Almost half of the children under 5 living in low and middle income countries are not reaching their developmental potential. This will affect their long-term education, well-being and productivity. In order to investigate interventions, accurate assessment of brain development is needed. TNO with partners are creating a validated instrument to internationally measure brain development. This is called the Development score or D-score.

Approximately 43% of children under age of 5 years are not reaching their developmental potential, due to a lack of adequate nutrition, nurturant caregiving, and opportunities for early learning. This will put them and their countries at risk for low human capital development. Brain development in early life is responsible for long-term education, well-being and productivity throughout the entire life span. Initiatives such as the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) and United Nations’ 2030 Sustainable Development Goals aim to maximize children’s opportunities for a healthy and productive life.

First 1000 days

In order to improve child health, it is important to understand that children simultaneously develop physical, intellectual, social and emotional capabilities. These developmental processes are interrelated, interdependent and mutually reinforcing. Child health and wellbeing can be positively influenced by concurrently addressing the basic needs of children. These are: good nutrition, a nurturing and safe environment, and the ability to adapt to their surroundings. Interventions aimed at ensuring these basic needs should take place as early as possible, even before conception, and continue until the age of two at least. This window of time is framed as the first 1000 days. There is increasing evidence that investments during this period will not only contribute to child survival but will also lead to the continued health and wellbeing of children and enhance their ability to thrive.

Growth charts

There are huge differences in height and weight between children in prosperous countries and those in less developed parts of the world.  In the Netherlands our clinics accurately record and monitor the details of each child’s height and weight, as well as other developmental parameters. This yields a wealth of valuable data, such as growth charts. This is coordinated by Stef van Buuren at TNO. Drawing on TNO’s knowledge of youth health care and statistics, a new method is being developed to determine which interventions, at which places in the world, are the most effective in terms of substantially reducing mortality and poor development among children. “The first thousand days are critical”, says Stef. “At birth, children everywhere are all about the same height and weight. Yet, two years later, you see that children in many developing countries are well below the World Health Organization’s (WHO) standard. Once you have a deficit like that, you can never catch up. A poor start will affect you for the rest of your life. Together with the Bill & Melinda Gates Foundation we aim to change this situation.”

D-score for children worldwide

International D-score

During the first 1000 days, the child’s body (the regulatory system) is trained to respond to stimuli, in varying degrees and during different developmental periods. This may optimize or compromise the child’s capacity for resilience and adaption, which in turn
provide the foundation for lifelong good or compromised health respectively. Current research has shown how interventions during the first 1000 days can increase the odds of favorable child development.

TNO has created a simple and robust scale of child development (D-score) combining physical, emotional and communication indicators to detect developmental delay in infancy. The D-score is based on items routinely used in the Dutch child health care system, like “Can the child stack two blocks”, “Can the child walk”, and so on. This has been developed for the Dutch Preventive Child Health Services and has the potential to be applied in other settings and countries. Currently, TNO is involved in a substantial international effort to create early child development standards for children between birth and 3 years. The project will run for 5 years and should lead to a brief instrument to monitor development at the population level, and a longer instrument to monitor program effectiveness. A major challenge in the new project is to create instruments that “work the same everywhere”. A scale of child development needs to be developed first, and then the instruments can be composed that provides efficient measurements in that scale. The instruments used in the international project will be based on caregiver reports.

Read our White paper: Investing in the first 1000 days of life

A child’s first thousand days

This TNO project supports the following Sustainable Development Goals


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