Child development

In this step Dr Bilal Avan explores early childhood development, providing an overview of the key issues discussed in his book, Early Childhood Development: From Understanding to Initiatives (2008). Early Childhood Development (ECD) refers to the intellectual, linguistic, socio-emotional and physical development and wellbeing of young children. Childhood development refers to age-associated changes occurring in a gradual continuum. ECD is a broad-based scientific discipline with roots in medical, behavioural and social sciences. Critical factors which affect childhood development are categorized into: Pre-Pregnancy, Prenatal and Perinatal well-being; Health and Nutrition of the child; Caregiver’s Attitude towards the child; and Stimulating Physical and Social environment.


Childhood is a precious phase of life for the child and family. More broadly, it creates a promise of happiness and prosperity for communities and nations. The critical significance of the early phase of life is borne out of modern scientific facts generated by behavioural, economic, medical and social sciences. Sound nurturing of children yields physically well-developed adults, psycho-socially stable personalities, cognitively and economically productive citizens, and above all, a healthy society whose people are responsible and conscientious.

Traditionally, families and communities have formed their own local beliefs and practices around providing for young children with regard to security, shelter, clothing, hygiene and feeding needs. Emphasis has been placed on, and priority given to, these practices, irrespective of how grounded they were in fact. Consequently, the concept of childcare and expectations for development have been restricted to responding only to a child’s basic needs for survival and physical growth. This has resulted in a significant loss of human potential. The magnitude of the problem is evidenced by the fact that well over 200 million pre-school children from low-and-middle-income countries (LMICs) experience poverty and malnutrition. It is estimated that one in every three of these pre-school children have a delayed cognitive or socio-emotional status.

Until recently in the public health sphere, limited conscious emphasis was placed on meaningful interaction and stimulation as a child’s basic needs. Nor was the case made that investment in early childhood reaps a greater yield of human development in the future. The questions that communities and nations must grapple with are: WHY and HOW MUCH to invest, and WHAT to expect in terms of optimal growth and development during early childhood.


Childhood is an integral part of the human lifespan, and is acknowledged as such across cultures and disciplines. Historically, one common belief was that children’s primary worth lies in their potential to give sense and accomplishment to the lives of their parents. However, in recent times attitudes and understanding have shifted dramatically. New thinking developed after the First World War, when an unprecedented number of children were left without parents. Conventional family structures were uprooted in a short span of time. Industrialization affected family configurations and living conditions, and advances in developmental psychology and social epidemiology were making vital contributions to our understanding of early childhood development.

At the socio-cultural level, children in LMICs have generally been considered a blank slate at the time of birth - free of any blemish or cultural imprint. From this perspective, a child embodies an opportunity: with adequate training and nurturing, he or she can be made into a rational, successful human being. The corollary of this belief was the misconception that any intervention to nurture children should begin after birth. However, current scientific evidence strongly suggests that perinatal and prenatal influences lay the foundation of life-long metabolic changes, consequently influencing adult-health outcomes. Hence the genesis-of-life-course approach to achieving optimal childhood and human development.

At the population level, the development of young children with adverse early-life experiences is likely to be delayed - resulting in poor academic performance and a high school-dropout rate - compared with children whose early-life experiences are healthy. In the absence of remedial interventions, this gap persists throughout the life span - leading to a significant loss of human potential.

At the conceptual level, age-defined boundaries of early childhood development are not fully agreed across the service delivery disciplines (e.g. the Health sector generally targets children of 0-3 years; the Education sector, children of 5-8 years; and the Social sector generally becomes active from 3 years onwards). This makes the delivery of complementary and integrated ECD interventions challenging, and not always feasible.

At the measurement level, ECD also proposes a significant challenge:

  1. ECD is a multidimensional construct – each domain needs its own separate assessment in order to arrive at a reliable, conclusive decision about ECD status. However, in practice domain-specific assessment and overall assessments of the developmental status of children are used interchangeably - leading to ambiguous population-level estimates.
  2. ECD manifestations are child-behaviour dependent. ,Meaning that ECD assessment generally requires a culturally-adapted psychometric instrument, which is technically and economically challenging for developing countries, where it is most likely to be needed.

At the ECD programme and service delivery level, it is essential to acknowledge that the determinants of high neonatal and child mortality and morbidity are the same determinants that affect the development of surviving children. In practice, the work of public health professionals dedicated to child survival and child development respectively is mostly compartmentalized.

These professionals generally work in silos, and sometimes even act as antagonists. It is important to expand the prevailing narrow concept of mere child survival to the quality of survival. This implies the process of enabling the child to achieve a higher level of human performance in society through development of expertise and skills.


It is worth noting that in order to track progress towards meeting the Sustainable Development Goals, a clear target has been set to ensure that by the year 2030 all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education. This binds signatory nations to periodically follow up on children under 5 years of age who are developmentally on track in health, learning and psycho-social well-being, for reasons of efficient policy and recourse allocation. This paradigm is sure to stimulate the efforts of practitioners in the field of ECD to support health, education and social care endeavours dedicated to fulfilling the potential of children and optimizing their chances of a happy, healthy, prosperous future.

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This article is from the free online course:

Improving the Health of Women, Children and Adolescents: from Evidence to Action

London School of Hygiene & Tropical Medicine