Elsevier

The Lancet

Volume 389, Issue 10064, 7–13 January 2017, Pages 77-90
The Lancet

Series
Early childhood development coming of age: science through the life course

https://doi.org/10.1016/S0140-6736(16)31389-7Get rights and content

Summary

Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.

Introduction

Two Lancet Series on Child Development in Developing Countries (2007 and 2011) spearheaded the review of evidence linking early childhood development with adult health and wellbeing. The finding that 219 million (39%) children younger than 5 years (under-5s) in low-income and middle-income countries (LMICs) are at risk of not reaching their developmental potential, leading to an average deficit of 19·8% in adult annual income,1 attracted global attention.2 These two Series reviewed evidence related to key biological and psychosocial risks; summarised neuroscientific evidence on both adverse and positive experiences affecting early brain development; reviewed effectiveness of programmes and policies to improve early childhood development; provided the estimated costs of not investing in preschools; and concluded that inequities in development begin prior before conception, and that timely interventions reduce inequities and increase productivity (appendix pp 2).3, 4, 5, 6

New evidence supports a life course perspective on childhood development and strengthens the conclusions and recommendations from the earlier Lancet Series, primarily through advances in neuroscience and longitudinal follow-up approaches. Poverty and adverse childhood experiences have long-term physiological and epigenetic effects on brain development and cognition.7, 8, 9 Neural processes, influenced by genetic and epigenetic variation, underlie the attachment and early learning systems, influencing subsequent health and development.10 Longitudinal follow-up studies among children exposed to poverty and other adverse conditions show beneficial effects of interventions on adult wage earning,11, 12 competence (eg, intelligence quotient, educational attainment, and general knowledge),13, 14 health biomarkers,15 reductions in violence, depressive symptoms and social inhibition,14 and growth in the subsequent generation.16, 17 These findings provide strong economic justification for investment in early childhood,18 especially in children younger than 3 years (under-3s).19

In response to the loss of human potential associated with early adversities, leaders from international organisations have issued urgent calls for strategies to ensure that young children reach their developmental potential.2 This Series responds to those calls. Paper 1 proposes a life course perspective and the study of global commitments to early childhood development; Paper 2 examines evidence to implement and sustain effective early childhood development programmes at scale;20 and Paper 3 proposes models and strategies to promote early childhood development at scale.21 This Series focuses on the period from conception up to and including under-5s. Particular attention is given to children under the age of 3, because of the importance associated with the sensitivity and vulnerability of early brain development, the relative lack of attention to early childhood development in general during this period, and the potential for service delivery through the health, nutrition, and social protection sectors.

Key messages

  • The proportion of children younger than 5 years in low-income and middle-income countries at risk of not attaining their developmental potential because of extreme poverty and stunting remains high (43%).

  • The accumulation of adversities, beginning before conception and continuing throughout prenatal and early life, can disrupt brain development, attachment, and early learning. Developmental delays are evident in the first year, worsen during early childhood, and continue throughout life.

  • Despite substantial progress in early childhood development research, programmes, and national policies since 2000, services are of varying quality with uncoordinated and inequitable access, especially for children younger than 3 years.

  • Children's early development requires nurturing care—defined as health, nutrition, security and safety, responsive caregiving, and early learning—provided by parent and family interactions, and supported by an environment that enables these interactions.

  • Coordination, monitoring, and evaluation are needed across sectors to ensure that high quality early childhood development services are available throughout early childhood and primary school, up to the age of 8 years.

  • Action at global, national, and local levels is needed to increase political commitment to and investment in early childhood development.

This first paper has five objectives: (1) to update the estimates of children at risk of not attaining their developmental potential; (2) to present a life course conceptual framework of early childhood development; (3) to assess global commitments and progress in early childhood development since 2000; (4) to examine access to centre-based and home-based early childhood development programmes; and (5) to describe cross-sectoral opportunities to implement early childhood development programmes.

Section snippets

Estimates of children at risk of not attaining developmental potential

Since the 2007 Lancet publication of the number of under-5 children in LMICs at risk for not reaching their developmental potential due to stunting and extreme poverty,1 definitions of stunting and extreme poverty have been updated, with improvements to the source data and estimation methods. As a result, the estimated number of children in LMICs at risk of not reaching their developmental potential, calculated in 2004, was revised from 219 million to 279 million.22 Between 2004 and 2010, the

Life course conceptual framework of early childhood development

Childhood development is a maturational and interactive process, resulting in an ordered progression of perceptual, motor, cognitive, language, socio-emotional, and self-regulation skills.25 Although the developmental process is similar across cultures, progression rates can vary as children acquire culture-specific skills.24 The acquisition of skills and learning in middle childhood, throughout adolescence, and into adulthood builds on foundational capacities established between preconception

Global commitments to early childhood development

We examined changes since 2000 in global commitments to early childhood development using a policy process heuristic72 (figure 2). This heuristic assesses progress in five categories: agenda setting, evaluation, implementation, policy formation, and leadership and partnership.

We used five approaches to collect data related to the heuristic. First, we conducted a 2000–14 literature review on early childhood development risk and protective factors6 to examine changes in the knowledge base (

Home activities

Low-cost activities, such as storytelling, singing, and playing with household objects, expose young children to experiences that promote early development.81 According to Multiple Indicator Cluster Survey data from 2005–15, 48·4% of the nearly 230 000 3 year-olds and 4 year-olds sampled had an adult read to them, and 67·7% had an adult either name or count objects within 3 days before the survey. These figures vary by wealth quintile within countries worldwide, with reading ranging from 62·4%

Opportunities to coordinate early childhood development across sectors

The implementation of early childhood development programmes is often fragmented, particularly for children under 3 years, with confusion between multisector and integrated approaches. Multisector approaches include coordinated services across sectors, ideally with unifying policies.91 Integrated approaches refer to integration across services with shared messages and opportunities for synergy.92 Although there have been multiple calls for integrated services,92 logistical issues remain.59 We

Conclusions

Despite remarkable progress in early childhood development research, programmes, and policies, services for young children are inadequate and inequitably distributed. The burden of children not reaching their developmental potential remains high. The lack of attention to nurturing care as a comprehensive concept is a major concern, especially during the period of rapid brain development and learning, and the formation of caregiver–child attachments that characterises children under 3 years.

The

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