Child safety from the perspective of essential needs

OBJECTIVE: to characterize the maternal care for children under one year of age with a view to child health promotion at home. METHOD: exploratory study with qualitative data analysis, thematic mode, based on the conceptual framework of the essential needs of children, based on interviews recorded with 16 mothers. RESULTS: the analysis of the maternal narratives showed elements that facilitate the promotion of child safety: presence and involvement of the parents, constant surveillance for physical and emotional protection, experiences to stimulate child development, support networks for childcare at home; and inhibiting elements of child safety: limited perception of characteristics of child development and of children's singularities, overprotection and difficulties to set limits. CONCLUSION: the study enhances the understanding of home care in child health promotion, directing professional actions to guarantee ongoing nurturing relationships, protection, respect for individual differences, experiences appropriate to child development, limit setting and construction of stable and supportive social networks. In addition, the relevance of considering the maternal perspective in child health care is considered, as a strategy to apprehend aspects related to the attendance of the growth and development needs, particularly for child health promotion at home.


Introduction
The safety and protection of children and their implications for health are current themes in research (1)(2)(3)(4)(5) , and the study of child safety has also stood out, given the range of morbidity and mortality levels due to external causes in childhood (3) , the importance of safe practices at home (4) , the concern with the quality of the environment the child lives on and the impact on his/her development (5) . Thus, the promotion of child health in the domestic sphere is extremely relevant and represents a challenge for health professionals (3) , especially in the context of primary health care. The actions focused on child health should be associated not only with survival, but mainly with the person's holistic development. Childcare, particularly in the first years of life, is fundamental for them to grow and develop healthily, be physically healthy, emotionally safe and respected as social subjects (6) .
In the growth and development process, it is essential to acknowledge the double importance of physical and emotional health (1) .
In primary health care, childcare, with regard to health promotion, including child safety, aims to guarantee child growth and development monitoring and surveillance, with care integrality and longitudinality, and mainly considering maternal and family values (7) . The knowledge and reflections about the subjects' needs, which often go by unnoticed or are reduced to demands modulated by health service supplies (8) , are vital for the understanding and feasibility of the care process. Therefore, it is fundamental for the professionals to appropriately acknowledge the individuals' needs and offer resources to attend to these needs.
Aspects of child care and safety, in view of the children's needs, have been hardly disseminated, particularly of children living in contexts of socioeconomic deprival and cultural diversity, with high levels of unattended health needs (1,9) and injury risks (4) . Admitting the vital role of caregivers in the management of injury risks for small children (4) , it is relevant to investigate what care is performed to attend to their health and safety needs in those contexts, given their potential for unsafe environments. In that sense, the objective in this investigation was to characterize the maternal care for children of less than one year of age with a view to child health promotion at home, under precarious social conditions.

Method
Exploratory study with qualitative data analysis, based on the conceptual framework of the essential needs of the children (10) .
The conceptual framework of the essential needs of the children in the health promotion framework involves the apprehension of the needs into: Need for ongoing nurturing relationships; need for physical protection, safety and regulation; need for experiences tailored to individual differences; Need for experiences appropriate to child development; Need for limit setting, structure and expectations; Need for stable and supportive communities and cultural continuity (10) . the feeling of belonging to the family and community (10) .
The set of these needs entails relevant implications for the promotion of the child's health and physical and emotional safety. The data analysis, based on thematic content analysis, involved the pre-analysis (reading of empirical material to map the reports and meanings the subjects attributed); analysis of the meanings (identification of senses and meanings); elaboration of themes (synthesis of empirical material) and final analysis (discussion of themes) (11) . For analytic purposes, thematic units were constructed to apprehend the maternal experiences in care for the child and his/her safety and to identify aspects of the essential needs, highlighting that they do not appear in isolation, but are interwoven and indicate the presence of multiple dimensions for health care.

Results
The results were grouped in thematic units that translate the main care the interviewees reported, linked to the promotion of their children's safety: Ongoing nurturing relationships; Physical protection and safety; Experiences appropriate to child development; Limit setting; Stable and supportive communities.

Ongoing nurturing relationships
The participants discussed what they consider important for the child to grow and develop in the first year of life, highlighting the relevance of the mother and father's loving presence and engagement in daily care for the child.
Having the monitoring of the mother and father

Physical protection and safety
The reports contain aspects related to hygiene, food, disease and accident prevention, which the mothers consider important in daily childcare to prevent diseases. One aspect that should be highlighted is that children under one year of age, when they sleep with adults, can be exposed to vulnerable situations.

Stable and supportive communities
The reports indicate the relevance of a support network with professionals from the public Health, The reports suggest that the support networks, When referring to their low education level, however, they indicated a feeling of inability to attend to the child's needs more completely, which they aim to compensate for with the support of the health services.

Discussion
This study shows the importance of acknowledging the parents' participation and responsibility in childcare.
In line with other studies (1)(2) , the narratives are coherent with the idea that the parents, especially the mothers, In daily care at home, according to the maternal perspectives, measures that prevent diseases and other health problems should be prioritized, always keeping an adult alert. Thus, the need for small children to be supervised by careful adults is acknowledged, who should make insightful choices of material and equipment and promote proper modifications in the environment with a view to child safety (2) . In fact, many non-intentional (accidents) and intentional (violence) physical injuries happen at home, which implies the need to hold the caregivers accountable for their prevention in that context (3) .  (2,6) . Human brain development is influenced by the environment and by the relations established in early childhood, and the facilitating caregiver-child interactions include emotionally positive attitudes, sensitivity, responsiveness and non-use of physical punishments (5) .
In the promotion of healthy development, at different times in their life, children gain certain skills and experiences. Therefore, the parents' understanding is important, as rushing children in a certain skill or stage of life can often make them slower (10) . In addition, the parents should know that individual differences are part of the children's development and that the care should be adapted to these differences (10) .
In the childcare process, it is important to know the aspects linked to support and the social network, fully analyze the children and their families (7) . Child health monitoring that stimulates bonding among child, family and service is vital to prevent problems and promote health, besides creating the possibility for expanded and shared care between family and health services (7) .
The social networks are considered articulated sets of relations between the subjects and institutions, and what is expected is that they get consolidated in long-lasting interactions (13)(14) . Special attention should be paid to the predominant communication standards in the different communities, in which social and community standards and values can mold the mother-child interactions (15) . In this study, the maternal narratives show that the construction of strong bonds with the families offers support, but it is important that this is real and truly part of their social network. The construction of long-lasting bonds can be achieved through supportive interactions, following courses the professionals can and should take to encourage and expand the childcare opportunities in their growth and development process. Thus, a strengthened network promotes supportive interactions for the family in childcare (10) . Nurses in general guide the parents in making important choices at times of transition, which mold subsequent trajectories in their own and their children's life, giving responses to the vulnerabilities and support to the parents to protect the children (16) . In that sense, the skills to allocate resources and strategies to the essential health needs (8,17) are fundamental, knowing and evaluating the family needs (18) with a view to the reduction of social inequities (5,17) .
The health professionals are responsible for enhancing the family's position in the interactions, sharing knowledge and granting support to counter social, individual and institutional vulnerabilities.

Conclusion
In this study, the elements could be apprehended overprotection and difficulties to set limits. In addition, the relevance of considering the maternal perspective on daily childcare was reaffirmed, as a strategy to apprehend aspects related to attendance to the needs to promote growth and development, particularly the promotion of child safety at home.
The children's safety, permeated by the essential needs, contributes to an effective balance in their growth and development and the elements identified here are important for clinical practice in primary health care.
It should be highlighted that child safety is a complex research problem. Expansion to other studies is needed with a view to observing the care and mechanisms through which the interventions can reduce injuries at home, based on the essential and special needs for comprehensive child health care.