Human health and development is a dynamic process,
and early intrauterine life conditions can influence a variety of adult
outcomes, including lifestyle-related diseases, the process of aging,
and geriatric morbidity. The life cycle approach to health is a concept
that emphasizes on prevention and early intervention at every stage of
life – intrauterine period, early childhood, adolescence, youth, middle
age and old age. Outcome at one point in the life cycle might be a
determinant for health elsewhere further in the cycle. It is also a
holistic concept with an integrated methodology that should link the
various policy support measures at every stage of the cycle.
Specifically, from a pediatrician’s perspective, the life cycle approach
to child and adolescent development is a philosophy that encompasses all
actions essential for preparing for future motherhood, joyful pregnancy,
safe delivery, and optimal growth development that in turn should lead
to responsible parenthood. This in essence involves caring for the most
critical nine months of intrauterine growth, the vulnerable first six
years of life and the most neglected adolescent period [1]. In the
developing countries, including India, health inequalities are visible
across different strata of society and different geographical regions.
Health during childhood is determined by the health of the mother, which
in turn is affected by the nutrition of adolescent girls. This concept
also has adequate policy endorsement of Indian Academy of Pediatrics and
Government of India.
The life cycle approach can be best understood by
example of childhood malnutrition. The first 1000 days ranging from
conception to the end of the second year of life is crucial for any
intervention to ensure adequate nutrition and development, which will
bring benefits throughout life [2]. Focusing on this period increases
the child’s chance of having a healthy and productive life in the
future, and helps to break the inter-generational cycle of poverty. We
also know that maternal nutrition is an important determinant of child
malnutrition. Many children are born malnourished because their mothers
are malnourished, highlighting the significance of nutrition for women
of childbearing age. The nutritional status of the women is a result of
interactions among many risk factors like access to food,
disempowerment, customs and traditions, nutritional demands of frequent
pregnancies and lactation, and access to health services. Therefore, to
tackle the issue of malnutrition, we need to have a life cycle approach
– care during intrauterine life, the vulnerable first few years of life
and the most neglected adolescent period.
UNICEF has adopted a life cycle approach to child
development [3], and is of the opinion that greater attention given to
the care, empowerment and protection of adolescents is the best way to
break the intergenerational transmission of poverty and risk. For
example, good quality education empowers children’s lives as they gain
the knowledge, skills and confidence to meet the global challenges.
Educated girls are less likely to marry early or get pregnant as
teenagers, and are more likely to have correct and comprehensive
knowledge about health-related issues. They are more likely to have
healthy children when they eventually become mothers.
Another scenario that explains life cycle approach is
childhood onset of adult cardiovascular disease. Physically active
lifestyle, including obesity reduction, avoidance of tobacco and
lowering blood pressure, can positively affect the health of children
and adolescents [4]. Childhood and adolescence has to be viewed as an
opportune time to prevent the onset of certain risky lifestyle
behaviors and promote healthy states. Pediatricians, who care for
children and adolescents, can incorporate screening of adult
cardiovascular disorders into their practice.
Pediatricians can play a vital role in the education
of parents and other caregivers, and can act by using the concepts and
recommendations in their professional practice. Pediatricians have to
work together with other professionals in the development and
dissemination of scientific knowledge to support health policies and
practices. More importantly, they should also participate in the
planning and implementation of community interventions. A shift to
primary prevention is warranted to solve the current health problems,
and may demand pediatricians to move from the current curative care
approach towards an integrated approach to child and adult health, and
development.
References
1. Nair MK, Mehta V. Life cycle approach to child
development. Indian Pediatr. 2009;46 (Suppl):s7-11.
2. Prentice AM, Ward KA, Goldberg GR, Jarjou
LM, Moore SE, Fulford AJ, et al. Critical windows for nutritional
interventions against stunting. Am J Clin Nutr. 2013;97:911-8.
3. UNICEF. Adolescents and Youth. Lifecycle Approach.
Available from: http://www.unicef.org/adolescence/index_73650.html.
Accessed November 15, 2015.
4. Catalano RF, Fagan AA, Gavin LE. Worldwide application of
prevention science in adolescent health. Lancet. 2012;379:1653.