research articles on early childhood development

InBrief: The Science of Early Childhood Development

This brief is part of a series that summarizes essential scientific findings from Center publications.

Content in This Guide

Step 1: why is early childhood important.

: Brain Hero
: The Science of ECD (Video)
You Are Here: The Science of ECD (Text)

Step 2: How Does Early Child Development Happen?

: 3 Core Concepts in Early Development
: 8 Things to Remember about Child Development
: InBrief: The Science of Resilience

Step 3: What Can We Do to Support Child Development?

: From Best Practices to Breakthrough Impacts
: 3 Principles to Improve Outcomes

The science of early brain development can inform investments in early childhood. These basic concepts, established over decades of neuroscience and behavioral research, help illustrate why child development—particularly from birth to five years—is a foundation for a prosperous and sustainable society.

Brains are built over time, from the bottom up.

The basic architecture of the brain is constructed through an ongoing process that begins before birth and continues into adulthood. Early experiences affect the quality of that architecture by establishing either a sturdy or a fragile foundation for all of the learning, health and behavior that follow. In the first few years of life, more than 1 million new neural connections are formed every second . After this period of rapid proliferation, connections are reduced through a process called pruning, so that brain circuits become more efficient. Sensory pathways like those for basic vision and hearing are the first to develop, followed by early language skills and higher cognitive functions. Connections proliferate and prune in a prescribed order, with later, more complex brain circuits built upon earlier, simpler circuits.

In the proliferation and pruning process, simpler neural connections form first, followed by more complex circuits. The timing is genetic, but early experiences determine whether the circuits are strong or weak. Source: C.A. Nelson (2000). Credit: Center on the Developing Child

The interactive influences of genes and experience shape the developing brain.

Scientists now know a major ingredient in this developmental process is the “ serve and return ” relationship between children and their parents and other caregivers in the family or community. Young children naturally reach out for interaction through babbling, facial expressions, and gestures, and adults respond with the same kind of vocalizing and gesturing back at them. In the absence of such responses—or if the responses are unreliable or inappropriate—the brain’s architecture does not form as expected, which can lead to disparities in learning and behavior.

The brain’s capacity for change decreases with age.

The brain is most flexible, or “plastic,” early in life to accommodate a wide range of environments and interactions, but as the maturing brain becomes more specialized to assume more complex functions, it is less capable of reorganizing and adapting to new or unexpected challenges. For example, by the first year, the parts of the brain that differentiate sound are becoming specialized to the language the baby has been exposed to; at the same time, the brain is already starting to lose the ability to recognize different sounds found in other languages. Although the “windows” for language learning and other skills remain open, these brain circuits become increasingly difficult to alter over time. Early plasticity means it’s easier and more effective to influence a baby’s developing brain architecture than to rewire parts of its circuitry in the adult years.

Cognitive, emotional, and social capacities are inextricably intertwined throughout the life course.

The brain is a highly interrelated organ, and its multiple functions operate in a richly coordinated fashion. Emotional well-being and social competence provide a strong foundation for emerging cognitive abilities, and together they are the bricks and mortar that comprise the foundation of human development. The emotional and physical health, social skills, and cognitive-linguistic capacities that emerge in the early years are all important prerequisites for success in school and later in the workplace and community.

Toxic stress damages developing brain architecture, which can lead to lifelong problems in learning, behavior, and physical and mental health.

Scientists now know that chronic, unrelenting stress in early childhood, caused by extreme poverty, repeated abuse, or severe maternal depression, for example, can be toxic to the developing brain. While positive stress (moderate, short-lived physiological responses to uncomfortable experiences) is an important and necessary aspect of healthy development, toxic stress is the strong, unrelieved activation of the body’s stress management system. In the absence of the buffering protection of adult support, toxic stress becomes built into the body by processes that shape the architecture of the developing brain.

Brains subjected to toxic stress have underdeveloped neural connections in areas of the brain most important for successful learning and behavior in school and the workplace. Source: Radley et al (2004); Bock et al (2005). Credit: Center on the Developing Child.

Policy Implications

The basic principles of neuroscience indicate that early preventive intervention will be more efficient and produce more favorable outcomes than remediation later in life.
A balanced approach to emotional, social, cognitive, and language development will best prepare all children for success in school and later in the workplace and community.
Supportive relationships and positive learning experiences begin at home but can also be provided through a range of services with proven effectiveness factors. Babies’ brains require stable, caring, interactive relationships with adults — any way or any place they can be provided will benefit healthy brain development.
Science clearly demonstrates that, in situations where toxic stress is likely, intervening as early as possible is critical to achieving the best outcomes. For children experiencing toxic stress, specialized early interventions are needed to target the cause of the stress and protect the child from its consequences.

Suggested citation: Center on the Developing Child (2007). The Science of Early Childhood Development (InBrief). Retrieved from www.developingchild.harvard.edu .

Theories of Child Development and Their Impact on Early Childhood Education and Care

Published: 29 October 2021
Volume 51 , pages 15–30, ( 2023 )

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research articles on early childhood development

Olivia N. Saracho ORCID: orcid.org/0000-0003-4108-7790 1

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Developmental theorists use their research to generate philosophies on children’s development. They organize and interpret data based on a scheme to develop their theory. A theory refers to a systematic statement of principles related to observed phenomena and their relationship to each other. A theory of child development looks at the children's growth and behavior and interprets it. It suggests elements in the child's genetic makeup and the environmental conditions that influence development and behavior and how these elements are related. Many developmental theories offer insights about how the performance of individuals is stimulated, sustained, directed, and encouraged. Psychologists have established several developmental theories. Many different competing theories exist, some dealing with only limited domains of development, and are continuously revised. This article describes the developmental theories and their founders who have had the greatest influence on the fields of child development, early childhood education, and care. The following sections discuss some influences on the individuals’ development, such as theories, theorists, theoretical conceptions, and specific principles. It focuses on five theories that have had the most impact: maturationist, constructivist, behavioral, psychoanalytic, and ecological. Each theory offers interpretations on the meaning of children's development and behavior. Although the theories are clustered collectively into schools of thought, they differ within each school.

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The author is grateful to Mary Jalongo for her expert editing and her keen eye for the smallest details.

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Saracho, O.N. Theories of Child Development and Their Impact on Early Childhood Education and Care. Early Childhood Educ J 51 , 15–30 (2023). https://doi.org/10.1007/s10643-021-01271-5

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The Power of Playful Learning in the Early Childhood Setting

Play versus learning represents a false dichotomy in education (e.g., Hirsh-Pasek & Golinkoff 2008). In part, the persistent belief that learning must be rigid and teacher directed—the opposite of play—is motivated by the lack of a clear definition of what constitutes playful learning (Zosh et al. 2018). And, in part, it is motivated by older perceptions of play and learning. Newer research, however, allows us to reframe the debate as learning via play—as playful learning.

This piece, which is an excerpt from Chapter 5 in Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth Through Age 8, Fourth Edition (NAEYC 2022), suggests that defining play on a spectrum (Zosh et al. 2018, an idea first introduced by Bergen 1988) helps to resolve old divisions and provides a powerful framework that puts playful learning —rich curriculum coupled with a playful pedagogy—front and center as a model for all early childhood educators. ( See below for a discussion of play on a spectrum.)

This excerpt also illustrates the ways in which play and learning mutually support one another and how teachers connect learning goals to children’s play. Whether solitary, dramatic, parallel, social, cooperative, onlooker, object, fantasy, physical, constructive, or games with rules, play, in all of its forms, is a teaching practice that optimally facilitates young children’s development and learning. By maximizing children’s choice, promoting wonder and enthusiasm for learning, and leveraging joy, playful learning pedagogies support development across domains and content areas and increase learning relative to more didactic methods (Alfieri et al. 2011; Bonawitz et al. 2011; Sim & Xu 2015).

Playful Learning: A Powerful Teaching Tool

This narrowing of the curriculum and high-stakes assessment practices (such as paper-and-pencil tests for kindergartners) increased stress on educators, children, and families but failed to deliver on the promise of narrowing—let alone closing—the gap. All children need well-thought-out curricula, including reading and STEM experiences and an emphasis on executive function skills such as attention, impulse control, and memory (Duncan et al. 2007). But to promote happy, successful, lifelong learners, children must be immersed in developmentally appropriate practice and rich curricular learning that is culturally relevant (NAEYC 2020). Playful learning is a vehicle for achieving this. Schools must also address the inequitable access to play afforded to children (see “Both/And: Early Childhood Education Needs Both Play and Equity,” by Ijumaa Jordan.) All children should be afforded opportunities to play, regardless of their racial group, socioeconomic class, and disability if they have been diagnosed with one. We second the call of Maria Souto-Manning (2017): “Although play has traditionally been positioned as a privilege, it must be (re)positioned as a right, as outlined by the United Nations Convention on the Rights of the Child, Article 31” (785).

What Is Playful Learning?

Playful learning describes a learning context in which children learn content while playing freely (free play or self-directed play), with teacher guidance (guided play), or in a structured game. By harnessing children’s natural curiosity and their proclivities to experiment, explore, problem solve, and stay engaged in meaningful activities—especially when doing so with others—teachers maximize learning while individualizing learning goals. Central to this concept is the idea that teachers act more as the Socratic “guide at the side” than a “sage on the stage” (e.g., King 1993, 30; Smith 1993, 35). Rather than view children as empty vessels receiving information, teachers see children as active explorers and discoverers who bring their prior knowledge into the learning experience and construct an understanding of, for example, words such as forecast and low pressure as they explore weather patterns and the science behind them. In other words, teachers support children as active learners.

Importantly, playful learning pedagogies naturally align with the characteristics that research in the science of learning suggests help humans learn. Playful learning leverages the power of active (minds-on), engaging (not distracting), meaningful, socially interactive, and iterative thinking and learning (Zosh et al. 2018) in powerful ways that lead to increased learning.

Free play lets children explore and express themselves—to be the captains of their own ship. While free play is important, if a teacher has a learning goal, guided play and games are the road to successful outcomes for children (see Weisberg, Hirsh-Pasek, & Golinkoff 2013 for a review). Playful learning in the form of guided play, in which the teacher builds in the learning as part of a fun context such as a weather report, keeps the child’s agency but adds an intentional component to the play that helps children learn more from the experience. In fact, when researchers compared children’s skill development during free play in comparison to guided play, they found that children learned more vocabulary (Toub et al. 2018) and spatial skills (Fisher et al. 2013) in guided play than in free play.

Self-Directed Play, Free Play

NAEYC’s 2020 position statement on developmentally appropriate practice uses the term self-directed play to refer to play that is initiated and directed by children. Such play is termed free play in the larger works of the authors of this excerpt; therefore, free play is the primary term used in this article, with occasional references to self-directed play, the term used in the rest of the DAP book.

Imagine an everyday block corner. The children are immersed in play with each other—some trying to build high towers and others creating a tunnel for the small toy cars on the nearby shelves. But what if there were a few model pictures on the wall of what children could strive to make as they collaborated in that block corner? Might they rotate certain pieces purposely? Might they communicate with one another that the rectangle needs to go on top of the square? Again, a simple insertion of a design that children can try to copy turns a play situation into one ripe with spatial learning. Play is a particularly effective way to engage children with specific content learning when there is a learning goal.

Why Playful Learning Is Critical

Teachers play a crucial role in creating places and spaces where they can introduce playful learning to help all children master not only content but also the skills they will need for future success. The science of learning literature (e.g., Fisher et al. 2013; Weisberg, Hirsh-Pasek, & Golinkoff 2013; Zosh et al. 2018) suggests that playful learning can change the “old equation” for learning, which posited that direct, teacher-led instruction, such as lectures and worksheets, was the way to achieve rich content learning. This “new equation” moves beyond a sole focus on content and instead views playful learning as a way to support a breadth of skills while embracing developmentally appropriate practice guidelines (see Hirsh-Pasek et al. 2020).

Using a playful learning pedagogical approach leverages the skill sets of today’s educators and enhances their ability to help children attain curricular goals. It engages what has been termed active learning that is also developmentally appropriate and offers a more equitable way of engaging children by increasing access to participation. When topics are important and culturally relevant to children, they can better identify with the subject and the learning becomes more seamless.

While educators of younger children are already well versed in creating playful and joyful experiences to support social goals (e.g., taking turns and resolving conflicts), they can use this same skill set to support more content-focused curricular goals (e.g., mathematics and literacy). Similarly, while teachers of older children have plenty of experience determining concrete content-based learning goals (e.g., attaining Common Core Standards), they can build upon this set of skills and use playful learning as a pedagogy to meet those goals.

Learning Through Play: A Play Spectrum

As noted previously, play can be thought of as lying on a spectrum that includes free play (or self-directed play), guided play, games, playful instruction, and direct instruction (Bergen 1988; Zosh et al. 2018). For the purposes of this piece, we use a spectrum that includes the first three of these aspects of playful learning, as illustrated in “Play Spectrum Showing Three Types of Playful Learning Situations” below.

The following variables determine the degree to which an activity can be considered playful learning:

level of adult involvement
extent to which the child is directing the learning
presence of a learning goal

Toward the left end of the spectrum are activities with more child agency, less adult involvement, and loosely defined or no particular learning goals. Further to the right, adults are more involved, but children still direct the activity or interaction.

Developmentally appropriate practice does not mean primarily that children play without a planned learning environment or learn mostly through direct instruction (NAEYC 2020). Educators in high-quality early childhood programs offer a range of learning experiences that fall all along this spectrum. By thinking of play as a spectrum, educators can more easily assess where their learning activities and lessons fall on this spectrum by considering the components and intentions of the lesson. Using their professional knowledge of how children develop and learn, their knowledge of individual children, and their understanding of social and cultural contexts, educators can then begin to think strategically about how to target playful learning (especially guided play and games) to leverage how children naturally learn. This more nuanced view of play and playful learning can be used to both meet age-appropriate learning objectives and support engaged, meaningful learning.

In the kindergarten classroom in the following vignette, children have ample time for play and exploration in centers, where they decide what to play with and what they want to create. These play centers are the focus of the room and the main tool for developing social and emotional as well as academic skills; they reflect and support what the children are learning through whole-group discussions, lessons, and skills-focused stations. In the vignette, the teacher embeds guided play opportunities within the children’s free play.

Studying Bears: Self-Directed Play that Extends What Kindergartners Are Learning

While studying the habits of animals in winter, the class is taking a deeper dive into the lives of American black bears, animals that make their homes in their region. In the block center, one small group of children uses short lengths and cross-sections of real tree branches as blocks along with construction paper to create a forest habitat for black bear ﬁgurines. They enlist their friends in the art center to assist in making trees and bushes. Two children are in the writing center. Hearing that their friends are looking for help to create a habitat, they look around and decide a hole punch and blue paper are the perfect tools for making blueberries—a snack black bears love to eat! Now multiple centers and groups of children are involved in making the block center become a black bear habitat.

In the dramatic play center, some of the children pretend to be bear biologists, using stethoscopes, scales, and magnifying glasses to study the health of a couple of plush black bears. When these checkups are complete, the teacher suggests the children could describe the bears’ health in a written “report,” thus embedding guided play within their free play. A few children at the easels in the art center are painting pictures of black bears.

Contributed by Amy Blessing

Free play, or self-directed play, is often heralded as the gold standard of play. It encourages children’s initiative, independence, and problem solving and has been linked to benefits in social and emotional development (e.g., Singer & Singer 1990; Pagani et al. 2010; Romano et al. 2010; Gray 2013) and language and literacy (e.g., Neuman & Roskos 1992). Through play, children explore and make sense of their world, develop imaginative and symbolic thinking, and develop physical competence. The kindergarten children in the example above were developing their fine motor and collaboration skills, displaying their understanding of science concepts (such as the needs of animals and living things), and exercising their literacy and writing skills. Such benefits are precisely why free play has an important role in developmentally appropriate practice. To maximize learning, teachers also provide guided play experiences.

Guided Play

While free play has great value for children, empirical evidence suggests that it is not always sufficient when there is a pedagogical goal at stake (Smith & Pellegrini 2008; Alfieri et al. 2011; Fisher et al. 2013; Lillard 2013; Weisberg, Hirsh-Pasek, & Golinkoff 2013; Toub et al. 2018). This is where guided play comes in.

Guided play allows teachers to focus children’s play around specific learning goals (e.g., standards-based goals), which can be applied to a variety of topics, from learning place value in math to identifying rhyming words in literacy activities. Note, however, that the teacher does not take over the play activity or even direct it. Instead, she asks probing questions that guide the next level of child-directed exploration. This is a perfect example of how a teacher can initiate a context for learning while still leaving the child in charge. In the previous kindergarten vignette, the teacher guided the children in developing their literacy skills as she embedded writing activities within the free play at the centers.

Facilitating Guided Play

Skilled teachers set up environments and facilitate development and learning throughout the early childhood years, such as in the following:

Ms. Taglieri notices what 4-month-old Anthony looks at and shows interest in. Following his interest and attention, she plays Peekaboo, adjusting her actions (where she places the blanket and peeks out at him) to maintain engagement.
Ms. Eberhard notices that 22-month-old Abe knows the color yellow. She prepares her environment based on this observation, placing a few yellow objects along with a few red ones on a small table. Abe immediately goes to the table, picking up each yellow item and verbally labeling them (“Lellow!”).
Mr. Gorga creates intrigue and participation by inviting his preschool class to “be shape detectives” and to “discover the secret of shapes.” As the children explore the shapes, Mr. Gorga offers questions and prompts to guide children to answer the question “What makes them the same kind of shapes?”

An analogy for facilitating guided play is bumper bowling. If bumpers are in place, most children are more likely than not to knock down some pins when they throw the ball down the lane. That is different than teaching children exactly how to throw it (although some children, such as those who have disabilities or who become frustrated if they feel a challenge is too great, may require that level of support or instruction). Guided play is not a one-size-fits-all prescriptive pedagogical technique. Instead, teachers match the level of support they give in guided play to the children in front of them.

Critically, many teachers already implement these kinds of playful activities. When the children are excited by the birds they have seen outside of their window for the past couple of days, the teachers may capitalize on this interest and provide children with materials for a set of playful activities about bird names, diets, habitats, and songs. Asking children to use their hands to mimic an elephant’s trunk when learning vocabulary can promote learning through playful instruction that involves movement. Similarly, embedding vocabulary in stories that are culturally relevant promotes language and early literacy development (García-Alvarado, Arreguín, & Ruiz-Escalante 2020). For example, a teacher who has several children in his class with Mexican heritage decides to read aloud Too Many Tamales (by Gary Soto, illus. Ed Martinez) and have the children reenact scenes from it, learning about different literary themes and concepts through play. The children learn more vocabulary, have a better comprehension of the text, and see themselves and their experiences reflected. The teacher also adds some of the ingredients and props for making tamales into the sociodramatic play center (Salinas-González, Arreguín-Anderson, & Alanís 2018) and invites families to share stories about family tamaladas (tamale-making parties).

Evidence Supporting Guided Play as a Powerful Pedagogical Tool

Evidence from the science of learning suggests that discovery-based guided play actually results in increased learning for all children relative to both free play and direct instruction (see Alferi et al. 2011). These effects hold across content areas including spatial learning (Fisher et al. 2013), literacy (Han et al. 2010; Nicolopoulou et al. 2015; Hassinger-Das et al. 2016; Cavanaugh et al. 2017; Toub et al. 2018; Moedt & Holmes 2020), and mathematics (Zosh et al. 2016).

There are several possible reasons for guided play’s effectiveness. First, it harnesses the joy that is critical to creativity and learning (e.g., Isen, Daubman, & Nowicki 1987; Resnick 2007). Second, during guided play, the adults help “set the stage for thought and action” by essentially limiting the number of possible outcomes for the children so that the learning goal is discoverable, but children still direct the activity (Weisberg et al. 2014, 276). Teachers work to provide high-quality materials, eliminate distractions, and prepare the space, but then, critically, they let the child play the active role of construction. Third, in guided play, the teacher points the way toward a positive outcome and hence lessens the ambiguity (the degrees of freedom) without directing children to an answer or limiting children to a single discovery (e.g., Bonawitz et al. 2011). And finally, guided play provides the opportunity for new information to be integrated with existing knowledge and updated as children explore.

Reinforcing Numeracy with a Game

The children in Mr. Cohen’s preschool class are at varying levels of understanding in early numeracy skills (e.g., cardinality, one-to-one correspondence, order irrelevance). He knows that his children need some practice with these skills but wants to make the experience joyful while also building these foundational skills. One day, he brings out a new game for them to play—The Great Race. Carla and Michael look up expectantly, and their faces light up when they realize they will be playing a game instead of completing a worksheet. The two quickly pull out the box, setting up the board and choosing their game pieces. Michael begins by ﬂicking the spinner with his ﬁnger, landing on 2. “Nice!” Carla exclaims, as Michael moves his game piece, counting “One, two.” Carla takes a turn next, spinning a 1 and promptly counting “one” as she moves her piece one space ahead. “My turn!” Michael says, eager to win the race. As he spins a 2, he pauses. “One . . . two,” he says, hesitating, as he moves his piece to space 4 on the board. Carla corrects him, “I think you mean ‘three, four,’ right? You have to count up from where you are on the board.” Michael nods, remembering the rules Mr. Cohen taught him earlier that day. “Right,” he says, “three, four.”

Similar to guided play, games can be designed in ways that help support learning goals (Hassinger-Das et al. 2017). In this case, instead of adults playing the role of curating the activity, the games themselves provide this type of external scaffolding. The example with Michael and Carla shows how children can learn through games, which is supported by research. In one well-known study, playing a board game (i.e., The Great Race) in which children navigated through a linear, numerical-based game board (i.e., the game board had equally spaced game spaces that go from left to right) resulted in increased numerical development as compared to playing the same game where the numbers were replaced by colors (Siegler & Ramani 2008) or with numbers organized in a circular fashion (Siegler & Ramani 2009). Structuring experiences so that the learning goal is intertwined naturally with children’s play supports their learning. A critical point with both guided play and games is that children are provided with support but still lead their own learning.

Digital educational games have become enormously popular, with tens of thousands of apps marketed as “educational,” although there is no independent review of these apps. Apps and digital games may have educational value when they inspire active, engaged, meaningful, and socially interactive experiences (Hirsh-Pasek et al. 2015), but recent research suggests that many of the most downloaded educational apps do not actually align with these characteristics that lead to learning (Meyer et al. 2021). Teachers should exercise caution and evaluate any activity—digital or not—to see how well it harnesses the power of playful learning.

Next Steps for Educators

Educators are uniquely positioned to prepare today’s children for achievement today and success tomorrow. Further, the evidence is mounting that playful pedagogies appear to be an accessible, powerful tool that harnesses the pillars of learning. This approach can be used across ages and is effective in learning across domains.

By leveraging children’s own interests and mindfully creating activities that let children play their way to new understanding and skills, educators can start using this powerful approach today. By harnessing the children’s interests at different ages and engaging them in playful learning activities, educators can help children learn while having fun. And, importantly, educators will have more fun too when they see children happy and engaged.

As the tide begins to change in individual classrooms, educators need to acknowledge that vast inequalities (e.g., socioeconomic achievement gaps) continue to exist (Kearney & Levine 2016). The larger challenge remains in propelling a cultural shift so that administrators, families, and policymakers understand the way in which educators can support the success of all children through high-quality, playful learning experiences.

Consider the following reflection questions as you reflect how to support equitable playful learning experiences for each and every child:

One of the best places to start is by thinking about your teaching strengths. Perhaps you are great at sparking joy and engagement. Or maybe you are able to frequently leverage children’s home lives in your lessons. How can you expand practices you already use as an educator or are learning about in your courses to incorporate the playful learning described in this article?
How can you share the information in this chapter with families, administrators, and other educators? How can you help them understand how play can engage children in deep, joyful learning?

This piece is excerpted from NAEYC’s recently published book Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth Through Age 8, Fourth Edition. For more information about the book, visit NAEYC.org/resources/pubs/books/dap-fourth-edition .

Teaching Play Skills

Pamela Brillante

While many young children with autism spectrum disorder enjoy playing, they can have difficulty engaging in traditional play activities. They may engage in activities that do not look like ordinary play, including playing with only a few specific toys or playing in a specific, repetitive way.

Even though most children learn play skills naturally, sometimes families and teachers have to teach children how to play. Learning how to play will help develop many other skills young children need for the future, including

social skills: taking turns, sharing, and working cooperatively
cognitive skills: problem-solving skills, early academic skills
communication skills: responding to others, asking questions
physical skills: body awareness, fine and gross motor coordination

Several evidence-based therapeutic approaches to teaching young children with autism focus on teaching play skills, including

The Play Project: https://playproject.org
The Greenspan Floortime approach: https://stanleygreenspan.com
Integrated Play Group (IPG) Model: www.wolfberg.com

While many children with autism have professionals and therapists working with them, teachers and families should work collaboratively and provide multiple opportunities for children to practice new skills and engage in play at their own level. For example, focus on simple activities that promote engagement between the adult and the child as well as the child and their peers without disabilities, including playing with things such as bubbles, cause-and-effect toys, and interactive books. You can also use the child’s preferred toy in the play, like having the Spider-Man figure be the one popping the bubbles.

Pamela Brillante , EdD, has spent 30 years working as a special education teacher, administrator, consultant, and professor. In addition to her full-time faculty position in the Department of Special Education, Professional Counseling and Disability Studies at William Paterson University of New Jersey, Dr. Brillante continues to consult with school districts and present to teachers and families on the topic of high-quality, inclusive early childhood practices.

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Jennifer M. Zosh, PhD, is professor of human development and family studies at Penn State Brandywine. Most recently, her work has focused on technology and its impact on children as well as playful learning as a powerful pedagogy. She publishes journal articles, book chapters, blogs, and white papers and focuses on the dissemination of developmental research.

Caroline Gaudreau, PhD, is a research professional at the TMW Center for Early Learning + Public Health at the University of Chicago. She received her PhD from the University of Delaware, where she studied how children learn to ask questions and interact with screen media. She is passionate about disseminating research and interventions to families across the country.

Roberta Michnick Golinkoff, PhD, conducts research on language development, the benefits of play, spatial learning, and the effects of media on children. A member of the National Academy of Education, she is a cofounder of Playful Learning Landscapes, Learning Science Exchange, and the Ultimate Playbook for Reimagining Education. Her last book, Becoming Brilliant: What Science Tells Us About Raising Successful Children (American Psychological Association, 2016), reached the New York Times bestseller list.

Kathy Hirsh-Pasek, PhD, is the Lefkowitz Faculty Fellow in the Psychology and Neuroscience department at Temple University in Philadelphia, Pennsylvania. She is also a senior fellow at the Brookings Institution. Her research examines the development of early language and literacy, the role of play in learning, and learning and technology. [email protected]

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Early Childhood Development: the Promise, the Problem, and the Path Forward

Subscribe to the center for universal education bulletin, tamar manuelyan atinc and tamar manuelyan atinc nonresident senior fellow - global economy and development , center for universal education emily gustafsson-wright emily gustafsson-wright senior fellow - global economy and development , center for universal education.

November 25, 2013

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Access more content from the Center for Universal Education here , including work on early childhood education .

Early Childhood: The Scale of the Problem

More than 200 million children under the age of five in the developing world are at risk of not reaching their full development potential because they suffer from the negative consequences of poverty, nutritional deficiencies and inadequate learning opportunities (Lancet 2007). In addition, 165 million children (one in four) are stunted, with 90 percent of those children living in Africa and Asia (UNICEF et al, 2012). And while some progress has been made globally, child malnutrition remains a serious public health problem with enormous human and economic costs. Child death is a tragedy. At 6 million deaths a year, far too many children perish before reaching the age of five, but the near certainty that 200 million children today will fall far below their development potential is no less a tragedy.

There is now an expanding body of literature on the determining influence of early development on the chances of success later in life. The first 1,000 days from conception to age two are increasingly being recognized as critical to the development of neural pathways that lead to linguistic, cognitive and socio-emotional capacities that are also predictors of labor market outcomes later in life. Poverty, malnutrition, and lack of proper interaction in early childhood can exact large costs on individuals, their communities and society more generally. The effects are cumulative and the absence of appropriate childcare and education in the three to five age range can exacerbate further the poor outcomes expected for children who suffer from inadequate nurturing during the critical first 1,000 days.

The Good News: ECD Interventions Are Effective

Research shows that there are large gains to be had from investing in early childhood development. For example, estimates place the gains from the elimination of malnutrition at 1 to 2 percentage points of gross domestic product (GDP) annually (World Bank, 2006). Analysis of results from OECD’s 2009 Program of International Student Assessment (PISA) reveals that school systems that have a 10 percentage-point advantage in the proportion of students who have attended preprimary school score an average of 12 points higher in the PISA reading assessment (OECD and Statistics Canada, 2011). Also, a simulation model of the potential long-term economic effects of increasing preschool enrollment to 25 percent or 50 percent in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6.4 to 17.6, depending on the preschool enrollment rate and the discount rate used (Lancet, 2011).

Indeed, poor and neglected children benefit disproportionately from early childhood development programs, making these interventions among the more compelling policy tools for fighting poverty and reducing inequality. ECD programs are comprised of a range of interventions that aim for: a healthy pregnancy; proper nutrition with exclusive breast feeding through six months of age and adequate micronutrient content in diet; regular growth monitoring and immunization; frequent and structured interactions with a caring adult; and improving the parenting skills of caregivers.

The Reality: ECD Has Not Been a Priority

Yet despite all the evidence on the benefits of ECD, no country in the developing world can boast of comprehensive programs that reach all children, and unfortunately many fall far short. Programs catering to the very young are typically operated at small scale and usually through external donors or NGOs, but these too remain limited. For example, a recent study found that the World Bank made only $2.1 billion of investments in ECD in the last 10 years, equivalent to just a little over 3 percent of the overall portfolio of the human development network, which totals some $60 billion (Sayre et al, 2013).

The following are important inputs into the development of healthy and productive children and adults, but unfortunately these issues are often not addressed effectively:

Maternal Health. Maternal undernutrition affects 10 to 19 percent of women in most developing countries (Lancet, 2011) and 16 percent of births are low birth weight (27 percent in South Asia). Malnutrition during pregnancy is linked to low birth weight and impaired physical development in children, with possible links also to the development of their social and cognitive skills. Pre-natal care is critical for a healthy pregnancy and birth. Yet data from 49 low-income countries show that only 40 percent of pregnant women have access to four or more antenatal care visits (Taskforce on Innovative International Financing for Health Systems, 2009). Maternal depression also affects the quality of caregiving and compromises early child development.

Child Care and Parenting Practices. The home environment, including parent-child interactions and exposure to stressful experiences, influences the cognitive and socio-emotional development of children. For instance, only 39 percent of infants aged zero to six months in low and middle-income countries are exclusively breast-fed, despite strong evidence on its benefits (Lancet, 2011). Also, in half of the 38 countries for which UNICEF collects data, mothers engage in activities that promote learning with less that 40 percent of children under the age of six. Societal violence and conflict are also detrimental to a child’s development, a fact well known to around 300 million children under the age of four that live in conflict-affected states.

Child Health and Nutrition. Healthy and well-nourished children are more likely to develop to their full physical, cognitive and socio-emotional potential than children who are frequently ill, suffer from vitamin or other deficiencies and are stunted or underweight. Yet, for instance, an estimated 30 percent of households in the developing world do not consume iodized salt, putting 41 million infants at risk for developing iodine deficiency which is the primary cause of preventable mental retardation and brain damage, and also increases the chance of infant mortality, miscarriage and stillbirth. An estimated 40 to 50 percent of young children in developing countries are also iron deficient with similarly negative consequences (UNICEF 2008). Diarrhea, malaria and HIV infection are other dangers with a deficit of treatment in early childhood that lead to various poor outcomes later in life.

Preprimary Schooling. Participation in good quality preprimary programs has been shown to have beneficial effects on the cognitive development of children and their longevity in the school system. Yet despite gains, enrollment remains woefully inadequate in Sub-Saharan Africa and the Middle East and North Africa. Moreover, national averages usually hide significant inequalities across socio-economic groups in access and almost certainly in quality. In all regions, except South Asia, there is a strong income gradient for the proportion of 3 and 4 year olds attending preschool.

Impediments to Scaling Up

So what are the impediments to scaling up these known interventions and reaping the benefits of improved learning, higher productivity, lower poverty and lower inequality for societies as a whole? There are a range of impediments that include knowledge gaps (especially in designing cost-effective and scalable interventions of acceptable quality), fiscal constraints and coordination failures triggered by institutional organization and political economy.

Knowledge Gaps . Despite recent advances in the area, there is still insufficient awareness of the importance of brain development in the early years of life on future well-being and of the benefits of ECD interventions. Those who work in this area take the science and the evaluation evidence for granted. Yet awareness among crucial actors in developing countries—policymakers, parents and teachers—cannot be taken for granted.

At the same time much of the evaluation evidence from small programs attests to the efficacy of interventions, we do not yet know whether large scale programs are as effective. The early evidence came primarily from small pilots (involving about 10 to 120 children) from developed countries. [1] ;While there is now considerable evidence from developing countries as well, such programs still tend to be boutique operations and therefore questions regarding their scalability and cost-effectiveness.

There are also significant gaps in our knowledge as to what specific intervention design works in which context in terms of both the demand for and the provision of the services. These knowledge gaps include the need for more evidence on: i) the best delivery mode – center, family or community based, ii) the delivery agents – community health workers, mothers selected by the community, teachers, iii) whether or not the programs should be universal or targeted, national or local, iv) the frequency and duration of interventions, of training for the delivery agents and of supervision, v) the relative value of nutritional versus stimulative interventions and the benefits from the delivery of an integrated package of services versus sector specific services that are coordinated at the point of delivery, vi) the most effective curricula and material to be used, vii) the relative effectiveness of methods for stimulating demand – information via individual contact, group sessions, media, conditional cash transfers etc. In all these design questions, cost-effectiveness is a concern and leads to the need to explore the possibility of building on an existing infrastructure. There is also a need for more evidence on the kinds of standards, training and supervision that are conducive to Safeguarding the quality of the intervention at scale.

Fiscal Constraints . Fiscal concerns at the aggregate level are also an issue and force inter-sectoral trade-offs that are difficult to make. Is it reasonable to expect countries to put money into ECD when problems persist in terms of both access and poor learning outcomes in primary schools and beyond? Even though school readiness and teacher quality may be the most important determinants of learning outcomes in primary schools, resource allocation shifts are not easy to make for policymakers. In addition, as discussed above, we do not yet have good answers to the questions around the cost implications of high quality design at scale.

Institutional Coordination and Political Context. Successful interventions are multi-sectoral in nature (whether they are integrated from the outset or coordinated at the point of delivery) and neither governments nor donor institutions are structured to address well issues that require cross-sectoral cooperation. When programs are housed in the education ministry, they tend to focus on preprimary concerns. When housed in the health ministry, programs ignore early stimulation. We do not know well what institutional structure works best in different contexts, including how decentralization may affect choices about institutional set ups.

There are also deeper questions about the nature of the social contract in any country that shapes views about the role of government and the distribution of benefits across the different segments of the population. Some countries consider that the responsibilities of the public sector start when children reach school age and view the issues around the development of children at a younger age to be the purview of families. And in many countries, policies that benefit children get short shrift because children do not have political voice and their parents are imperfect agents for their children’s needs. Inadequate political support then means that the legislative framework for early year interventions is lacking and that there is limited public spending on programs that benefit the young. For example, public spending on social pensions in Brazil is about 1.2 percent of GDP whereas transfers for Bolsa Familia which targets poor children are only 0.4 percent of GDP (Levy and Schady 2013). In Turkey, only 6.5 percent of central government funds are directed to children ages zero to 6, while the population above 44 receives a per capita transfer of at least 2.5 times as large as children today (World Bank, 2010). Finally, the long gestation period needed to achieve tangible results compounds the limited appeal of ECD investments given the short planning horizon of many political actors.

The Future: An Agenda for Scaling Up ECD

Addressing the constraints to scaling up ECD requires action across a range of areas, including more research and access to know how, global and country level advocacy, leveraging the private sector, and regular monitoring of progress.

Operational Research and Learning Networks. Within the EDC research agenda, a priority should be the operational research that is needed to go to scale. This research includes questions around service delivery models, including in particular their cost effectiveness and sustainability. Beyond individual program design, there are broader institutional and policy questions that need systematic assessment. These questions center on issues including the inter-agency and intergovernmental coordination modalities which are best suited for an integrated delivery of the package of ECD services. They also cover the institutional set-ups for quality assurance, funding modalities, and the role of the private sector. Finally, research is also needed to examine the political economy of successful implementation of ECD programs at scale.

Also necessary are learning networks that can play a powerful role in disseminating research findings and in particular good practice across boundaries. Many of the issues regarding the impediments for scaling up are quite context specific and not amenable to generic or off-the-shelf solutions. A network of peer learning could be a powerful avenue for policymakers to have deeper and face-to-face interactions about successful approaches to scaling up. South-South exchanges were an enormously valuable tool in the propagation of conditional cash transfer schemes both within Latin America and globally. These types of exchanges could be equally powerful for ECD interventions

Advocacy. There is a need for a more visible global push for the agenda, complemented by advocacy at country or regional levels and a strong role for business leaders. It should be brought to the attention of policymakers that ECD is not a fringe issue and that it is a matter of economic stability to the entire world. It is also in the interest of business leaders to support the development of young children to ensure a productive work force in the future and a thriving economy. Currently, there is insufficient recognition of the scale of the issues and the effectiveness of known interventions. And while there are pockets of research excellence, there is a gap in the translation of this work into effective policies on the ground. The nutrition agenda has recently received a great deal of global attention through the 1000 days campaign and the Scaling up Nutrition Movement led by the United States and others. Other key ECD interventions and the integration and complementarities between the multi-sectoral interventions have received less attention however. The packaging of a minimum set of services that all countries should aspire to provide to its children aged zero to six would be an important step towards progress. The time is ripe as discussions around the post-2015 development framework are in full swing, to position ECD as a critical first step in the development of healthy children, capable of learning and becoming productive adults.

Leveraging the Private Sector. The non-state sector already plays a dominant role in providing early childhood care, education and healthcare services in many countries. This represents both a challenge and an opportunity. The challenge is that the public sector typically lacks the capacity to ensure quality in the provision of services and research evidence shows that poor quality child care and education services are not just ineffective; they can be detrimental (Lancet 2011). The challenge is all the greater given that going to scale will require large numbers of providers and we know that regulation works better and is less costly in markets with fewer actors. On the opportunity side of the ledger, there is scope for expanding the engagement of the organized private sector. The private sector can contribute by providing universal access for its own workforce, through for-profit investments, and in the context of corporate social responsibility activities. Public-private partnerships can span the range of activities, including providing educational material for home-based parenting programs; developing and delivering parent education content through media or through the distribution chains of some consumer goods or even financial products; training preprimary teachers; and providing microfinance for home or center-based childcare centers. Innovative financing mechanisms, such as those in the social impact investing arena, may provide necessary financing, important demonstration effects and quality assurance for struggling public systems. Such innovations are expanding in the United States, paving the way for middle and low-income countries to follow.

ECD Metrics. A key ingredient for scaling up is the ability to monitor progress. This is important both for galvanizing political support for the desired interventions and to provide a feedback loop for policymakers and practitioners. There are several metrics that are in use by researchers in specific projects but are not yet internationally accepted measures of early child development that can be used to report on outcomes globally. While we can report on the share of children that are under-weight or stunted, we cannot yet provide the fuller answer to this question which would require a gauge of their cognitive and socio-emotional development. There are some noteworthy recent initiatives which will help fill this gap. The UNICEF-administered Multiple Indicator Cluster Survey (MICS) 4 includes an ECD module and a similar initiative from the Inter-American Development Bank collects ECD outcome data in a handful of Latin American countries. The World Health Organization has launched work that will lead to a proposal on indicators of development for zero to 3 year old children while UNESCO is taking the lead on developing readiness to learn indicators (for children around age 6) as a follow up to the recommendations of the Learning Metrics Task Force (LMTF) which is co-convened by UNESCO and the Center for Universal Education at Brookings.

The LMTF aims to make recommendations for learning goals at the global level and has been a useful mechanism for coordination across agencies and other stakeholders. A related gap in measurement has to do with the quality of ECD services (e.g., quality of daycare). Overcoming this measurement gap is critical for establishing standards and for monitoring compliance and can be used to inform parental decisions about where to send their kids.

ECD programs have a powerful equalizing potential for societies and ensuring equitable investment in such programs is likely to be far more cost-effective than compensating for the difference in outcomes later in life. Expanding access to quality ECD services so that they include children from poor and disadvantaged families is an investment in the future of not only those children but also their communities and societies. Getting there will require concerted action to organize delivery systems that are financially sustainable, monitor the quality of programming and outcomes and reach the needy.

Lancet (2007). Child development in developing countries series. The Lancet, 369, 8-9, 60-70, 145, 57, 229-42. http://www.thelancet.com/series /child-development-in-developing-countries.

Lancet (2011). Child development in developing countries series 2. The Lancet, 378, 1325-28, 1339- 53. http://www.thelancet.com/series/child-development-in-developing-countries-2.

Levy, S. and Schady, N. (2013). Latin America’s Social Policy Challenge: Education, social Insurance, Redistribution. Journal of Economic Perspectives 27(2) , 193-218.

OECD and Statistics Canada (2011). Literacy for Life: Further Results from the Adult Literacy and Life Skills Survey. Paris/Ottawa: Organisation for Economic Co-operation and Development/Canada Minister of Industry.

Sayre, R.K., Devercelli, A.E., Neuman, M.J. (2013). World Bank Investments in Early Childhood: Findings from Portfolio Review of World Bank Early Childhood Development Projects from FY01-FY11. Draft, March 2013, Mimeo.

Taskforce on Innovative International Financing for Health Systems (2009). More money for health, and more health for the money: final report. Geneva: International Health Partnership. http://www.internationalhealthpartnership.net//CMS_files/documents/taskforce_report_EN.pdf

United Nations Children’s Fund (2005). Multiple Indicator Cluster Survey 3. UNICEF. http://www.childinfo.org/mics3_surveys.html.

United Nations Children’s Fund (2008). Sustainable Elimination of Iodine Deficiency: Progress since the1990 World Summit on Children. New York: UNICEF.

United Nations Children’s Fund, World Health Organization and The World Bank (2012). UNICEF- WHO-World Bank Joint Child Malnutrition Estimates. New York: UNICEF; Geneva: WHO; Washington D.C.: The World Bank.

World Bank (2006). Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action. Directions in Development series. Washington D.C.: The World Bank.

World Bank (2010). Turkey: Expanding Opportunities for the Next Generation- A Report on Life Chances. Report No 48627-TR. Washington D.C.: The World Bank.

World Bank (2013). World Development Indicators 2013. Washington D.C.: The World Bank.

[1] The Perry preschool and Abecedarian programs in the United States have been rigorously studied and show tremendous benefits for children in terms of cognitive ability, academic performance and tenure within the school system and suggest benefits later on in life that include higher incomes, higher incidence of home ownership, lower propensity to be on welfare and lower rates of incarceration and arrest.

Early Childhood Education Global Education

Global Economy and Development

Center for Universal Education

June 20, 2024

Elyse Painter, Emily Gustafsson-Wright

January 5, 2024

Brenna Hassinger-Das, Katelyn Fletcher

September 20, 2023

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Published: 26 August 2024

Defining child health in the 21st century

Ruth E. K. Stein 1

Pediatric Research ( 2024 ) Cite this article

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The concept of child health has evolved over many decades and has gone from defining health as the absence of disease and disability to a much more sophisticated understanding of the ways in which a confluence of many factors leads to a healthy childhood and to producing the infrastructure for a healthy lifetime. We review the evolution of these ideas and endorse the definition featured in Children’s Health, the Nation’s Wealth , which states tha t child health is: “… the extent to which individual children or groups of children are able or enabled to: (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments.”

The definition of child health and the model presented form a framework for conducting and interpreting research in child health and understanding the ways in which influences affect child health.

They also demonstrate how child health is the foundation for life-long health.

Child health is dynamic and is always changing.

There are many influences affecting child health at any given time.

Because each child’s health is different, they may react in distinctive ways to a new health challenge.

Improving child health through Big Data and data science

SPR perspectives: Environmental influences on Child Health Outcomes (ECHO) Program: overcoming challenges to generate engaged, multidisciplinary science

SPR Perspectives: scientific opportunities in the Environmental influences on Child Health Outcomes Program

This model is best represented by a kaleidoscope of influences (biology, social and built environment, behavior, policies, and services) working together over a child’s life and developmental trajectory. The model has life-long implications for adult health and well-being and has far-reaching implications for promoting children’s health and for understanding research in child health. Pediatrics is a field devoted to improving the health of children, but what does that really mean? There are several aspects to this all-important question. How do we currently view and define child health? How do we understand the things that underpin a healthy childhood? What is the significance of child health for life-long health? The answers to these questions are important for all our endeavors as child-oriented clinicians and are key to our ongoing research efforts to improve child health.

Approaches to child health

The concept of child health has evolved over many decades and has gone from defining health as the absence of disease and disability to a much more sophisticated understanding of the ways in which a confluence of many factors leads to a healthy childhood and to producing the infrastructure for a healthy lifetime. While this is true in the United States and most of the upper income nations and the elite in many other communities, many low- and middle-income countries still experience high childhood morbidity and mortality and low rates of immunizations that protect children from many diseases. Thus, for many of them, the absence of disease continues to be a major marker of improvements in child health.

The recognition that health is more than the absence of disease was relatively novel when it was written into the constitution of the World Health Organization (WHO) in 1945. In April 7, 1948, the WHO Charter was adopted and definition was formally recognized. It stated “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” ( https://www.who.int/about/accountability/governance/constitution ). There were several other rather revolutionary components to the constitution, including the notion that health was a human right, a call for equity in health, and the statement that governments had a responsibility for insuring health ( https://www.who.int/about/accountability/governance/constitution ). Unfortunately, the latter two elements are still not always accepted as fundamental in the United States.

An often-overlooked component of the WHO Charter is the principle that: “Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development” ( https://www.who.int/about/accountability/governance/constitution ). This last principle is the only component that mentions development, something that is fundamental to childhood and yet was not incorporated into most people’s thinking about health at the time. It should be emphasized that there was little thought to differentiating the definitions of health for children and adults.

Over the next several decades, the focus was on the elimination of diseases, something that became possible with the explosion of new biomedical understanding of the causes and mechanisms for disease and the morbidity and mortality that they caused. This was a period during which there was development of a library of antibiotics and vaccines to treat and prevent many infectious diseases. The dominance of biomedical sciences resulted in a focus primarily on aspects of physical health, with emotional, cognitive, or social well-being being relatively ignored during that period. As a result, the notion that health was more than the absence of diseases got relatively little attention and a biomedical model of health dominated most discussions, whether focused on children or adults.

The mid 1970’s saw an explosion of new thoughts about child health and the key role of child development. Major elements of this new thinking were the increasing focus on differences in the biology of children and adults and in the appreciation of the extent to which factors outside of biology influenced health, especially among young children. In terms of appreciating differences between child and adult health, there was increasing recognition of the rapidly changing nature of children’s physical and behavioral characteristics; of their inherent dependency, especially early in life, and the differences in their exposure to environmental hazards and in the way that manifest poor health. The growing awareness of their biological differences led to recognition of such variations as their relative surface area, their play which placed them in closer proximity to ground level pollutants, and a myriad of metabolic differences that pediatric research had revealed.

Additionally, there was growing data on a variety of key factors other than the child’s vulnerability to infectious disease that were coming to the fore. One was the importance of infant attachment for healthy development; another was the recognition of how environmental factors such as lead were detracting from healthy development and well-being, and a third was recognition of child abuse and neglect by Henry Kempe. 1 In addition, the implementation of Medicaid and the Children and Youth projects had brought many underserved communities into traditional medical venues, where clinicians were increasingly recognizing the impact of poverty on child health. These ideas were crystalized in Robert Haggerty’s studies of Child Health and the Community , published in 1975, 2 which examined health care in Monroe country, a microcosm of the US population and focused on many factors in the lives of children beyond their biology and exposure to infectious diseases.

In response to these trends and to the increasing recognition of non-infectious causes of disease, three new broad models were put forward, each of which made major contributions to the conceptualization of child health.

The first of these was from George Engel, a psychiatrist at the University of Rochester, who proposed a revolutionary concept, which he called the “biopsychosocial” model of child health. 3 His thesis was that biological, psychological, and social components each contributed to health and that all these factors had to be considered. 3 The notion that the body and mind were connected was not entirely new and has been cited as going back at least to Descartes, but had been neglected during the focus on biology as the primary cause of illness. Engel reintroduced the concept that the social and psychological contributions to illness and well-being needed to be considered in medical science and health care, both as causes of disease and as important in their treatment. 4 Broadening the notion of health to include factors outside of biology required consideration of how these elements interacted. Engel’s model was a Venn diagram with overlap of the three types of factors: biological, social, and psychological factors. The interaction of these elements resulted in the manifestations of illness and the elements that needed to be considered in approaching care and understanding health.

At about the same time, a second set of ideas about how these factors affected one another came from a psychologist, Arnold Sameroff, 5 who developed the notion of factors relating to health affected one another in a transactional way. He proposed that the parent, child, and environment interact in ways in which each affects the other and it is the sum of those interactions that leads to the child’s development and affects the child’s health and well-being. The notion of reciprocity and interactions of multiple factors remains key in thinking today. 5

The third idea was the ecological model developed by Uri Bronfenbrenner, also a psychologist, who proposed a series of systems that influence one another and in total affect child health and development. 6 The five components ranged from the microsystem (the child’s relationship with his or her immediate environment, school, and family) to macrosystems (culture, economy, customs, and bodies of knowledge). Each layer of the environment was visualized as a concentric circle, with the child in the middle. To a large degree it was his thinking about the broader set of factors that impact child health that has stayed with us and has helped us to think beyond the child’s immediate context when considering influences on health. Bronfenbrenner’s view of the way that environment interacted with the child’s health and development dominated for many years. 6

After these three models were proposed, there was little innovative thinking about child health for a rather long period. During the ensuing decades most people accepted that the context in which a child was growing impacted his or her mental and physical health and contributed to well-being. An increasing number of studies focused on the broader issues affecting child health and on how these issues altered the manifestations of health and the outcomes of treatment. Yet none of this thinking led to a reformulation of how to define child health.

Current definition

In 2001, at Congress’s request the Office of Disease Prevention and Health Promotion of the United States Department of Health and Human Services funded the Board of Children, Youth, and Families (BoCYF) of the National Research Council and the Institute of Medicine to do a study to assess the ways that child health was monitored in the United States and to make recommendations about ways to improve its measurement. 7 This Committee on the Evaluation of Children’s Health: Measures of Risk, Protective and Promotional Factors for Assessing Child Health in the Community was charged with examining what was known about child health, the risk and protective factors and how the assessment of child health could be improved. The BoCYF convened a multidisciplinary committee to conduct the study. The first step that the committee undertook was to define child health and to do so it looked at available definitions of health. The committee noted that in general definitions of child health were not distinct from those for adult health. The WHO definition, as modified by the Ottawa Convention was the primary definition available. In the Ottawa Convention the term health was viewed as “the extent to which a group or individual can fulfil their ambitions and needs, on the one hand, and evolve with or adapt to the environment, on the other” ( https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference ). It further stated that “Health is thus seen as a resource for everyday life, not as the goal of life; it is a positive concept that emphasises [sic] social and individual resources as well as physical capabilities. Thus, health promotion is not just a health issue, but goes beyond healthy lifestyles to well-being” ( https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference ). This was the first time promotion of health was specifically advocated by a large number of countries. 8

In examining the Ottawa Convention definition, the committee became aware that there were no clear references to the notion of development, which is such a critical component of child health and a fundamental concept in pediatrics. This is because using the WHO and Ottawa definitions, an individual who did not develop at all after birth might be considered entirely healthy–something most people would not agree with.

Based on the special characteristics of children’s health and the prior definitions, “the committee sought a comprehensive and integrative definition and conceptualization of health that reflects the dynamic nature of childhood, is conceptually sound, is based on the best scientific evidence, and provides a basis for both measuring and improving child health.” 7 (page 32) Further, it recognized “that health and well-being are a result of interactions of many biological, psychological, social, cultural, and physical factors.” 7 (pages 32 and 33)

The committee defined child health:

“… as the extent to which individual children or groups of children are able or enabled to: (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments.” 7 (pages 32 and 33)

Several features of this definition are noteworthy. First is the continued conceptualization of health as a positive construct – more than the absence of illness or disease. Second, it incorporates the special characteristics, particularly rapid development and continuous change throughout childhood, as essential components of health. It also considers all the many influences that interact over time in different ways as children develop and change, and it acknowledges the ways children interact with their specific environments and the long-term implications of these environmental factors. This definition underscores the long reach of child health into adulthood underscoring that the health of children has profound effects on the health of the adults they will become. It acknowledges that the manifestations of health may vary for different communities and cultures and encompasses all aspects of health: physical, emotional, cognitive, and social health.

Domains of health

So how did the committee conceptualize the measurement of child health? First, it should be acknowledged that most commonly used measures are actually proxies of health or measures of only one aspect of the more complex construct embodied in the definition. For example, we might use body mass index to define obesity, or measure only cognitive functioning on a psychological test.

The model also emphasized the importance of tracking data on children’s health or aspects of their health on trajectories in a manner that is like the ways weight, length, are tracked. One cannot know the meaning of most isolated measures without knowing their place on a trajectory. For example, it is impossible to know if 20 pounds is a healthy weight or not without knowing the child’s age and prior weights. Similarly, one would have trouble determining the developmental health of child who speaks in 3-word sentences without knowing his age and whether his language was previously more or less advanced. Assessing trajectories was viewed as an essential part of efforts to improve children’s health. This requires longitudinal data.

Nevertheless, the committee conceptualized three domains of health that should be the basis for measuring child health: Health conditions : disorders or illnesses of body systems; Functioning : manifestation of health on an individual’s daily life, and Health potential : development of assets and positive aspects of health, such as resilience, competence, capacity, and developmental potential.

In considering the measurement of health conditions, it is important to note that these conditions can either be acute or chronic. Health conditions are the most traditional way of measuring health –or its absence. These conditions are usually inventoried by clinician diagnoses or by questionnaires inquiring about specific conditions or diseases. Those that are chronic can be assessed using two major approaches. The first is using a list or inventory of individual conditions. However, the list of such conditions is extensive because of the large number of uncommon disorders, and no list can be complete and be feasible to administer. Unfortunately, evidence shows that the more examples that are provided on a list, the more likely people will respond to the option of “or any other condition.” This finding is clearly counterintuitive and limits the utility of a list approach.

Another method of inventorying chronic conditions depends on a non-categorical or generic approach. 9 , 10 , 11 This approach explores the consequences of conditions, as well as their duration, based on a noncategorical definition. 12 The definition includes having a condition that lasts or is expected to last a year and having at least one of three types of consequences of conditions: Increased use of health care beyond the usual for age; dependence on a compensatory mechanism or assistance to function in a typical way; or the presence of functional limitations. 12 Three instruments that operationalize that definition have been developed and are in use. 13 , 14 , 15 , 16

This approach allows the identification of children with ongoing conditions without having to name the condition. A non-categorical approach is now incorporated into several national surveys using the shortest of these instruments, the CSHCN Screener. 15 It is used to track both the number of children with conditions and disparities in the ways in which care is delivered to children both with and without ongoing conditions.

Functioning has been defined by the International Classification of Functioning, Disability and Health as “an umbrella term for body function, body structures, activities and participation. It denotes the positive or neutral aspects of the interaction between a person’s health condition(s) and that individual’s contextual factors (environmental and personal factors)” ( https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf ). Functioning is viewed as the way in which an individual can do things and is the final expression of health of individuals. One strength of this type of measure is that it can assess the consequences of many coexisting conditions and both conditions and their treatment. This is not something that is possible to assess when considering conditions as proposed above. Even when multiple conditions are inventoried individually, it does not give any indication of their combined effect on the child’s health. Also, in some instances, there are more symptoms or impairments from the treatment than from the condition itself, such as when encountering serious side effects from chemotherapy, during treatment or when the original condition itself is in remission. There are few other ways in which to get the type of summative information that can be obtained by assessing functioning. 17

There are relatively few measures of functional limitations specifically developed for children. Many of the measures of functioning in the past have focused on gross motor functioning and some of them measure only one type of functioning, such as cognition, which is measured by a range of psychological tests. More recently there have been attempts to develop more comprehensive measures. Few of them work across populations, culture, levels of health/disability and ages. Some more comprehensive measures are age specific, such as measures of development or of school readiness. 18 In general, such measures assess a range of skills including independence, physical, social, cognitive, emotional, and language skills. Nevertheless, there are few functional measures that work across populations, cultures, levels of health/disability and ages. Among the range of measures that are broader and in use are FSII (R) 19 ; Wee FIM 20 and Functional Status Scale 21 and health quality of life measures. 22 Each of them has a different focus and measures different aspects of functioning.

There are even fewer measures of health potential, but this is an important area for future research. This domain is critical to improving understanding of why some children experiencing a major stress are able to bounce back and overcome the trauma, while others are stunted in their further development, or never rebound at all. Some areas that are included are resilience, problem solving ability, resistance to illness, immunization status, ability to develop positive peer relations, and physical fitness. How these factors fit together and become protective is an area worthy of exploration, but clearly some children differentiate themselves from others by their ability to rebound from adversity or illness, while others suffer long-term consequences of poor health and well-being.

Finally, it is important to acknowledge that the entire field of measurement is complicated by the fact that many children, especially younger ones cannot reliably respond to questionnaires on their own. As a result, most measures require responses from other individuals, typically caregivers. Others are completed by clinicians. Their biases and differences in their frames of reference may further complicate all these measures.

Factors influencing health

In exploring the issue of risk and protective factors that influence and affect health status, the committee realized that many known factors did not fall neatly into either category. In some cases, it was because they may be both risks and protective depending on the context (i.e: peer groups). In others, it’s effect was dependent on the level of exposure, as might be characterized by iron on iodine, both of which can cause problems if they are insufficient or be toxic if exposure is excessive.

Rather than think of them in terms of risk or protective factors, the committee chose to conceptualize the factors that affect child health as influences , since many may be both risks and protective, depending on the context and level of exposure.

The influences were grouped into six categories following the model of Healthy People 2010, which was the operant model at the time. 23 One objection to that model was that it was very linear, something that seemed at odds to the ways in which influences are understood to interact. However, the committee thought that the major categories or domains in the model that affected health were sound. These components were: biology, behavior, physical environment, social influences, services, and policy. Another significant modification of the Healthy People 2010 model was the considerable expansion of services and policy domains beyond those of health policy and health services, which was the original intent of the 2010 model. This is because the committee recognized that a wide range of services (e.g. education, welfare, and sanitation services) and policies (e.g. tax, law enforcement, road safety and environmental policies) have considerable impact on child health. Each of these categories was conceptualize as having many elements within them. A partial list of components of these domains is shown in Table 1 . Both within the groupings and across groupings these influences interact with one another and their relative importance changes over time and through development. Some of these changes are predictable and others depend on what the individual child experiences. For example, in early childhood the family is probably the most important social influence, while later in development other components, such as the community and the peer group, have greater impact. In terms of unique experiences, changes in the family composition or family dislocation, illness or toxic exposures may have great impact in one child’s development, in contrast with those who experience long term stability.

A new model

Altogether various influences interact over time and throughout development in a way that can be compared to and visualized as being like a kaleidoscope. That is to say, the patterns that emerge are partly determined by the initial constellation of factors at the time of the child’s birth. All prior exposures are embedded in his or her biology at birth and are incorporated into the initial template. But two individuals with different initial patterns will react differently to subsequent influences, even when they are exposed to the identical ones. Moreover, influences that are experienced by the individual at different stages of development will also have discrete effects, depending on when they are experienced. As a result, two children with different preexisting templates may react differently and their subsequent health will reflect those differences.

A picture of the component influences at any given time can be visualized as a Venn diagram (Fig. 1 ). Within each component, there are many subcomponents, as discussed in the section on influences, and each of those subcomponents may be of different importance at a given time and stage. They may be viewed as mini kaleidoscopes within the domain and are also similar to the whole domain in that they vary in their importance throughout development.

Multiple interacting influences.

As things change during a child’s development and over time, the kaleidoscope changes, depending on how the influences affect the individual or group of children (Fig. 2 ). The ways in which influences of various types affect a given child will depend on the arrangements of the preexisting template at the time of the new experience. This is like giving a twist to the crystals in the kaleidoscope, in which different sets of crystals will produce differing patterns.

Model of children’s health and its influences.

Additionally, the committee also recognized that there are some periods of time that are critical or sensitive and have magnified impact on health and development. Critical periods are ones in which an influence has a determinative effect on health, such as early prenatal exposure to Thalidamide during a critical period of embryogenesis, while sensitive periods are ones in which there is increased vulnerability, but no absolute effect. During these periods, exposure to certain influences has a more significant impact. For example, children who are not exposed to language in early infancy, may not recoup that loss completely, while that same lack of exposure later in development may have a far smaller effect. Similarly, parental separation or death may have different consequences depending on both the child’s template at the time of the occurrence and the age at which the trauma is experienced.

Nature vs nurture

For many generations people have argued about the role of nature versus nurture in determining health outcomes. However, in the last several decades this debate finally has some important answers, and we are finally beginning to understand how environments “get under our skin.” Since the mapping of the human genome, we have learned that the environment affects and alters the expression of our genes mainly by upregulating and down regulating them through epigenetic mechanisms. At other times exposures to specific influences actually interfere with gene replication and expression in a more deterministic fashion, as when there is exposure to radiation that alters the genes themselves.

Moreover, we now understand that adverse childhood experiences produce toxic stress and that when the allostatic load becomes too great, it produces changes in gene expression through epigenetic mechanisms. The ensuing changes affect multiple body systems including the brain, autonomic, neuroendocrine, immune, cardiovascular, and gastro-intestinal systems. 24 , 25 These changes have been associated with chronic inflammation, something that may affect long-term health and survival and sometimes can even be passed to the next generation, as has been shown for the effects of racism. Epidemiologic studies have long supported that increasing numbers of childhood exposures to these forms of stress are associated with physical and mental illness and premature death in adulthood. 26 , 27

It is important to also acknowledge the critical role that caregivers play in nurturing children and in buffering them against the noxious effects of stresses. This nurturance and buffering effect is something that is critical in helping children to thrive in spite of influences that threaten their health. It is also likely that those buffers are of special importance at times of transition in growth and development.

Implications

The implications of the committee’s definition and model of health are far reaching. One inherent implication of the model is that we can never measure all the factors that influence child health in any single study. As a result, it brings a new perspective to some of our efforts to interpret research data. For example, if two studies of outcomes of very low birth weight infants come to somewhat different conclusions about predictors of outcome, our tendency has been to try to determine which study was flawed and which was more reliable. Perhaps, instead we should question whether the subjects differed in some unmeasured, but significant, way that influenced their outcome.

The model also emphasizes that health does not derive primarily from medical care. In doing so it brings into question the ways in which our society divides budgets for the many kinds of services and policies that contribute to health and healthy development. The effects of decisions in these domains often omit consideration of their impact on children’s health and well-being. Some have suggested that we should have a process like our consideration of environmental impact for projects that would consider child health impact when new projects or policies are put into effect.

Finally, the model underscores the long reach of childhood influences on adult health. This is far more appreciated now, than at the time of the committee report, because of several factors. First is the increased understanding of epigenetics and the long-term implications of changes in gene expression. Another factor is the growing literature on the effects of adverse childhood experiences (ACES). It is now unquestionable that these societal issues impact both child wellbeing and adult health and survival. Our awareness of these factors has also led to far more consideration of other social factors, and to the appreciation of the influence of social determinants of health. These include economic stability, education access and quality, health care access and quality, neighborhood and built environment, social and community context ( https://health.gov/healthypeople/priority-areas/social-determinants-health ) – a list quite like those in the Committee’s model.

The growing awareness of the long reach of child health is important for the field of pediatrics, which has long suffered from a lack of investment. This is a result of the degree to which finances have driven investment in health and health care. In general child health costs are so much lower than the costs of adult care, except for care of the very low birth weight infant and certain malignancies. As appreciation grows for the importance of environmental factors during childhood on ultimate health, we can hope that investments increase in relatively low-cost preventive measures that may alter longer term outcomes.

Future projections

Given our increased knowledge about the impact of environment and life events on children, we would be remiss if we did not highlight the changing nature of the world in which we live. The numerous wars around the world are massively disrupting children’s lives and causing mass migration. The COVID pandemic caused millions of deaths, including those of many caregivers, and world-wide disruption of daily life with loss of educational and social opportunities for countless numbers of children. Many of these losses appear to be having long-reaching impact on their education, development, and mental health. 28 Additionally, the direct and indirect effects of climate change, which is making some areas of the globe less habitable, and subjecting others to catastrophic weather event, fires, and floods, are producing massive dislocations. Many of these influences are affecting the children who are already most vulnerable.

When children experience these catastrophes, it has lasting effects on their health and developmental trajectories. In addition to the frequent events themselves, they are often accompanied by loss of caregivers, whose protection is so important to helping children deal with stresses, and to loss of routines, which provide stability and a sense of normalcy. Additionally, they often lose educational opportunities that would enable them to develop skills that would improve their future welfare. Even when there are no direct physical or observable injuries, all these factors increase children’s allostatic load and are embedded in their gene expression, causing inflammation and premature aging of many body systems, and setting them up for future poor health. It is important for the child health community to do all that it can to help buffer these effects and to help inform policy makers of their long impacts and costs to the individual and to society. The definition and model inform the child health community that our failure to do so is likely to be accompanied by a generation whose health and well-being is in peril.

Conclusions

We believe that the definition that the committee adopted and the model of how health evolves has had a major impact on thinking in the field. To some extent it forecast the CDC’s Health People 2020’s model of health “that recognized a life stages perspective. This approach recognizes that specific risk factors and determinants of health vary across the life span. Health and disease result from the accumulation (over time) of the effects of risk factors and determinants” ( https://wayback.archive-it.org/5774/20220413162937/https://www.healthypeople.gov/2020/leading-health-indicators/Leading-Health-Indicators-Development-and-Framework ). The emphasis on child development may have had some role in helping other clinicians to focus on the fact that development does not stop when one reaches adulthood. It is entirely compatible with the Healthy People 2030’s goal to “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all” 29 and can serve as a guiding principle for pediatrics and our society. It suggests that society should want to invest in children because they are our nation’s most important resource. The definition of child health presented by the committee has many useful principles that can guide our research, clinical care, and policies to try to protect long-term thriving of the maximum number of children. It is one that can continue to guide our work for many decades to come.

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A Practical Guide for State Teams to Increase Inclusion in Early Childhood Programs

August 29, 2024

Lori Connors-Tadros

GG Weisenfeld

A Practical Guide for State Teams to Increase Inclusion in Early Childhood Programs offers valuable insights for state agency leaders and advocates on using data to promote inclusive policies for young children in early care and education settings. Designed for State Early Childhood Inclusion Teams, the guide provides actionable steps to foster a culture of inclusion, particularly for children with disabilities. It outlines key strategies such as forming dedicated teams, leveraging data for decision-making, and understanding funding opportunities to achieve inclusive goals. The Inclusion Guide primarily focuses on preschool children, ages three to five, aiming to ensure they have access to the programs and services that best support their development.

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Dr. Lori Connors-Tadros is a recognized national leader in early care and education policy and research and provides technical assistance to states to use research to craft and implement effective policies. Lori has deep expertise in comprehensive state early childhood systems, finance and governance for effective policy implementation, leadership and agency capacity to implement policy and improve access, and research and policy to improve outcomes for young children.

GG Weisenfeld is a Senior ECE Policy Specialist at the National Institute for Early Education Research (NIEER) at Rutgers University, Graduate School of Education.

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The National Institute for Early Education Research (NIEER) at the Graduate School of Education, Rutgers University, New Brunswick, NJ, conducts and disseminates independent research and analysis to inform early childhood education policy.

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Brain Development and the Role of Experience in the Early Years

Adrienne l. tierney.

Harvard Graduate School of Education

Charles A. Nelson, III

Children’s Hospital Boston Harvard Medical School

Charles A. Nelson III, PhD, is a professor of pediatrics and neuroscience at Harvard Medical School and the Richard David Scott Chair in Pediatric Developmental Medicine Research at Children’s Hospital Boston. A developmental cognitive neuroscientist, Nelson’s interests lie broadly with how experience influences brain development, with a particular interest in the processing of faces and facial expressions. He has conducted research on typically developing infants and children and children who have experienced early biological and psychosocial adversity.

Research over the past several decades has provided insight into the processes that govern early brain development and how those processes contribute to behavior. In the following article, we provide an overview of early brain development beginning with a summary of the prenatal period. We then turn to postnatal development and examine how brain functions are built and how experience mediates this process. Specifically, we discuss findings from research on speech and on face processing. The results of this research highlight how the first few years of life are a particularly important period of development of the brain.

The past 30 years of research have provided a new and deeper understanding of the brain and its role in psychological functions. In particular, researchers now have a better sense of how brain development affects the development of behavior. Measurement techniques such as electroencephalogram (EEG) and event related potentials (ERP) can be used to study infants, children, and adults, and this flexibility has allowed researchers to investigate a variety of developmental processes.

Research using these measures on the developing brain has clarified several arguments about the nature of child development and informed debates such as those surrounding the state of the infant’s brain at birth (whether it is a “blank slate” or not), the identification of critical periods of development, and the relative importance of genes versus environment.

It is important to note that, although much of the research has been conducted on infants, it is a collaborative effort between infant and animal research that has uncovered the neurobiological principles that govern development in humans. Researchers have made use of the homology that exists among developing nervous systems of different species, and many of the cutting-edge ideas discussed in the developmental literature have their origins in animal research—but they have been tested and clarified in neurobehavioral experiments with infants and young children. In humans, researchers can investigate the neural correlates of behavior whereas in animals they can dig deeper into the mechanisms that drive the processes that these neural correlates reflect. To this end, much of human brain research in the past three decades has focused on the brain basis of behavior. A more recent a focus on experience has helped refine researchers’ understanding of how developmental processes are fueled.

In the following paragraphs, we will examine some of the essential ideas that have helped researchers understand the development of the human brain in the early years of life. We begin with an overview of the stages involved in the anatomical development of the brain. Subsequently, we examine three topics that research in brain development has uncovered, clarified, and elaborated: how development is hierarchically structured, such that later development depends on early development; how experience in the first year of life modulates the plasticity of the brain; and how early deprivation has strong and lasting effects on the brain.

Early Stages of Brain Development

An account of brain development in the early years of childhood is only complete if we first examine the origins of this process during the prenatal months. Brain development is a protracted process that begins about 2 weeks after conception and continues into young adulthood 20 years later. Brain development that occurs during the prenatal months is largely under genetic control, although clearly the environment can play a role; for example, it is well known that the lack of nutrition (e.g., folic acid) and the presence of toxins (e.g., alcohol) can both deleteriously influence the developing brain. In contrast, much of brain development that occurs postnatally is experience-dependent and defined by gene–environment interactions. Below we provide brief descriptions of the anatomical changes that characterize the early stages of brain development.

Neurulation

About 2 weeks after conception, the developing embryo has organized itself into a three-layered, spherical structure. In one area of this sphere, the cells thicken to form what is called the neural plate . This plate then folds over onto itself, forming a tube that gradually closes first at the bottom and then at the top, much like a zipper. This creates the neural tube, the inner cells of which will lead to the formation of the central nervous system (brain and spinal cord) while the outer cells will give rise to the autonomic nervous system (nerves outside the brain and spinal cord).

Once the neural tube is closed, it becomes a three-vesicle structure and shortly thereafter a five-vesicle structure. The different regions of tissue around the ventricles will become distinct brain structures. The anterior portion of the tube will become the forebrain , which includes the cerebral hemispheres; the diencephalon (the thalamus and the hypothalamus); and the basal ganglia. The cells around the middle vesicle will become the midbrain , a structure that connects the diencephalon to the hindbrain. The rear-most portion of the tube will give rise to the hindbrain , which will consist of the medulla oblongata, the pons, and the cerebellum. Finally, the cells that remain will give rise to the spinal cord.

Proliferation

Once the general structure of the neural tube has been laid out, the cells that line the innermost part of the tube, called the ventricular zone , proliferate at a logarithmic rate. As these cells multiply, they form a second zone, the marginal zone , which will contain axons and dendrites. This proliferative stage continues for some time, with the consequence that the newborn brain will have many more neurons than the adult brain. The overproduction of neurons is eventually balanced by a process of apoptosis , or programmed cell death. Apoptosis is responsible for a decrease in the cell numbers to adult levels and is completely under genetic control.

Cell migration

After the cells are born, they travel to their final destinations. The cerebral cortex is composed of multilayered tissue several millimeters thick. It is formed by the movement of cells in an inside-out direction, beginning in the ventricular zone and migrating through the intermediate zone, with the cells eventually reaching their final destination on the outside of the developing brain. The earliest migrating cells occupy the deepest cortical layer, whereas the subsequent migrations pass through previously formed layers to form the outer layers. About 25 weeks after conception, all six layers of the cortex will have formed.

The inside-out pattern of migration described here is that of radial migration , which applies to about 70%–80% of migrating neurons, most of which are pyramidal neurons and glia. Pyramidal neurons are the large neurons in the cortex that are responsible for sending signals to different layers of the cortex and other parts of the brain. Glia are nonneuronal brain cells that are involved in the support of neuronal processes (such as producing myelin or removing debris, such as dead brain cells). In contrast, interneurons —relatively smaller neurons that are involved in communication between pyramidal cells within a particular layer of the cortex—follow a pattern of tangential migration.

Differentiation

Once a neuron has migrated to its target destination, it generally proceeds along one of two roads: It can differentiate into a mature neuron, complete with axons and dendrites, or it can be retracted through apoptosis. Current estimates suggest that the number of neurons that are retracted is between 40% and 60% (see Oppenheim & Johnson, 2003 ). The development of axons is facilitated by growth cones , small structures that form at the edge of an axon. The cellular processes that occur at the growth cone promote growth toward certain targets and away from others. Such processes are driven by molecular guidance cues as well as by anatomic structures at the tip of the growth cone.

Dendrite formation occurs by a slightly different process, one that is thought to be driven by genes controlling calcium-regulated transcription factors ( Aizawa et al., 2004 ). Early dendrites appear as thick strands with few spines (small protuberances) that extend from the cell body. As dendrites mature, the number and density of spines increases, which in turn increases the chances that a dendrite will make contact with a neighboring axon. Connections between dendrites and axons are the basis for synaptic connections between neurons, which, as we will describe below, is essential for brain function.

Synaptogenesis

A synapse is a point of contact between two brain cells, often two neurons and frequently a dendrite and an axon. The first synapses are generally observed by about the 23rd week of gestation ( Molliver, Kostovic, & Van der Loos, 1973 ), although the peak of production does not occur until some time in the first year of life. As is the case with neurons, massive overproduction of synapses is followed by a gradual reduction. This process of synapse reduction, or pruning , is highly dependent on experience and serves as the basis of much of the learning that occurs during the early years of life. It is important to note that the various structures of the brain reach their peak of synapse production at different points. In the visual cortex, for example, the peak is reached somewhere between the 4th and 8th postnatal month, but areas of the prefrontal cortex do not reach their peak until the 15th postnatal month. The difference in timing in peak synapse production is important because it affects the timing of the plasticity of these regions; the later the peak synapse production, the longer the region remains plastic.

Synapse pruning

The overproduction of synapses is followed by a pruning back of the unused and overabundance of synapses. Until the stage of synaptogenesis, the stages of brain development are largely gene driven. However, once the brain reaches the point where synapses are eliminated, the balance shifts; the process of pruning is largely experience driven. As with synapse production, the timing of synapse pruning is dependent on the area of the brain in which it occurs. In the parts of the cortex involved in visual and auditory perception, for example, pruning is complete between the 4th and 6th year of life. In contrast, pruning in areas involved in higher cognitive functions (such as inhibitory control and emotion regulation) continues through adolescence ( Huttenlocher & Dabholkar, 1997 ). The processes of overproduction of synapses and subsequent synaptic reduction are essential for the flexibility required for the adaptive capabilities of the developing mind. It allows the individual to respond to the unique environment in which he or she is born. Those pathways that are activated by the environment are strengthened while the ones that go unused are eliminated. In this way, the networks of neurons involved in the development of behavior are fine-tuned and modified as needed.

Myelination

The final process involved in the development of the brain is called myelination . In this process the axons of neurons are wrapped in fatty cells, which ultimately facilitates neuronal activity and communication because this insulation allows myelinated axons to transmit electrical signals faster than unmyelinated axons. The timing of myelination is dependent on the region of the brain in which it occurs. Regions of the brain in certain sensory and motor areas are myelinated earlier in a process that is complete around the preschool period. In contrast, regions involved in higher cognitive abilities, such as the prefrontal cortex, the process is not complete until adolescence or early adulthood (for recent reviews see Nelson, de Haan, & Thomas, 2006 ; Nelson & Jeste, 2008 ).

In general, brain development begins a few weeks after conception and is thought to be complete by early adulthood. The basic structure of the brain is laid down primarily during the prenatal period and early childhood, and the formation and refinement of neural networks continues over the long term. The brains’ many functions do not develop at the same time nor do their developmental patterns follow the same time frame. Although basic sensation and perception systems are fully developed by the time children reach kindergarten age, other systems such as those involved in memory, decision making, and emotion continue to develop well into childhood. The foundations of many of these abilities, however, are constructed during the early years.

The principles of anatomical change described above are essential to the maturation and development of the brain. These processes are in turn responsible for the development of a vast repertoire of behaviors that characterizes the early years of life. In terms of motor development, both synaptic pruning and myelination are responsible for the improved precision and speed of coordinated movement. In addition, they are important in the development of cognitive skills. Improved perception of speech sounds and face recognition, for example, are likely the result of synaptic reorganization, a process that is dependent on experience.

Although development continues into early adult years, early childhood represents a period particularly important to development of a healthy brain. The foundations of sensory and perceptual systems that are critical to language, social behavior, and emotion are formed in the early years and are strongly influenced by experiences during this time. This is not to say that later development cannot affect these behaviors—on the contrary, experiences later in life are also very important to the function of the brain. However, experiences in the early years of childhood affect the development of brain architecture in a way that later experiences do not. In the following pages we will elaborate on how experience affects development between birth and 3 years of age.

Brain Beginnings: Constructing a Foundation for the Future

The development of the brain is a life-long process. Indeed, recent research suggests that the brain is capable of changing throughout the lifespan ( Crawford , Pesch, & von Noorden, 1996 ; Jones, 2000 ; Keuroghlian & Knudsen, 2007 ), although perhaps not in all ways (e.g., humans do not “learn” to see or hear better as they age). However, the changes that take place during the early years are particularly important because they are the bedrock of what comes after. Higher level functions are dependent on lower level functions, the evidence for which is primarily in the basic cognitive processes and sensory perceptual systems. When infants are born, their brains are prepared for certain types of experience. For example, as discussed below, infants’ brains are tuned to the sounds of virtually all languages, but with experience, their brains become most tuned to their native language (see Kuhl, 2004 , for discussion). This perceptual bias is the basis for learning language; the brain is partially tuned to be sensitive to language sounds but not so broadly tuned as to be sensitive to all possible sounds.

Subsequent language development builds on this initial sensitivity. Within the first year of life, infants learn to discriminate among sounds that are specific to the language they are exposed to in their particular environment. Before the time they are 6 months old, infants can discriminate among sounds of almost any language. Between 6 and 12 months, the brain begins to specialize in discriminating sounds of the native language and loses the ability to discriminate sounds in nonnative languages ( Kuhl, Tsao, & Liu, 2003 ). This narrowing of perceptual sensitivity is important because it is related to later language ability in that better discrimination of native language sounds predicts better language skills later in life ( Kuhl, 2004 ).

Sensitive Period: Plasticity Is Affected by Experience

The brain is much more sensitive to experience in the first few years of life than in later years. The plasticity of the brain underlies much of the learning that occurs during this period. In the language example in the previous section, we noted that infants are sensitive to most language sounds in the first half-year of life but during the second half they begin to specialize in their native tongue at the expense of the broad sensitivity to nonnative language sounds. The period of heightened sensitivity to language exposure is not, however, a critical period in the sense that infants can no longer learn the sounds of another language once it is over. In fact, 12-month-old infants given additional experience with speech sounds from a nonnative language continue to be able to discriminate among sounds ( Kuhl, Tsao, & Liu, 2003 ).

Similarly, in the domain of face processing , an index of development of visual perception important to social behavior, 6-month-olds, 9-month-olds, and adults are all equally capable of discriminating between two human faces, whereas 6-month-olds alone can discriminate between two monkey faces ( Pascalis, de Haan, & Nelson, 2002 ). However, 6-month-olds given 3 months of experience viewing a range of monkey faces retain the recognition ability at 9 months ( Pascalis et al., 2005 ). Thus, the plasticity that characterizes brain processes during this time suggests that although the brain is particularly sensitive to experiences that occur, experience-dependent change is not limited to this short window. The sensitive period is effectively extended by specific experience.

A similar phenomenon exists in visual acuity, which is demonstrated by the natural occurrence of cataracts, rather than the laboratory manipulations discussed above. Maurer, Lewis, Brent, and Levin (1999) reported that for infants who are born with cataracts, a few moments of visual experience after the cataracts have been removed and replaced with new lenses leads to substantial improvements in visual acuity. This effect is stronger the sooner after birth this corrective procedure takes place. The longer the cataracts are left untreated, however, the lower the effect of experience on the outcome.

As demonstrated above, both speech and faces are initially processed by a broadly tuned window that then narrows with experience, yet the window can remain broader if experience includes a wide range of inputs. These studies suggest that the early period of life is characterized by sensitive periods that are dependent on the pattern of input from the environment. In response to certain input, the networks become biased, and future modifications become more difficult.

Deprivation: Environmental Effects on Brain Structure and Function

The effects of experience go beyond the simple modulation of plasticity. In fact, experience shapes the structure of the brain, a finding that has been demonstrated by the Bucharest Early Intervention Project (BEIP). This ongoing longitudinal study has found that institutionalization at a young age leads to severe consequences in the development of both brain and behavior. The study is following three groups of children: an Institutionalized group, children who have lived virtually all their lives in an institutional setting in Bucharest, Romania; a Foster Care group, which includes children who were institutionalized at birth and then placed in foster care ( at a mean age of placement of 22 months); and a Never Institutionalized group, which includes children living with their biological families in the Bucharest region (for details see Zeanah et al., 2003 ). As discussed above, for healthy development of brain circuits, the individual needs to have healthy experiences; the lack of these may lead to the underspecification and miswiring of brain circuits. Children raised in institutional settings in Romania lack experiences that stimulate healthy growth and thus we would expect to see consequent “errors” in brain development giving rise to a range of problems. Indeed this is the case; the institutionalized children show patterns of physical and cognitive growth that are stunted and delayed, and they have very different patterns of brain activity when compared to children who have never been institutionalized ( Marshall, Fox, & the BEIP Core Group, 2004 ). In addition, the effect of timing of experience is also important in preventing and amelioriating the effects of deprivation: children who were placed in foster care before they were 2 years old show patterns of brain activity that are more similar to never-institutionalized children than do those placed in foster care after they turn 2 ( Marshall et al., 2008 ). The same general trends are also observed for IQ ( Nelson et al., 2007 ) and language ( Windsor et al., 2007 ). These results support the idea that the lack of good quality experience has detrimental effects on brain function and that once the child is older than 2 years these effects tend to be worse.

An important distinction that must be made here is between deprivation and enrichment . The studies described earlier took place in the context of deprivation, in comparison to a baseline norm in which certain needs of the child are met, not enrichment beyond the norm, and they clearly showed that a child deprived of a certain quality of experience will have abnormal brain development. These findings do not indicate, however, whether environments that provide more than the baseline norm will produce brain development that is in some way superior. So although the BEIP studies do suggest that a lack of good quality experience is detrimental, they do not provide evidence for the effects of enriched experience.

Conclusions

In this article we have attempted to illustrate how the developmental neurosciences can shed light on early childhood development. Prenatal development is largely driven by genetic processes, many of which are sensitive to the biochemical makeup of the mother’s body but are under genetic regulation. In postnatal development, however, the environment plays a crucial role in fostering development, and the interactions between genetics and experiences account for most developmental outcomes. Brain research suggests that development is a hierarchical process of wiring the brain, in that higher level processes build on a foundation of lower level processes. For example, language development depends critically on sensory and perceptual development (e.g., discrimination of speech sounds). The types of stimuli infants and children are exposed to help shape the brain and behavior. Although the brain may come equipped with biases for certain perceptual information, such as for speech, language, or faces, it is the specific speech, language, and range of faces they are exposed to that drives subsequent development. Depriving young children of the kinds of experiences that are essential to later development—that is, the building blocks that create the scaffolding upon which development depends—leads to severe consequences in both brain structure and function. Studies of institutionalized children suggest that quality psychosocial experiences are necessary for the development of a healthy brain.

It is important to emphasize that the individual does not play a passive role in this process. By experience we do not mean events and circumstances that simply happen in an individual’s life; rather, we define experience as the interaction between the individual and his or her environment. The individual is an agent that can shape his or her experience ( Scarr & McCartney, 1983 ). For example, a child who appears happy in response to a caregiver singing a song may elicit more singing. This child consequently may have more experience with songs, which could affect his or her language development and the brain processes that underlie it.

Much of brain research is descriptive and simply tells us how the brain contributes to the development of behavior that is typical of young children (e.g., language and face processing). However, some of this research has implications on the decisions we make for young children. Research on deprivation can be used to make the case that environments that adversely affect infants and young children need to be remedied before they have long lasting consequences on both brain and behavior. Intervening in adverse circumstances is more successful if it occurs before brain processes become entrenched and in turn harder to rewire.

Contributor Information

Adrienne L. Tierney, Harvard Graduate School of Education.

Charles A. Nelson, III, Children’s Hospital Boston Harvard Medical School.

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InBrief: The Science of Early Childhood Development

Content in This Guide

Step 2: How Does Early Child Development Happen?

Step 3: What Can We Do to Support Child Development?

Brains are built over time, from the bottom up.

The interactive influences of genes and experience shape the developing brain.

The brain’s capacity for change decreases with age.

Cognitive, emotional, and social capacities are inextricably intertwined throughout the life course.

Toxic stress damages developing brain architecture, which can lead to lifelong problems in learning, behavior, and physical and mental health.

Policy Implications

Related Topics: toxic stress , brain architecture , serve and return

Theories of Child Development and Their Impact on Early Childhood Education and Care

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The Power of Playful Learning in the Early Childhood Setting

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Playful Learning: A Powerful Teaching Tool

What Is Playful Learning?

Self-Directed Play, Free Play

Why Playful Learning Is Critical

Learning Through Play: A Play Spectrum

Guided Play

Facilitating Guided Play

Evidence Supporting Guided Play as a Powerful Pedagogical Tool

Next Steps for Educators

Teaching Play Skills

Early Childhood Development: the Promise, the Problem, and the Path Forward

Early Childhood: The Scale of the Problem

The Good News: ECD Interventions Are Effective

The Reality: ECD Has Not Been a Priority

Impediments to Scaling Up

The Future: An Agenda for Scaling Up ECD

Defining child health in the 21st century

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Brain Development and the Role of Experience in the Early Years

Charles A. Nelson, III

Early Stages of Brain Development

Neurulation

Proliferation

Cell migration

Differentiation

Synaptogenesis

Synapse pruning

Myelination

Brain Beginnings: Constructing a Foundation for the Future

Sensitive Period: Plasticity Is Affected by Experience

Deprivation: Environmental Effects on Brain Structure and Function

Conclusions