The Lancet: Series on Early Childhood Development

Photo Credit: Unsplash User Eddie Kopp

On October 18, 2016, Karen Brown reported for the Dart Center for Journalism & trauma, a project of Columbia Journalism School, on a new series in the Lancet, ”Advancing Early Childhood Development: from Science to Scale”.  The series draws on neuroscience, epigenetics, public health and economics, and makes the troubling prediction that, in middle- and low-income countries, almost 250 million children (45% of children under 5) will fail to meet their developmental potential because of extreme poverty and deprivation. The authors conclude that the cognitive deficits, physical and mental illness, and lack of education that come from early, extreme stress will translate not only into economic costs to society, as well as the biological and moral costs.

A quote from World Bank Group President Him Yong Kim (October 1, 2015) puts it starkly: “There can be no equality of opportunity without…appropriate stimulation, nurturing, and nutrition for infants and young children.  Conditions of poverty, toxic stress and conflict will have produced such damage that they may never be able to make the best of any future opportunities.  If your brain won’t let you learn and adapt in a fast changing world, you won’t prosper, and neither will society.”

The series argues that this is not just an accumulation of individual losses, but a massive societal loss, resulting in a hard, tangible liability to entire countries. They estimate that the children damaged by early adversity stand to lose out on 26% of anticipated lifetime earnings, and countries that do not invest in care of these vulnerable, impacted children can expect to spend up to twice their entire health budgets on the after-effects.  The benefits of primary intervention, however, would cost as little as fifty cents per child.

The three-part series surveys new science on child brain development after adversity, a knowledge base that has grown considerable in the intervening years since the previous two Lancet publications on early childhood development in 2007 and 2011, and places emphasis on the urgency and cost-effectiveness of primary prevention.

Among the scientific highlights:

• Children in the first 1000 days of life – from conception to two or three years old –  are most vulnerable to adversity and most responsive to intervention.
• Through the lens of epigenetics – which looks at how gene expression is affected by environmental factors even if DNA remains the same –adversity in one generation can lead to developmental shortcomings in later generations.
• Poverty is associated with developmental delays in the first year of life, and those delays expand over a lifetime.
• Longitudinal studies, such as following orphans in Romania through institutionalization and foster care, show the longterm impact of psychological deprivation as well as the potential for reversal.
• Parenting that focuses heavily on nurturing can help reverse the damage caused by adversity.

Highlights from program evaluations include:

• Prenatal care is paramount, from iodine supplements to deworming and proper nutrition. Giving cash to pregnant women so they can get prenatal care has led to significant positive results.
• When it comes to mitigating the effects of adversity on the young brain, some of the simplest and least expensive interventions are among the most effective – like reading aloud at home, telling stories, and facilitating play.
• Psychosocial interventions by community health workers for brand new moms lead to stronger mother-baby attachment and infant cognitive function.
• Programs that focus on teaching parental nurturing, including breastfeeding techniques, show particular promise.

Key recommendations for policy makers and political leaders:

• Prioritize early childhood development.
• The first step is to understand which interventions work.
• Create conditions that allow primary prevention intervention programs to flourish and reach the right populations.
• Support initiatives such as paid parental leave, breastfeeding breaks at work, paid sick leave, a minimum wage, and access to free preschool.
• Coordinate disconnected programming “silos”.
• Launch programs where the most vulnerable populations already interact with institutions or community leaders, such as clinics and schools.  They suggest that community health programs offer a particular opportunity to reach pregnant women and very young children, at a time when interventions can do the most good.
• Most urgently, focus on developing the political will, particularly at the top levels of government, to invest in early childhood programs that will reach entire national populations, in order to address the devastating costs of inaction.

Gary Darmstadt, one of the co-authors of the Lancet series, is a pediatrician who has spent his career studying global maternal and newborn health and newborn survival and, more recently, how to optimize the development of surviving children. Darmstadt is Associate Dean for Maternal and Child Health at Stanford University School of Medicine. He was on the steering committee that led the planning, research, and writing of the Lancet series on early child development.

Darmstadt spoke with Karen Brown about the series, explaining how the series authors defined the “lost potential” that is facing 250 million children who live in extreme poverty, war, or other states of deprivation.  You can access the audio interview at:  https://dartcenter.org/blog/2016/10/lancet-series-author-outlines-lost-potential-250-million-children-worldwide