Connecting the Brain to the Rest of the Body

Early Childhood Development and Lifelong Health Are Deeply Intertwined

We know that responsive relationships and language-rich experiences for young children help build a strong foundation for later success in school.

The rapidly advancing frontiers of 21st-century biological sciences now provide compelling evidence that the foundations of lifelong health are also built early, with increasing evidence of the importance of the prenatal period and first few years after birth.

Launching a New Conversation About Early Childhood Programs and Policies

The extreme challenges of 2022 have laid bare longstanding inequities that affect the lives of children and families, as well as the health of a nation

Fully addressing these deeply embedded inequities and the inter-generational trauma of systemic racism will require transformative change at a societal level. More robust early childhood policies and programs must be part of this change because significant adversity in the lives of young children can disrupt the development of the brain and other biological systems.

And these disruptions can undermine young children’s opportunities to achieve their full potential. 

This Working Paper examines how developing biological systems in the body interact with each other and adapt to the contexts in which a child is developing—for better or for worse—with lifelong consequences for physical and mental health. It explains in clear language how these systems are affected by adversity early in life, and shows how those adaptations can result in costly, common chronic illnesses.

The paper encourages us to think beyond early learning in policy and practice. It explores how policymakers, leaders of human services systems, intervention developers, and practitioners can also reduce disparities in preventable diseases and premature deaths and lower the high costs of health care for chronic illnesses that have their origins in early childhood adversity.

A growing understanding of how responsive relationships and language-rich experiences for young children help build a strong foundation for later success in school has driven increased investment and sparked innovation in early learning around the world.

The rapidly advancing frontiers of 21st-century biological sciences now provide compelling evidence that the foundations of lifelong health are also built early, with increasing evidence of the importance of the prenatal period and first few years after birth.

A child who is living in an environment with supportive relationships and consistent routines is more likely to develop well-functioning biological systems, including brain circuits, that promote positive development and lifelong health. Children who feel threatened or unsafe may develop physiological responses and coping behaviors that are attuned to the harsh conditions they are experiencing at the time, at the long-term expense of physical and mental well-being, self-regulation, and effective learning.

Policymakers, leaders of human services systems, intervention developers, and practitioners can all use this knowledge to create innovative solutions to reduce preventable diseases and premature deaths and lower the high costs of health care for chronic illnesses.

All biological systems in the body interact with each other and adapt to the contexts in which a child is developing—for better or for worse.

When external threats trigger the body’s stress response, multiple systems spring into action like a team of highly skilled athletes, each with a specialized capability that complements the others. Systems relating to brain activity, heart and lung function, digestion, energy production, and fighting infection are all interconnected and influence each other’s development.

The brain and all other organs and systems in the body are like a team of highly skilled athletes, each with a specialized capability that complements the others and all of whom are dedicated to a common goal.

Systems relating to brain development, heart and lung function, digestion, energy production, fighting infection, and physical growth are all interconnected and influence each other’s development and function. Each system “reads” the environment, prepares to respond, and shares that information with the others.

Each system then “signals back” to the others through feedback loops that are already functioning at birth.

Therefore, the environments we create and the experiences we provide for young children and their families affect not just the developing brain, but also many other physiological systems, including cardiovascular function, immune responsiveness, and metabolic regulation. All of these systems are responsible for our lifelong health and well-being.

Excessive and persistent adversity early in life can overload biological systems and lead to long-term consequences.

When stress responses are activated frequently, intensively, and persistently during early childhood, they can become set on permanent high alert—they may activate more easily and quickly and may not turn off as readily as they should. From a biological perspective, this is essential for survival. If the world is a dangerous place, the internal systems designed to protect us need to develop in a way that anticipates frequent threats.

Yet over time, these repeated activations lead to greater risk for stress-associated diseases well into the adult years—conditions such as cardiovascular disease, obesity, type 2 diabetes, respiratory and immunological disorders, and a range of mental health problems. That’s the trade-off of adapting to significant early adversity.

Physiological systems typically work most effectively when they operate within a well-regulated range—and significant deviations beyond either end of that range can lead to problems in physical and mental health.

 For example, an immune system that doesn’t react at a sufficiently high level will be unable to fight off serious infection, but one that is hyper-reactive could flood the body with disease-causing inflammation.

There are many opportunities to build resilience in the face of significant adversity—poor health outcomes are not inevitable, but they are more likely if we do not adequately support children and families experiencing persistent hardships or threats, particularly in the face of structural inequities that impose enormous challenges.

The brain’s developing circuits are highly sensitive to the disruptive effects of elevated stress activation.

Three brain systems are particularly susceptible:

(1) emotion regulation, where circuitry for fear and threat develops early in life;

(2) memory systems, where circuitry for memory and simple learning begins early and continues into later childhood; and (3) executive function systems, where circuitry for focused attention, impulse control, and higher-level cognitive skills develop in the preschool period and become more refined well into the adult years.

Early, frequent activation of the immune system, which defends the body against infection and a variety of toxic substances, can result in a “double hit” against lifelong health.

One of the most important components of the immune system’s response is inflammation, a physiological function that attacks invading bacteria or viruses, clears out the tissue destruction they cause, and begins the repair process.

Our bodies need this for survival, but over time it can put powerful inflammatory substances used to kill microbes in constant contact with multiple organs, which can eventually damage them (the first “hit”). At the same time, a constant state of activation can also make the immune system less efficient in its fight against microbes (a second “hit”).

This may explain why children living in adverse environments are more susceptible to recurrent infection and more prone to develop chronic inflammatory conditions across the lifespan, including heart disease, diabetes, depression, arthritis, gastrointestinal disorders, autoimmune disorders, multiple types of cancer, and dementia, among many others.

The combination of stress and inflammation is especially threatening to health and well-being through its effects on the cardiometabolic system.

Extensive research has documented increased obesity and elevated blood pressure in children experiencing the stresses of poverty, racism, unsupportive caregiving, overstimulation from excessive noise and overcrowding, and sedentary behavior from living in a violent neighborhood with no safe space for playing outdoors.

There is also growing evidence that inflammation contributes to that risk, and that excessive amounts of stress hormones such as cortisol, combined with chronic inflammation, can result in insulin resistance—a physiological disruption that can lead to metabolic syndrome, obesity, diabetes, and cardiovascular disease, as well as brain changes and cognitive impairment.

Implications for Policy and Practice

• Efforts to prevent many chronic illnesses in adults need to begin in the early childhood years.
  The experiences we have early in life are at least as important for the biological foundations of physical and mental health as the lifestyle choices we make as adults.
  
• Three of the most common and costly examples of chronic health impairments—cardiovascular disease, diabetes, and depression—alone account for more than $600 billion in direct health care expenditures in the United States annually (above and beyond their indirect costs, such as lost productivity).
• All three share a common association with elevated inflammation, which can be traced to recurrent hardships or threats in early childhood.

Three science-based principles should be used to inform more effective policies and programs across sectors to protect the developing brain and other biological systems from the disruptive effects of early adversity.

These principles can guide interventions that go beyond providing learning experiences for children and information for parents and other caregivers to create conditions that will strengthen the early childhood foundations of both learning and health.

• Support responsive relationships: Reliable “serve-and-return” interactions between young children and the adults who care for them help to reduce the physiological disruptions of excessive stress activation and protect developing biological systems, especially in the earliest years. Adult caregivers also need supportive relationships to reduce stress, solve problems, and share ideas.

• Reduce sources of stress: Policies and programs that lessen economic and psychosocial burdens on families with young children pay off in two ways. First, they reduce chronic activation of stress systems in both adults and children. Second, they enhance adult capacity for providing responsive caregiving that facilitates healthy child development.

• Strengthen core life skills: In order to provide a well-regulated caregiving environment, adults must be able to set and meet goals, manage their own behavior and emotions, establish daily routines, and facilitate social-emotional development and skill-building in young children. Well-matched programs can help both children and adults build and apply these skills through modeling, coaching, and practice.

Primary health care offers a key delivery channel for reaching the largest number of children at the earliest possible ages in a non-stigmatizing context. Team-based care provided through culturally and linguistically responsive, trusted relationships offers a promising model for individualized approaches to building resilience and preventing, reducing, or mitigating the consequences of early adversity.

Reducing disparities in child health outcomes at a population level, however, will require a substantial shift in professional training, current practice, and payment systems to address the following challenges.

There is an urgent need for more effective strategies to support young children by confronting poverty, racism, violence, housing instability, food insecurity, and other sources of chronic adversity that impose significant stresses on their families.

Services and supports must move beyond a sole focus on children and parents to an intentional, “upstream” focus on macro-level policies that systematically threaten the health and wellbeing of families affected by structural inequities and systemic racism. Science-informed thinking combined with on-the-ground expertise and the lived experiences of families raising young children under a wide variety of conditions (many of whom are typically marginalized) can be a powerful catalyst of new ideas.

All policies and delivery systems serving young children and families across sectors (including but not limited to medical care and early care and education) can and must measure their success by improved child outcomes in both health and learning. Persistent attempts to increase access to services, reduce fragmentation, build integrated delivery systems, and secure sustainable funding remain important objectives.

But these efforts will not produce greater impacts until the measurement of their success moves beyond serving more children and enhancing interagency collaboration and begins to focus more explicitly on key child outcomes.

How to Reduce the Effects of ACEs

 and Toxic Stress in children

Adverse Childhood Experiences (ACEs) may increase a child’s risk of health problems, but parents’ consistent care and support help to protect children’s health. Relationships with loving and supportive adults can reduce children’s stress levels. Even simple activities like playing with bubbles, bear hugs, lullabies, listening to music together, and colouring can make a difference. What’s the best way to respond to a child’s ACEs?

If possible, prevention of ACEs is best.

 In addition, you can:

• Tune in and learn your child’s signals. Help your child calm down when you sense that she is stressed or scared.

Soothe your child, and teach ways to calm down when feeling upset.

• Talk and play with your child. Babies like to be rocked, cuddled, and massaged. Toddlers thrive on hugs, shared stories and songs, and daily routines. These actions can help children feel seen, heard, and understood. • Focus on managing your own stress. This can help you better adjust the way these feelings impact how you respond to your child. Having a calm parent will help protect your child during periods of stress.

• Take your child to regular medical visits. Your medical provider can help you understand when your child’s health may be at risk.

Other ways to help your child’s body deal with stress:

 • Stick to daily routines. They help children know what’s happening next, which can reduce stress.

• Have your child exercise regularly. Make sure your child is getting at least an hour per day of active play.

 • Help your child eat well. Good nutrition builds brain health and protects the body. Serve fruits and veggies at meals and avoid junk food.

• Turn to supportive relationships in your family and community.

 • Ensure your child gets adequate sleep. Sleep gives the body time to grow and recharge and children who get adequate sleep manage stress more easily.

• Seek mental health care if needed.

 • Practice being in the moment; try breathing and meditation. It can help the body manage stress.

• Talk to your health care provider about whether your child’s ACEs might be affecting his health and what you can do about it. 

The Basics of Infant and Early Childhood Mental Health:

 In the first years of life, more than 1 million new neural connections are formed every second.

Babies’ earliest relationships and experiences shape the architecture of their brain, creating a foundation on which future development and learning unfolds. Babies who engage with responsive, consistent, nurturing caregivers and who are living in safe and economically secure environments are more likely to have strong emotional health—also referred to as infant and early childhood mental health (IECMH).

As they mature, their emotional health supports growth and well-being in other essential areas including physical development and health, cognitive skills, language and literacy, social skills, and even their approach to learning and readiness for school.

When emotional health is compromised, so too is development across these other areas, leaving children more susceptible to poor health, poor educational performance, and even criminal justice involvement over the course of their lives.

Promoting the emotional health of infants and young children should be underscored as an essential ingredient for a bright future for all infants and young children.

During the infant and toddler years, there are many opportunities to promote emotional health, to prevent emotional disturbances from taking root, and to treat mental health problems before they can manifest into more severe problems later in life.

Policymakers need to support a continuum of services delivered by trained professionals with a financing mechanism that covers the cost of services. Investing early in supporting the mental health of infants and young children will yield benefits later and will allow states to forgo much more costly interventions that all too often result when mental health challenges go unaddressed.

What Is Infant and Early Childhood Mental Health?

IECMH is the developing capacity of the child from birth to 5 years old to form close and secure adult and peer relationships; experience, manage, and express a full range of emotions; and explore the environment and learn—all in the context of family, community, and culture.

Experts from a range of disciplines consider IECMH to be the foundation of healthy, lifelong development. IECMH is also a term used to describe the full continuum of services and supports (i.e., promotion, prevention, and treatment) necessary to promote healthy development, prevent mental health problems, and treat mental health disorders.

ZERO TO THREE. .

The Basics of Infant and Early Childhood Mental Health:

While positive early childhood experiences promote strong emotional health, negative experiences can adversely impact brain development, with serious lifelong consequences.

When an infant or young child’s emotional health deteriorates significantly, they can, and do, experience mental health problems.

Approximately 9.5%–14.2% of children birth to 5 years old experience emotional, relational, or behavioral disturbance.

Young children who live in families dealing with parental loss, substance abuse, mental illness, or exposure to trauma are at heightened risk of developing IECMH disorders.

And the stressors of poverty can multiply these risks. If untreated, IECMH disorders can have detrimental effects on every aspect of a child’s development (i.e., physical, cognitive, communication, sensory, emotional, social, and motor skills) and the child’s ability to succeed in school and in life.

In fact, young children who do not achieve early social and emotional milestones perform poorly in the early school years and are at higher risk for school problems and juvenile delinquency later in life.

However, when mental health concerns are identified early, there are services that can redirect the course and place children who are at risk on a pathway for healthy development.

Early and accurate identification of mental health disorders requires a developmentally specific diagnostic classification system such as DC:0–5™:

Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5). Research demonstrates that early prevention and treatment is more beneficial and cost-effective than attempting to treat emotional difficulties and their effects on learning and health after they become more serious.

.Policymakers can and should take an active role in promoting the kinds of services and supports that prevent and, if necessary, treat mental health issues. Because of the early onset of emotional and behavioral disorders, the Institute of Medicine estimates that their ensuing indirect and direct costs total $247 billion annually,

Impacting federal and state spending on health care, education, child welfare, criminal justice, and economic productivity.

A full continuum of services—from promotion to prevention to treatment—is needed to best support babies, young children, and the significant adults in their lives.

While there is no single remedy to prevent or treat IECMH disorders, policymakers can use evidence-based strategies and explore promising approaches to improve outcomes for infants, young children, and their families.

The following recommendations, examples of actions policymakers can take to improve and advance IECMH, first appeared in Planting Seeds in Policy Recommendations in Brief

1. Establish cross-agency leadership for IECMH.

2. Ensure Medicaid payment for IECMH services.

3. Invest in prevention through mental health consultation.

4. Train the workforce on IECMH.

5. Raise public awareness of IECMH.

Key Terms Infant and Early Childhood Mental Health:

Infant and early childhood mental health (IECMH) is the developing capacity of the child from birth to 5 years old to form close and secure adult and peer relationships; experience, manage, and express a full range of emotions; and explore the environment and learn—all in the context of family, community, and culture.

Promotion:

Promotion of healthy emotional development focuses on supporting the well-being of all children. It might involve programs to educate parents and other caregivers about the role they play in creating responsive and nurturing environments for young children.

Prevention:

Prevention approaches, such as IECMH consultation, can help identify and support children who are at risk of developing mental health problems. Child care settings, pediatric offices, home visiting programs, and other early childhood programs can provide screening and support aimed at addressing the situations that cause children to be at risk.

Treatment:

Treatment focuses on specialized interventions for infants, toddlers, and families who are already exhibiting symptoms of mental health challenges. Treatment is provided by staff who have advanced training in IECMH  TO THREE

The Basics of Infant and Early Childhood Mental Health:

Establish cross-agency leadership for IECMH. Improving IECMH outcomes requires leadership. To ensure coordination and accountability and to drive a statewide IECMH strategy, the state should designate an accountable person (or team) to develop IECMH policies, make programmatic and funding recommendations, manage implementation, and monitor the state’s progress.

It is helpful to have an identified IECMH lead person within each early childhood delivery system such as child care, home visiting, early intervention, child welfare, and health.

Cross-agency collaboration is critical to integrate and prioritize IECMH policies across otherwise siloed state entities and funding streams.

Ensure Medicare payment for IECMH services. Nearly 50% of children under 6 years old receive health care coverage through Medicare

States should leverage Medicare payment to support IECMH prevention, assessment, diagnosis, and treatment services for children and their families.

In many states, contracts with Medicare Managed Care Organizations or accountable provider-led organizations can serve as a lever. The contracts with these providers can include specific promotion and prevention strategies to support emotional health.

Invest in prevention through mental health consultation. An early childhood mental health consultation system involves a consultant with mental health expertise working collaboratively with programs, their staff, and families to improve their ability to prevent and identify mental health issues among children in their care.

Mental health consultation helps reduce problem behaviors in young children and, more broadly, promotes positive emotional development

Selected Behaviors That Warrant Concern Infants and Toddlers (Birth to 3 Years Old)

- Chronic eating or sleeping difficulties

- Inconsolable “fussiness” or irritability

-  Incessant crying with little ability to be consoled

- Extreme upset when left with another adult 

- Inability to adapt to new situations

- Easily startled or alarmed by routine events

- Inability to establish relationships with other children or adults

- Excessive hitting, biting, and pushing of other children or very withdrawn behavior

- Flat affect (shows little to no emotion at all)

Preschoolers (3 to 5 Years Old)

- Engages in compulsive activities (e.g., play enacted in a specific order, hand washing, repeating words silently) -

-  Throws wild, despairing tantrums

- Withdrawn; shows little interest in social interaction 

-  Displays repeated aggressive or impulsive behavior 

-  Difficulty playing with others

- Little or no communication; lack of language

- Loss of earlier developmental achievements 

-  Anxious and fearful in most situation

Activities  to help children with Mental health issues

Importance of teaching mindfulness to children

Help little ones in your care discover the power of a meditative mind by teaching mindfulness at your centre. 

Young school-age children and toddlers are susceptible to stress, just like adults.

Various factors can contribute to this, such as school challenges, family conflicts, perceived expectations from adult figures and friendships. According to Government research, one in seven children and teens between the ages of 4–17 experiences a mental health issue every year in Australia. 

Research suggests that teaching mindfulness and meditation are effective methods for helping children cope with stress and anxiety.

In fact, meditation is included in the mental health and suicide prevention plan that the Australian government funded in 2020‑21.

By practising mindfulness, children can improve their focus, stress management, behaviour, emotion regulation, academic performance, interpersonal relationships and outlook on life. 

Teaching mindfulness activities to children in childcare 

Mindfulness is simply being in the present. It can be practised by acknowledging your thoughts, paying attention to how your body feels and noticing what you see, smell, hear or taste. By practising mindfulness, we can sustain our awareness for longer periods. If you want to support children’s emotional and mental wellbeing through teaching mindfulness, here are some activities to help young learners connect with their thoughts, feelings and the present moment. 

1. Breathing exercises 

When little ones are faced with unpleasant feelings, mindful breathing can help them stay calm whilst they attempt to deal with them. Introduce them to breathing exercises when they are relaxed, feeling good, willing to learn and ready to practice. Find a quiet space and times that are conducive to mindful breathing practice. 

You can first teach them the ‘flower breath’, where you encourage them to think of their favourite flower and imagine smelling it. Guide them to calmly breathe through their nose and out through their mouth. Children can feel better by connecting with their breath and releasing tension in this simple way. Another kind of mindful breathing to try is the ‘hissing breath’, where they breathe in through the nose with a long deep inhale and release it with a hissing sound coming out of the mouth. This technique is used to calm the mind and cool down the body.

During nap or story time, you can practice the ‘hibernating bear breath’ technique with children. They can do this by breathing in for four seconds, pausing for two, exhaling for four seconds and pausing for another two seconds before repeating. You may lead them through these five to seven times. It helps children to relax and may help soothe themselves to sleep. 

Teaching breathing exercises is imparting a lifelong mindfulness tool. Children can practise these breathing exercises anywhere, anytime and may find them helpful when experiencing difficult emotions. 

2. Beginner’s yoga practise 

Because our bodies are designed to move, exercise and movement help reduce stress and anxiety, according to research. Practising yoga asanas (poses) is an excellent way to improve toddlers’ mental and physical health. The good thing about this yoga is that it doesn’t require any special skills or prior knowledge to practise it.

You can start with easy asanas, like the tree pose, downward facing dog, cat pose, cobra pose, frog pose or lion pose. 

Regular yoga practice will help children develop better body awareness, self-control and concentration while becoming spiritually connected and mentally and physically agile.

Guide children through the poses and make sure that they’re comfortable. Assure them that it’s normal to stop holding a pose when they start feeling uncomfortable. Some poses need extra precautions, so be sure to research them thoroughly and consult an expert before practising with children. 

3. Sensory engagement 

One way to train a child’s ability to stay in the present is through sensory activities. The simple practice of counting the things they see, hear, feel, smell or taste can be an excellent way to remain present.

Create opportunities for children to engage and explore their senses—playtime in a sandbox, tasting delicious and nutritious foods, finger painting, play dough, water play and so many more. 

You can ask questions or play a game to make it more fun and exciting. For example, blindfolded children can touch things with different textures and share with the group what it feels like and what they think it is. This can also be done with food where they guess what snack, fruit, or vegetable they took a bite of while blindfolded. Besides helping children develop mindfulness skills, sensory play can also be beneficial to calming a child feeling anxious or stressed. Through these activities, they also make sense of the things around them. 

4. Nature time 

Outdoor play has many benefits for young children, not only in terms of physical development and learning but also for their psychological and emotional wellbeing. Allocating time to go out, explore and observe the environment helps children develop their self-awareness and a sense of belonging. 

During outdoor playtime or quiet time, encourage children to listen to the sounds of nature.

Get them to look at the trees, flowers, sky, and birds and feel the breeze and the warmth of the sun. Little sensory observations like this in nature spark curiosity and creativity. Children who are connected to nature become more empathetic toward the plants and animals they share the world with.

They develop an awareness that considers the needs of everyone they share their environment with, including animals, plants and other people. They learn to value every member of their community, respecting the diversity and complexity of others. 

Scavenger hunts, gardening, blowing bubbles, walking and running are also practical outdoor activities you can use to practice mindfulness in nature with children. 

5. Colouring mandala art 

A mandala is art formed by a series of circles, geometric patterns and symbols representing the infinite universe in Buddhism and Hinduism.

They are used in meditative practices and bring mental and emotional benefits. You can teach children to draw a circle on a piece of paper and mindfully outline shapes and patterns within the circle. Encourage them to colour it precisely and calmly. 

You can play relaxing music while they carefully draw and colour to set the mood.

Suppose you’re in a younger children who might find drawing challenging.

In that case, you can download free mandala colouring sheets available online, print them and distribute them during the colouring session.

 Colouring the mandala can help improve a child’s hand-eye coordination, shape recognition, precision, focus and reasoning.