The early years are critical to the development and future health and outcomes for all children. Scotland’s key policy documents outline the importance of an early years focus and early intervention;
- The Early Years Framework
- Towards a Mentally Flourishing Scotland
- Healthy Eating
- Download the Active Living Action Plan [1.3MB].
Giving children a strong foundation in the early years enhances the key components of growth and development – communication, physical skills and coordination, learning skills, emotional health and wellbeing, and resilience – and thus enables them to perform better at school, develop good social skills and grow into healthy adults.
Growth and development and health inequalities from 3-5 years
As children grow towards primary school age, their social, emotional, physical and education wellbeing build upon foundations laid in earlier years and continue to be influenced by their home environment and their relationship with their parents.
Targeted supports for specific problems and vulnerable families can help mitigate health and social inequalities.
Quick links:
- What are health inequalities?
- Policy context
- What affects growth and development in 3-5s?
- How do inequalities impact on growth and development?
- Health-related factors affecting growth and development in 3-5s
- Deprivation, parenting and social and emotional wellbeing
- Speech, language and communication development
- Looked-after children
- Identifying those at risk
- Providing information and support to parents
What are health inequalities?
The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."
For a fuller discussion, please see Inequalities in the early years.
Policy context
Activity in this area is consistent with commitments and priorities detailed in the Early Years Framework and the National Parenting Strategy, Equally Well, Achieving our Potential, a range of NHS Scotland's Quality Indicators and is relevant to Scotland's national practice model for child-centred services - Getting it Right for Every Child (all external links).
What affects growth and development in 3-5s?
In order to grow and develop and reach their potential, children require all of their needs to be met. These needs include physical needs for nutrition, sleep, warmth, personal care and a safe, healthy environment.
Just as important are their emotional and psychological needs for comfort and attention, positive and consistent interactions with parents, stimulating play and, later, guidance and support as they begin to explore their world.
The UN Convention on the Rights of the Child asserts that:
"the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding."
How do inequalities impact on growth and development?
Factors related to family experience of inequality can impact on parents' ability to meet the needs of their children and in turn are associated with an increased risk of children experiencing difficulties in social, emotional and cognitive development.
They include:
- Socioeconomic status - socioeconomic disadvantage.
- Income - unemployment/workless household.
- Housing - living in social housing, a deprived area or experiencing housing difficulties.
- Parental relationship - lone parent, unemployed lone parent, co-habiting, living with a stepfather and disagreement between parents over parenting.
- Parenting high level of parental conflict
- Ethnicity - Indian, Pakistani/Bangladeshi or Black-African origin
- Maternal factors - depression, stress, psychopathology, alcohol consumption during pregnancy, smoking during pregnancy, living away from home prior to 17 years old.
(Evidence Summary: Interventions to support parents, their infants and children in the early years (pregnancy to 5 years), p.32 (external link)).
The above factors are derived from population-level studies and are not validated for use at individual level. However, it is appropriate that those working with children take them into account when considering whether children may be at risk of delayed growth and development.
Health-related factors affecting growth and development in 3-5s
For detailed discussions on key factors, advice for parents and those working with children, and evidence-based interventions that can help, please see the following:
Deprivation, parenting and social and emotional wellbeing
While most families living in deprivation do manage to provide caring, nurturing and stable environments for their children, there are strong links between deprivation and parental substance misuse, mental illness, neglect and domestic violence.
Growing up in such circumstances can lead to emotional and behavioural problems that can affect children's development and opportunities (NICE public health guidance 40 - Social and emotional wellbeing: early years p.18 (external link)).
For a fuller discussion of the issues, advice for parents and those working with children, and information on evidence-based interventions that can help, please see Parenting and health inequalities from 3-5 years.
Speech, language and communication development
By the age of 5 years, children should be able to use sentences with a developing grammar, take part in conversations, talk about past events and ask questions.
For a fuller discussion, see Speech and language development - what to expect 3 - 5 years.
For a fuller discussion of the impact of inequalities and key messages for parents and those working with children, please see Speech, language and communication development and health inequalities from 3-5 years.
Looked-after children
The fact that looked after children may have come from abusive or neglectful situations and the experience of growing up in the care system - particularly the effect of multiple placements - mean that looked after children generally suffer poorer outcomes in terms of education and health.
This is recognised in The Education (Additional Support for Learning) (Scotland) Acts 2004 & 2009, whereby looked after children are automatically considered as having additional support needs (unless assessment proves otherwise).
There is good evidence to suggest that placement with professional foster carers and lower age at first placement improve outcomes.
For a full survey of research into effective interventions, please see Health Scotland's Evidence summary: Looked after children (external link).
Identifying those at risk
Because those at risk can be difficult to identify, it's important to link with other professionals who may know more about the family and their circumstances, e.g. speech and language therapists, carers, GPs, social workers, health visitors, nursery school and other childcare staff, and voluntary sector agencies.
A range of risk factors should be considered - see the list above in How do inequalities impact on growth and development in 3-5s?
For a fuller discussion of inequalities, see Inequalities in the early years.
Providing information and support to parents
The 2012 Health Scotland paper: Exploration of the information support needs of parents (external link), was the result of in-depth work with 132 parents from across Scotland.
It found that parents preferred 'personal, empathetic support from individuals in dealing with their specific needs for information and support on child health and parenting'.
Three overarching themes emerged:
- Parent information/support is undermined when parents feel marginalised
- ‘Trust’ shapes how information is sought, received and used
- Parents respond most positively to personalised information and support.
Among its recommendations, the report emphasises the need for:
- continuing professional development for staff to enable them to present more personalised information and support
- alternative formats, products and services that more fully take account of the needs, views and preferences of young mothers, fathers and parents with literacy issues
- increased opportunities for face-to-face peer support and virtual social networks.
