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Analysis Women’s, Children’s, and Adolescents’ Health

Effective interventions and strategies for improving early child development

BMJ 2015; 351 doi: (Published 14 September 2015) Cite this as: BMJ 2015;351:h4029

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  1. Bernadette Daelmans, coordinator of policy, planning, and programmes1,
  2. Maureen M Black, endowed professor of pediatrics2,
  3. Joan Lombardi, senior adviser3,
  4. Jane Lucas, consultant in early child development 4,
  5. Linda Richter, director 5, distinguished research fellow 6,
  6. Karlee Silver, vice president programmes 7,
  7. Pia Britto, chief of early child development 8,
  8. Hirokazu Yoshikawa, professor of globalization and education9,
  9. Rafael Perez-Escamilla, professor of epidemiology and public health 10,
  10. Harriet MacMillan, professor of psychiatry and behavioural neurosciences11,
  11. Tarun Dua, medical officer12,
  12. Raschida R Bouhouch, technical officer 1,
  13. Zulfiqar Bhutta, inaugural chair in global child health 13, professor of women and children’s health, 14,
  14. Gary L Darmstadt, associate dean for maternal and child health , professor of neonatal and developmental pediatrics15,
  15. Nirmala Rao, professor of early childhood development and education16
  16. on behalf of the steering committee of a new scientific series on early child development
  1. 1Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
  2. 2Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
  3. 3Bernard van Leer Foundation, The Hague, Netherlands
  4. 4New York, USA
  5. 5DST_NRF Centre of Excellence in Human Development, Durban, South Africa
  6. 6Human Sciences Research Council, Durban, South Africa
  7. 7Grand Challenges Canada, Toronto, Canada
  8. 8United Nations Children’s Fund, New York, USA
  9. 9Department of Applied Psychology, NYU Steinhardt, New York, USA
  10. 10Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
  11. 11Departments of Psychiatry and Behavioural Neurosciences and Pediatrics, McMaster University, Hamilton, ON, Canada
  12. 12Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  13. 13Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
  14. 14Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  15. 15Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
  16. 16Faculty of Education, University of Hong Kong, China
  1. Correspondence to: B Daelmans daelmansb{at}

Investing in early child development is a smart and essential strategy for building human capital, reducing inequities, and promoting sustainable development, argue Bernadette Daelmans and colleagues

The millennium development goal on child health has led to great improvements in child survival worldwide. Child mortality has fallen by almost 50%, resulting in an estimated 17 000 fewer children dying every day in 2013 than in 1990.1 Nevertheless, many children who survive do not thrive, with over 200 million children under 5 years of age at risk of not attaining their developmental potential.2 Physical and mental health, educational and occupational attainment, family wellbeing, and the capacity for mutually rewarding social relationships all have their roots in early childhood. We now have a good understanding of the serious implications of young children going off course, including the longer term economic and societal ramifications. Here, we synthesise evidence about effective interventions and strategies to improve early child development, and call for it to be included in a new global strategy on women’s, children’s, and adolescents’ health.


Our analysis draws on the following evidence: WHO records on early child development, beginning with the Commission on Maternal Care and Mental Health led by John Bowlby in 19513; four special scientific journal issues on early child development and on efficacy and effectiveness of interventions and programmes2 4 5 6; the conclusions of the Commission on Social Determinants of Health7; the WHO expert meeting held in January 2013 to review evidence on the role of the health sector in improving early child development8; and empirical neuroscience research linking early experiences with health and diseases across the lifespan.

Why early development is important

Child development refers to the expansion of physical, cognitive, psychological, and socioemotional skills that lead to increased competence, autonomy, and independence. What …

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