The early childhood years, particularly ages 0-3, are the building blocks of life. In 2018, the World Health Organisation, UNICEF, the World Bank and the Partnership for Maternal, Newborn and Child Health came up with a framework that highlights the importance of nurturing care for the overall development of a child. Research has shown that adversity faced during early childhood can have a life-long impact. Ogechi Ekeanyanwu of The Conversation Africa asked Robert Hughes, a public health researcher and lecturer on early childhood development, to talk about the effect of toxic stress on children and what proper care looks like.
What is toxic stress and how does it affect children?
Toxic stress is when combined pressures on a developing or growing child become too much. It is when stressors – things like being unwell, or breathing polluted air, or being abused or shouted at – add up so that they undermine growth and healthy development, especially of the brain.
Early childhood seems to be the period of life when this toxic stress has the biggest impact. Most worryingly, there is good evidence that these harms in early childhood can be very hard to overcome later in life. That is why people who work in this field are so keen to make sure that every child has the best possible start in life.
We’re getting better at unpicking the details of the different things that contribute to toxic stress in different settings – like my research area of overcrowding and often poor quality of childcare in informal urban settlements or the drivers of malnutrition. But it’s important to remember that underlying these are two connected, common causes –poverty and a lack of focus on the early years.
Toxic stress is not just a short-term problem for children. There is good data from many countries showing how early adversity undermines learning and then earning.
Is there a way to reverse the impact of early childhood adversity?
Most of the time, yes. Programmes can help to reverse its effects. But this is much harder than preventing it in the first place. There are studies which show that children can catch up (to some degree at least) if they move from very difficult circumstances to much better ones (for example when they are adopted into loving families, or when they move away from areas of conflict and displacement). But such radical changes are quite hard – and very expensive – to achieve. So investment should focus on the early years.
Unfortunately, at the moment, early years interventions are often not there, or are very poorly funded when compared to things like schooling. This is especially the case in much of Africa, and is likely to be made worse by the COVID-19 pandemic.
All that said, lots of promising interventions do exist. But they need to match the reality of early adversity in different contexts, and we need to build the political will to unlock serious resources for the early years.
How can we help children survive and thrive during times of adversity?
Parents and other carers need to give children all the love, care, attention and fun that they can. We need to remember that those early years are vital, and think about them as much as we do about healthcare and formal education. But – as every parent knows – wanting to be able to invest time in care is one thing; the reality of juggling different demands is often another. This is where employers, government and policy makers come in.
Governments (and, in some countries, donors) need to take the lead, investing in early years services like home visiting and subsidised childcare like they do schools and hospitals. Employers need to make sure parents are supported through proper parental leave. The law needs to make sure all of this actually happens. Finally, researchers – like me and my colleagues – need to help work out the best combination of programmes and policies to support children to thrive in different contexts.
What should quality care by parents and caregivers consist of?
The short answer is lots of love and attention, and meeting the child’s needs as they grow. A slightly longer version is provided by what the World Health Organisation and UNICEF call nurturing care. This framework talks about five connected domains, all of which are important to helping babies to thrive.
Firstly, good health: preventative care like vaccinations and also healthcare when children are sick.
Second, adequate nutrition: that means both the quality and quantity of food, ideally starting with breastfeeding and the support this sometimes needs.
Third, responsive care: interaction with and between babies and toddlers, responding to their verbal and nonverbal cues, playing, laughing together.
Fourth, we know that early learning is important too; and it doesn’t start at school.
Finally, security and safety are central to early childhood. This includes the absence of neglect or abuse, as well as living in safety and peace.
A lot of it makes sense intuitively. Everyone in society has a role to play to give all children a good start in life.
Robert Hughes, Clinical Research Fellow, Department of Population Health, London School of Hygiene & Tropical Medicine