Investing in the foundation of sustainable development: pathways to scale up for early childhood development

Abstract

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

Myxoedema in a patient with achondroplasia in rural area of Guatemala

“…The moment in our case report where the patient's mother was told that ‘nothing could be done for her’ because she was ‘special’ highlights a lack of capacity to think broadly about fostering child development, rather than just focusing narrowly on physical growth as the only metric of interest. Although training in early child development is virtually non-existent in Guatemala at this time, very recent international policy emphases on early child development9—as well as new training materials for frontline health workers produced by the WHO10 —should lead to new programmatic emphases in public and private sector efforts to integrate training in child development and developmental services into existing primary care programmes 11…”

Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape

“…54,55 Other research looking at factors associated with neurodevelopment and poverty has focused on the toxic effects of violence, abuse, and exposure to conflict. Data from the recent Lancet series on early child development 56 also suggest that by using conjoint estimates of poverty and stunting, some 200 million children worldwide are at risk for suboptimal development with huge economic costs over their lifetimes and potentially across generations. These data do not, as yet, take into account the number of families and young children affected by violence, abuse, and exposure to conflict.…”

“…More recently, a systematic review of key interventions that can impact maternal, newborn, and child health and nutrition outcomes has shown the potential of integrating strategies for health, nutrition, and nurturing care across the life course 89 with much potential for intergenerational benefits. 56 Second, much more needs to be known about how experience is biologically embedded. Acquiring this knowledge will require in-depth research into potential mechanisms that link various stress and protective pathways to tailor interventions to different neural and behavioral systems.…”

Effect of Caregiver Training on the Neurodevelopment of HIV-Exposed Uninfected Children and Caregiver Mental Health: A Ugandan Cluster-Randomized Controlled Trial

“…7, 8 From this literature, the WHO/UNICEF sponsored Care for Child Development (CCD) package emerges as the most widely used manualized program for early childhood development (ECD) intervention in LMICs (https://www.unicef.org/earlychildhood/index_68195.html,). 1, 6, 9 A core feature of CCD, and other similar integrated ECD intervention packages, is the use of caregiver training that focuses on promoting both child nutrition and cognitive stimulation typically via play interactions with home-made toys and learning materials. 1, 11–13 …”