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Indian Pediatr 2019;56: 819-820 |
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Early Childhood Development – Pediatricians,
the Bridge between Science and Parenting
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Digant Shastri
National President, Indian Academy of Pediatrics,
2019.
Email:
[email protected]
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N
urturing a child’s development today, to have an
intelligent, creative and productive adult tomorrow, is increasingly the
focus of every parent and pediatrician. Today, Pediatrics has integrated
developmental neuroscience, molecular biology, genomics, epigenetics,
developmental psychology, epidemiology and economics as never before.
There is emerging evidence linking toxic stress of adversities in early
childhood and nurturing parental care affecting brain development and
function through the life span of an individual
[1]. Do we know how early childhood
development (ECD) has the potential to do permanent changes in language,
cognition and socio-emotional learning? How do behavior, resilience and
stress prevent or cause chronic disease? How do unhealthy lifestyles
lead to widening health disparities? Units like Centre for Child
Development at Harvard University are investing a lot of time and effort
in these areas of research. Global institutions such as WHO, UNICEF and
UNESCO have ECD in their work agenda with continuum of care from
pre-conception through the early years. They are strongly generating
global political priority for ECD.
Child’s brain develops fastest in the first 1000 days
of life. ECD encompasses physical, socio-emotional, cognitive and motor
development between 0-8 years of age. Optimum early development is the
right of every child. All ECD programs must address health, nutrition,
safety, responsive caregiving, and early learning. ECD programs need to
be adequate on different scales – from individuals to governments and
global community. It is very cost-effective to achieve sustainable
development by investing in ECD rather than fixing the problems
occurring due to inaction in this crucial phase
[2]. Focus on ECD will help establish world
peace, and thereby protect the right of every child to survive and
thrive!
The 2016 estimates based on proxy markers of stunting
and poverty reveal that 250 million, or 43%, of children in low- and
middle-income countries are at risk of not achieving full development
potential. Children under the age of 3 years are at highest risk with
suboptimal exposures to ECD programs across their quality and
implementations [3].
The burden and cost of inaction is high. Young
children need nurturing care from the beginning. We need to strengthen
government leadership to scale-up what works. Nurturing care framework
for ECD was launched at the 71 st
World Health Assembly [3]. These conclusive observations are the basis
of operational priorities in ECD, world over [4].
Health is the first point of contact for reaching the
youngest child and the families during pregnancy, child birth and early
childhood. Pediatricians can help bridge the gap between parenting and
science. As an apex body of pediatricians in India, we have immense
power to shape the future of these children. Thereby, we also have a
huge responsibility to provide timely guidelines to our members, and
work in tandem with global institutions to make optimum ECD a universal
reality.
Apart from health, there are additional risk factors
like maternal illiteracy, physical and sexual abuse, and poverty.
Therefore, it is essential that multi-sector interventions are applied
in health, nutrition, security and safety, responsive caregiving, and
early learning. Many aspects of the child development have been the
working domain of many of our members of Indian Academy of Pediatrics
(IAP) with several IAP chapters – Infant and Young Child Feeding,
Neonatology, Nutrition, Growth Development & Behavior, Neuro-developmental
Disorders, Child Abuse & Neglect & Child Labor – dedicated to it. There
are a few guidelines, recommendations and modules of training for
screening and management of development and its problems. But we lack
uniformity of standardized protocols. We are still dependent on
protocols developed for western nations with different socio-cultural
norms. Much more needs to be done to cover the depth of subjects within
ECD in the Indian context.
We have some resources and setups to backup ECD in
antenatal, neonatal and 3 to 6 years age groups in healthcare working
systems. But preconception and 0 to 3 years groups are left out from the
effective interventions. Similarly, our roles in parenting guidance and
inputs in educational areas are meager. The fact that fastest brain
development occurs first 1000 days adds to the urgency of our efforts to
be concentrating on this age group.
Lastly, we cannot ignore the local communities,
nonprofit organizations and social resources. We need to build the
social infrastructure to support successful parenting interventions,
improving maternal wellbeing and child development [5]. As mentioned in
a previous editorial [6], we are seeing such opportunities in voluntary
movements like ‘Parenting for Peace’ with many of our members working
with other professionals and non professional volunteers across the
country. Few non-government organizations such as Aga khan Foundation
have their own structured comprehensive ECD programs. Research-driven
community-based parenting program for early childhood can be crafted in
lines of ‘Reach Up’ program at West Indies University.
India is reasonably tackling survival issues, and now
development issues should be high on stake. IAP has ECD on agenda, and
is in process of making guidelines for its members in collaboration with
UNICEF as technical and scientific partner. Let us together preserve and
enhance cognitive and working capital of the country, and add to the
economic progress too.
References
1. Shonkoff JP, Garner AS; Committee on Psychosocial
Aspects of Child and Family Health; Committee on Early Childhood,
Adoption, and Dependent Care; Section on Developmental and Behavioral
Pediatrics. The lifelong effects of early childhood adversity and
toxic stress. Pediatrics. 2012;129:e232-46.
2. Sayre R, Devercelli AE, Neuman MJ, Wodon Q.
Investing in Early Childhood Development: Review of the World Bank’s
Recent Experience. Washington, DC: World Bank, 2015. Available from:
https://olc.worldbank.org/sites/default/files/Investing%20in%20Early%20Chidhood%
20Development_eview%20of%20the%20WB%20Recent %20Experience_eBook_0.pdf. Accessed
September 26, 2019.
3. Black MM, Walker SP, Fernald LCH, Andersen CT,
DiGirolamo AM, Lu C, et al. Early childhood development coming of
age: Science through the life course. Lancet. 2017;389:77-90.
4. World Health Organization, United Nations
Children’s Fund WBG. Nurturing Care for Early Childhood Development: A
Framework for Helping Children Survive and Thrive to Transform Health
and Human Potential. Geneva: World Health Organization; 2018.
5. Singla DR, Kumbakumba E, Aboud FE. Effects of a
parenting intervention to address maternal psychological wellbeing and
child development and growth in rural Uganda: A community-based, cluster
randomised trial. Lancet Glob Health. 2015;3:e458-69.
6. Shastri D. Pediatrician, parenting and peace. Indian Pediatr.
2019;15;56:361-2.
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