Mandeep Rana, MD
Mandeep Rana
Pediatric Neurologist and Sleep Specialist
Boston Medical Center

Birth to Three: A Neurologist’s Perspective

In so many ways, the first three years of life are critical—and worth extra time, attention, and investment. What science has been able to tell us is that there is a dramatic increase in the overall brain size in earlier years of life, with the brain reaching 80 to 90 percent of its adult volume by age two. This large increase makes this period a time of substantial growth and development. And any disruption or delay of the developmental process, due to, say, a genetic problem or an environmental insult, can have lasting effects on brain structure and function.

In the first year alone, the leaps and bounds babies make in development are astounding. Case in point are the behavioral experiments that involve showing young babies a series of the same pictures. At first glance, babies spend a long time looking at the stimulus. Over time, though, this changes. After several more exposures, they glance only briefly at them—at which time the experimenter presents a new one. If the infant categorizes the new display as different, she typically returns to her original, prolonged looking time—giving us a clear indication of what she knows or doesn’t know, and confirming that during the first year, babies come to know objects are solid, and that they continue to exist even when out of sight.

On the other hand, when babies are deprived of physical stimulation and touch, the effects extend not only to perceptual but also cognitive development. Animal studies, for instance, reveal that rats deprived of maternal contact for six hours a day that first month of life fail to reach milestones and exhibit behavior difficulties later in life. Though setting up human studies of deprivation isn’t possible (and clearly unethical), scholars speculate similar results when human infants go without physical touch.

We know, too, that visual stiumlation is essential those first few months of life. When infants born with dense cataracts (which obscure vision) undergo surgery and visual stimulation therapy in the first six to eight weeks of life, they do much better than those who prolong the procedure. Interestingly, vision remains stagnant in the absence of patterned visual input but reaches near perfect when surgery is performed early, suggesting that these inputs trigger changes in neural mechanisms (nerve cells, neural circuits, neurotransmitters, and hormones).

All of this points to the fact that timing is critical when making interventions for the youngest children. Consider this study from Bucharest: a group of Romanian children suffering from extreme deprivation in orphanages were placed in foster homes before two years of age—and showed far greater improvements in their development quotient (DQ) and intelligence quotient (IQ) than those placed in foster care after the age of two. A profound change in structural brain development may make this infant to toddler period a critical one in human development.

What we’re only starting to uncover, however, are the connections between the physical growth of the brain and the emergence of new behaviors and abilities during infancy, childhood, and across the lifespan. Addressing this question has important implications not just for academia but also for clinical, educational, and social policies. What we do know, though, is that to reach their full potential, children need to spend time in a consistent, caring, secure, and nurturing environment with the appropriate sensory input.

Parents and families are key players in early child development—but they, too, need support to provide the right environment. Healthcare providers and educators also play an important role, as they are the points of early contact outside the family unit. Ideally, they identify concerns for families and children and, when appropriate, mobilize developmental or medical interventions.

A great deal is at stake in helping children reach their full potential—and become productive members of their family and community, not to mention self-actualized individuals. Investing in young children also contributes in big ways to the development of our national economy and society. Put differently, as we spend educational and healthcare dollars over a child’s lifetime, we may have the greatest, best impact if we focus on (and invest in) those first three years.

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Learn More

“Insights from the Youngest Minds (What Babies Know),” Natalie Angier, The New York Times, 2012

Zero to Three: Early Experience Matters, National Center for Infants, Toddlers, and Families

“Brain Development in Childhood – The Dana Guide,” Dana Foundation

“Baby’s Brain Begins Now: Conception to Age 3,” Urban Child Institute

The Myth of the First Three Years (chapter one), John T. Bruer

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