Role of nutrition in integrated early child development
What we know already: Early child development (ECD) is a key predictor of future social capital and national productivity. Worldwide, 250 million children under five years old may fail to reach their developmental potential due to extreme poverty and social injustice.
What this article/series adds: A special issue of Maternal and Child Nutrition that compiled previously published articles on ECD related to nutrition shows that nutrition-specific interventions, though essential, are not sufficient for children to reach their full developmental potential. Non-nutrition factors such as social determinants of health, parenting style and early childhood stimulation affect other ECD dimensions (psychosocial, cognitive and educational); poverty and social exclusion limit access. Multi-sector programmes are needed at scale that consider responsive parenting, learning stimulation, education and social protection, in addition to health and nutrition.
Child development has multiple dimensions, including physical, sensorimotor, social, emotional, language and cognitive. Children develop rapidly during the first five years of life from being unable to speak and walk to having fairly advanced motor, social and cognitive skills. The importance of the first 1,000 days (from gestation to two years) in helping a child develop healthy growth is well established. The brain grows very rapidly during the same period; between three and five years of age its development continues with new abilities building on those already acquired.
Early child development (ECD) is recognised as one of the most important predictors of future social capital and national productivity, yet the recent ECD Lancet Series reports that about 250 million children under five years old are at risk of not reaching their developmental potential (see summary in this edition of Field Exchange). This special issue of Maternal and Child Nutrition brings together important, previously published articles on ECD (with priority given to the last two years) to identify how the nutrition sector can contribute to ECD in the context of multi-sector interventions. This is crucial given the centrality of ECD indicators as part of the 2030 Sustainable Development Goals (SDGs).
The 14 papers in the series are identified under four headings:
Nutrition and child development across the life-course
Auduchon-Endsley et al (2016) found that excessive maternal weight and gestational weight gain was associated with poorer neurobehaviour in infants via hormonal pathways, highlighting the importance of peri-conceptual nutrition.
The positive association between breastfeeding and academic ability at 12 years of age was found to be independent of socioeconomic status and parenting behaviours, according to a prospective study by Huang, Vaughn and Kremer (2016).
Crookston et al (2011) found concurrent stunting (stunted at 4.5-6 years of age) to have a greater impact on cognitive skills than early stunting (6-18 months of age) in Peruvian children participating in the Young Lives study. Another cohort study in Malawi found that improved height gain between two and 15 years of age, but not between birth and two years of age, was independently associated with cognitive development (Teivaanmäki et al, 2016), strongly suggesting the importance of promoting linear growth post-1,000 days for long-term cognitive development.
Liu and Raine (2016) found that malnourished children in a large sample of three-year-olds in Mauritius had impaired social functioning, with a dose-response relationship; i.e. increased malnutrition was associated with more impaired social behaviour.
Findings from studies investigating the association between micronutrients and ECD remain inconclusive. Makrides et al (2011) confirmed that the effect of maternal fatty acid supplementation on global neurobehavioural outcomes for children remains unclear, although fatty acid supplementation of women expressing milk for their pre-term infants appears to improve infant neurodevelopmental performance.
Social and behavioral mediators
Mallan et al (2015) found that maternal postpartum depression, assessed at four months postpartum, had a negative association with the mother’s ability to feed her two-year-old children responsively (i.e. pressure to eat, restrictive feeding style and emotional feeding). Such practices may undermine child self-regulation of intake, which is associated with increased risk of overweight.
A meta-analysis by Larson and Yousafzai (2015) concludes that the mental development of children under two years in low and middle-income countries (LMICs) is more strongly influenced by their motor development than their growth status resulting from postnatal nutrition interventions. This important finding underscores the need to integrate child psychosocial stimulation with nutrition as part of ECD interventions.
The Baby-Friendly Hospital Initiative (BHFI) Ten Steps were found to have a positive impact on short, medium and long-term breastfeeding outcomes, with a dose-response relationship between the number of BFHI steps women are exposed to and breastfeeding outcomes (Pérez-Escamilla et al, 2016)). Such findings have major implications for ECD, since strong and consistent evidence supports the impact of breastfeeding on a child’s intellectual development, an effect which carries on into adulthood (Victora et al, 2016).
A randomised controlled trial in India (Vazir et al, 2013)) found that responsive feeding education of caregivers improved dietary intake, growth and mental development among toddlers, underlining the need for integration of parenting skills as part of nutrition interventions targeting young children.
Fabrizio et al (2014) identified key components of effective behaviour-change interventions to improve complementary feeding practices as identifying barriers and enablers and delineating programme-impact pathways, pointing to the need for inter-disciplinary partnership in maternal-child nutrition.
In a review of water, sanitation and hygiene (WASH) interventions, Cumming and Cairncross (2016) add to the strong evidence that malnutrition and infectious diseases are interrelated and that WASH should be part of multi-focal ECD interventions.
Subramanian et al (2016) call for a rethinking of policies to address child stunting in South Asia, the region most affected, and conclude that upstream social determinants of health must be urgently addressed to tackle the problem.
This collection of papers shows that nutrition-specific interventions, though essential for child development, are not sufficient for children to reach their full developmental potential. This is due to the many non-nutrition factors, such as social determinants of health, parenting style and early childhood stimulation that affect other ECD dimensions (psychosocial, cognitive and educational). Poverty and social exclusion limit the access of families to most, if not all, of these factors. Multi-sector programmes need to consider including responsive parenting (including responsive feeding), learning stimulation, education and social protection, in addition to health and nutrition. Programme scale-up by governments to address multiple factors in an integrated way is crucial. Research is needed to better understand if and how childhood obesity affects the different dimensions of ECD.
All references and papers are free to access online at
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Reference this page
Marie McGrath (). Role of nutrition in integrated early child development. Field Exchange 53, November 2016. p43. www.ennonline.net/fex/53/nutritionroleinchilddevelopment