Singapore study to examine impact of parents’ sensitivity and responsiveness to kids’ needs

SINGAPORE – Local researchers have launched Singapore’s largest parenting trial to examine how sensitive caregiving can impact young children’s emotional, cognitive and physical health.

Sensitive caregiving is a caregiver’s ability to notice a child’s cues such as a cry or a specific behaviour, interpret them correctly, and then respond promptly and appropriately.

Known as the LOVING study, it will employ the video feedback method, which is a home visiting programme that gives families personalised feedback based on the video footage of parent-child interactions. 

LOVING stands for Learning about Our behaviour is Valuable for Increasing Nurturing relationships and healthy Growth. The researchers plan to recruit 624 families from May 26, making it the largest parenting-related randomised controlled trial (RCT) in Singapore. RCT is considered the “gold standard” in research.

Previously, RCTs on parenting had primarily focused on mobile apps used during the post-partum or infancy period, with the most extensive one involving 200 parenting couples.

The current study brings together experts from various institutions, including the Yong Loo Lin School of Medicine and the Saw Swee Hock School of Public Health at the National University of Singapore (NUS), the A*STAR Institute for Human Development and Potential, and KK Women’s and Children’s Hospital.

Early childhood is considered a critical period for shaping a child’s long-term outcomes, especially in the context of today’s fast-paced lifestyles, time constraints, increasing digital exposure, and growing concerns about health and development.

Sensitive caregiving is linked to children’s behavioural regulation, and their social and cognitive development. There is also some evidence that such parenting is associated with a decrease in obesity risk. Crucially, although it may seem like “common sense”, this type of caregiving is a skill that can be strengthened. 

“In Singapore, we know that some of those challenges (in caregiving) happen more in lower-income groups, and we also know that sensitive caregiving, at least from international work, is a hopefully preventative mechanism to kind of put kids on a better path,” said the study’s lead researcher, Research Associate Professor Anne Rifkin-Graboi from the departments of psychological medicine and paediatrics at NUS Medicine.

“So one of the things we wanted to do was to see (if we could) adapt an international programme with good evidence… for the local context, and also to increase its impact, not just in the psychological and cognitive realms, but also in physical health, for a broad reach.” 

Senior Minister of State for National Development and for Transport Sun Xueling launched the study at the LOVING Symposium held at NUS on May 4. She said the trial will provide robust data to help Singapore identify effective, acceptable and scaleable caregiving interventions for families with young children. 

Findings from two major longitudinal studies – Growing Up In Singapore Towards Healthy Outcomes and the Singapore Longitudinal Early Development Study – have directly shaped Grow Well SG, the national programme that aims to foster healthier lifestyles in children and adolescents, she added. 

For instance, Singapore has launched updated guidelines on screen use and individual health plans for each child, among other efforts. 

“In the months ahead, you’ll hear more about how the community can come together to support Grow Well SG and also how physical infrastructure, such as playgrounds and community spaces, can be designed to meaningfully support and help our families when it comes to our children’s growth,” Ms Sun said.

Participants of the LOVING study will be either the father or mother of a young child aged two to 5½ at the time of recruitment, from median- to lower-income households.

They will be randomly assigned to one of three groups. One group will use the home-based video feedback intervention, where they will be filmed doing various activities, with individualised feedback provided through video recordings and discussions to enhance observed sensitive caregiving.

Another group will learn from videos with locally contextualised scenarios to guide caregiving behaviours. The third group will use online education covering key topics such as brain development, learning and social relationships in young children.

In the video feedback intervention, one of the activities is the Don’t Touch Snack session, in which a child is asked to wait at the table before eating two of their favourite snacks, starting with the less preferred of the two. 

In a video clip played during the launch, Ms Sarah Lee, a 33-year-old homemaker who participated in the developmental phase of the study, is seen commenting on the shapes of the snacks to keep her then four-year-old son Asher engaged during the waiting period.

This is an example of sensitive discipline, which is to achieve obedience without being harsh, said Prof Rifkin-Graboi.

Ms Lee also asked Asher if he wanted to start with the circle-shaped snack, which was his less preferred snack. If he had refused, the study’s intervener would have explained to Ms Lee that the child had difficulty choosing his least preferred snack to help her understand his decision, said Prof Rifkin-Graboi.

The development phase involved 25 families across three studies, while the pilot phase involved 36 families who were randomly assigned.

Ms Lee told the media before the launch that she learnt to manage her son’s tantrums by focusing on building emotional bonds and using practical strategies such as timeout sessions.

Over seven sessions, she was filmed participating in an activity with Asher, after which she received feedback.

“What I learnt was that it would be good if I can build that emotional bond with him by taking the time to play more with him, like when I read to him, to hug him and be closer to him,” she told the media at a briefing ahead of the study’s launch. 

“When I do that, he would feel safer to turn to me when he has difficult emotions.”

Dr Hana Alhadad, co-founder of the child-centred initiative Hayat Collective, said the study shifts the focus from “How do we control children’s behaviour?” to “What do children need to feel safe, connected, and able to learn and thrive?”

“Sensitive, responsive caregiving isn’t just about being ‘nice’ – it’s foundational to how children learn to regulate emotions, build relationships and engage with the world,” said Dr Hana, who is also senior consultant with EveryChild.SG, which champions children’s holistic well-being.

Prof Rifkin-Graboi said they will measure the success of the study through observation of behaviour in the home-based intervention group, interviews, and laboratory-based tests to assess the children’s executive functioning, physical health and stress levels, to see how sensitive caregiving leads to changes in stress physiology and behaviour.

Ultimately, having a wonderful relationship with one’s children is what matters most, not whether the child is the most physically fit or the best in an activity, she said.