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Time Is of the Essence: In recent years we have gained fascinating new knowledge about brain development in humans. This new information is having a great impact upon pediatricians and other health care providers as they counsel parents about how best to promote their children's neurologic advancement. All the neurons are present in the brain of a newborn child, but new research has shed light on the fact that synapses are formed at a very rapid pace during the early months of life. The number of synapses -- the connectors that allow one neuron to transmit information to another -- will increase twenty-fold during a child's first eight months. Following this period of remarkable growth, pruning of synapses occurs until about age ten, at which time a child has roughly the same number of synapses as an adult. Genes and experiences. Genes certainly play a role in the development of the brain, but they are not the only influence. An infant's brain forms and retains those synapses that are used frequently, while it prunes those that are not used. Early experiences are crucial to the formation and retention of synapses in the brain. Research using PET scans has demonstrated that certain areas of the brain show increased activity at different ages. The visual cortex lights up at 2 to 3 months of age, while the frontal cortex shows activity at 6 to 8 months. If a child doesn't receive appropriate stimulation during critical periods of time, areas of the brain can lose function forever. For example, PET scans of Romanian orphans, institutionalized at birth and given little stimulation in early infancy, show a loss of activity in the temporal lobes which regulate emotions and receive input from the senses. Later in life, these children often have impairments that effect both memory and emotions. Windows of opportunity. We now know that there are windows of opportunity during which appropriate stimulation must occur if children are to reach their full potential. When brain regions mature dictates how long they will have plasticity. If a window of opportunity is missed, permanent loss of function can result. This can be seen most dramatically in research on visual development. If a baby cannot see during the first few months because of cataracts, neural development in the visual cortex never occurs and the child will remain blind for life. Studies on language development yield similar information. Infants whose mothers talk and read to them have much larger vocabularies as toddlers than those who receive less stimulation. Research also explains the difficulty of learning foreign languages at older ages. A child must ideally be exposed to the phonemes of a language between the ages of birth and 5 years in order to speak the language like a native. Stress and brain development. Unfortunately, the plasticity of the immature brain makes it very vulnerable to stress and trauma. Research indicates that children who have experienced high levels of stress will have brains less capable of emotion and memory. These children will tend to be hyperactive, inattentive, anxious and impulsive. They are also at risk for learning deficits. Our role. What we are learning about brain development places a great responsibility on all of us, as parents and as health care providers. We need to educate parents about the importance of appropriate early stimulation for their children's development. Health care providers must encourage parents to talk and read to their children from a very early age. Parents can play simple games such as peek-a-boo and blocks. These should be a give and take experience between the parent and the child, so that activities occur when the child is alert and receptive. Parents can be encouraged to recognize their children's cues and respond to their needs. Family support groups, pre- and post-natal parenting classes, and home visitation programs can be helpful in teaching parents these skills. We must all work harder to prevent child abuse and neglect. Recognition of parental mental health problems and appropriate treatment is a key concern. High quality home visitation programs can, again, be helpful in this regard. Child care providers and teachers must also provide stimulation to optimize development. Unfortunately not all child care programs provide high quality care, and this must be changed. Preschool programs and grade schools are often slow to apply new information to optimize stimulation during windows of opportunity. For example, foreign language instruction is typically delayed until junior or senior high school, even though we know that this is well beyond the window of opportunity for language acquisition. Healthy Steps Initiative. The University of Iowa is one of 15 sites throughout the country that is participating in the national Healthy Steps Initiative. As part of this study, we are examining ways to deliver augmented pediatric care to families in order to optimize children's development. The major interventions in the study involve using Healthy Steps specialists -- pediatric nurse practitioners, social workers, and early childhood development specialists -- to augment typical pediatric care. These specialists spend time with parents to:
The knowledge gained through this study will be shared with primary care providers throughout Iowa. It is both fascinating and daunting to think of the crucial role each of us plays in fostering optimal brain development in young children. As primary care providers, we need to more systematically share what research is teaching us about early brain development, so that all children can reach their full potential. Resources. Meeting the Needs of Our Youngest Children (Carnegie Corporation). Rethinking the Brain: New Insights into Early Development (Families and Work Institute, 1996). |
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