Building Better Brains: The Core Story of Early

Building Better Brains: The Core Story of Early

Building Better Brains: The Core Story of Early Brain and Child Development (EBCD) Name of Presenter Material developed by the American Academy of Pediatrics Revised: August 2018 Objectives Participant will be able to

Define the critical elements of Early Brain and Child Development (EBCD) Describe factors that shape the developing brain Identify specific actions to take to promote EBCD Our Agenda Virtually every aspect of early human development, from the brains evolving circuitry to the child capacity for empathy, is affected by the

environment and experiences that are encountered in a cumulative fashion, beginning in the prenatal period and extending throughout the early childhood years. - Neurons to Neighborhoods National Research Council, Institute of Medicine, Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: The National Academies Press; 2000:6 Our Agenda

Its all about nurturing relationships. Early relationships build their brains and our future. Andrew Garner, MD, PhD, FAAP Chair, AAP EBCD Leadership Workgroup (2012-2014) Why is ECBD Important? The brain is hard wired for social, emotional, intellectual and developmental trajectories by the age of 5 What happens early affects all aspects of a

childs development Nurturing relationships in the early years are critical First 1,000 days have a profound impact Source: Center on the Developing Child at Harvard University Website. https://developingchild.harvard.edu/. Accessed on July 19, 2018. Why is ECBD Important? Executive function supports childrens later success Toxic stress has a negative impact on a childs

development Early interventions are critical for optimal life course outcomes Source: Executive Function & Self-Regulation. Center on the Developing Child at Harvard University Website. https://developingchild.harvard.edu/science/key-concepts/executive-function/. Accessed on July 16, 2018. Why Early Experiences Matter IsaacMao. Brain.2005. https://www.flickr.com/photos/isaacmao/19245594/in/album72057594061652307/. Accessed June 16, 2018.

Early Brain Development Birth Born with lifetime supply of neurons 3 Years Synapses form based on early

experiences 15 Years Mind is fine tuned to the world children inhabit Brain Image Scan :Dean, D.C., OMuircheartaigh, J., Dirks, H. et al. Brain Struct Funct (2015) 220: 1921. https://doi.org/10.1007/s00429-014-0763-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481335/figure/Fig1/, Accessed August 28, 2018

The Biology of Health The architecture of the brain depends on the mutual influences of the following: Genetics Environment Experience Source: National Scientific Council on the Developing Child. The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper #5. 2007. http://www.developingchild.net. Accessed June 16, 2018.

Source: "The Challenge: The Ability to Change Brains and Behavior Decreases Over Time." Conceptual graph created by Pat Levitt in collaboration with the Center on the Developing Child at Harvard University (2009) and published in From Best Practices to Breakthrough Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and Families (2016). Accessed June 16, 2018. Executive Functioning Includes: Working Memory Mental Flexibility Self-control Executive Function & Self-Regulation. Center on the

Developing Child at Harvard University Website. https://developingchild.harvard.edu/science/keyconcepts/executive-function/. Accessed on July 16, 2018. Impacts: School readiness Math and reading competence Job productivity Positive relationships Overall quality of life

Diamond A. Executive functions. Annu Rev of Psychol. 2013; 64: 135-168. doi: 10.1146/annurevpsych-113011-143750. The Foundations of Health Stable and responsive environment and relationships Safe & supportive physical environments Appropriate nutrition Source: Lifelong Health. Center on the Developing Child at Harvard University Website. https://developingchild.harvard.edu/science/deep-dives/lifelonghealth/. Accessed on July 19, 2018.

Stable & Responsive Environments Provide consistent, nurturing and protective interactions with adults Positive relationships can serve as social emotional buffers Source: Center on the Developing Child at Harvard University Website. https://developingchild.harvard.edu/. Accessed on July 19, 2018. Safe & Supportive

Physical Environments Safe places to learn Places free of toxins Places that nurture and support families Source: Center on the Developing Child at Harvard University Website. https://developingchild.harvard.edu/. Accessed on July 19, 2018. What shapes the developing brain?

Shonkoff JP, Garner AS, American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1):e232-e246. doi: 10.1542/peds.2011-2663. How Does Life Course Science Impact Children? Lu M, Halfon N. Racial and ethnic disparities in birth outcomes: a life course perspective. Matern Child Health J 2003; 7(1):13-30.

Shaping the Capacity of the Brain The interactive influences of genes and experiences shape the architecture of the developing brain Brains are built from the bottom up Sources: Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press; 1979. Sameroff A. A unified theory of development: a dialectic integration of nature and nurture. Child Dev. 2010; 81(1): 622. doi: 10.1111/j.1467-8624.2009.01378.x. National Research Council, Institute of Medicine, Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early

Childhood Development. Washington, DC: The National Academies Press; 2000. Impact of Early Stress CHILDHOOD TOXIC STRESS STRESS Hyper-responsive stress response; calm/coping

Chronic fight or flight; cortisol / norepinephrine Changes in Brain Architecture Garner A, Saul R. Thinking Developmentally. Itasca, IL: American Academy of Pediatrics; 2018.

Early Stress Source: Perry BD. Childhood experience and the expression of genetic potential: What childhood neglect tells us about nature and nurture. Brain and Mind 2002; 3(1):79-100. doi: 10.1023/A:1016557824657. Development: Dance Between Nature and Nurture From Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, 4th ed.: Modified with permission from Garner A, Forkey H, Stirling J, Nalven L, Schilling S; American Academy of Pediatrics, Dave Thomas Foundation for Adoption. Helping

Foster and Adoptive Families Cope With Trauma. Elk Grove Village, IL: American Academy of Pediatrics; 2015. https://www.aap.org/traumaguide. Accessed July 19, 2018. What Can We Do? 91% of children under 6 had a well-child visit in 2013, up from 83% in 2006. 25.9% of infants, toddlers, and preschoolers re in center-based child care settings, the next most

common contact with a formal service system. Source: Well-Child Visits. Child Trends Databank Website. https://www.childtrends.org/indicators/well-child-visits. Updated October 2014. Accessed July 16, 2018. Child Care. Child Trends. https://www.childtrends.org/indicators/child-care. Updated May 2016. Accessed July 16, 2018. Recommendations for Preventive Pediatric Health Care. Bright Futures/American Academy of Pediatrics. https://www.aap.org/ en-us/Documents/periodicity_schedule.pdf Updated February 2017. Accessed July 16, 2018. The First 1,000 Days: Examples for Promoting EBCD

Consistent with Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, 4th ed. Explore the Childs environment Build relationships/reciprocity

Cultivate development Develop parenting confidence Source: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/EBCD/Documents/EBCD_W ell_Child_Grid.pdf . Accessed July 2018 Take Home Messages First 1000 days are not so much

about what to DO Not ordering a specific methylation test Not giving a specific standardized screen Not referring to a specific resource (although all of these may be appropriate) More about what to SEE! Developing a Shared VISION

Its like a snake! Toxic Stress Its like a tree trunk! Its like a straw

fan! Take Home Messages This is not to say that if bad things happen there are necessarily long term negatives. Take Home Messages Change the LENS we use to PRIORITIZE how we use our limited time w/ families:

- Use an ecobiodevelopmental framework - Understand life-course theory and developmental trajectories - Know the biological threats to healthy life courses - Identify/address environmental risks early - Whenever possible, proactively build wellness Promote the Five Rs of Early Childhood Education Reading together as a daily family activity Rhyming, playing, talking, singing, & cuddling together

often Routines & regular times for meals, play, & sleep, which help child know what they can expect and what is expected of them Rewards for everyday successes, realizing that praise from those closest to a child is a very potent reward Relationships that are reciprocal, nurturing & enduring are the foundation of healthy child development AAP Council on Early Childhood and AAP Council on School Health. The Pediatricians Role in Optimizing School Readiness. Pediatrics. 2016;138(3):e20162293. doi: 10.1542/peds.2016-2293.

Take Home Messages It is easier to build strong children than to repair broken men. Frederick Douglass Questions?

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