The Knee High Project conducted research and engagement activities to help us better understand where design can help to improve the health and wellbeing of children under 5 in Southwark and Lambeth. Building upon existing early years research and knowledge, our approach aimed to uncover how families live, what they want, what they value, and why they behave the way they do. Families, professionals and other local people contributed their experiences, perspectives, and ideas to the work.

Our research uncovered a number of actionable insights which have begun to direct our thinking towards where opportunities might lie. Nine actionable insights from the research are introduced below. These insights have particularly highlighted the importance of networks and informal support, play and exploration, and a common need among parents for emotional support. Over the next few months we will be looking to further explore these areas and test some new ideas.

Children’s early social and emotional development is invisible to many parents.
One of the most important components of creating nurturing environments is families’ attitudes towards investing in the early development of their child. Throughout the crucial first years of brain development, children spend the majority of their time with their family, who become their primary educators.

Our research highlighted a lack of awareness around child development in many families, particularly around the social and emotional dimensions; the importance of quality time between children and their families as opportunities for investment; and the family’s roles in creating stimulating social environments for their children. For example, while the importance of quality time was often undervalued, parents did notice the positive effect it had on children’s behaviour and the family’s wellbeing.

“Maybe twice a month we’ll go to McDonalds or Chinese, just me and Raul, and have some special family time together. I always look forward to it.” Local mum

However, many families lack confidence and understanding around what they describe as ‘invisible’ development, where the lack of feedback makes it hard to see the results of their investment in their child’s early development. Making this ‘invisible’ development tangible for parents is a major opportunity to encourage more parents to take responsibility for their children’s early social and emotional development.

Families are most likely to learn from practical solutions that offer results.
It is striking that many professionals are hooked on the question of ‘how can we teach parents to do x,y,z’. Yet through our research it was apparent that the teaching offered by services in its current form is a less effective way for families to learn than creating strategies that work for themselves.

Our research saw that learning delivered by services did not translate into practice when carried over into the home environment. For example, immediately following a parenting class that focussed on safety in the home, one mother left unattended pans on the heat with the handles sticking out into the room. The social aspect of these sessions was clearly valued above the learning content.

Secondary research tells us something about where parents look for information about bringing up children, finding that parents are most likely to ask friends or relatives for advice and information (39%), compared with children’s centres (11%) and health visitors (6%). ‘Parenting on instinct’ is not enough to give children the best start in life and therefore families also need to learn about becoming good parents.

“I restrain his limbs to get him to have a nap, otherwise he won’t sleep. I got the idea from one of my blogs.” Local mum

Our research showed that families are most likely to learn from practical solutions that offer results, reduce stress benefit both parents and children, or make parents them feel good about themselves. Families are adept at creating strategies that work for them. However, some families are better at this than others and more could be done to spread learning between parents about what works well and what does not.

Creativity allows for the key developmental activity of the early years – play.
Creativity appears to be a core capability of families in making nourishing environments for their children. A family’s creative and imaginative capabilities also support the emotional wellbeing and resilience of their children. Creativity and play as ordinary parts of life seem to be under-valued or unnoticed by many families and many early years services.

For example, more than one family encouraged quiet activities such as watching TV over energetic or creative interactions and valued these behaviours as ‘good’ and ‘bad’.

“Thomas is a good boy – he can sometimes watch TV for hours at a time. But Peter gets bored very quickly. He prefers to go off and play by himself and makes up his imaginary games. His concentration span is not as good as Thomas’.” Local mum

As well as undervaluing the importance of play, there are practical barriers to parents encouraging play and creativity such as a lack of space in the home and perceived lack of safety in outdoor spaces. Secondary research suggests that children’s free time and time to play has decreased in recent years, as well as their freedom to roam away from the home and to play outdoors. However, it is evident from our research that many children love to play outdoors, with many of them listing the park as one of their favourite places. Children’s imaginations give them an incredible ability to turn any activity into an opportunity to play and to learn, even from everyday activities that adults may consider ‘mundane’ chores.

Parents emotional wellbeing and mental health directly correlates to that of their children.
Research shows that the emotional experiences of a parent effect the quality of the nurturing given to a child. For example, studies of millennium cohort data found that parents’ self-esteem, a sense of control over their environment and perceived competence as a parent are all significantly linked to children’s character development. Therefore, meeting the emotional needs of parents is vital in giving families and children the best possible chance to thrive.

Half of the families we met had been diagnosed with mental health issues of varying degrees, while others had experienced low mood, low self-esteem and other emotional difficulties but had not sought support. Our research explored the emotional needs of parents and began to look at what might be possible if these needs were met.

“For me, one of the biggest challenges of being a parent is balancing my parental responsibilities with my own passions and interests. I have to be disciplined in carving out time to spend alone and with Jacob. When teachers or parents refer to me as Samuel’s Mum’ or ‘Hope’s Mum’, I try to encourage them to call me by my name.” Local mum

During our research we met many parents who had aspirations for their own future and that of their family, and those who had a huge amount to offer their communities. We also met families who were struggling to match their experience with their expectations. For these parents it is evident that emotional wellbeing is dependent on a number of factors and characteristics including; past experience; existing relationships including trust, honesty and support; self-confidence and confidence as a parent.

Stressed families find it harder to invest in their children; to create quality time and to find opportunities for play.
Being a parent is challenging and at times stressful for everybody. Not all stress is bad for child development but issues arise when stress becomes ‘toxic’. For children this means prolonged stress without the support of a responsive caregiver. A report by The American Academy of Paediatrics states that “toxic stress” in infancy or early childhood can “disrupt the architecture of the developing brain, thereby influencing behavioural, educational, economic and health outcomes decades and generations later”.

Our research began to look at some of the main sources of stress and the coping strategies that families use. As well as the stresses caused by finances, housing and routines such as disrupted sleep, many of the parents we met were simply “worn thin” by parenting – constantly attending to their children’s needs without meeting basic needs of their own.

“I’ve been trying to wash my hair for over a week now but haven’t been able to.” Local mum

In some families we saw how the stress could be directly damaging to the children, while in others the children certainly suffer from the reduced stimulation this entails. For example, coping strategies included the use of TV as a pacifier to enable parents to ‘get on’ with other tasks without interruption from their children, as well as an over-expectation on some children to assist with chores in a functional way that did not present opportunities for stimulation or learning.

In some affluent families, childcare is used to alleviate the stress placed on a parent. For many families in ‘survival mode’ there is no release from the day-to-day strain of life, often leading to longer term anxiety and depression. Prolonged stress in the home is a significant barrier in a family’s ability to invest in their children’s development.

Leaving the house can be challenging, both practically and emotionally.
Many families in Southwark and Lambeth are living in poor quality housing that has a direct impact on the health and wellbeing of their children. Additionally, issues around transport and the local area mean that many families do not leave the house frequently enough. Consequently, many children are missing out on both active indoor and outdoor play, which results in a lack of physical activity, social interaction, vitamin D and opportunities to bond with parents. Secondary research shows that only just over 30% of five year olds meet the recommended level of daily physical activity.

“It was really cold this morning and walking my daughter to school was just too cold for the boys and they kept crying. When I only had my daughter we used to bike everywhere, but now we are walking with the pram or going on the bus. The tube is just too difficult with a double buggy.” Local mum

Our research explored the barriers and enablers to families making the most of their environments to invest in their child’s development. As well as physical barriers around the practicalities of leaving the home, transport and the safety of the local area, it is evident that there are also emotional barriers to family’s ability to leave their homes. However, we also saw that when environments are ‘family friendly’ this offers families a much needed reason to leave the home and a rewarding experience when they do so.

Men are largely absent from bringing up children.
Despite the pressure on families bringing up children, men are largely absent in the day-to-day. This affects bonding between children and their fathers, creating more stress for some mothers and reducing the diversity of stimulation for the children. Increasing involvement of fathers is proven to improve speech and language development, increase physical activity and accelerate social and emotional development.

Social and economic pressures and cultural traditions largely preclude men from taking a leading role in their children’s development. Many families are choosing a traditional arrangement of mother as primary care giver. Parental leave still favours the mother and gender pay inequality means it is often more financially prudent for the father to work.

Our research found that services do not effectively engage fathers and often perceive them as a ‘risk to be managed’ rather than an active influence on their children. We found that the absence of men in children’s early development is perpetuated by the attitudes of services, but also by the attitudes of some families and cultural traditions.

“I think parenting is harder for men. For women the parenting role is a more natural and intuitive one. Men find it harder to see what their role can be.” Local mum

Cultural diversity in Southwark and Lambeth leads to a myriad of child rearing traditions and gender roles. In our research we met fathers occupying varying roles, from those taking a leading role in bringing up their children, to father’s who ‘play to their strengths’ and select roles that they feel they are good at or comfortable performing, to those who take a decidedly less active role and regard childcare as the mother’s domain. Many fathers would like to take a more active role but often lack the confidence or experience to infiltrate this female-centric domain.

Sharing parenting beyond the immediate family relieves pressure and expands horizons.
Involving the wider family, friends and the community in childcare reduces parental stress, grows and strengthens the nurturing environment and diversifies experiences for children. Sharing parenting is difficult when families live in different parts of the world and people don’t know their neighbours, but some of the families we met were very successful at sharing the load.

“I think it is really important for Robert to interact with other kids, and he loves it. It gives me a break where I can either do the shopping or go to the gym.” Local mum

The families we met were employing a range of strategies and ways of calling on the resources of those around them for support: from community parenting, to involving grandparents, and the use of formal and paid-for childcare. Cultural traditions also played a role here with extended periods of early childcare being offered by some grandmothers. However, some parents felt more comfortable than others in asking for help or involving others in their child’s development. If ‘it takes a village’ to bring up a child, strengthening the network of support around a family could have a variety of positive effects on child health and wellbeing.

Services have an important role in investing in children’s development.
Services are an important part of the local landscape for all the families we met. The most popular services are parks, libraries, children’s centres, cafes and restaurants, shops and shopping centres, playgroups and churches. Beyond these, the other services families frequently use include GPs, midwives, health visitors and social services. Many of these services are directly related to children’s wellbeing, and all have at least an indirect impact on it. Services have an important role in investing in children’s development. They are at their best when they enable families to invest in their own children, pursue economic resilience, and provide specialist help. However, too often services are disempowering and inadvertently reinforce dependency.

All the families we met rely on some services and all clearly appreciate the help that they get. The community research revealed a reasonable level of satisfaction with services, while deeper ethnographies showed that there are frustrations with services that are rarely expressed by many parents.

“I think a lot of the mothers at the session had been referred, maybe by social services. There were a lot of young mothers, and the woman running it was really patronising. She was talking to us like we were dumb, and I felt quite offended, which I’m sure the other girls felt too.” Local mum

Services need to build families capabilities, provide the space for families to make strong relationships, and enable families to raise the value they place on their own health.