Objective 1: Build Strong Beginnings

The U.S. Government will help ensure that children under 5 not only survive, but also thrive by supporting comprehensive programs that promote sound development of children through the integration of health, nutrition, and family support.

Significant Adversity Impairs Development in First Three YearsIn lower- and middle-income countries, an estimated 200 million children under 5 years of age – more than 30 percent of the world’s children – fail to reach their developmental potential, limiting their future ability to contribute to their communities and families or obtain gainful employment.1 Evidence-based investments early in the lives of children are cost-effective and successful, mitigating the risk factors that cause long-term harm.2

Early childhood health and developmental protections,3 which link the young child’s cognitive, social/emotional, language, and motor development with stable and supportive caregiving, help break cycles of poverty and inequality, particularly among the most vulnerable children.4 Although not the only time to provide developmental support,5 return on investment for human capital growth is greatest in children’s early years.6 Failure to address adversity at this time leads to lifelong deficiencies. Toxic stress, ill health, and chronic undernutrition leave children vulnerable to many risks, impair cognitive function, stunt physical growth, and reduce lifetime earning potential. When children experience responsive relationships – including a secure attachment with a permanent primary caregiver – and an environment rich with stimulation, they are more likely to thrive and grow up to be productive adults.7

Below are the specific outcomes that the U.S. Government aims to achieve within targeted subpopulations.

Outcome 1.1: The percentage of children achieving age-appropriate growth and developmental milestones is increased.

Outcome 1.2: The percentage of children under 5 years of age demonstrating secure attachment with a primary caregiver is increased.

Outcome 1.3: The number of U.S. Government-funded programs that integrate health, nutrition, developmental protections, and caregiving support is increased.


  1. Grantham-McGregor, S., et al. (2007). Developmental potential in the first five years for children in developing countries. The Lancet, 369(9555). pp. 60-70.
  2. The essential package: Holistically addressing the needs of young vulnerable children and their caregivers affected by HIV/AIDS. (2012). Accessed June 2012 at http://www.ecdgroup.com/pdfs/EPBrochure%20Final.pdf. [PDF, 1.5MB]
  3. Developmental protection supports age-appropriate development among young children. It targets early childhood (prenatal to 8 years of age), which encompasses the most rapid period of growth and change in human development. Based on research, developmental protection focuses on early cognitive, social, emotional, and physical development within the context of care (by families, communities, and nations), with an emphasis on promoting healthy development and safeguarding against modifiable threats to development. Including health, nutrition, education, social science, economics, child protection, and social welfare, developmental protection strives to ensure that young children’s overall safety and well-being during early life, with the understanding that early experiences and exposures play a role in shaping brain architecture and impact long-term well-being, ability, and productivity in adulthood.
  4. Walker, S.P., et al. (2011). Inequality in early childhood: Risk and protective factors for early childhood development. The Lancet, 378(9799). pp. 1325-1338. Published online September 23, 2011; Engle, P.L., et al. (2011). Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. The Lancet, 378(9799). pp. 1339-1353. Published online September 23, 2011.
  5. Recent research shows that the neuroplasticity of the adolescent brain allows for recovery from trauma and continued learning in older children and youth, which helps build resilience. See the adolescent brain: New research and its implications for young people transitioning from foster care. The Jim Casey Youth Opportunities Initiative. Available at http://www.jimcaseyyouth.org/adolescent-brain%E2%80%94new-research-and-its-implications-young-people-transitioning-foster-care.
  6. Carneiro, P. M. and Heckman, J.J. (2003). Human capital policy. NBER Working Paper Series, Vol. w9495; Knudsen, E., et al. (2006). Economic, neurobiological, and behavioral perspectives on building America’s future workforce. Proceedings of the National Academy of Sciences, 103(27). pp.10155-10162.
  7. National Scientific Council on the Developing Child. (2004). Young children develop in an environment of relationships: Working Paper No. 1. Retrieved from http://www.developingchild.harvard.edu.


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