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Child development in India is the Indian experience of biological, psychological, and emotional changes which children experience as they grow into adults. Child development has a significant influence on personal health and, at a national level, the health of people in India.
Children constitute a significant part of the national disease burden of India. [1] Environmental health problems such as Pollution-related diseases, challenges with a water supply, and sanitation in India are difficult to fix and greatly affect children. [1] Many children in India miss vaccination and consequently acquire infectious diseases that vaccines could have prevented.
40% of children in India experience malnutrition or stunted growth due to lack of access to healthy meals. [2] India has a success story in the Midday Meal Scheme, which feeds 100 million children daily.
Early childhood is the period up to the age of six. [3] Other definitions extend ECD to age eight to account for changes that occur during a child's transition into primary level education. [4] Children can develop brain damage in the absence of healthy conditions. [5] [6]
Common markers used by researchers and experts in the statistical examination of childhood development include, age, income, and locality. This show marked differences in the India context.
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. [7] The general recommendation for babies is that they should breastfeed soon after birth to get colostrum. [7] Some factors which prevent mothers from giving colostrum to their newborns include maternal health challenges, including the risk of maternal mortality and social taboo. [7]
After a child is born, regular access to primary care from a doctor improves health outcomes. [8] Young children visiting a doctor get vaccinated. [8] Children in families that are much poor are less likely to access the care they need. [8]
Preadolescence is the period where early childhood ends, and puberty begins. Girls at this time need education and preparedness to do menstrual hygiene management. [9] A 2020 study reported that half of the girls in India get their first information about menstruation after their first period. [9] Girls who are prepared for this have better development outcomes. [9]
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. [10] The first 1000 days 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. [11]
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. [12] [13] Exposure to multiple adversities poses a cumulative detrimental burden to a child's wellbeing, especially in low- and middle-income communities. [14] [15]
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. [16] 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. [17]
Childhood development is considered a key factor in achieving the ambitious global Sustainable Development Goals. [18] 45% of Indian under-threes experience stunting, a measure of chronic malnutrition. [19]
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. [20]
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. [21] Current trends in the program are adapting the meals based on research to meet more specific nutrition needs. [21]
Since the 1970s, India has had programs to prevent vitamin A deficiency, but this problem is much less nowadays. [22] [23] Vitamin D deficiency is a challenge that the government is addressing with food fortification. [24]
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. [25] Kerala organized poverty reduction programs and, after that, had better children's health. [2] Various commentators have examined the Kerala model as an example of what might work elsewhere in India. [2]
Children in India are significantly affected by environmental health problems. [1] Challenges such as air pollution, water pollution, health effects of pesticides, and sanitation require government-level planning to fix and are challenging to address. [1]
Urbanisation in India has been increasing more quickly than many cities can develop. [26] There is a great disparity in access to healthcare within cities, depending on the money a person has. [26]
Of all countries, India has the highest number of deaths of children under age five. [27] Most of these deaths are from vaccine-preventable diseases. [27] If children in India got vaccines, then their health and lives would be improved. [27]
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. [27] For DPT vaccine against diphtheria, pertussis, and tetanus, 19% get it on time and 63% by age 5. [27] For the meningococcal vaccine against meningococcal disease, 34% get it on time, and 76% get it by age 5. [27]
Children in slums more often lack vaccine protection. [28]
Various difficult and social issues are related to child development in India. Poverty presents particular challenges for street children in India, [29] child workers in India, [30] and children trafficked in India. [31] Children's health matters related to gender include gender inequality in India, [32] female infanticide in India, [33] and certain aspects of child marriage in India. [34]
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. [35]
A report on Haryana recommended access to cleaner-burning fuel to improve children's health through improved household aid quality. [36]
A 2017 study reported that India's government has policy and delivery systems that are favorable for achieving improvements in child nutrition. [37] The challenges are financing such social programs, researching to keep them on track, and urban capacity to grow programs. [37]
The efforts of several privately funded organizations, including the Aga Khan Foundation, have positively impacted ECD in India. [38]
Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recommended in healthy babies as soon after birth as possible. In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated. Adults who do not have tuberculosis and have not been previously immunized, but are frequently exposed, may be immunized, as well. BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous mycobacterial infections. Additionally, it is sometimes used as part of the treatment of bladder cancer.
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.
Diarrhea, also spelled diarrhoea or diarrhœa, is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.
Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.
Human nutrition deals with the provision of essential nutrients in food that are necessary to support human life and good health. Poor nutrition is a chronic problem often linked to poverty, food security, or a poor understanding of nutritional requirements. Malnutrition and its consequences are large contributors to deaths, physical deformities, and disabilities worldwide. Good nutrition is necessary for children to grow physically and mentally, and for normal human biological development.
Rotaviruses are the most common cause of diarrhoeal disease among infants and young children. Nearly every child in the world is infected with a rotavirus at least once by the age of five. Immunity develops with each infection, so subsequent infections are less severe. Adults are rarely affected. Rotavirus is a genus of double-stranded RNA viruses in the family Reoviridae. There are nine species of the genus, referred to as A, B, C, D, F, G, H, I and J. Rotavirus A is the most common species, and these rotaviruses cause more than 90% of rotavirus infections in humans.
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious, vaccine-preventable bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or three months of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in. The violent coughing may last for 10 or more weeks, hence the phrase "100-day cough". The cough may be so hard that it causes vomiting, rib fractures, and fatigue. Children less than one year old may have little or no cough and instead have periods where they cannot breathe. The incubation period is usually seven to ten days. Disease may occur in those who have been vaccinated, but symptoms are typically milder.
Vulimiri Ramalingaswami was an Indian medical scientist, pathologist and medical writer. His pioneering research on nutrition got him elected to the National Academy of Sciences, Russian Academy of Medical Sciences and the Royal Society of London.
Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. The scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.
Global health is the health of the populations in the worldwide context; it has been defined as "the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide". Problems that transcend national borders or have a global political and economic impact are often emphasized. Thus, global health is about worldwide health improvement, reduction of disparities, and protection against global threats that disregard national borders, including the most common causes of human death and years of life lost from a global perspective.
Enterotoxigenic Escherichia coli (ETEC) is a type of Escherichia coli and one of the leading bacterial causes of diarrhea in the developing world, as well as the most common cause of travelers' diarrhea. Insufficient data exists, but conservative estimates suggest that each year, about 157,000 deaths occur, mostly in children, from ETEC. A number of pathogenic isolates are termed ETEC, but the main hallmarks of this type of bacterium are expression of one or more enterotoxins and presence of fimbriae used for attachment to host intestinal cells. The bacterium was identified by the Bradley Sack lab in Kolkata in 1968.
Stunted growth, also known as stunting or linear growth failure, is defined as impaired growth and development manifested by low height-for-age. It is a primary manifestation of malnutrition and recurrent infections, such as diarrhea and helminthiasis, in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother. The definition of stunting according to the World Health Organization (WHO) is for the "height-for-age" value to be less than two standard deviations of the median of WHO Child Growth Standards. Stunted growth is usually associated with poverty, unsanitary environmental conditions, maternal undernutrition, frequent illness, and/or inappropriate feeding practice and care during early years of life.
Health can affect intelligence in various ways. Conversely, intelligence can affect health. Health effects on intelligence have been described as being among the most important factors in the origins of human group differences in IQ test scores and other measures of cognitive ability. Several factors can lead to significant cognitive impairment, particularly if they occur during pregnancy and childhood when the brain is growing and the blood–brain barrier of the child is less effective. Such impairment may sometimes be permanent, sometimes be partially or wholly compensated for by later growth.
A public health intervention is any effort or policy that attempts to improve mental and physical health on a population level. Public health interventions may be run by a variety of organizations, including governmental health departments and non-governmental organizations (NGOs). Common types of interventions include screening programs, vaccination, food and water supplementation, and health promotion. Common issues that are the subject of public health interventions include obesity, drug, tobacco, and alcohol use, and the spread of infectious disease, e.g. HIV.
Catherine S. Peckham FFPHM is a British paediatrician.
Environmental enteropathy is an acquired small intestinal disorder characterized by gut inflammation, reduced absorptive surface area in small intestine, and disruption of intestinal barrier function. EE is most common amongst children living in low-resource settings. Acute symptoms are typically minimal or absent. EE can lead to malnutrition, anemia, stunted growth, impaired brain development, and impaired response to oral vaccinations.
Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.
Non-specific effects of vaccines are effects which go beyond the specific protective effects against the targeted diseases. Non-specific effects can be strongly beneficial by increasing protection against non-targeted infections. This has been shown with two live attenuated vaccines, BCG vaccine and measles vaccine, through multiple randomized controlled trials. Theoretically, non-specific effects of vaccines may be detrimental, increasing overall mortality despite providing protection against the target diseases. Although observational studies suggest that diphtheria-tetanus-pertussis vaccine (DTP) may be highly detrimental, these studies are at high risk of bias and have failed to replicate when conducted by independent groups.
The first 1,000 days describes the period from conception to 24 months of age in child development. This is considered a "critical period" in which sufficient nutrition and environmental factors have life-long effects on a child's overall health. While adequate nutrition can be exceptionally beneficial during this critical period, inadequate nutrition may also be detrimental to the child. This is because children establish many of their lifetime epigenetic characteristics in their first 1,000 days. Medical and public health interventions early on in child development during the first 1,000 days may have higher rates of success compared to those achieved outside of this period.
Joanne Katz is an epidemiologist, biostatistician, and Professor of International Health at the Johns Hopkins Bloomberg School of Public Health. She holds joint appointments in the Departments of Biostatistics, Epidemiology and Ophthalmology. Her expertise is in maternal, neonatal, and child health. She has contributed to the design, conduct and analysis of data from large community based intervention trials on nutritional and other interventions in Indonesia, Philippines, Bangladesh, Nepal and other countries.