The Developmental Approach to Child and Adult Health

University of Chicago, Chicago, Illinois, United States
Pediatrics (Impact Factor: 5.47). 12/2012; 131(Supplement). DOI: 10.1542/peds.2013-0252d


Pediatricians should consider the costs and benefits of preventing rather than treating childhood diseases. We present an integrated developmental approach to child and adult health that considers the costs and benefits of interventions over the life cycle. We suggest policies to promote child health which are currently outside the boundaries of conventional pediatrics. We discuss current challenges to the field and suggest avenues for future research.

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Available from: Gabriella Conti, May 15, 2014
    • "In addition to these older randomized studies, recent randomized clinical trials (Welsh, Nix, Blair, Bierman, & Nelson, 2010 ); rigorous quasiexperimental studies (Gormley, Gayer, Phillips, & Dawson, 2005); and observational studies, such as the Study of Early Child Care and Youth Development (Dearing, McCartney, & Taylor, 2009; Tucker-Drob, 2012) also show relations between high-quality EEC and reduced income-linked achievement gaps. Longer-term effects have been reported through elementary school (Belsky et al., 2007; Peisner-Feinberg et al., 2001), high school (Vandell, Belsky, Burchinal, Steinberg, Vandergrift, & the NICHD Early Child Care Research Network, 2010), and adulthood (Conti & Heckman, 2012; McCormick et al., 2006; Pungello et al., 2010; Schweinhart et al., 2005). Further, cost-benefit analyses have led some to view investment in early childhood education as one of the most effective means for promoting opportunities for all children (Bartik, 2011; Heckman, 2010). "
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    ABSTRACT: Research on early education and care (EEC) dosage, defined as the amount or timing of either current or cumulative participation in EEC programming, generally suggests that more time in high-quality EEC programs is beneficial for children's developmental outcomes. Many of the studies on time in high quality EEC programs are with black and white children and less is known about the effects of dosage with dual language learner (DLL) children. This study used data from an implementation evaluation of Educare - a high-quality early education program serving children from birth to 5 - to examine the extent to which age of entry and time in care relate to language and social-emotional skills for DLL and English-only (EO) children from low-income families. Participants were 5037 children who were enrolled in one of 12 Educare schools as infants, toddlers, or preschoolers between 2003 and 2013 and were followed for their duration in Educare. Longitudinal assessments of children's receptive language and social-emotional skills were analyzed with hierarchical linear modeling, controlling for demographic characteristics and classroom quality. Both age of entry and duration were positively associated with receptive language outcomes, with stronger effect sizes for DLL than EO children. DLL children who entered early consistently scored well across the assessment ages, and late enterers made significant gains during their 1 or 2 years of EEC but lagged considerably behind early entering DLL children when they left for kindergarten. Spanish-speaking DLLs did not lose their proficiency in Spanish as they learned English. Teacher ratings of children's social-emotional skills were lower if children entered at a younger age, but still within normal ranges, and the ratings improved with longer attendance. Results suggest that renewed focus is needed on ensuring that children at-risk for poor school outcomes have access to high-quality EEC early in life and for sustained periods of time to reduce later achievement gaps.
    No preview · Article · Feb 2015 · Early Childhood Research Quarterly
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    • "Overweight and rapid weight gain during infancy are associated with increased later risk of overweight [1-24], as well as numerous co-morbidities including hypertension [25-28], coronary heart disease [29,30], type 2 diabetes mellitus [24,31,32], and asthma [33-35]. Because infancy is a critical period of developmental plasticity with long-lasting metabolic and behavioral consequences [36-38], interventions developed for delivery during this period may alter long-term risk for obesity and associated co-morbidities. With 22.8% of 2–5 year old US children already meeting criteria for overweight [39], and overweight by age 5 years strongly associated with later life overweight [40], early interventions to address this epidemic are needed. "
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    ABSTRACT: Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings. Discussion With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings. Trial registration NCT01167270. Registered 21 July 2010.
    Full-text · Article · Jul 2014 · BMC Pediatrics
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    • "It also suggests that optimal LCHD occurs when we take a whole child, whole family, and whole community approach. Whole child means promoting the development of the diverse and interdependent capabilities of the whole child, by starting early, providing the comprehensive and integrated health promoting scaffolding that can protect children from harm, minimize risk, and optimize health development [143]. Whole family means supporting the optimal development of parents, and the interdependent capabilities they need to create the relational environment that every child needs to thrive. "
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    ABSTRACT: During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.
    Full-text · Article · Aug 2013 · Maternal and Child Health Journal
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