The provision of simple toys and structured play could enable more than 200 million of the world's poorest children to achieve their developmental potential and so help break the cycle of deprivation, according to a series of research papers published in leading medical journal The Lancet.
The first report, 'Developmental potential in the first five years for children in developing countries', by a team from University College London's Institute of Child Health, says that 200 million children are held back intellectually because of a lack of stimulation and nourishment in the first five years of life.
These children are not reaching their potential at school and are likely to earn low incomes, provide poor care for their own children and bequeath their poverty to the next generation. Most of the children affected live in south Asia and sub-Saharan Africa.
However, the team, led by Professor Sally McGregor, argues that some solutions could be relatively simple, such as the provision of toys to stimulate young children's minds.
'There is a relationship between children's success at school and their IQ when they arrive at school,' says Professor McGregor. 'So, helping them to develop cognitive skills, through structured play, for example, could help to prevent them from being held back intellectually.'
The study concludes, 'The problem of poor child development will remain unless a substantial effort is made to mount appropriate integrated programmes. There is increasing evidence that early interventions can help prevent the loss of potential in affected children and improvements can happen rapidly. In view of the high cost of poor child development, both economically and in terms of equality and individual wellbeing, and the availability of effective interventions, we can no longer justify inactivity.
'To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high-quality, cost-effective early child development programmes.'
Toys and imagination
The importance of helping cognitive development has been recognised by the leading aid agencies. 'We support the need to expand and improve early childhood care and education, especially for the most vulnerable and disadvantaged children,' says Oxfam. The charity particularly supports programmes that are sensitive to and embedded in the cultural environment and language of young girls and boys and their families.
Save The Children runs several play-based learning schemes for the under-fives in developing countries. 'One example is of play-based and active learning in travelling "ger kindergartens" for nomadic communities in Mongolia in remote areas where pre-school is unavailable,' says a spokeswoman for the charity. 'These also provide training for parents to stimulate the cognitive and physical development of their children. Another example is in Serbia, where we have toy libraries and parents' clubs that use play-based learning to stimulate child development and promote interactions between disabled and non-disabled children and families.'
Yorkshire primary school teacher Kathryn Cummings, who has made exchange trips to a school in Ghana, says, 'I can see that the children there are deprived of toys. On the other hand, I have seen children using their imaginations and making up games in a way our five- and six-year-olds can't seem to do now.
'However, the poorest children (those covered by the study) won't be playing at all. They will be working, which is a huge factor in their development. These children will be out in the fields collecting, or sweeping the home or something like that.'
'I don't want to see some sort of educational toy syndrome where commercial companies move in and just make a lot of money,' says Professor Tina Bruce of Roehampton University,London. 'I visited a township in South Africa and saw children under five enjoying the benefits of what looked like reasonably stimulating play. They were playing in the sand on the street and having a lot of contact with adults.
'There was a study in the 1980s saying that it is ideal if young children spend about a quarter of their time just socialising. It is child-led and people talk to them about they are doing. It is stimulating and the children learn different things that children in our urbanised society are not learning.
'It's not about toys, it's about having safe space and a balance between real-life everyday activities with practical experiences, and the time to play and build on those experiences.'
A mother's role
Helen Penn, professor of early childhood studies at the University of East London, would defend parents in developing countries. 'I don't accept the argument that teaching mothers about hygiene, nutrition and how to stimulate their children breaks the generational transmission of poverty, or makes much difference to it in the long run,' she says.
'This ignores structural issues like poverty and debt repayment, and puts forward a deficit model of mothering which many anthropological studies that have looked closely at how mothers cope in situations of extreme poverty, would argue is inappropriate.
'In some situations where society has badly broken down, in post-apartheid South Africa or in the migrant townships in many poor countries, there may be a case for maternal interventions - providing the mothers have time to get involved in any programmes. Many women work long hours at jobs like domestic service or market trading and are simply too busy to do very much with their children.
'In many traditional societies regarding children as the focus of adult attention is culturally inappropriate, and children are brought up successfully without the kind of adult input we consider so necessary.'
The most effective programmes in the study in The Lancet reflect local culture and use homemade toys made locally from waste materials to encourage parents to engage with their children in structured play, says Professor McGregor.
She cites a two-year project she worked on in Jamaica with undernourished children aged between eight and 24 months, where health aides were trained to 'visit homes once a week ,taking toys we had made and demonstrating play to the mothers and showing them how to praise their child and not focus on what he could not do.
'We had a semi-structured curriculum and a range of activities of increasing difficulty. I call it simple play, but it was very carefully thought through by a team from the University of the West Indies.
'We started by going to mothers whose children were doing well, even though they were poor, and asking them about the games they played with their children and the songs they sang to them. We integrated that into the project.
'It was tailored to each child's development, and we focused on the mothers as much as the child.'
All the children received medical care, but
* One group received extra food
* One group received play provision
* One group received extra food and play provision
* One group received nothing extra.
The study found that play improved the child's development, the extra food improved the child's development, and those with the extra food and play provision matched the development of a control group of non-malnourished children.
Professor McGregor explains, 'We followed up these groups and found the effects of the extra food washed out with time, but the effects of extra play did not. By the age of 18, this group had higher IQs and better reading and writing skills. Fewer of them had dropped out of school, and they were less depressed, less anxious and had higher self-esteem.' NW
WHAT THE STUDY EXAMINES
The series 'Child development in developing countries', by an international group of academics, is published in The Lancet (www.thelancet.com) Paper 1, Developmental potential in the first five years for children in developing countries, shows that more than 200 million children under five in developing countries do not reach their developmental potential.
Paper 2, Child development: risk factors for adverse outcomes in developing countries, identifies four well-documented risks it says require urgent intervention: stunted growth, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation. It also cites risks where interventions are warranted by epidemiological evidence: maternal depression, violence exposure, environmental contamination, and malaria.
Paper 3, Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world, assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential and concludes that the most effective early child development programmes provide direct learning experiences to children and families; are targeted toward younger and disadvantaged children; are of longer duration, high quality, and high intensity; and are integrated with family support, health, nutrition, or educational systems and services.
