Total Environment Assessment Model for Early Child Development

Spheres of
Influence:
The Individual
consistent caring, support and affection early
in life. Infants and toddlers with a secure
attachment use the emotional and physical
security that it provides as a base from which
to explore things and people in the environment.
Successful attempts at exploration
increase the child’s self-confidence and
encourage more exploration. Thus the child
begins to learn about and master his or her
environment and to gain in both competence
and self-confidence [18].
effects of early nutrition
throughout the life course
From childhood through adulthood, one’s
emotional health and habitual way of reacting
to new situations have their basis in the
secure attachments formed initially through
processes such as breast feeding. Beyond
breastfeeding, however, nutrition will
continue to play a critical role in children’s
ability to learn.
Children who are malnourished (and there
are approximately 150 million children under
the age of five years in the developing world)
are more susceptible to the effects of infection;
have more severe diarrhoeal episodes; have a
higher risk of pneumonia; have lower functioning
immune systems; and often have low
levels of iodine, iron, protein and thus energy,
which can contribute to chronic illness [19].
They also are more likely to suffer the
consequences of poor physical and mental
development; and have poorer school performance
[192]. Children who are hungry during
school are prevented from benefiting from
education both in developed and developing
countries [192] while younger children may be
impaired in their ability to interact effectively
with their physical and social environments.
Epidemiological studies on the importance
of nutrition and growth during the early years
has led to a hypothesis that the risk of developing
chronic non-communicable diseases
in adulthood such as hypertension, coronary
heart disease or diabetes is influenced not only
by genetic and adult life-style factors but also
by nutritional (and other) factors acting in
early life.
A substantial number of published studies
suggest that impaired foetal growth is related
to higher risk of hypertension, diabetes and
22
cardiovascular disease in adulthood [192, 237,
238]. More recent studies point to a particularly
high risk of cardiovascular disease in
overweight or obese subjects with a history of
impaired foetal growth and in subjects who
experienced accelerated growth in childhood
[193, 236].
It is thus likely that early nutrition
and growth make a major contribution to
long-term disease risk. The evidence for
“developmental origins of health and disease”
then has obvious and important biological,
medical, and social implications [194, 235]
and also illustrates the importance of life
course and intergenerational influences of
ecd.
an agenda for addressing
malnutrition
We now know that malnutrition is shaped
by a complex combination of environmental,
social and economic factors, which begin in
utero and affect both physical growth and
mental development. What can be done to
address the nutritional needs of mothers and
young children
In many resource-rich countries the
most destitute mothers are able to receive
some nutritional supplementation from
government programs. However, even there,
the available support is often insufficient
resulting in poor maternal and infant/child
nutrition [195] 3 . In resource-poor countries,
the resources and infrastructure are lacking
for broad-based government programs.
In the global context, reducing malnutrition
requires systematic action at the local
level in the areas of maternal health (including
adequate nutrition) and health care;
food security, with adequate micronutrient
intake; safe water; access to education for
all; and protection from illness such as
provided by immunization programs. While
attention to these factors is important, it is
equally important to ensure the presence of a
systematic, community-based follow-up and
support for malnourished children and their
families—especially the most vulnerable
children.
3 Interestingly, both malnutrition and obesity are present in
richer countries, and both of these (seemingly opposite conditions)
are far more prevalent in lower socioeconomic groups
(Drewnowski & Specter, 2004 and reference for malnutrition in
rich countries)