Psychology and Nutrition: Welcome Partners in Global Child Development
By Maureen Black, PhD
Maureen Black is the John A. Scholl MD & Mary Louise Scholl MD Professor of Pediatrics at the University of Maryland School of Medicine and a member of APA’s Committee on International Relations in Psychology (CIRP)
Almost 90% of the world’s children under 5 years of age live in developing countries. Undernutrition is a major problem that begins early in life with high rates of low-birth-weight (approximately 25% in some Asian and African countries) and contributes to the death of almost 10 million children annually. Appalling as these figures are, recent evidence has shown that over 200 million children under 5 years of age in developing countries are not reaching their developmental potential, largely due to chronic undernutrition and the lack of early learning opportunities. Without adequate preparation for school, millions of young children are at risk for poor academic performance and behavioral problems, potentially resulting in poor economic productivity and increased risk for psychopathology – conditions that undermine the well-being of adults and ultimately jeopardize the human capital of families and entire societies.
Adequate nutrition, beginning in the prenatal period (probably earlier) and extending through childhood is essential for children’s health and development. Advances in developmental neuroscience have documented not only the impacts that nutritional deficiencies can have on brain structure, functioning, and behavior, but also the impacts (positive and negative) that environmental interactions and opportunities can have. Consequently, our understanding of how nutrition is related to children’s development now extends beyond calories and proteins to include the essential roles that micronutrients have on brain development and functioning, and ultimately on children’s cognitive and socio-emotional development. Collaborations between psychologists and nutritionists have strengthened and models linking nutrition and child development now routinely include specific micronutrients (e.g., iron) along with considerations of caregiver sensitivity and family and environmental conditions. We have learned that children require both healthy nutrition and an interactive, responsive social environment to facilitate early development.
For example, studies conducted in developing countries have shown that children of mothers with depressive disorders are at increased risk for poor growth and delays in cognitive development and exploratory behavior. Depression, recognized as a principal source of disability throughout the world, has been associated with micronutrient deficiencies, including iron, zinc, polyunsaturated fatty acids (PUFAs), and vitamins B-6, B-12, C, D, and E. In March 2009, the American Journal on Clinical Nutrition, published a special issue, entitled Maternal and Child Mental Health: Role of Nutrition, edited by a psychologist (MMB) and a nutritionist (Usha Ramakrishnan, PhD).
There are now two international, interdisciplinary groups of academic and program professionals (including psychologists) to focus attention on how scientific findings about early child development can influence global policies. In 2007, the Global Child Development Group published a 3-paper series in The Lancet on global child development, including estimates of the prevalence of the children not reaching their developmental potential, primary risk factors, and evidence regarding intervention programs in developing countries. In the past two years, the group has published papers in nutritional, psychological, educational, pediatric, and public health journals documenting the critical link between nutrition, caregiver sensitivity, learning opportunities, and early child development. The group is in the process of preparing a follow-up to The Lancet series, highlighting additional risk and mitigating factors related to early child development and recent changes in global intervention programs and policies.
In 2009, the Responsive Feeding and Care for Growth and Development Consortium was formed to focus on how caregiver-child interactions are related to the development of healthy eating patterns. The concept of responsive feeding has origins in Baumrind’s theory of parenting styles, as applied to caregiver-child interactions during feeding. Although the provision of healthy, micronutrient-rich food is essential, children’s growth is also influenced by responsive feeding, defined by the context in which feeding occurs, the interaction between the caregiver and child (particularly in response to food refusals), and the promotion of children’s autonomy. These concepts have been applied to situations where children experience aberrant growth – both undernutrition and overweight. In both situations, principles of responsive feeding, parenting and early child development, together with nutrient intake, play primary roles in facilitating healthy mealtime behavior and growth.
The link between psychology and nutrition has been strengthened scientifically during the past decade. It forms the basis for program and policy recommendations that integrate nutritional and early learning interventions to promote children’s growth and health. For example, the International Union of Nutritional Sciences featured a symposium on Nutrition and Cognitive Development at their November 2009 meeting in Bangkok, chaired by a psychologist (the author, Maureen Black) and nutritionist (Saskia Osendarp, PhD) and attended by Princess Maha Chakri Sirindhorn of Thailand. International agencies, such as UNICEF, the World Health Organization, and the World Bank are focusing on innovative strategies to promote children’s early growth and development – a welcome opportunity for psychologists.
Working with colleagues from nutrition and other disciplines, psychologists have opportunities to develop and evaluate integrated strategies to promote early child development and to prevent undernutrition and overweight – conditions that can have long-lasting effects on the health and well-being of children throughout the world.
For additional information or to join the listservs associated with Global Child Development Group or the Responsive Feeding and Care for Growth and Development Consortium, please contact Maureen Black.
Black, M.M., Ramakrishnan, U. (2009). Introduction to Special issue Maternal and Child Mental Health: Role of Nutrition. American Journal of Clinical Nutrition, 89, 933S-934S.
Black, M.M., Walker, S. P., Wachs, T. D., et al. (2008). Policies to reduce undernutrition include child development. The Lancet, 371, 454-455.
Engle, P., & Black, M. M. (2008). The effect of poverty on child development and educational outcomes. Annals of the New York Academy of Sciences, 1136, 243-256.
Engle, P.L., Black, M.M., Behrman, J.R., et al. (2007). Strategies to avoid the loss of developmental potential among over 200 million children in the developing world. The Lancet, 369, 230-242.
Grantham-McGregor, S., Cheung, Y.B., Cueto, S. et al. (2007). Over two hundred million children fail to reach their developmental potential in the first five years in developing countries. The Lancet, 369, 60-70,
Wachs, T., Black, M. M., Engle, P. (2009). Maternal Depression: A Global Threat to Children’s Health, Development and Behavior and to Human Rights. Child Development Perspectives, 3, 51-59.
Walker, S.P., Wachs, T.D., Gardner, J.M., et al. (2007). Child development: Risk factors for adverse outcomes in developing countries. The Lancet, 369, 145-157.