Child development in India

Early childhood is the stage in human development that occurs between infancy and approximately six years of age.{{Cite web|last=Starting Strong|date=|title=Early Childhood Development in India – Guide for funders and charities|url=https://www.thinknpc.org/wp-content/uploads/2018/07/Starting_strong.pdf|access-date=|website=New Philanthropy Capital}} Other definitions extend Early Childhood Development (ECD) to age eight to account for changes that occur during a child's transition into primary level education.{{cite book |last1=World Health Organization |title=Improving Early Childhood Development: WHO guideline |date=2020 |publisher=World Health Organization |location=Geneva, Switzerland |page=1 |url=https://www.who.int/maternal_child_adolescent/child/Improving_Early_Childhood_Development_WHO_Guideline_Summary__.pdf |access-date=21 October 2020}} Children can develop brain damage in the absence of healthy conditions.{{Cite book|date=22 January 2008|editor-last=Garcia|editor-first=Marito H.|editor2-last=Pence|editor2-first=Alan|editor3-last=Evans|editor3-first=Judith|title=Africa's Future, Africa's Challenge|doi=10.1596/978-0-8213-6886-2|isbn=978-0-8213-6886-2}}{{cite book |last1=Center on the Developing Child at Harvard University |title=From Best Practices to Breakthrough Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and Families |date=2016 |publisher=Harvard University |location=Cambridge (MA) |page=15 |url=https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2016/05/From_Best_Practices_to_Breakthrough_Impacts-4.pdf |access-date=21 October 2020 |archive-date=17 November 2020 |archive-url=https://web.archive.org/web/20201117102623/https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2016/05/From_Best_Practices_to_Breakthrough_Impacts-4.pdf |url-status=dead }}

Common markers used by researchers and experts in the statistical examination of childhood development include, age, income, and locality. These show marked differences in the India context.

{{main|First 1000 days}}

The first 1000 days is considered to be a critical period in child development that recommends planning to give a child the best possible start in their first 1000 days after birth.{{cite journal |last1=Chellaiyan |first1=VG |last2=Liaquathali |first2=F |last3=Marudupandiyan |first3=J |title=Healthy nutrition for a healthy child: A review on infant feeding in India. |journal=Journal of Family & Community Medicine |year=2020 |volume=27 |issue=1 |pages=1–7 |doi=10.4103/jfcm.JFCM_5_19 |pmid=32030072|pmc=6984033 |doi-access=free }} The general recommendation for babies is that they should breastfeed soon after birth to get colostrum. Some factors which prevent mothers from giving colostrum to their newborns include maternal health challenges, including the risk of maternal mortality and social taboo.

After a child is born, regular access to primary care from a doctor improves health outcomes.{{cite journal |last1=Zuhair |first1=Mohd |last2=Roy |first2=Ram Babu |title=Socioeconomic Determinants of the Utilization of Antenatal Care and Child Vaccination in India |journal=Asia-Pacific Journal of Public Health |date=14 December 2017 |volume=29 |issue=8 |pages=649–659 |doi=10.1177/1010539517747071|pmid=29237280 |s2cid=20590408 }} Young children visiting a doctor get vaccinated. Children in impoverished families are less likely to have access to medical care.

Preadolescence is the period where early childhood ends, and puberty begins. Girls at this time need education and preparedness to do menstrual hygiene management.{{cite journal |last1=Sharma |first1=S |last2=Mehra |first2=D |last3=Brusselaers |first3=N |last4=Mehra |first4=S |title=Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions. |journal=International Journal of Environmental Research and Public Health |date=19 January 2020 |volume=17 |issue=2 |pages=647 |doi=10.3390/ijerph17020647 |pmid=31963862|pmc=7013590 |doi-access=free }} A 2020 study reported that half of the girls in India get their first information about menstruation after their first menstrual cycle. Girls who are prepared for this have better development outcomes.

Optimal child development starts before conception and is dependent on adequate nutrition for mother and child, protection from threats, provision of learning opportunities, and caregiver interactions that are stimulating, responsive, and emotionally supportive.{{Cite web|title=WHO {{!}} Nurturing care for early childhood development: Linking survive and thrive to transform health and human potential|url=https://www.who.int/maternal_child_adolescent/child/nurturing-care-framework/en/|archive-url=https://web.archive.org/web/20170920175818/http://www.who.int/maternal_child_adolescent/child/nurturing-care-framework/en/|url-status=dead|archive-date=20 September 2017|access-date=11 June 2020|website=WHO}} The first 1000 days of life are considered crucial because of the adaptability of children's brains during this period and because reversing early deficits becomes more difficult as children grow older.{{Cite book|date=13 November 2000|title=From Neurons to Neighborhoods|doi=10.17226/9824|pmid=25077268|isbn=978-0-309-06988-5|author1=National Research Council (US) Institute of Medicine (US) Committee on Integrating the Science of Early Childhood Development|last2=Shonkoff|first2=J. P.|last3=Phillips|first3=D. A.}}

Optimal development in early childhood can be disrupted by various adversities concerning a child's environments and relationships with caregivers. These adversities vary in intensity and range from violence in the home, neglect, abuse, lack of opportunity for play and cognitive stimulation, and parental ill-health.{{Cite journal|last1=Cronholm|first1=Peter F.|last2=Forke|first2=Christine M.|last3=Wade|first3=Roy|last4=Bair-Merritt|first4=Megan H.|last5=Davis|first5=Martha|last6=Harkins-Schwarz|first6=Mary|last7=Pachter|first7=Lee M.|last8=Fein|first8=Joel A.|date=September 2015|title=Adverse Childhood Experiences|journal=American Journal of Preventive Medicine|volume=49|issue=3|pages=354–361|doi=10.1016/j.amepre.2015.02.001|pmid=26296440|issn=0749-3797}}{{Cite journal|last1=Walker|first1=Susan P|last2=Wachs|first2=Theodore D|last3=Meeks Gardner|first3=Julie|last4=Lozoff|first4=Betsy|last5=Wasserman|first5=Gail A|last6=Pollitt|first6=Ernesto|last7=Carter|first7=Julie A|date=January 2007|title=Child development: risk factors for adverse outcomes in developing countries|journal=The Lancet|volume=369|issue=9556|pages=145–157|doi=10.1016/s0140-6736(07)60076-2|pmid=17223478|s2cid=11120228|issn=0140-6736}} Exposure to multiple adversities poses a cumulative detrimental burden to a child's wellbeing, especially those in low- and middle-income communities.{{Cite journal|last1=Walker|first1=Susan P|last2=Wachs|first2=Theodore D|last3=Grantham-McGregor|first3=Sally|last4=Black|first4=Maureen M|last5=Nelson|first5=Charles A|last6=Huffman|first6=Sandra L|last7=Baker-Henningham|first7=Helen|last8=Chang|first8=Susan M|last9=Hamadani|first9=Jena D|last10=Lozoff|first10=Betsy|last11=Gardner|first11=Julie M Meeks|date=October 2011|title=Inequality in early childhood: risk and protective factors for early child development|journal=The Lancet|volume=378|issue=9799|pages=1325–1338|doi=10.1016/s0140-6736(11)60555-2|pmid=21944375|s2cid=14964512|issn=0140-6736}}{{Citation|last1=Wachs|first1=Theodore D.|title=The Nature and Impact of Risk and Protective Influences on Children's Development in Low-Income Countries|date=15 January 2013|work=Handbook of Early Childhood Development Research and Its Impact on Global Policy|pages=85–122|publisher=Oxford University Press|isbn=978-0-19-992299-4|last2=Rahman|first2=Atif|doi=10.1093/acprof:oso/9780199922994.003.0005}}

In 2008, there were an estimated 158 million children under the age of six in India. Generally, these children suffered from poor nutrition and healthcare.{{Citation|title=Foreword|date=31 December 2008|work=The State of the World's Children 2008|series=State of the World's Children|pages=3|publisher=UN|doi=10.18356/c8d42ffb-en|isbn=978-92-1-059754-8}} Around one in ten Indian children experience diarrhoea and almost one in six experience fever. Half of children younger than three were deprived of full immunisation.{{Cite journal|last1=Vart|first1=Priya|last2=Jaglan|first2=Ajay|last3=Shafique|first3=Kashif|date=5 June 2015|title=Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005–2006|journal=BMC Public Health|volume=15|issue=1|page=537|doi=10.1186/s12889-015-1881-4|pmid=26044618|pmc=4456806|s2cid=18616090|issn=1471-2458|doi-access=free}}

Childhood development is considered a key factor in achieving the ambitious global Sustainable Development Goals.{{Cite journal|last1=Daelmans|first1=Bernadette|last2=Darmstadt|first2=Gary L|last3=Lombardi|first3=Joan|last4=Black|first4=Maureen M|last5=Britto|first5=Pia R|last6=Lye|first6=Stephen|last7=Dua|first7=Tarun|last8=Bhutta|first8=Zulfiqar A|last9=Richter|first9=Linda M|date=January 2017|title=Early childhood development: the foundation of sustainable development|journal=The Lancet|volume=389|issue=10064|pages=9–11|doi=10.1016/s0140-6736(16)31659-2|pmid=27717607|s2cid=205983467|issn=0140-6736}} 45% of Indian under-threes experience stunting, a measure of chronic malnutrition.{{Cite journal|last1=Vart|first1=Priya|last2=Jaglan|first2=Ajay|last3=Shafique|first3=Kashif|date=5 June 2015|title=Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005–2006|journal=BMC Public Health|volume=15|issue=1|page=537|doi=10.1186/s12889-015-1881-4|pmid=26044618|pmc=4456806|s2cid=18616090|issn=1471-2458|doi-access=free}}

{{main|Malnutrition in India}}

A 2017 study reported that 57% of newborns in their first 1000 days in India transition on time from breastfeeding to nutritious solid food; 48% get their meals frequently enough; 33% have enough food variety for nutrition, and 21% get overall adequate meals.{{cite journal |last1=Aguayo |first1=Víctor M. |title=Complementary feeding practices for infants and young children in South Asia. A review of evidence for action post-2015 |journal=Maternal & Child Nutrition |date=October 2017 |volume=13 |issue=Suppl 2 |pages=e12439 |doi=10.1111/mcn.12439|pmid=29032627 |pmc=6865921 }}

India's Midday Meal Scheme has been a major success for school-age children, which provides a daily hot healthy meal to 100 million children.{{cite journal |last1=Ramachandran |first1=P |title=School Mid-day Meal Programme in India: Past, Present, and Future. |journal=Indian Journal of Pediatrics |date=June 2019 |volume=86 |issue=6 |pages=542–547 |doi=10.1007/s12098-018-02845-9 |pmid=30637675|s2cid=58541996 }} Current trends in the program are adapting the meals based on research to meet more specific nutrition needs.

Since the 1970s, India has had programs to prevent vitamin A deficiency, but this problem is much less nowadays.{{cite journal |last1=Greiner |first1=Ted |last2=Mason |first2=John |last3=Benn |first3=Christine Stabell |last4=Sachdev |first4=H. P. S. |title=Does India Need a Universal High-Dose Vitamin A Supplementation Program? |journal=The Indian Journal of Pediatrics |date=14 January 2019 |volume=86 |issue=6 |pages=538–541 |doi=10.1007/s12098-018-02851-x|pmid=30644040 |s2cid=58654408 |url=https://findresearcher.sdu.dk/ws/files/157802777/Does_India_need_universal_high_dose_vitamin_A_final_.pdf }}{{cite journal |last1=Awasthi |first1=S |last2=Peto |first2=R |last3=Read |first3=S |last4=Clark |first4=S |last5=Pande |first5=V |last6=Bundy |first6=D |last7=DEVTA (Deworming and Enhanced Vitamin A) |first7=team. |title=Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial. |journal=Lancet |date=27 April 2013 |volume=381 |issue=9876 |pages=1469–77 |doi=10.1016/S0140-6736(12)62125-4 |pmid=23498849|pmc=3647148 }} Vitamin D deficiency is a challenge that the government is addressing with food fortification.{{cite journal |last1=G |first1=R |last2=Gupta |first2=A |title=Fortification of foods with vitamin D in India: strategies targeted at children. |journal=Journal of the American College of Nutrition |year=2015 |volume=34 |issue=3 |pages=263–72 |doi=10.1080/07315724.2014.924450 |pmid=25790322|s2cid=52804739 }}

{{main|Poverty in India}}

Children in poverty experience health problems which children in families with more money will not have. In general, any sort of health problem is worse for someone without immediate access to healthcare. Medical problems which have poverty as a cause include issues in oral health.{{cite journal |last1=Peres |first1=MA |last2=Macpherson |first2=LMD |last3=Weyant |first3=RJ |last4=Daly |first4=B |last5=Venturelli |first5=R |last6=Mathur |first6=MR |last7=Listl |first7=S |last8=Celeste |first8=RK |last9=Guarnizo-Herreño |first9=CC |last10=Kearns |first10=C |last11=Benzian |first11=H |last12=Allison |first12=P |last13=Watt |first13=RG |title=Oral diseases: a global public health challenge. |journal=Lancet |date=20 July 2019 |volume=394 |issue=10194 |pages=249–260 |doi=10.1016/S0140-6736(19)31146-8 |pmid=31327369|hdl=10072/412320 |s2cid=197604973 |url=https://discovery.ucl.ac.uk/id/eprint/10079507/3/Watt%20Lancet%20paper%201%20revised%20-%20clean%201%20copy.pdf }} Kerala organized poverty reduction programs and, after that, had better children's health. Various commentators have examined the Kerala model as an example of what might work elsewhere in India.

{{main|Environmental health}}

Children in India are significantly affected by environmental health problems. Challenges such as air pollution, water pollution, health effects of pesticides, and sanitation require government-level planning to fix and are challenging to address.

Urbanisation in India has been increasing more quickly than many cities can develop.{{cite journal |last1=Sharma |first1=J |last2=Osrin |first2=D |last3=Patil |first3=B |last4=Neogi |first4=SB |last5=Chauhan |first5=M |last6=Khanna |first6=R |last7=Kumar |first7=R |last8=Paul |first8=VK |last9=Zodpey |first9=S |title=Newborn healthcare in urban India. |journal=Journal of Perinatology |date=December 2016 |volume=36 |issue=s3 |pages=S24–S31 |doi=10.1038/jp.2016.187 |pmid=27924107|pmc=5144125 }} There is a great disparity in access to healthcare within cities, depending on the money a person has.

{{main|Vaccination in India}}

Of all countries, India has the highest number of deaths of children under age five.{{cite journal |last1=Shrivastwa |first1=Nijika |last2=Gillespie |first2=Brenda W. |last3=Lepkowski |first3=James M. |last4=Boulton |first4=Matthew L. |title=Vaccination Timeliness in Children Under India's Universal Immunization Program |journal=The Pediatric Infectious Disease Journal |date=September 2016 |volume=35 |issue=9 |pages=955–960 |doi=10.1097/INF.0000000000001223|pmid=27195601 |s2cid=4585001 }} Most of these deaths are from vaccine-preventable diseases. If children in India got vaccines, then their health and lives would be improved.

Ideally, all children would get their vaccinations on time. The BCG vaccine against tuberculosis and leprosy 31% of children get it on time, and 87% get it by age 5. For DPT vaccine against diphtheria, pertussis, and tetanus, 19% get it on time and 63% by age 5. For the meningococcal vaccine against meningococcal disease, 34% get it on time, and 76% get it by age 5.

Children in slums more often lack vaccine protection.{{cite journal |last1=Singh |first1=S |last2=Sahu |first2=D |last3=Agrawal |first3=A |last4=Vashi |first4=MD |title=Ensuring childhood vaccination among slums dwellers under the National Immunization Program in India – Challenges and opportunities. |journal=Preventive Medicine |date=July 2018 |volume=112 |pages=54–60 |doi=10.1016/j.ypmed.2018.04.002 |pmid=29626558|s2cid=4879865 }}

Various difficult and social issues are related to child development in India. Poverty presents particular challenges for street children in India,{{cite journal |last1=Nigam |first1=S |title=Street children of India – a glimpse. |journal=Journal of Health Management |year=1994 |volume=7 |issue=1 |pages=63–7 |pmid=12289892}} child workers in India,{{cite journal |last1=Srivastava |first1=Rajendra N. |title=Children at Work, Child Labor and Modern Slavery in India: An Overview |journal=Indian Pediatrics |date=28 August 2019 |volume=56 |issue=8 |pages=633–638 |doi=10.1007/s13312-019-1584-5|pmid=31477640 |s2cid=201751620 }} and children trafficked in India.{{cite journal |last1=Dhawan |first1=J |last2=Gupta |first2=S |last3=Kumar |first3=B |title=Sexually transmitted diseases in children in India. |journal=Indian Journal of Dermatology, Venereology and Leprology |year=2010 |volume=76 |issue=5 |pages=489–93 |doi=10.4103/0378-6323.69056 |pmid=20826987|doi-access=free }} Children's health matters related to gender include gender inequality in India,{{cite web |last1=Subramanian |first1=Samyukta |title=India's policy on early childhood education |url=https://www.brookings.edu/research/indias-policy-on-early-childhood-education/ |website=Brookings Institution |date=15 October 2019}} female infanticide in India,{{cite journal |last1=Sahni |first1=M |last2=Verma |first2=N |last3=Narula |first3=D |last4=Varghese |first4=RM |last5=Sreenivas |first5=V |last6=Puliyel |first6=JM |title=Missing girls in India: infanticide, feticide and made-to-order pregnancies? Insights from hospital-based sex-ratio-at-birth over the last century. |journal=PLOS ONE |date=21 May 2008 |volume=3 |issue=5 |pages=e2224 |doi=10.1371/journal.pone.0002224 |pmid=18493614|pmc=2377330 |bibcode=2008PLoSO...3.2224S |doi-access=free }} and certain aspects of child marriage in India.{{cite journal |last1=Nour |first1=NM |title=Child marriage: a silent health and human rights issue. |journal=Reviews in Obstetrics & Gynecology |year=2009 |volume=2 |issue=1 |pages=51–6 |pmid=19399295|pmc=2672998 }}

A 2012 nutrition study in Maharashtra found that household and family access to food was less of a problem, but having a variety of nutritious food was a challenge to address.{{cite journal |last1=Chandrasekhar |first1=S. |last2=Aguayo |first2=Víctor M. |last3=Krishna |first3=Vandana |last4=Nair |first4=Rajlakshmi |title=Household food insecurity and children's dietary diversity and nutrition in India. Evidence from the comprehensive nutrition survey in Maharashtra |journal=Maternal & Child Nutrition |date=October 2017 |volume=13 |issue=Suppl 2 |pages=e12447 |doi=10.1111/mcn.12447|pmid=29032621 |pmc=6866156 }}

A report on Haryana recommended access to cleaner-burning fuel to improve children's health through improved household aid quality.{{cite book |last1=Pillarisetti |first1=A |last2=Jamison |first2=DT |last3=Smith |first3=KR |last4=Mock |first4=CN |last5=Nugent |first5=R |last6=Kobusingye |first6=O |last7=Smith |first7=KR |title=Disease Control Priorities, Third Edition (Volume 7): Injury Prevention and Environmental Health |chapter=Household Energy Interventions and Health and Finances in Haryana, India: An Extended Cost-Effectiveness Analysis |date=27 October 2017 |pages=223–237 |doi=10.1596/978-1-4648-0522-6_ch12 |pmid=30212113|isbn=978-1-4648-0522-6 }}

A 2017 study reported that India's government has policy and delivery systems that are favorable for achieving improvements in child nutrition.{{cite journal |last1=Avula |first1=Rasmi |last2=Oddo |first2=Vanessa M. |last3=Kadiyala |first3=Suneetha |last4=Menon |first4=Purnima |title=Scaling-up interventions to improve infant and young child feeding in India: What will it take? |journal=Maternal & Child Nutrition |date=October 2017 |volume=13 |issue=Suppl 2 |pages=e12414 |doi=10.1111/mcn.12414|pmid=29032618 |pmc=6866129 |s2cid=20148659 |doi-access=free }} The challenges are financing such social programs, researching to keep them on track, and urban capacity to grow programs.

The efforts of several privately funded organizations, including the Aga Khan Foundation, have positively impacted ECD in India.{{Cite web|title=Early Childhood Development in India {{!}} Aga Khan Development Network|url=https://www.akdn.org/where-we-work/south-asia/india/early-childhood-development-india|access-date=11 June 2020|website=akdn.org}}

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Category:Child development

Category:Childhood in India

Category:Children's health in India