":"2025083110201591000_3.1.e001516.43","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jped.2016.02.001","article-title":"Social and biological determinants of growth and development in underprivileged societies","volume":"92","author":"Hadders-Algra","year":"2016","journal-title":"J Pediatr (Rio J)"},{"key":"2025083110201591000_3.1.e001516.44","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1016\/S2214-109X(18)30003-2","article-title":"Similarities and differences in child development from birth to age 3 years by sex and across four countries: a cross-sectional, observational study","volume":"6","author":"Ertem","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2025083110201591000_3.1.e001516.45","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-2663"},{"key":"2025083110201591000_3.1.e001516.46","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1590\/S0104-12902015000200002","article-title":"Tipologia das regi\u00f5es de sa\u00fade: condicionantes estruturais para a regionaliza\u00e7\u00e3o no Brasil","volume":"24","author":"Viana","year":"2015","journal-title":"Saude soc"},{"key":"2025083110201591000_3.1.e001516.47","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1590\/1413-81232021269.10112021","article-title":"Primary Care Asssement Tool: diferen\u00e7as regionais a partir da Pesquisa Nacional de Sa\u00fade do Instituto Brasileiro de Geografia e Estat\u00edstica","volume":"26","author":"Pinto","year":"2021","journal-title":"Ci\u00eanc sa\u00fade coletiva"},{"key":"2025083110201591000_3.1.e001516.48","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmph.2022.101064","article-title":"Moving up but not getting ahead: Family socioeconomic position in pregnancy, social mobility, and child cognitive development in the first seven years of life","volume":"17","author":"Johnson","year":"2022","journal-title":"SSM Popul Health"},{"key":"2025083110201591000_3.1.e001516.49","doi-asserted-by":"crossref","first-page":"e873","DOI":"10.1016\/S2214-109X(16)30298-4","article-title":"Early childhood development: a new challenge for the SDG era","volume":"4","author":"Barros","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2025083110201591000_3.1.e001516.50","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-4774.2012.01096.x"},{"key":"2025083110201591000_3.1.e001516.51","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1542\/peds.2008-1315l","article-title":"Selected complementary feeding practices and their association with maternal education","volume":"122 Suppl 2","author":"Fein","year":"2008","journal-title":"Pediatrics"},{"key":"2025083110201591000_3.1.e001516.52","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0b013e32835ad2ee"},{"key":"2025083110201591000_3.1.e001516.53","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0087896","article-title":"Mode of delivery and offspring body mass index, overweight and obesity in adult life: a systematic review and meta-analysis","volume":"9","author":"Darmasseelane","year":"2014","journal-title":"PLoS One"},{"key":"2025083110201591000_3.1.e001516.54","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-021-02623-1","article-title":"Maternal and neonatal factors associated with child development in Cear\u00e1, Brazil: a population-based study","volume":"21","author":"Rocha","year":"2021","journal-title":"BMC Pediatr"},{"key":"2025083110201591000_3.1.e001516.55","doi-asserted-by":"crossref","first-page":"158","DOI":"10.7322\/jhgd.114483","article-title":"Association between breastfeeding, obstetric factors and child development in Northeast Brazil","volume":"27","author":"Severiano","year":"2017","journal-title":"J Hum Growth Dev"},{"key":"2025083110201591000_3.1.e001516.56","doi-asserted-by":"crossref","first-page":"301","DOI":"10.7322\/jhgd.v30.10382","article-title":"Influence of type of birth on child development: a comparison by Bayley- III Scale","volume":"30","author":"Cavaggioni","year":"2020","journal-title":"jhgd"},{"key":"2025083110201591000_3.1.e001516.57","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/j.clnu.2022.08.005","article-title":"The association between maternal ultra-processed food consumption during pregnancy and child neuropsychological development: A population-based birth cohort study","volume":"41","author":"Puig-Vallverd\u00fa","year":"2022","journal-title":"Clin Nutr"},{"key":"2025083110201591000_3.1.e001516.58","doi-asserted-by":"crossref","DOI":"10.3390\/ijms21186546","article-title":"Neuroinflammation-Associated Alterations of the Brain as Potential Neural Biomarkers in Anxiety Disorders","volume":"21","author":"Won","year":"2020","journal-title":"Int J Mol Sci"},{"key":"2025083110201591000_3.1.e001516.59","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.14720"},{"key":"2025083110201591000_3.1.e001516.60","doi-asserted-by":"publisher","DOI":"10.1111\/apa.14287"},{"key":"2025083110201591000_3.1.e001516.61","doi-asserted-by":"crossref","first-page":"3425","DOI":"10.1590\/S1413-81232012001200027","article-title":"Estado nutricional de crian\u00e7as assistidas em creches e situa\u00e7\u00e3o de (in)seguran\u00e7a alimentar de suas fam\u00edlias","volume":"17","author":"Souza","year":"2012","journal-title":"Ci\u00eanc sa\u00fade coletiva"},{"key":"2025083110201591000_3.1.e001516.62","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1590\/1414-462x2017000100xx","article-title":"Preditores de riscos nutricionais de crian\u00e7as assistidas em creches em munic\u00edpio de porte m\u00e9dio do Brasil","volume":"25","author":"Pedraza","year":"2017","journal-title":"Cad sa\u00fade colet"},{"key":"2025083110201591000_3.1.e001516.63","doi-asserted-by":"crossref","DOI":"10.20396\/san.v29i00.8653701","article-title":"Inseguran\u00e7a alimentar em crian\u00e7as que frequentam creches p\u00fablicas em Ponta Grossa, PR","volume":"29","author":"Stavski","year":"2022","journal-title":"Segur Aliment Nutr"},{"key":"2025083110201591000_3.1.e001516.64","unstructured":"BRASIL . Lei n. 12.796, de 4 de abril de 2013. altera a lei no 9.394, de 20 de dezembro de 1996, que estabelece as diretrizes e bases da educa\u00e7\u00e3o nacional, para dispor sobre a forma\u00e7\u00e3o dos profissionais da educa\u00e7\u00e3o e dar outras provid\u00eancias. In: Jur\u00eddicos. Dispon\u00edvel em, 2013. Available: http:\/\/www.planalto.gov.br\/ccivil_03\/_ato2011"},{"key":"2025083110201591000_3.1.e001516.65","doi-asserted-by":"publisher","DOI":"10.1037\/a0038785"},{"key":"2025083110201591000_3.1.e001516.66","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.worlddev.2019.02.012","article-title":"Improving the quality of early childhood care at scale: The effects of 'From Zero to Forever'","volume":"118","author":"Bernal","year":"2019","journal-title":"World Dev"},{"key":"2025083110201591000_3.1.e001516.67","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0167660","article-title":"A Systematic Review and Meta-Analysis of a Measure of Staff\/Child Interaction Quality (the Classroom Assessment Scoring System) in Early Childhood Education and Care Settings and Child Outcomes","volume":"11","author":"Perlman","year":"2016","journal-title":"PLoS One"},{"key":"2025083110201591000_3.1.e001516.68","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0183673","article-title":"Education of staff in preschool aged classrooms in child care centers and child outcomes: A meta-analysis and systematic review","volume":"12","author":"Falenchuk","year":"2017","journal-title":"PLoS ONE"},{"key":"2025083110201591000_3.1.e001516.69","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4025\/rtpe.v22i1.47427","article-title":"Apontamentos sobre educa\u00e7\u00e3o de beb\u00eas e de crian\u00e7as pequenas","volume":"22","author":"Tunes","year":"2019","journal-title":"Teor Prat Educ"},{"key":"2025083110201591000_3.1.e001516.70","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyp272"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-001516","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:20:28Z","timestamp":1756660828000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-001516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":70,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,2,6]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bmjph-2024-001516"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-001516","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}