International Ed - Brain development

2.3 Nurturing

The Nurturing Care Framework (NCF) introduced on page 1, outlines five components of nurturing care: good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. You will begin to explore these components on this page, as well as in subsequent modules.

It is the environments that surround children that matter. To really think about babies and how they develop, we have to think about their immediate environment, who is taking care of them, the nature of the relationship(s) and how to best support these relationships.

In the overview of this module, Dr. Stuart Shanker explained that infants are “fetuses outside the womb” for the first nine months, completely dependent on caregivers for survival. We have also learned about the interactive nature of genetics and experience in determining how development unfolds. Clearly, the caregiver-child relationship is absolutely critical to early brain development and the key to the child’s survival, health, and development.

First and foremost, the physical and social environments young children experience are created and then mediated in relationships with adults who care for them. Early caring relationships are a filter for experiences that drive the development of neural pathways involved in sensory perception, stress response patterns, self-regulation, language, and intellectual abilities.

As you learned on the first page of this module, one of the components of the NCF is good health, including the health and well-being of both children and caregivers. Close physical contact is an important aspect of nurturing and researchers have found that skin-to-skin contact is especially important. The next video, from KidCareCanada, is an interview with Dr. Nils Bergman, a Swedish public health physician who has studied and worked in Zimbabwe and South Africa. He is perhaps best known as one of the founders of the Kangaroo Mother Care movement that promotes skin-to-skin contact between mothers and their newborns – identified in the NCF as an important intervention providing essential newborn health care.

The Lancet Series: Advancing Early Childhood Development: From Science to Scale emphasizes the important role of nurturing care for healthy development and supporting parents’ capacity to provide nurturing care through multi-sectoral interventions.

Nurturing care in the early years ensures individuals and societies thrive” (The Lancet Early Child Development Series, 2016).

Responsive care

The foundational component of the NCF is responsive caregiving, or “…the ability of the parent/caregiver to notice, understand, and respond to their child’s signals in a timely and appropriate manner” (Nurturing Care for Early Childhood Development, 2018, p. 2).

There are many factors that can influence a caregiver’s capacity to provide responsive care. But what do “responsive, emotionally supportive and developmentally stimulating” interactions look like? The National Scientific Council on the Developing Child compares parent-baby interaction to the “serve and return” (or back and forth) aspect of a tennis match. This refers to the way a baby makes vocalizations and gestures that encourage adults to respond back in a similar way.

In the next video, watch a loving interaction between a mother and her son.

The following video, from the National Scientific Council on the Developing Child, illustrates how “serve and return” interactions work.

In the next reading, be sure to read the section entitled “What Science Tells Us”.

Early relationships matter. Dr. Megan Gunnar, professor and former director of the Institute of Child Development at the University of Minnesota, describes her research on babies’ responses to receiving immunization shots in a doctor’s office. She explains how the infant-caregiver relationship, specifically, an infant’s secure attachment to a caregiver, can act as a buffer for stress. Babies with insecure attachments to caregivers experienced a rise in cortisol while those with secure attachments did not. On the next page in this module (2.4 – Stress), you will learn more about the harmful effects of excessive cortisol elevation.

In the next video from Cuba, watch as 7-month-old Solange experiences a visit to the doctor.

Think now about nurturing care and gene expression. When a caregiver holds a baby and provides close loving contact, the baby’s senses are stimulated, and the baby is comforted and feels safe. The physical attention stimulates the baby’s brain development and affects the way genes are expressed. An emotionally nurturing environment is as important to physical development as good nutrition. To put it simply, nurturing can “turn on” genes for positive traits and suppress, or “turn off”, genes associated with negative outcomes.

Dr. Thomas Boyce, pediatrician and distinguished professor emeritus in the Departments of Pediatrics and Psychiatry at the University of California, San Francisco, explains that nurturing environments are particularly important for children who are highly reactive or sensitive to context. He also refers to the animal research of both Dr. Steven Suomi and Dr. Michael Meaney, which is described below.

Next, Boyce explains that some children are particularly sensitive to their environmental situations. This highlights the importance of positive, nurturing environments.

What does animal research tell us about nurturing care?

Michael Meaney’s work from McGill University on rodent models has given insight into how maternal care affects the response of young rats to stress. Mother rats lick their young and this is a possible equivalent to a human mother’s touch. Similar to humans, there are variations in parenting in rodents. Some mother rats lick their offspring more than others. Meaney has focused much of his research on comparing the offspring of high versus low-licking mothers. Meaney and his team have demonstrated that offspring of high-licking mothers release lower levels of stress hormones (glucocorticoids) when exposed to stress. Although the release of stress hormones is adaptive when confronted with a stressor, prolonged rises in glucocorticoids have deleterious effects, including deficits in learning and memory. Therefore, having a high-licking mother is advantageous, as these offspring have been shown to be less reactive to stress and demonstrate higher capacities for learning than those reared by low-licking mothers.

Dr. Stephen Suomi, chief of the Laboratory of Comparative Ethology at the National Institute of Child Health and Human Development in the United States, has done extensive research with rhesus monkeys. Suomi researches social competence and other behaviours in communities of rhesus monkeys including attachment relationships and the impact of maternal nurturing on stress levels, aggression and eventual social status of their offspring. He is able to manipulate genetic and environmental factors. One example is to compare adult competence when an anxious baby monkey is raised by a nurturing foster mother rather than his own anxious mother (Suomi in Keating and Hertzman, 1999).

Animal studies allow scientists to study genetic expression. The following clip describes the primate laboratory at the National Institute of Health as well as two field sites that Suomi directs.

In the next clip, Suomi explains some of his findings with the genetically controlled groups of monkeys and the importance of mothering in influencing biology and behaviour. Suomi’s primate research demonstrates that the genetic blueprint is actually shaped by the quality of nurturing care infant monkeys receive.

Nutrition

Poor nutrition in the first 1,000 days of a child’s life – from a woman’s pregnancy to that child’s second birthday – can lock them into a lifetime of health and social challenges that are devastating and irreversible” (Scaling up Nutrition, 2015, para. 1).

Providing adequate nutrition is one of the five inter-related components of the Nurturing Care Framework. Listen as the late Dr. Fraser Mustard, founder of the Canadian Institute for Advanced Research and co-founder of the Council for Early Childhood Development, describes the importance of an integrated approach to fostering early child development.

In the clip, Mustard refers to the research findings of an early child development intervention conducted in Jamaica that illustrated the power of including “stimulation”, that is, fostering nurturing relationships, and promoting learning opportunities between caregivers and their children, along with nutrition for improving developmental outcomes of young children. (Further information about the Jamaican early childhood intervention study is included in the Ecology of Childhood module, page 2.3.)

Mary Eming Young, director at the China Development Research Foundation, emphasizes the importance of considering an integrated approach from the perspective of funders.

Proper nutrition early in life, sets the stage for healthy brain development, growth, and learning. Malnourishment, on the other hand, leads to poor health, makes learning hard, and often results in long-term cognitive deficits. Compared to well-nourished children, children who are malnourished early in life are more likely to start school late, have lower schooling attainment, and score poorly in cognitive tests.

The following UNICEF website provides statistics on child malnutrition.

As the UNICEF reports and statistics indicate, malnutrition continues to be a reality for millions of children. During the global COVID-19 pandemic, it became even worse for many more millions of children and families.

The unprecedented global social and economic crisis triggered by the COVID-19 pandemic posed grave risks to the nutritional status and survival of young children in low-income and middle-income countries (LMICs)” (Headey, D. et al., July 27, 2020, para. 1).

The following two Lancet readings address the issue of child malnutrition in the global pandemic. The first presents projected increases in child malnutrition due to COVID-19 while the second proposes five immediate actions needed in order to protect children’s right to nutrition.

The Pakistan Early Child Development Scale Up (PEDS) Trial evaluated the benefits of psychosocial stimulation interventions and the feasibility of scaling up an ECD strategy within the primary healthcare system of Pakistan. Listen as Dr. Aisha Yousafzai, associate professor of Global Health, Harvard T.H. Chan School of Public Health, explains the background of the PEDS trial in which she was the principal investigator.

In the next clip, Yousafzai briefly describes the research methodology of the study and highlights that early results had already indicated positive trends.

As Yousafzai described, one of the groups of mothers in this study received the early childhood development (ECD) module plus the Lady Health Worker services. In the next clip, listen as she and several others involved in the study describe the ECD sessions for mothers in this group and the benefits observed.

The following slide presentation, developed following the end of the study and narrated by Yousafzai, provides a detailed description of the PEDS Trial, the lessons learned, and presents key results.

The following article by Yousafzai and Arabi (2015), “Bridging survival & development in the post-2015 agenda: Partnerships in nutrition and early child development”, presents evidence on the benefit of providing integrated interventions so children not only survive but thrive.

Listen as Asifa Nurani, former regional health program manager, Aga Khan Foundation, East Africa, describes an initiative in Tanzania and Kenya that integrates the WHO/UNICEF Care for Child Development program within a nutrition initiative.

Filmed in Kenya and Mozambique, the following video highlights effective integrated supports and services in the health sector that encourage nurturing care in order to improve outcomes for children.