Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta-analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer-reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta-analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta-analysis. Of the studies, 15 were from high income countries (HICs) and four from low-middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta-analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs.
Klébya Hellen Dantas de Oliveira, Géssica Mercia de Almeida, Muriel Bauermann Gubert et al.
Height-for-age (HA) and weight-for-age (WA) of children are standard measures to study the determinants of stunting and short-term underweight. Rather than studying these indicators separately, this paper looks at their interaction and therefore at the dynamics of height and weight. Considering HA a child's health stock and WA nutritional investment, we develop an overlapping generations model. The main features of the model are self-productivity of health stocks and the dynamic complementarity between past health stocks and contemporaneous nutrition. We test the model's predictions on a Senegalese panel of 305 children between 0 and 5 years over three periods. To control for endogeneity and serial correlation we employ different GMM methods. We find evidence of self- productive health stocks and that child health produced at one stage raises the productivity of nutritional inputs at subsequent stages. Our results indicate that child health is quickly depleted and needs constant updating. Simulations based on our estimates show that a positive nutritional shock during the first six months of life is essentially depleted at the age of 2. Consequently, sustainable development and nutrition programs have to be long-term and yield higher returns if they reach babies in the early months of infancy.
This article explores the role of education in early childhood development, emphasizing the importance of early learning in cognitive, social, and emotional growth. It discusses the role of educators, the impact of early education on social equality, and the significance of family involvement in the educational process.
Importance: Evidence on the relative importance of various factors associated with child anthropometric failures (ie, stunting, underweight, and wasting) and their heterogeneity across countries can inform global and national health agendas. Objective: To assess the relative significance of factors associated with child anthropometric failures in 35 low- and middle-income countries (LMICs). Design, Setting, and Participants: This cross-sectional study of 299 353 children who were born singleton and aged 12 to 59 months with nonpregnant mothers and valid anthropometric measures assessed the strengths of associations of 26 factors with child stunting, underweight, and wasting, using Demographic and Health Surveys (2007-2018) from 35 LMICs. Data analysis was conducted from July 2019 to February 2020. Exposures: A total of 9 direct factors (ie, dietary diversity score; breastfeeding initiation; vitamin A supplements; use of iodized salt; infectious disease in past 2 weeks; oral rehydration therapy for children with diarrhea; care seeking for suspected pneumonia; full vaccination; and indoor pollution) and 17 indirect factors (household wealth; maternal and paternal education; maternal and paternal height and body mass index; maternal autonomy for health care, movement, and money; water source; sanitation facility; stool disposal; antenatal care; skilled birth attendant at delivery; family planning needs; and maternal marriage age) were assessed. Main Outcomes and Measures: Three anthropometric failure outcomes were constructed based on the 2006 World Health Organization child growth standards: stunting (height-for-age z score less than -2 standard deviations [SDs]), underweight (weight-for-age z score less than -2 SDs), and wasting (weight-for-height z score less than -2 SDs). Results: Among the 299 353 children aged 12 to 59 months included in the analysis, 38.8% (95% CI, 38.6%-38.9%) had stunting, 27.5% (95% CI, 27.3%-27.6%) had underweight, and 12.9% (95% CI, 12.8%-13.0%) had wasting. In the pooled sample, short maternal height was the strongest factor associated with child stunting (odds ratio [OR], 4.7; 95% CI, 4.5-5.0; P < .001), followed by lack of maternal education (OR, 1.9; 95% CI, 1.8-2.0; P < .001), poorest household wealth (OR, 1.7; 95% CI,1.6-1.8; P < .001), and low maternal body mass index (OR, 1.6; 95% CI, 1.6-1.7; P < .001). Short paternal height was also significantly associated with higher odds of stunting (OR, 1.9; 95% CI, 1.7-2.2; P < .001). Consistent results were found for underweight (eg, short maternal height: OR, 3.5; 95% CI, 3.3-3.7; P < .001; lack of maternal education: OR, 1.8; 95% CI, 1.7-2.0; P < .001) and wasting (eg, low maternal body mass index: OR, 2.3; 95% CI, 2.1-2,4; P < .001; poorest household wealth: OR, 1.2; 95% CI, 1.1-1.3; P < .001). Parental nutritional status and household socioeconomic conditions ranked the strongest (1st to 4th) for most countries, with a few exceptions (eg, lack of maternal education ranked 18th-20th in 8 countries for child wasting). Other factors were not associated with anthropometric failures in pooled analysis and had large country-level heterogeneity; for example, unsafe water was not associated with child underweight in the pooled analysis (OR, 0.97; 95% CI, 0.95-1.00; P < .001), and it ranked from 4th to 20th across countries. Conclusions and Relevance: In this study, socioeconomic conditions and parental nutritional status were the strongest factors associated with child anthropometric failures. Poverty reduction, women's education, and nutrition programs for households could be important strategies for reducing child undernutrition; however, country-specific contexts should be considered in national policy discussions.
Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015-2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world's children with disabilities are unlikely to be realised.
Bolajoko Olubukunola Olusanya, Scott Mitchell Wright, Tracey Smythe et al.
Early childhood development is the physical, cognitive, linguistic, and socioemotional development of young children until primary school. Although a child right, unfortunately many children cannot reach their developmental potential. A pediatrician is a physician who is concerned primarily with the health, welfare, and development of children. Pediatricians have the responsibility to promote early childhood development as well as developmental surveillance and screening for early diagnosis. The WHO/UNICEF Nurturing Care framework has specified 5 main strategies/domains: health, nutrition, responsive care giving, secure-safe environment and early education opportunities for early childhood development. The pediatrician plays the role of service provider, advocate, researcher or educator in all these domains. All these domains can only be successfully fulfilled through multidisciplinary collaboration, a way of working that pediatricians are accustomed to using.
Importance: Although a growing number of studies have reported negative associations of the COVID-19 pandemic with academic performance among school-aged children, less is known about the pandemic's association with early childhood development. Objective: To examine the association between the COVID-19 pandemic and early childhood development. Design, Setting, and Participants: In this cohort study conducted in all accredited nursery centers in a Japanese municipality, baseline surveys of children aged 1 and 3 years (1000 and 922, respectively) were conducted between 2017 and 2019, and participants were followed up for 2 years. Exposure: Children's development was compared at age 3 or 5 years between cohorts that were exposed to the pandemic during the follow-up and a cohort that was not. Main Outcome and Measure: Children's developmental age was measured by nursery teachers using the Kinder Infant Development Scale (KIDS). Data were analyzed between December 8, 2022, and May 6, 2023. Results: A total of 447 children (201 girls [45.0%] and 246 boys [55.0%]) aged 1 year at baseline were followed up to age 3 years, and 440 children (200 girls [45.5%] and 240 boys [54.5%]) aged 3 years at baseline were followed up to age 5 years. During the follow-up, the cohorts that were exposed to the pandemic were 4.39 months behind in development at age 5 compared with the cohort that was not (coefficient, -4.39; 95% credible interval, -7.66 to -1.27). Such a negative association was not observed in development at age 3 years (coefficient, 1.32; 95% credible interval, -0.44 to 3.01). Variations in development were greater during the pandemic than before the pandemic regardless of age. Additionally, the quality of care at nursery centers was positively associated with development at age 3 years during the pandemic (coefficient, 2.01; 95% credible interval, 0.58-3.44), while parental depression appeared to amplify the association between the pandemic and delayed development at age 5 (coefficient of interaction, -2.62; 95% credible interval, -4.80 to -0.49; P = .009). Conclusions and Relevance: The findings of this study showed an association between exposure to the pandemic and delayed childhood development at age 5 years. Variations in development widened during the pandemic regardless of age. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.
Stunting is a chronic nutritional problem affecting child growth and development in Indonesia. The prevalence of stunting remains a serious problem, influenced in part by caregiver feeding practices. The study aimed to find the relationship between parenting styles and feeding practices on the incidence of stunting in children aged five years and under. The method was cross-sectional with data collected through interviews using a structured questionnaire. Samples were selected from 150 children aged between 6 and 59 months from five villages in the border area of Argamakmur Health Centre, Arga Makmur, using a cluster sampling technique. Data were analysed applying the chi-square analysis test to find associations between some of the variables studied. The analysis showed statistically significant associations between parenting styles (p value = 0.010) and feeding practices (p value = 0.015) on the incidence of stunting of children aged under five years and below. This study concludes that parenting style and feeding practices have a significant association with the incidence of stunting in children aged five years and below. Therefore, an integrated multisectoral approach is needed in care interventions and feeding practices to prevent stunting in children aged five years and under.
This study examines the long-term relationships among macroeconomic indicators, labor market dynamics, and child nutrition outcomes in four ASEAN economies—Brunei, Malaysia, the Philippines, and Singapore—from 1999 to 2024. Drawing on twelve complete indicators from the World Development Indicators, the analysis employs a correlational–comparative design to assess country-specific association patterns. The methodological approach combined secondary time-series data with Pearson’s correlation analysis, computed separately for each country to avoid aggregation bias. Indicators spanned three domains: macroeconomic (inflation, purchasing power parity, foreign reserves), labor (employment-to-population ratio, labor force participation, unemployment), and child nutrition (stunting and overweight prevalence). By integrating country-level correlations with insights from the literature on maternal employment, household resources, and service systems, the study situates macro trends within household-level nutrition risks. Findings reveal significant heterogeneity across countries. Singapore demonstrated strong positive links between reserves and employment, and negative correlations between employment and stunting, underscoring the role of institutional childcare and social spending in converting growth into human capital gains. Brunei, despite substantial reserve accumulation, exhibited inverse labor engagement and paradoxical increases in stunting, consistent with the “resource curse” narrative. Malaysia presented transitional patterns: reserves were weakly mobilized for nutrition outcomes, while purchasing power partially reduced unemployment and stunting. The Philippines displayed strong inverse relationships between purchasing power and unemployment, and between reserves and stunting, but showed mixed employment–nutrition dynamics, reflecting the persistence of informality and fragile social protection. Across contexts, employment alone did not uniformly reduce undernutrition and sometimes correlated positively with stunting in weaker care systems. The results affirm that macroeconomic growth and stability, while necessary, are insufficient for achieving equitable nutrition outcomes. Aligning fiscal surpluses, purchasing power, and employment growth with inclusive, nutrition-sensitive, and family-responsive policies is critical. The study contributes to ASEAN’s policy dialogue by highlighting the structural conditions under which economic progress translates into improved child health and sustainable human development.
Young children living in conditions of war, disaster, and displacement are at high risk for developmental difficulties that can follow them throughout their lives. While there is robust evidence supporting the need for early childhood development (ECD) in humanitarian settings, implementation of ECD programming remains sparse, largely due to the lack of evidence of how and why these programs can improve outcomes in humanitarian settings. In order to build the evidence base for ECD in humanitarian settings, we review the current state of implementation research for ECD programming (targeting children 0-8) in humanitarian settings, through a literature review and a series of key informant interviews. Drawing from existing frameworks of implementation research and the findings from our analysis, we present a framework for ECD implementation research in humanitarian settings and propose an agenda for future research.
Katie Maeve Murphy, Hirokazu Yoshikawa, Alice J. Wuermli
