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Centre for Global Child Health

SickKids contributes to early childhood development in the new Lancet research series

An estimated 43 per cent–250 million–of children under five living in low-and middle-income countries (LMICs) are at risk of not reaching their developmental potential due to poverty and stunting, according to new research published in The Lancet. Despite the decrease in childhood mortality worldwide, the burdens during early childhood development continue to be underestimated.

Early childhood development begins at conception. The first 1000 days in a child’s life, starting from conception, are recognised as a crucial period of development, yet many children are exposed to poor sanitation, infections, lack of nurturing care and inadequate stimulation during this period. New estimates suggest that children who do not meet their developmental potential may forfeit up to a quarter of average adult earning capacity, and that the overall cost to countries can be up to double their national expenditure on health.

These findings, published in The Lancet’s three-paper series, Advancing Early Childhood Development: from Science to Scale, involved collaboration among 45 authors from 22 global institutions, including Dr. Zulfiqar A. Bhutta, Robert Harding Chair in Global Child Health, and Co-Director, SickKids Centre for Global Child Health, and Tyler Vaivada, Clinical Research Project Assistant, SickKids Centre for Global Child Health.

The series focuses on the role of nurturing care interventions, defined as care that ensures health, nutrition, responsive caregiving, safety and security and early learning, as well as the importance of increased global commitment to early childhood development in LMICs. It also provides evidence for the burden and cost of inaction.
“Emerging evidence points to the importance of windows of opportunity to address child development during vulnerable periods, not just in the early years of life but including fetal growth and even the preconception period, as well as opportunities for continued emotional development and maturation in the adolescent period,” said Bhutta, who also served as a member of the steering committee for the series.

Research shows the first three years of child development is the most critical period for brain development and learning. During these early years, children start to adapt and respond to interventions and are most sensitive to environmental influences. When children are deprived of protection, stimulation and nutrition there can be long term detrimental effects not only for the child but also for family members and communities. Some of these include severe impact on adult health, lower degree of education, adult earnings and chronic disease.

According to the series, it is essential to implement interventions to promote healthy early childhood development. Several interventions have been proposed to support the scale-up of early childhood development services:

  • Encouraging the adoption and implementation of policies to create supportive environments for families to provide nurturing care for young children.
  • Building capacity and strengthening coordination to promote early childhood development through existing health, nutrition, education, social, and child protection services.
  • Strengthening measurement and ensuring accountability for early childhood development services.
  • Increasing research, and fostering global and regional leadership and action.
  • Expanding political will and funding through advocacy for the Sustainable Development Goals (SDGs).

”With the transition from the Millennium Development Goals to Sustainable Development Goals, the series is most timely in that it points to the need to focus on issues of morbidity and long term development. While many interventions will need to target child survival, there is much opportunity to augment these with strategies to ameliorate adverse outcomes and promote healthy growth and development, essential for sustainable development,” said Bhutta.