In India, where millions of children are growing up in less than perfect environments for their development, their wellbeing could not be more precarious.
According to the World Health Organisation, there are 200 million children with disabilities worldwide. Approximately 50 million of them live in India, and a vast number of these children have acquired their disabilities. They weren’t born with them, they didn’t have to have them.
Malnutrition, poverty and lack of responsive caregiving, especially in the crucial first three years of a child’s life, are among the prominent causes of acquired disability. The cost to the nation is staggering: that girl was going to be the one to find a cure for pancreatic cancer; that boy was meant to invent a solar-powered jet.
It is important to spell out what children need in the first three years of their lives so we can all do our part to fulfil those needs as well as put systems in place that will ensure those needs continue to be met. A majority of these solutions begin with the child’s mother. Children born to teenagers; children born to underweight, anaemic women; or to women addicted to drugs, tobacco or alcohol are statistically more likely to be premature and underweight themselves. If the next generation should grow up healthy and smart, their mothers have to first be healthy and smart themselves. As a society, we have to campaign against child marriage, work for girls’ education and support good nutrition for teenagers and young women.
What happens after a baby is born? A healthy early-childhood involves:
Steady, adequate weight gain – Good nutrition means exclusive breastfeeding for the first six months. A gradual introduction of a range of healthy solids, including fresh vegetables, fruits, khichidi, curd, dalia and porridges ensures that babies get the balanced diet they require. Letting them feed themselves as early as possible makes mealtime a pleasure and not a battleground.
Height is as important as weight. Stunting – “being too short for one’s age” according to the WHO – is often overlooked as a health problem in developing countries, where many families assume short stature is just a genetic trait. Now recognised as a significant risk-marker of poor childhood development, stunted children are more likely to have poor overall cognitive and physical development, with long-term outcomes like attaining less education and having lower incomes as adults. According to the WHO, 160 million children, mostly in developing countries are likely to be have been stunted as of 2012.
Third, the Government of India has an ambitious universal immunisation program in operation. However, a UNICEF report in 2012 found that 7.4 million children still remain unprotected – mostly from poor families.
Further, avoiding infections is key to good development in young children, but it’s easier said than done. Clean drinking water within the home, indoor toilets, adequate sanitation and good personal hygiene are essential to achieve it and their provision requires an act of political will. Children contracting diseases we know how to prevent or repeatedly succumbing to infections brought on by poor hygiene can be seen as criminal neglect – not only in terms of the immediate and needless suffering these children and their families undergo but also in terms of lost potential (e.g.,a sick child is not learning and growing as she should); lost productivity (e.g., caregivers are not working because they need to nurse the child) and the negative impact on public health.
And these are the basic requirements. But we know from experience that these alone cannot guarantee optimal development. Tens of thousands of infants were consigned to the bleakest of existences in Romanian orphanages during the dictatorship of Nicolae Ceaușescu in the 1980s. These were mainly normal children with typical development. They were taken care of physically but they had no secure relationships, no bonding with caregivers and no stimulation of any kind. Infants were left in their cribs for days at a time and cared for by as many as 17 nurses staff over a week. Nobody smiled at them, played with them or responded to them in any predictable way.
The discovery of these children gave researchers worldwide a new opportunity to learn about the effects of neglect on the development of the human brain as well as to evaluate the impact of institutional care on the social and emotional well-being of young children. Brain scans of these children compared with scans of typical children revealed shocking “black holes” in their development. According to a report in the journal Science, “these children, who display a variety of behavioural and cognitive problems, have less white matter in their brains than do a group of comparable children in local families.”
The conclusion is stunning: how caregivers interact with their children can actually alter those children’s brains. And attributes as important as how they play, respond and talk are crucial to the child’s normal development.
The popular idea of a child’s brain being like a sponge makes Dr Vibha Krishnamurthy a little crazy. A Harvard-trained developmental paediatrician and the founder and director of the Ummeed Child Development Centre in Mumbai, Dr Krishnamurthy knows there is nothing passive about neurodevelopment. Babies are not just lying there just receiving experiences. “It’s more like a game of tennis,” she says, “where there’s constant back and forth between the child and the caregiver.”