Pediatricians can do more to spur healthy brain development

Editor’s Note: The American Academy of Pediatrics launched Healthy Child Care America in 1995, a project to promote quality early education and child care experiences for families and communities. Chapters across the country are launching early brain and child development programs. We invited Dr. Lee Beers from Children’s National Medical Center and a member of our D.C. KIDS COUNT advisory board to write about what the D.C. chapter is doing.

As pediatricians, we see infants and toddlers several times during the year for well-child visits and immunizations when we check on their development progress. And when we see signs of potential delays or disabilities, we refer parents to early intervention services. Unfortunately, we are also in a position to see firsthand what happens when a young child’s brain is not stimulated for healthy growth and development –- and in some exceptional cases, we see the damage done by abuse and neglect.

As many of us know, there’s a body of research that clearly highlights the critical importance of the first three years of life for forming the foundation for lifelong learning. A newborn's brain is about 25 percent of its approximate adult weight. But by age 3, it has grown dramatically by producing billions of cells and hundreds of trillions of connections, or synapses, between these cells (See  ZERO TO THREE's interactive brain map).

What many pediatricians do not realize is that we can have an impact outside of our examination rooms. We can play a vital role in promoting children’s health and well-being in early education and child care settings.  We can do this through working directly with early childhood settings providing technical assistance and training in child health and development, or by advocating for policies that support quality early child care.

The reality is that an increasing number of infants and toddlers spend hours each day in various child care arrangements. In the past 35 years, the percentage of children in out- of-home care during their earliest and most formative years has increased from 30 percent to 70 percent. What young children experience in their first years of life profoundly influences how their brain will develop and they will interact and respond to their environment. And because a growing number of young children are spending a full work-day in child care, we need to ensure that they are getting age- appropriate stimulation through play, a colorful and interactive environment that encourages them to explore and build their senses and motor skills and demonstrated behavior that builds their social-emotional skills.

Take language for example: When an infant is three months old, his or her brain can distinguish several hundred different spoken sounds. Over the next several months, however, the child’s brain will organize itself more efficiently so that it only recognizes those spoken sounds that are part of the language that he or she regularly hears. What happens to children who are not exposed frequently to language?

Researchers found that when mothers frequently spoke to their infants, their children learned almost 300 more words by age 2 than did their peers whose mothers rarely spoke to them (Read the study by Hart & Risley, 1995). Furthermore, studies have suggested that mere exposure to language such as listening to the television or to adults talking amongst themselves provides little benefit. Rather infants need to interact directly with their caretakers, to hear adults talking about what they are seeing and experiencing, in order for them to develop optimal language skills. Unfortunately, many parents and providers are under the impression that talking to babies is not very important because they are too young to understand what is being said.

We have known that children of poorly educated, low-income parents often do not reach the same achievement levels as children of well-educated, wealthy parents. The developments in brain research have provided new insights into why this is so. Parents who are preoccupied with a daily struggle to ensure that their children have enough to eat and are safe from harm may not have the resources, information, or time they need to provide the stimulating experiences to properly foster brain development.

The message is clear –- young children who are rarely spoken to, who are exposed to limited toys, and who have little opportunity to explore and experiment with their environment may fail to fully develop the neural connections and pathways that facilitate later learning. These children are at a significant intellectual disadvantage and are likely to require costly special education or other remedial services when they enter school. Fortunately, intervention programs that start working with children and their families at birth or even prenatally can help prevent this tragic loss of potential.

There is so much providers and pediatricians can do to help families promote healthy brain development, including providing guidance regarding the importance of a language-rich and stimulating environment, helping families identify resources for quality child care (two helpful sites: and and screening and referring for potential delays, so that intervention begins as early as needed.  As medical providers, we have frequent contact with families and are a trusted source of guidance and information.  Encouraging positive and early brain development can have a significant and long term impact on a child’s life.

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