Timing is Everything
Matching the timing of individual, family and community interventions
to the critical stages of child development is a vital lesson in the
future health of the Public.  Even in an affluent nation like England,
professional help such as specialist public health nursing rarely seems to
reach the most disadvantaged children when and where such help is needed,
or on terms that their parents and elected local councils can grasp. 
Hertzman and colleagues (“Tackling inequality: get them while they’re
young” 13 February) recognise the role that good childhood environments in
the early years play in later physical and mental health. However,
successful ‘programmes to support early child development’ need to
incorporate responses to parental illness and disability, as well as the
economic gradients in Society. At a rough reckoning in England, the
percentages of households with young children where at least one parent
has: untreated mental illness (mainly depression) ~ 10%, untreated alcohol
dependence ~ 8%, disabilities detected when in mainstream schools but
still unresolved in adulthood (including mild learning disabilities) ~7% .
All of these adult problems are more common and less likely to get medical
attention in the poorest communities. Assuming some overlap (co-
morbidity) within poor households, perhaps 20% of children are dependent
on parents with these unresolved conditions? It is not surprising in our
profile of diverse parenting programmes across a County (population of 1.7
million) that long serving ‘Parenting Practitioners’ requested additional
training and supervision around problems with alcohol or disability, and
found entrenched parental behaviours like domestic violence affected their
work across many interventions to improve local childhoods. 
 Caan W. Being of sound mind, in the beginning. Department of
Health: Mental Health Promotion Update 2005; 2: 13-15.
 Cowley S, Dowling S, Caan W. Too little for early interventions?
Examining the policy-practice gap in English health visiting services and
organisation. Primary Health Care R&D 2009; 10: 130-142.
 Caan W. Providing a comprehensive picture of the Parenting
Programmes being run throughout Essex. Report for Essex County Council by
Anglia Ruskin University: Chelmsford, 2009.
Research and teaching in a Department of Child and Family Health
Competing interests: No competing interests