The importance of first years and how can paediatricians deal with adverse factors influencing early child development

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Ophelia Wilcox
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1 The importance of first years and how can paediatricians deal with adverse factors influencing early child development Associate Professor Milivoj Jovancevic, M.D. Ph.D., Paediatrician Center for Child Health

2 Part I Impact of Inheritance and External Stimulation on Early Brain Development Implications of Brain Research For ECD Practice and Policy

3 Early Brain Development During prenatal development, brain cells develop at the astounding rate of over 250,000 per minute.

4 Early Brain Development At birth, the brain is 70% the size of the adult brain and weighs 25 % of adult brain weight. The majority of increase in brain weight after birth results from the development of synaptic connections between neurons.

5 How the environment affects brain structure The child's experiences are the stimulation that sparks the activity between axons and dendrites and creates synapses.

6 Neurons and synapses

7 EBD and Neural Plasticity The brain has the ability to undergo physical, chemical, and structural changes as it responds to experiences and to one s environment. The architecture of each human brain changes as a result of all newly acquired skills and knowledge.

8 Synaptic increase over time

9 Threads that connect neurons form complex nerve pathways. If a neuron is repeatedly exposed to the stimulation of the same type connections become thicker. If the stimulation is not repeated, connections soon become thinner and soon they disappear (prune).

11 Functional magnetic resonance - FMRI

12 Visualising brain activity and pathways

14 4D US and prenatal behaviour

16 Brain at the 25 weeks of gestation

22 EARLY BRAIN DEVELOPMENT: synaptic pruning

23 EBD: Synaptic pruning Between birth and age 3, the brain creates more synapses than it needs. A toddler's brain has twice as many connections among its 100 billion neurons (the network communicators in the cerebral cortex) as the brain of a fully matured adult.

24 EBD: Synaptic pruning The synapses that are used often become a permanent part of the brain. The synapses that are not used frequently are eliminated in a process termed synaptic pruning

25 Increasing the number of synapsis, then decreasing newborn 6 years 14 years

28 Make every moment count! Experiences are like food for the brain. A positive environment nourishes the child's innate intelligence and allows her unique gifts to blossom.

29 Make every moment count! Conversely, an impoverished environment diminishes the brain. Unfortunately, many children's brains are starving due to a lack of attention and the right kinds of experiences. Without the opportunity to be used, neurons can actually wither away and die.

30 Nutrition Brain development is most sensitive to baby s nutrition during the prenatal period. Good nutrition and good health are very closely linked through out the life span, but the connection is even more striking during infancy. Poor nutrition generally affects cognitive development, decreases attention, and lowers achievement.

31 Policy Recommendations Micronutrients before and during pregnancy prevent abnormal brain development. This can NOT be repaired later. Proper nutrition during infancy is crucial.

32 Stress Stress in infancy or early childhood can impair development of brain cell communication zones.

33 Stress Increased amounts of key messengers in the body's stress response can inhibit synaptogenesis. (Dr. Tallie Z. Baram at UC Irvine and collaborators from the Max Planck Institute of Psychiatry in Germany)

34 Stress Extreme and/or prolonged stress can release excess hormones which can actually destroy neurons. Stressful events in early infancy fewfold increase the risk for psychological problems, coronary disease, family violence, addiction to drugs or alcohol.

35 Stress

36 Stress

37 Stress

38 Secure Attachment

39 Attachment Sensitive and responsive care giving can serve as a powerful buffer against stress hormone exposure. Children experiencing neglect, maltreatment, insecure or disorganized caregiver relationships (including maternal depression) can have abnormal patterns of cortisol production continuing into later years.

40 SEPARATION Separation from parent is extreme stress for the infant due to the existentional dependancy on adults and immature mechanisms of coping stress.

48 Overstimulation DOES EARLY TELEVISION EXPOSURE CONTRIBUTE TO ADHD? In August 1999, the American Academy of Pediatrics (AAP) issued guidelines clearly recommending that children under the age of two watch no television or any screen entertainment at all, because television 'can negatively affect early brain development'. French and Croatian paediatric societies: similar recommendations

49 Pacifiers and SIDS

director of the Center for Injury Research and Policy at the Children's Hospital in

50 Baby walkers! May Slow Developmental Process "Walkers are unsafe," said Gary Smith, a pediatrician and director of the Center for Injury Research and Policy at the Children's Hospital in Columbus, Ohio, and one of the authors of the restatement issued by the American Academy of Pediatrics. There should be a ban on the sale and manufacture of walkers."

51 Implications for Policy and Practice Attack the poverty problem Multidisciplinary approach

52 Policy Recommendations Provide for a stable relationship with a caring adult and a nurturing community: Support parenthood, secure type of attachment, prioritaze sufficient and good quality time for parent-child interaction Balance the emphasis between cognitive skills and social and emotional development in ECD programs.

55 Part II Environmental toxins

56 Child Development and Environmental Toxins The environment plays a role in 85% of all diseases. New science is showing that the effects of exposure to chemicals at low doses, and in combination, can have an impact on human growth and development. Some chemicals, pollutants, foods, and behavioral changes that may have minimal adverse effects in adults, may impact a developing fetus and have long-lasting effects on a child s health even into adulthood.

57 Air Pollution A link between early exposures to urban air pollutants that are formed by the combustion of gasoline and other fossil fuels, and children s cognitive development. New York City children who were prenatally exposed to high levels of these air pollutants scored more than 4 points lower on standardized intelligence tests at age 5 compared with the less-exposed children. A 2011 study conducted by the Columbia Center researchers has linked prenatal exposure to these pollutants with higher scores on tests of anxiety, depression, and attention problems at age 5. Higer risk for autism, vascular damage (PM 2.5 and PM 10)?

58 Dioxins -Key Facts Dioxins are a group of chemically-related compounds that are persistent environmental pollutants that are by-products of some manufacturing and incineration processes. Dioxins are found throughout the world in the environment and they accumulate in the food chain, mainly in the fatty tissue of animals. More than 90% of human exposure is through food, mainly meat and dairy products, fish and shellfish. Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer.

59 Endocrine Disruptors A growing body of evidence suggests that certain chemicals, known as endocrine disruptors, can mimic hormones or interfere with the function of the body s hormones. Endocrine disruptors, which usually mimic estrogen, are found in many of the everyday products we use, including some plastic bottles and containers, food can liners, detergents, flame retardants, toys, cosmetics, and pesticides.

60 Endocrine Disruptors Much of the concern about endocrine disruptors has focused on bisphenol A, a compound that is widely used in the manufacture of polycarbonate plastics and epoxy resins. Some endocrine disruptors were banned from commercial use more than 30 years ago, but they persist in the environment and in our bodies. These include DDT, a pesticide that was used to control the spread of mosquitoes and other insects.

61 Endocrine Disruptors Some endocrine disrupting compounds have the potential to simulate androgen, a group of hormones that influence the growth and development of the male reproductive system. An association between pregnant women s exposure to phthalates, compounds used in many consumer products, such as nail polish, hair spray, deodorant, and shampoo, and adverse effects on genital development in their male children. These investigators have also reported that prenatal exposure to phthalates can significantly reduce masculine behavior in boys.

62 Flame Retardants Babies are being exposed to at least eight different flame-retarding chemicals found in an array of products from car seats to changing table pads. These chemicals, which are added to polyurethane cushions to slow the spread of flames during a fire, can leak from the cushions and be inhaled or absorbed through a baby s skin. Research with laboratory animals has shown that some of these chemicals can cause tumors, while others can alter hormones that are essential to reproductive and neurological development.

63 Lead Early life exposure to lead may change the hypothalamic-pituitary-adrenal axis, a complex system that controls many organ functions. That may explain why early lead exposure significantly increases the risk of hypertension, cardiovascular disease, diabetes, schizophrenia, and neurodegenerative changes later in life.

64 Other factors Maternal smoking Mercury, lead, arsenic Cosmetics ( chemical compounds) Textile (8.000 chemical compounds) Nanoparticles 100nm (cosmetics, textile, air pollution) Tephlone (perfluorooctanoic acid PFOA) Electromagnetic radiation Organic solvents Drugs, narcotics

65 And many others. What to do? Controlling (state policy) as much as possible Education (professionals, parents) Smart choices during pregnancy and infancy reduced risk No phobia, no panic be informed!

66 Благодаря ви за вниманието!

Hormones. Hormones. When you hear the word hormones, what do you think of? When you hear the word hormones, what do you think of?

Hormones. Hormones. When you hear the word hormones, what do you think of? When you hear the word hormones, what do you think of? When you hear the word hormones, what When you hear the word hormones, what When you hear the word hormones, what When you hear the word hormones, what Hormones As your body s chemical messengers, hormones