Foundation of children’s development is in the first thousand days, says doctor

What determines the healthy development of a human being? An important part of that answer is in the first thousand days of life, or three years.

In this crucial period, the basis for full cognitive and emotional development is formed from the relationships with parents and caregivers and the stimuli that the child receives. Genetics, diet, microbiota and environmental stress also come into account.

In order to identify and predict exactly which factors favor good development and which are risk factors, 15 different research groups from USP (University of São Paulo) came together and created the Germina Project, which will monitor 500 children from the three months of life for three years.

“Our findings may even help in the development of public policies. If we are able to predict which children will have difficulties, we will be able to offer programs to promote good development”, says Guilherme Polanczyk, associate professor of child and adolescent psychiatry at the USP School of Medicine. and project leader.

The study is still recruiting volunteers. Participants will be able to know in detail the development of their babies, receive guidance in case any problem is detected and also the results of the research, including the sequencing of the children’s genome. Interested parents can apply through the project website.​

What is already known about the importance of the first three years of life for human development? We know that the relationship established mainly with the mother, but also with the father and other caregivers, at the beginning of life is the foundation of how the child interacts with the world, that is, it forms the basis of how the child receives stimuli and how feel safe to act actively in the world.

Previously, scientific literature had a more psychological focus. Today, with neuroscience, we have more and more methods of obtaining brain images and other laboratory measurements, and with that we have increasingly understood that many skills that will later be important are already beginning to develop in the first and second. years of life. Control of attention, language, motor control, emotion regulation, all these issues start to appear early in life.

In the last two decades, it has become very clear that there are adult mental health problems that start in childhood or adolescence. And we are seeing that many issues can even start earlier, sometimes even in pregnancy, such as obesity and cardiovascular risk. We are also seeing how the brain develops earlier and earlier.

And what else does the study want to find out? What are the gaps that need to be filled about this stage of life? An ambitious gap is trying to predict who will have development difficulties in the future. Studies show associations — for example, the child who cries the most is more agitated or has more difficulty with language, but that is not enough for me to say which child will have difficulty with language.

The idea is to get closer to that. This would be super important because it paves the way for prevention strategies. If I can identify earlier, I can offer a program with activities to promote good development.

This study has several innovative aspects. One of the most important is how comprehensively and broadly we are looking at childhood, and this could only happen because we have researchers from different areas — genetics, nutrition, brain development, pediatrics, psychiatry.

With this, we will be able to understand how these factors interact with each other and manage to predict who will develop well and who will have difficulties. Generally, studies assess one or two isolated factors.

When we say that a child who has suffered violence has developed well despite this, we are only looking at violence, without considering genetics, nutrition. The idea is to be able to look at all the factors and see how their combination tells you who is going to do well.

Do you also intend to assess how physical punishment can impact children’s development? Today, even with the spanking law and more discussion about it, it is still a controversial issue in Brazil. There is now good evidence that the use of physical violence is related to the development of anxiety and depression throughout life, but we are also making a broad assessment of the environment in which the child lives through questionnaires.

We ask about parenting practices, the stimulation the child receives, maternal care and we assess the interaction between mother and baby. There are standardized instruments, with ten-minute footage of the mother interacting with the child, to understand maternal behavior. The environment, including coercive and punitive practices, will indeed be assessed.

How is what happens in the first thousand days of life marked to the point of impacting what will happen in the future, even though we don’t remember this phase? This is marked in the brain, and we have evidence that shows how brain structure, hormonal patterns and epigenetic markers change from these experiences in the first years of life, which will shape skills that are not necessarily so conscious, such as regulating emotions or language development.

We know that the number of words children are exposed to in the first year greatly influences their language level, and we know that two-year-olds who speak sentences will have a better chance of healthy cognitive development. So these are skills that are not necessarily conscious or accessible to our memory; are basic, the foundation of the brain.

There’s a whole brain circuit that relates to fear. Children who are exposed to situations of stress, neglect, in which they do not feel cared for, will have changes in this circuit and will eventually develop anxiety.

The biggest study that shows the strength of these influences is the study of Romanian orphans, which brutally shows how the absence of touch and affection causes children to fail to develop cognitive and emotional skills.

About 200,000 children were basically deposited in orphanages, without having any skin contact with other people and without receiving affection. They were in cribs and the bottles were placed between the bars.

What we saw were children with very serious development, almost autistic, without speaking, without controlling the sphincter. It is one of the most brutal natural experiments that show the strength of childhood environment.

andWhen the child is not exposed to good risk factors early in life, but for some reason this scenario changes, what are the chances of recovering or saving damage that has already been done? It depends on the intensity of the damage and when it is removed from the hostile environment. In the case of Romania, some researchers showed that children adopted before the age of two had a similar pattern of brain functioning to children who had not been institutionalized. Even so, emotion regulation can be worked on over time, and language can be stimulated at an early age, in the first years of life.

What can and should parents and caregivers do, both in these first three years and later, to ensure good development? One of the most important things for parents and caregivers is to establish a connection with the child and develop a sensitive and responsive type of care.

That is, knowing the child, you can understand what he is communicating to you, if he is uncomfortable in a certain environment, if he likes a certain person, and respond to these needs and demands. This connection is one of the foundations for healthy emotional and cognitive development. At the same time, it is important to set limits and rules and think about the value that is important to you from an educational point of view.

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William Polanczyk

He is a child and adolescent psychiatrist and professor at the Department of Psychiatry at the USP School of Medicine. He graduated in medicine from the Federal University of Rio Grande do Sul and did postdoctoral work at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London (UK) and Duke University (USA).