Early childhood is a pivotal period of child development that begins before birth through age 8. This is a period of rapid brain and body development. In the first few years of life, more than 1 million new neural connections are formed every second (Center for Developing Child). The experiences and opportunities offered in early childhood lay the foundation for how children grow, learn, build relationships, and prepare for school.

A child does not grow in a silo. The health of their family, community, safety of their environment as well as the systems and policy all interact to affect the trajectory and health of a child.

Social Determinants of Health

Social determinants of health (SDOHs), according to the World Health Organization, are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Healthy People 2020 organizes SDOH into 5 key domains:

  • economic stability (eg, poverty and food insufficiency)
  • education (eg, high school graduate and early childhood education)
  • social and community context (eg, concerns about immigration status and social support)
  • health and health care (eg, health insurance status and access toa health care provider)
  • neighborhood and built environment(eg, neighborhood crime and quality of housing)

The AAP recommends surveillance for risk factors related to social determinants of health during all patient encounters. Practices can use a written screener or verbally ask family members questions about basic needs such as food, housing, and heat. ​Find resources here.

Racial and Ethnic Inequities

Research suggests that many disparities in overall health and well-being are rooted in early childhood. Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes. However, consistent, responsive caregiving relationships and supportive community and health care environments promote an optimal trajectory. The first 8 years of a child’s life build a foundation for future health and life success. Thus, the cumulative and lifelong impact of early experiences, both positive and negative, on a child’s development can be profound. Although the health, social service, and education systems that serve young children and their families and communities provide opportunities to support responsive relationships and environments, efforts by these systems are often fragmented because of restrictions that limit the age groups they can serve and types of services they can provide. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories. By promoting collaboration and data-driven intervention activities, public health can play a critical role in both the identification of at-risk children and the integration of systems that can support healthy development. These efforts can address disparities by reducing barriers that might prevent children from reaching their full potential.

Professional Resources