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A new study of children in Ukraine has found that for the growing number of HIV-infected children, the quality of care and the relationship between children and their caregivers play an important role in their development. Based on their findings, the researchers highlight the importance of comprehensive but focused intervention efforts to improve these relationships by changing caregivers' working schedules and providing training to enhance the stability and sensitivity of care.

Published in the January/February 2010 issue of the journal Child Development, the study was conducted by scientists at Leiden University in the Netherlands. One of the researchers, doctoral student Natasha Dobrova-Krol, is of Ukrainian origin.

The researchers sought to examine the effects of HIV infection and being raised in institutions on the development of 58 infected and uninfected Ukrainian 4-year-olds. Some of the children lived in institutions from shortly after birth, while others lived with their biological families.

The study found that the quality of the relationships between the children and their caregivers had a bigger impact on children's physical growth and cognitive performance than the presence of the HIV infection or the quality of the physical environment. In addition, the study found that for both children with and without HIV, family care, even when it was compromised, was better for children than institutional care.

"This study underscores efforts to strengthen the quality of children's relationship with caregivers as important for children infected with HIV," suggests Marinus H. van IJzendoorn, professor of child and family studies at Leiden University, who worked on the study.

"Because HIV-infected children are the least-preferred candidates for adoption or foster care, many of them will remain in rather low-quality institutions. Renovating the premises and giving them toys and learning materials has become a popular form of intervention in Eastern Europe, and it is certainly valuable. But our study shows that interventions should focus on more stable and sensitive relationships between children and their caregivers."

The researchers suggest that changing the work schedules of part-time workers enhances caregiver stability. They also developed a training program for caregivers and parents, based on feedback of videotaped interactions between adults and children, that was effective in promoting basic parenting skills and, they suggest, should be tried out in orphanages.