Introduction to the topic
The international evidence that high quality early childhood development (ECD) programmes benefit all children’s development, life experiences, and life chances is overwhelming. The evidence comes from studies of all kinds, including well-known large quantitative longitudinal studies (e.g. High/Scope Perry studies in the USA and the work of Heckman at http://heckmanequation.org/) to more localised qualitative case studies (e.g. Ames, Rojas & Portugal, 2010; Munthali, Mvula & Silo, 2014; Save the Children, 2003). As the HEART Early Childhood Development Topic Guide (Woodhead et. al., 2014) points out, early childhood development is an enormous field covering a range of sectors including early learning and education, nutrition, water, sanitation and hygiene (WASH), health, social protection and community. The ECD field extends across multiple sectors and spans the life period from conception through to eight years.
This reading pack focuses on ECD in emergencies, which can be caused by natural hazards (eg. earthquakes, typhoons) and conflicts. An emergency can last from three months to decades depending on the severity of the event and the country’s ability to cope with it. It causes both internal displacement and results in people becoming refugees. This pack starts with the evidence for why ECD is important in emergencies and then goes into examining its impact. Key readings are then provided to allow the reader to delve more deeply into some key concepts. Lastly, a set of key questions are presented to provoke further reflection and discussion.
Why is ECD important in emergencies?
Emergencies pose great risks for all people, and especially for the youngest and most disadvantaged. The youngest children are extremely vulnerable as they depend on a strong protective environment – namely their parents, extended family and community – to ensure their safety, development and well-being. During emergencies, the protective environment or the layers of the child’s ecology that support and influence children’s development, can be weakened and unbalanced thereby affecting normal development. In these situations young children could lose out on the safety and security of their daily routines, a loving caring relationship, early cognitive stimulation, learning, nutrition, immunisations and other support that is essential for their healthy development and well-being. Without these services, children who may have already been in a vulnerable position prior to an emergency face increasing risks when a disaster strikes (Williams et al., 2005). One major risk during emergencies is “toxic stress” which can cause physiological and chemical changes in the body that may never be fully reversed (Bryce et al., 2008; Victora et al., 2008).
Toxic stress and brain development
Toxic stress is the prolonged activation of stress response systems in the absence of sufficient protective factors such as relationships with parents and caregivers (Shonkoff et al., 2012). Some risk factors capable of causing toxic stress include child physical, sexual and emotional abuse, chronic neglect, parental substance abuse, maternal depression, separation from primary caregivers, and/or the accumulated burdens of family economic hardship. In humanitarian situations, the existing adversities children face are compounded and heightened. Research shows that the more risk factors a child has in his/her life, the more likely he/she is to experience toxic stress (Ibid). Harvard University’s research indicates that a significant increase in toxic stress, which often happens in humanitarian situations, even when temporary, has shown to negatively influence children’s brain development, learning and well-being (National Scientific Council on the Developing Children, 2007). Such disruptions increase the likelihood of later impairments in all areas of a child’s development: cognitive (ie: learning, executive function, working memory, decision-making), linguistic, socio-emotional (ie. behavior, impulse control, mood and self-regulation problems) and physical (ie. physical and mental illness) (Ibid). In addition to short term changes in observable behaviour, the chemicals that toxic stress produces can lead to permanent changes in brain structure and function, and can even be passed on from one generation to the next (Shonkoff et al., 2012).
The loss of a parent in particular has been highlighted as one of the most stressful events for children. This stress has been linked with future psychiatric disorders such as depression (Boyden and Mann, 2005). Evidence shows that children with secure, trusting relationships with parents or caregivers are better able to fight against the damaging effects of stress (National Scientific Council on the Developing Child, 2004). Scientific research highlights that by helping young children develop strong, supportive and constant relationships with parents or other caregivers as early in life as possible, ECD programmes can prevent or reverse the negative effects of toxic stress (Ibid).
Children are resilient and science tells us that a child’s experience can shift the scale from negative outcomes to more positive ones (Center on the Developing Child, 2015). ECD in emergency programmes can support children’s resilience and tip that balance when they have a combination of the following types of activities (which are not exhaustive): a stable, responsive and nurturing caregiver; access to early learning and stimulation through play; availability of nutritious food; and immunisations. The more positive inputs a child receives, especially in emergencies, the higher the likelihood that they will follow a positive development trajectory.
What works in emergencies?
Case study of mobile ECD services during the Nepal earthquake
After a mega earthquake hit Nepal in May 2015, killing nearly 10,000 people and destroying thousands of buildings (including early learning, health, community spaces and homes), Plan International started mobile services to reach those cut off from centre-based humanitarian and ECD support, using the Big Blue Bag Approach outlined in key reading 7. A team of four people from the local communities, with backgrounds in early learning and child development, child protection, basic health and nutrition, and community mobilisation, started going from village to village to provide ECD services in the open. In the villages, the teams split up with some working with children and others working with parents to strengthen their capacities to support their own children. Going from village to village, the mobile teams were able to provide ECD services where children had no access, building upon existing capacity.
Suggested entry points for ECD interventions in emergencies can be found in the key readings, particularly 5 (UNICEF, and Plan International), 6 and 7. Key reading 7 provides further case study examples of noteworthy practices, successes, challenges and lessons learnt.
Impact that ECD programmes can have in emergencies
The provision of ECD in emergencies can save lives by ensuring children receive crucial health, nutrition and stimulation inputs. Research conducted in famine stricken parts of Africa, including Ethiopia, showed that the provision of ECD services, in the form of nutrition and early stimulation and parenting education, saved lives and brought children out of acute malnutrition (Play Therapy Africa, 2009). Further, research has found that children who receive nutritional supplements along with early stimulation and learning that promotes brain development, had higher survival rates, healed faster and returned to a more normal development trajectory (Ibid; Hamadani et al., 2006; Yousafzai et al., 2014).
As young children’s brains are shaped during the years of early childhood (0-8 years), there is tremendous opportunity to teach children about tolerance, peace, diversity, problem solving, gender equality, preparing for future disasters and environmental protection. The role of ECD in promoting peace has been documented over the last decade and is getting even more global attention (Leckman et al., 2014; Sunar et al., 2013; UNICEF, 2015; Ang and Oliver, 2015). UNICEF is currently leading the establishment of the Early Childhood Peace Consortium. Well-designed programmes can help children’s willingness to play with others (including those different from themselves), ability to understand how being excluded makes one feel, and ability to recognise instances of exclusion without prompting (Ibid). Additionally, notions of gender equality and care for the environment can similarly be integrated into early years’ work and have shown positive results (UNESCO, 2007; UNICEF, 2011).
As parents and caregivers are included in ECD in emergency support, the benefits spread to them as well, thereby strengthening communities’ ability to care for and support their children’s development. Parenting education in numerous evaluations has shown positive results on parents’ knowledge and skills and children’s development outcomes in fragile contexts (Singla et al, 2015; Aboud, 2007).
Reading 1: National Scientific Council on the Developing Child (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain. Working Paper No. 3. Updated Edition. Retrieved from http://www.heart-resources.org/doc_lib/excessive-stress-disrupts-architecture-developing-brain/.
This article delves deeper into the types of stress and how toxic stress can disrupt a child’s brain development.
Reading 2: Center on the Developing Child at Harvard University (2015). Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience. Working Paper No. 13. http://www.heart-resources.org/doc_lib/supportive-relationships-active-skill-building-strengthen-foundations-resilience-working-paper-13/
This article looks at what influences a child’s ability to be resilient, and how supportive caregiver relationships are key to children’s positive development outcomes.
Reading 3: UNICEF (2013), Podcast #87: Peacebuilding through early childhood education http://learningforpeace.unicef.org/featured/podcast-86-peacebuilding-through-early-childhood-education/
This podcast includes experts’ research findings and practical implementation of peacebuilding through early childhood education.
Reading 4: UNICEF (2012), Peace Building through Early Childhood Development: A Guidance Note http://www.heart-resources.org/doc_lib/peace-building-early-childhood-development-guidance-note/
This guidance note goes deeper into the theory of change behind promoting peace through ECD. It also provides practical ways to implement peacebuilding through ECD.
Reading 5: UNICEF (2014) Early Childhood Development in Emergencies Integrated Programme Guide http://www.heart-resources.org/doc_lib/early-childhood-development-emergencies-integrated-programme-guide-unicef/
Plan International (2013) Early Childhood Care and Development in Emergencies: A Program Guide http://www.heart-resources.org/doc_lib/early-childhood-care-development-emergencies-programme-guide/
UNICEF and Plan International’s programme guides explore the implementation of ECD in emergencies, including theoretical underpinnings, concrete activities and indicators to measure, as well as some of the practical challenges of delivering ECD in emergency contexts.
Reading 6: UNICEF/WHO (2012) Integrating ECD activities into Nutrition Programmes in Emergencies: Why, What and How. http://www.heart-resources.org/doc_lib/integrating-ecd-activities-nutrition-programmes-emergencies/
This guide targets nutrition in emergencies staff and how they can integrate an ECD lens into their programming.
Reading 7: The Consultative Group on Early Childhood Care and Development/UNICEF (2013) Noteworthy Practices: Early Childhood Development in Emergencies. http://www.heart-resources.org/doc_lib/noteworthy-practices-early-childhood-development-emergencies/
This document provides in-depth case studies of promising approaches to ECD in emergencies.
- Aboud, F. (2007), “Evaluation of an Early Childhood Parenting Programme in Rural Bangladesh”, Journal of Health, Population, Nutrition, http://www.heart-resources.org/doc_lib/evaluation-early-childhood-parenting-programme-rural-bangladesh/
- Ames, P., Rojas, V., Portugal, T. (2010). Continuity and respect for diversity: Strengthening early transitions in Peru. Working Paper No.56, Studies in Early Childhood Transitions. The Hague, The Netherlands: Bernard van Leer Foundation. http://www.heart-resources.org/doc_lib/continuity-respect-diversity-strengthening-early-transitions-peru/
- Ang, L. and Oliver, S. (2015), A Systematic Policy Review of Early Childhood Development and Peace building in fourteen conflict-affected and post-conflict countries. UNICEF and UCL Institute of Education: London. http://www.heart-resources.org/doc_lib/systematic-policy-review-early-childhood-development-peace-building-fourteen-conflict-affected-post-conflict-countries/
- Boyden, J. and Mann, G. (2005). “Children’s Risk, Resilience, and Coping in Extreme Situations”, In Ungar, M. (Ed), Pathways to Resilience. Sage Publications.
- Bryce, J. et al. (2008). “Maternal and child under-nutrition: effective action at national level”, Lancet, 371, pp.510-526
- Hamadani, J. D., Huda, S. N., Khatun, F. and Grantham‐McGregor, S. M. (2006). Psychosocial stimulation improves the development of malnourished children in rural Bangladesh. Journal of Nutrition, 136, 2645‐ http://www.heart-resources.org/doc_lib/psychosocial-stimulation-improves-development-undernourished-children-rural-bangladesh/
- Leckman JF, Panter-Brick C and Salah R (2014). Peace is a Lifelong Process. In Leckman J, Panter-Brick C, and Salah R (Eds.). Pathways to Peace: The Transformative Power of Children and Families. Strüngmann Forum Report, volume 15. MIT Press, pp. 3-17.
- Munthali, A., Mvula, P. Silo, L. (2014). Early childhood development: The role of community based childcare centres in Malawi. SpringerPlus, 3:305. http://www.heart-resources.org/doc_lib/early-childhood-development-role-community-based-childcare-centres-malawi/
- National Scientific Council on the Developing Child (2004). Young children develop in an environment of relationships. Working Paper No. 1. http://www.heart-resources.org/doc_lib/young-children-develop-environment-relationships/
- National Scientific Council on the Developing Child (2007). The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper #5, http://www.heart-resources.org/doc_lib/timing-quality-early-experiences-combine-shape-brain-architecture/
- Play Therapy Africa (2009), Emotional Stimulation in the Context of Emergency Food Interventions, http://www.heart-resources.org/doc_lib/emotional-stimulation-context-emergency-food-interventions/
- Save the Children. (2003). What’s the Difference? An ECD Impact Study From Nepal. http://www.heart-resources.org/doc_lib/whats-difference-ecd-impact-study-nepal/
- Shonkoff, J.P., Garner, A.S., Siegel, B.S., Dobbins, M.I., Earls, M.F., McGuinn, L. et al. (2012) The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129(1): e232-246
- Singla, D., Kumbakumba, E. and Aboud, F. (2015), “Effects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: a community-based, cluster-randomised trial”, Lancet, 3: 458-469.
- Sunar D, Kagitcibasi C, Leckman J, Britto P, Panter-Brick C, Pruett K, Reyes W, Hodges W, Zonderman A, Yazgan Y, Göksel A and Sirali Y (2013). Is early childhood relevant to peacebuilding? Journal of Peacebuilding & Development. 8(3): 81-85.
- UNESCO (2007). Strong Foundations for Gender Equality in Early Childhood Care and Education. Bangkok: UNESCO. http://www.heart-resources.org/doc_lib/strong-foundations-gender-equality-early-childhood-care-education/
- UNICEF (2011). Promoting Gender Equality through UNICEF-Supported Programming in Young Child Survival and Development http://www.heart-resources.org/doc_lib/promoting-gender-equality-unicef-supported-programming-young-child-survival-development/
- UNICEF (2015), Starting early to build stronger and more peaceful societies, http://www.heart-resources.org/doc_lib/starting-early-build-stronger-peaceful-societies/
- Victora CG, Adair L, Fall C, et al, on behalf of the Maternal and Child Undernutrition Study Group. (2008) ‘Maternal and child undernutrition: consequences for adult health and human capital’. Lancet, 371, pp. 340–357 http://www.heart-resources.org/doc_lib/maternal-and-child-undernutrition-consequences-for-adult-health-and-human-capital/
- Williams, J.R.A., Hyder, T. and Nicoli, S. (2005). “Save the Children’s experience: ECD in emergencies” Early Childhood Matters, Vol. 124, Bernard Van Leer Foundation: The Hague.
- Woodhead, M., Bolton, L., Featherstone I. and Robertson P. (2014) Early Childhood Development: Delivering Inter-sectoral Policies, Programmes and Services in Low-resource Settings, HEART Topic Guide, Sussex: Health and Education Advice Resources Team. http://www.heart-resources.org/topic/early-childhood-development/
- Yousafzai, A. K. and Aboud, F. (2014) Review of Implementation Processes for Integrated Nutrition and Psychosocial Stimulation Interventions, Annals of the New York Academy of Sciences, 1308(1) http://www.heart-resources.org/doc_lib/review-implementation-processes-integrated-nutrition-psychosocial-stimulation-interventions/
For more on early childhood development see other Reading Packs in this series:
- Martin Woodhead on Integrated early childhood development (ECD) as a framework for research, policy and service development
- Paul Lynch on Early childhood development (ECD) and children with disabilities
Questions to guide reading
- What are promising innovative approaches to providing ECD in emergencies that can tip the balance away from toxic stress and toward positive development outcomes?
- What kinds of play-based activities can promote peace, tolerance, diversity etc?
- In what ways can the capabilities of parents, caregivers and other community members be strengthened to support young children’s development in emergencies?
- What are the barriers preventing governments and donors from investing more in ECD in emergencies? What role could DFID play in promoting greater investment in ECD in emergencies?