Improving the Nation’s Health

Step One: Reduce Toxic Stress in Early Childhood

These and other studies show that the line separating nature and nurture is blurred and that the period of greatest brain plasticity is in early childhood. “This is why we need to pay far more attention to the family and community environments of young children,” says Shonkoff. “If we can move our public policies in this direction, we are likely to see a significant change in the quality of adult health, which could help control the amount of money our nation spends on medical care.”

Science also tells us that attention to child development should begin before birth. Council Member Charles A. Nelson, the Richard David Scott Professor of Pediatric Developmental Medicine at Harvard Medical School and director of research at the Developmental Medicine Center at Children’s Hospital Boston, focuses his attention on the negative effects of prematurity. “If a baby is born about 5 or 6 weeks early, but is otherwise healthy and doesn’t experience any complications, there seem to be no negative consequences in terms of brain development,” says Nelson. “However, if a baby is born prematurely and has medical complications, such as low weight for gestational age or lung disease that leads to reduced oxygen, these can be associated with problems in brain architecture that weaken cognitive, motor, and sensory development.”

Perhaps most important, however, is the well documented finding that long term developmental outcomes for premature babies are highly influenced by the quality of the environments in which they are raised long after they go home from the hospital. When deviations from typical developmental expectations occur, early detection and intervention are essential.

“Concerns about hearing, vision, and other potential problems can be picked up very early,” says Council Member Deborah A. Phillips, Professor of Psychology and Co-Director of Georgetown University’s Center for Research on Children in the United States. “Absent attention to these basic and potentially profound issues, a child is unable to fully absorb the supports she needs for healthy development. Later investments in health care (and education) will then have to build on a more shaky foundation.”

Systemic Changes Are Key

Clearly we must look far beyond hospitals and doctor’s offices if we are to build a strong childhood foundation for lifelong health. Indeed, healthy development and the reduction of toxic stress in young children are inextricably linked to the institutions and values of the wider community—including families, child care facilities, libraries, parks, schools, neighborhoods, places of employment, and so on. These public environments—the infrastructure of human relationships—can be important facilitators of successful early childhood development, building on the better-known private environments of home and family.

“Relationships build the brain,” says Ross Thompson, professor of psychology at the University of California, Davis, and a Council member. “Supportive relationships buffer stress and contribute to the cognitive and emotional stimulation that developing brains need. They are the avenues for promoting healthy brain growth and they defend young children against both intentional and unintentional injuries.”

• Focus Child Care on Stable, Engaging Relationships. An increasing percentage of young children spend many of their most formative years in public environments such as child care facilities and preschools. Yet insufficient attention has been paid to the quality and stability of the relationships in those important settings. Regulations tend to focus on easily quantifiable features, such as group size and staff-to-child ratios, but the most important quality of child care is the extent to which it responds to children’s individual needs and provides consistent daily relationships with caring adults. These two variables—consistency and individual engagement—are critical building blocks in the formation of sturdy brain architecture and in the foundations of lifelong health.

For information about commonly used terms in Council publications, see Definitions.