Undernutrition in early childhood is associated with poor mental development and affects 45% of children in Bangladesh. Although limited evidence shows that psychosocial stimulation can reduce the deficits, no such interventions have been reported from Bangladesh. The Bangladesh Integrated Nutrition Program (BINP) has provided nutrition supplementation to undernourished children through community nutrition centers (CNCs). We added psychosocial stimulation to the treatment of undernourished children in a randomized controlled trial to assess the effects on children's development and growth and mothers' knowledge. Twenty CNCs were randomly assigned to intervention or control groups with 107 children in each group. We also studied 107 nonintervened better-nourished children from the same villages. Pre- and postintervention measurements included children's height, weight, development assessed on Bayley Scales, behavior ratings during the test, and a questionnaire on mothers' knowledge of childrearing. The intervention comprised home visits and group meetings with mothers and children for 12 mo. Intervention benefited children's mental development (4.6 +/- 2.0, P = 0.02), vocalization (0.48 +/- 0.23, P = 0.04), cooperation (0.45 +/- 0.16, P = 0.005), response-to-examiner (0.50 +/- 0.15, P = 0.001), emotional tone (0.33 +/- 0.15, P = 0.03), and mothers' knowledge (3.5 +/- 0.49, P < 0.001). At the end, undernourished controls had poorer mental (-4.6 +/- 2.0, P = 0.02) and motor (-6.6 +/- 2.2, P = 0.003) development, were more inhibited (-0.35 +/- 0.16, P = 0.03), fussier (-0.57 +/- 0.16, P < 0.001), less cooperative (-0.48 +/- 0.17, P = 0.005), and less vocal (-0.76 +/- 0.23, P = 0.001) than better-nourished children. Intervened children scored lower only in motor development (-4.4 +/- 2.3, P = 0.049). Neither group of undernourished children improved in nutritional status, indicating that treatment had no effect. In conclusion, adding child development activities to the BINP improved children's development and behavior and their mothers' knowledge; however, the lack of improvement in growth needs to be examined further.

We found adverse effects of arsenic exposure on IQ in girls, but not boys, at 5 years of age.

Poor stimulation in the home is one of the main factors affecting the development of children living in poverty. The family care indicators (FCIs) were developed to measure home stimulation in large populations and were derived from the Home Observations for Measurement of the Environment (HOME). The FCIs were piloted with 801 rural Bangladeshi mothers of children aged 18 months. Five subscales were created: ‘play activities’ (PA), ‘varieties of play materials’ (VP), ‘sources of play materials’, ‘household books’, and ‘magazines and newspapers’ (MN). All subscales had acceptable short-term reliability. Mental and motor development of the children was assessed on the Bayley Scales of Infant Development and their language expression and comprehension by mothers’ report. After controlling for socioeconomic variables, VP and PA independently predicted four and three of the developmental outcomes respectively, and MN predicted both the Bayley scores. The FCI is promising as a survey-based indicator of the quality of children's home environment.

Small benefits from early food and MM supplementation were found in infants of low-BMI but not of high-BMI mothers. However, the benefits were of doubtful functional importance, and longer follow-up is required to determine programmatic implications.

Background/Objective: Psychosocial stimulation (PS) and food supplementation (FS) improve development of malnourished children. This study evaluates the effects of a community-based approach of PS and FS on growth and development of severely malnourished children. Subjects/Methods: Severely underweight hospitalised children aged 6-24 months (n ¼ 507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS þ FS, (iv) clinic-control and (v) hospital-control. PS included play sessions and parental counselling on child development. This was done at each fortnightly follow-up visit, that is, every second week, for 6 months at community clinics. FS included distribution of cereal-based food packets (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplementation, health-education and growth monitoring. Children's development was assessed using revised version of Bayley Scales of Infant Development at baseline and after 3 and 6 months of intervention. Anthropometry was measured using standard procedure. Results: Comparing groups with any stimulation with those with no stimulation there was a significant effect of stimulation on children's mental development index (group * session interaction P ¼ 0.037, effect size ¼ 0.37 s.d.) and weight-for-age Z-score (group * session interaction P ¼ 0.02, effect size ¼ 0.26 s.d.). Poor levels of development and nutritional status were sustained, however, due to their initial very severe malnutrition. There was no effect on motor development and linear growth. Conclusion: Children receiving any stimulation showed a significant benefit to mental development and growth in weight. More intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status.

WHAT'S KNOWN ON THIS SUBJECT: More than 200 million children ,5 years old in low-and middle-income countries are not reaching their potential in cognitive development because of factors associated with poverty. WHAT THIS STUDY ADDS:Poverty affects children' s cognition as early as 7 months and continues to increase until 5 years of age. It is mainly mediated by parental education, birth weight, home stimulation throughout the 5 years, and growth in the first 24 months. abstract OBJECTIVE: We aimed to determine the timing and size of the cognitive deficit associated with poverty in the first 5 years of life and to examine the role of parental characteristics, pre-and postnatal growth, and stimulation in the home in Bangladeshi children. We hypothesized that the effect of poverty on cognition begins in infancy and is mainly mediated by these factors. METHODS:We enrolled 2853 singletons, a subsample from a pregnancy supplementation trial in a poor rural area. We assessed mental development at 7, 18, and 64 months; anthropometry at birth, 12, 24, and 64 months; home stimulation at 18 and 64 months; and family' s socioeconomic background. In multiple regression analyses, we examined the effect of poverty at birth on IQ at 64 months and the extent that other factors mediated the effect.RESULTS: A mean cognitive deficit of 0.2 (95% confidence interval -0.4 to -0.02) z scores between the first and fifth wealth quintiles was apparent at 7 months and increased to 1.2 (95% confidence interval -1.3 to -1.0) z scores of IQ by 64 months. Parental education, preand postnatal growth in length, and home stimulation mediated 86% of the effects of poverty on IQ and had independent effects. Growth in the first 2 years had larger effects than later growth. Home stimulation had effects throughout the period.CONCLUSIONS: Effects of poverty on children' s cognition are mostly mediated through parental education, birth size, growth in the first 24 months, and home stimulation in the first 5 years. Pediatrics

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