Prof. Sally Grantham-McGregor on early childhood development

In this video, Prof. Sally Grantham-McGregor discusses the importance of early childhood development. She argues that the main reasons for a child not reaching his or her full potential are partly nutritional, party health related and partly due to psychosocial stimulation or the quality of the home environment. She goes on to explain that how well a child has developed by the time it starts school (in terms of cognitive, language, social and emotional development), will determine how well it will do at school. In future years, what the child goes on to achieve at school will have an impact on prosperity, employment and ultimately well-being. In this way, early childhood development can be shown to be linked to the inter-generational cycle of poverty. It is therefore essential to ensure that children develop to their full potential from an early age.

Sally is an Emeritus Professor of Child Health and Nutrition at the Institute of Child Health, University College London. She trained as a physician in London then worked at the University of the West Indies in Jamaica, where she founded a research group to examine the effectiveness of nutrition and poverty on child development. She moved to London and assisted in developing a similar research group in Bangladesh. She is currently collaborating with the Institute of Fiscal Studies on early childhood development interventions in Colombia and India, and is advising the Peruvian government on a national early childhood development program. She has sat on several international and national committees and has consulted for many international agencies and NGOs. She has published over 200 articles/chapters, and with Pat Engle she headed the first Lancet series on Child development in Developing Countries in 2007 – of which a second series was published in 2011. She sits on the Early Childhood Board of the Open Society Foundation, the advisory early childhood development board of IDB and the Steering Committee of the Global Child Development Group.

Related resources

A study in Jamaica by Paul Gertler et al. (2013) found that a randomised intervention that gave psycho-social stimulation to stunted toddlers living in poverty was shown to have large effects on the earnings of participants. The intervention consisted of one-hour weekly visits from community health workers over a 2-year period that taught parenting skills and encouraged mothers to interact and play with their children in ways that would develop their children’s cognitive and personality skills. The study participants were re-interviewed 20 years after the intervention. Stimulation increased the average earnings of participants by 42 percent. Treatment group earnings caught up to the earnings of a matched non-stunted comparison group. These findings show that psychosocial stimulation early in childhood in disadvantaged settings can have substantial effects on labour market outcomes and reduce later life inequality.

Results from research into the effects of a community-based approach to food and psychosocial stimulation on growth and development in Bangladesh suggests that children receiving any stimulation showed a significant benefit to mental development and growth in weight. However, more intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status.

Young children with iron deficiency anemia (IDA) usually have poor development, but there is limited information on their response to psychosocial intervention. A paper by Tofail et al. (2013) compares the effects of psychosocial stimulation on the development of children with IDA and children who were neither anemic nor iron deficient (NANI) in Bangladesh. Children with IDA and NANI were found to respond differently to stimulation, with the NANI group improving more than the IDA group. In addition to iron treatment, children with IDA may require more intense or longer interventions than NANI children.

Evidence showing the effects of multiple micronutrient (MM) or food supplementation to undernourished pregnant women on their offsprings’ development is limited. A paper titled ‘Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study’, compares the effects on infant development of early (8 – 10 wk gestation) or usual (approximate to 17 wk gestation) supplementation with food and MM. The results indicate that there were no significant effects of any intervention in the group studied as a whole. However, infants of undernourished mothers who received early food supplementation performed slightly but significantly better on the support test than did infants of mothers who received usual food supplementation. The authors conclude that small benefits from early food and MM supplementation were found in infants of low-body mass index but not of high-body mass index mothers. However, the benefits were of doubtful functional importance, and longer follow-up is required to determine programmatic implications

A paper related to this topic by Black et al. (2013) featured in the 2013 Lancet series on Maternal and Child Nutrition. The key messages include that deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. Undernutrition during pregnancy, affecting fetal growth, and the first 2 years of life is a major determinant of both stunting of linear growth and subsequent obesity and non-communicable diseases in adulthood. The high present and future disease burden should lead to interventions focused on women of reproductive age, pregnancy, and children in the first 2 years of life

A recently published report by Save the Children titled ‘Food for thought – Tackling child malnutrition to unlock potential and boost prosperity’ demonstrates how investment in nutrition is essential for future prosperity. The evidence presented shows that preventing malnutrition of children and women in the crucial 1,000-day window – from the start of a woman’s pregnancy until her child’s second birthday – could greatly increase children’s ability to learn and to earn.

Much of the body of work by the economist James Heckman is relevant to early childhood development. In particular his work explores the benefits of investing in disadvantaged young children. Many of his ideas are described in ‘The case for investing in disadvantaged young children’, which is a chapter from ‘Big ideas for children: investing in our Nation’s future’. This chapter reviews the arguments for intervening in the lives of disadvantaged children. It examines the origins of inequality and analyses policies to alleviate it. He argues that families play a powerful role in shaping adult outcomes and that the accident of birth is a major source of inequality. In American society, about half the inequality in the present value of lifetime earnings is due to factors determined by age 18. Policies that supplement the child rearing resources available to disadvantaged families reduce inequality and raise productivity.

A powerpoint presentation by Prof. Heckman gives more information on why investing in disadvantaged young children is both good economics and good public policy. The presentation was originally given at Opportunity to Start Strong Conference Richmond, Virginia, 2007. The main arguments it presents are as follows:

  • Many major economic and social problems such as crime, teenage pregnancy, dropping out of high school and adverse health conditions can be traced to low levels of skill and ability in the population.
  • Ability gaps between the advantaged and disadvantaged open up early in the life of the child.
  • Life cycle skill formation is dynamic in nature. Skill begets skill; motivation begets motivation. If a child is not motivated and stimulated to learn and engage early on in life, the more likely it is that when the child becomes an adult, it will fail in social and economic life. The longer we wait to intervene in the life cycle of the child the more costly it is to remediate to restore the child to its full potential.
  • In analysing policies directed toward children, we should recognise the multiplicity of abilities.
  • Much public policy discussion focuses on promoting and measuring cognitive ability through IQ and achievement tests. No Child Left Behind focuses on achievement test scores in the 4th grade, not looking at a range of other factors that promote success in school and life.
  • Cognitive abilities are important for socioeconomic success.
  • But socioemotional skills, physical and mental health, perseverance, attention, motivation, self confidence are also important for success in life.
  • Motivation, perseverance and tenacity feed into performance in society at large and even affect scores on achievement tests.
  • Early family environments are major predictors of cognitive and socioemotional abilities, as well as crime, health and obesity.
  • This observation is a major source of concern because family environments in the U.S. and many other countries around the world have deteriorated over the past 40 years.
  • Experiments support a large body of non-experimental evidence that adverse family environments promote adult failure.
  • If society intervenes early enough, it can affect cognitive, and socioemotional abilities and the health of disadvantaged children.
  • Early interventions promote schooling, reduce crime, promote workforce productivity and reduce teenage pregnancy.
  • These interventions are estimated to have high benefit-cost ratios and rates of return.
  • Early interventions have much higher returns than other later interventions such as reduced pupil-teacher ratios, public job training, convict rehabilitation programs, tuition subsidies or expenditure on police.
  • A major refocus of policy is required to understand the lifecycle of skill and health formation and the importance of the early years.

The presentation also introduces what has become known as the Heckman Curve, which shows that the economic returns to early investments are high as they promote efficiency and reduce inequality. The returns to later interventions are much lower due to the technology of skill formation. Skill begets skill and early skill makes later skill acquisition easier.

Heckman curve

The Heckman Curve adapted from a powerpoint presentation by Prof. Heckman.

A recent HEART Helpdesk Report explored whether it is more beneficial to invest in early childhood development or secondary education. Different estimates of returns were identified which are useful in looking at the value of early childhood interventions and secondary education but are not directly comparable.  The report concluded that it is difficult to draw conclusions from the different data reported due to difference in methodologies, timelines and countries. In some reports there are different data for social and private returns. There may also be differences in the interpretation of cost-effectiveness data and rates of return. However, some research from the US suggests that human capital investment decreases as a child grows older. However, with regards to data on schooling in developing countries, the returns from primary, secondary and tertiary education do not often diminish but in many cases increase.


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