Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined WORKING15 PAPER 15 This paper is MEMBERS and Translational Science Institute; Swift-McNear Profes- sor of Pediatrics, University of Arizona dedicated to Jack P. Shonkoff, M.D., Chair Bruce S. McEwen, Ph.D. Julius B. Richmond FAMRI Professor of Child Health and Bruce S. McEwen, Ph.D.* (1938-2020) Development, Harvard T.H. Chan School of Public Health Alfred E. Mirsky Professor; Head, Harold and Margaret and Harvard Graduate School of Education; Professor Miliken Hatch Laboratory of Neuroendocrinology; The of Pediatrics, Harvard Medical School and Boston Chil- Rockefeller University dren’s Hospital; Research Staff, Massachusetts General Hospital; Director, Center on the Developing Child, Charles A. Nelson, Ph.D. Harvard University Professor of Pediatrics and Neuroscience, Harvard Medical School; Professor of Education, Harvard Gradu- Pat Levitt, Ph.D, Science Co-Chair ate School of Education; Richard David Scott Chair in Simms/Mann Chair in Developmental Neurogenetics, Pediatric Developmental Medicine Research, Boston Institute for the Developing Mind, Children’s Hospital Children’s Hospital Los Angeles; W.M. Keck Provost Professor in Neuroge- netics, Keck School of Medicine, University of Southern Patrícia Pelufo Silveira, M.D., Ph.D. California Assistant Professor, Department of Psychiatry, McGill University; Primary Investigator, Ludmer Centre for Neu- Nathan A. Fox, Ph.D., Science Co-Chair roinformatics and Mental Health Distinguished University Professor, Department of Human Development and Quantitative Methodology, * Dr. Bruce McEwen contributed in many ways to the Program in Neuroscience and Cognitive Science; Direc- drafting of this paper before his untimely death in SPONSORS tor, Child Development Lab, University of Maryland January 2020. We greatly miss him as a person and as a world-leading expert whose wide-ranging knowledge The Alliance for Early Judy Cameron, Ph.D. and gentle humor were so appreciated by the members Success Professor of Psychiatry, Neuroscience, Obstetrics- of the National Scientific Council and all of his many Gynecology Reproductive Sciences, and Clinical and admirers and students. Buffett Early Childhood Translational Science, University of Pittsburgh; Director of Outreach, School of Medicine, University of Pittsburgh Fund ACKNOWLEDGMENTS We gratefully acknowledge the significant contributions Greg J. Duncan, Ph.D. to this paper made by: Chan Zuckerberg Initia- Distinguished Professor, Department of Education, tive University of California, Irvine Reggie Bicha, M.S.W., Shine Early Learning Genentech Damien Fair, PA-C, Ph.D. W. Thomas Boyce, M.D., University of California, San Professor, Institute of Child Development, Department of Francisco Pediatrics; Director, Masonic Institute for the Developing Imaginable Futures Brain, University of Minnesota Gloria Corral, M.P.P., Parent Institute for Quality Educa- tion The JPB Foundation Philip A. Fisher, Ph.D. Philip H. Knight Chair; Professor of Psychology, Univer- Iheoma U. Iruka, Ph.D., HighScope Educational Research sity of Oregon; Senior Fellow, Center on the Developing Foundation The LEGO Foundation Child at Harvard University Nat Kendall-Taylor, Ph.D., FrameWorks Institute Overdeck Family Founda- Megan R. Gunnar, Ph.D. Joan Lombardi, Ph.D., Early Opportunities tion Regents Professor and Distinguished McKnight Univer- sity Professor, Institute of Child Development, University Michael J. Meaney, Ph.D., McGill University; Singapore of Minnesota Institute for Clinical Sciences, Agency for Science, Tech- The David and Lucile nology & Research; Yong Loo Lin School of Medicine, Packard Foundation Takao Hensch, Ph.D. National University of Singapore Professor of Molecular and Cellular Biology, Harvard Pritzker Children’s Initia- Faculty of Arts and Sciences; Professor of Neurology, Aaliyah Samuel, Ed.D., NWEA Harvard Medical School at Children’s Hospital tive Mandy Sorge, M.A.Ed. and Beth Caron, Ph.D., National Fernando D. Martinez, M.D. Governors Association The Simms/Mann Family Regents Professor; Director of the Arizona Respiratory Donna Wilson, Ph.D., National Conference of State Foundation Center; Director of BIO5 Institute; Director of the Clinical Legislatures About the Authors Tikun Olam Foundation The National Scientific Council on the Developing Child, housed at the Center on the Developing Child at Harvard University, is a multi- disciplinary collaboration designed to bring the science of early childhood and early brain development to bear on public decision- making. Established in 2003, the Council is committed to an evidence-based approach to building broad-based public will that transcends political partisanship and recognizes the complementary responsibilities of family, community, workplace, and government to promote the well- being of all young children. For more information, go to www.developingchild.net. Please note: The content of this paper is the sole responsibility of the authors and does not necessarily represent the opinions of the spon- sors. Suggested citation: National Scientific Council on the Developing Child. (2020). Connecting the Brain to the Rest of the Body: Early Child- hood Development and Lifelong Health Are Deeply Intertwined: Working Paper No. 15. Retrieved from www.developingchild.harvard.edu © JUNE 2020, NATIONAL SCIENTIFIC COUNCIL ON THE DEVELOPING CHILD, CENTER ON THE DEVELOPING CHILD AT HARVARD UNIVERSITY The Issue: Health and Learning Are Interrelated in the Body but Separated in Policy 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.1 The science is clear on two points: 1. What happens during this period can have substantial effects on both short- and long- term outcomes in learning, behavior, and both physical and mental health. 2. All of these domains are remarkably interdependent and the potential for learning is inexorably linked to the quality of physical and mental health. A child who is living in an environment lung function, digestion, energy production, with supportive relationships and consistent fighting infection, and physical growth routines is more likely to develop well- are all interconnected and influence each functioning biological systems, including other’s development and function. Each brain circuits, that promote positive system “reads” the environment, prepares to development and lifelong health. Children respond, and shares that information with who feel threatened or unsafe may develop the others. Each system then “signals back” physiological responses and coping behaviors to the others through feedback loops that are that are attuned to the harsh conditions already functioning at birth.8 As an example, they are experiencing at the time,2 at the long-term expense of physical and mental The environments we create and the experiences well-being, self-regulation, and effective learning.3 Policymakers, leaders of human we provide for young children and their families services systems, intervention developers, and practitioners can all use this knowledge to affect not just the developing brain, but also many create innovative solutions to reduce disparities other physiological systems. in preventable diseases and premature deaths and lower the high costs of health care for chronic illnesses that have their origins in early higher rates of infection in early childhood childhood adversity.4,5 Moreover, these costs can increase the level of anxiety at later are likely to grow unless society’s investment ages9, which can then compromise school in promoting health and preventing disease performance. Children living in conditions moves “upstream” to address the sources of of threat and deprivation may emerge as these problems in early childhood. adults with a greater risk for multiple forms Nearly all aspects of early development of cardiometabolic disease. In short, the and later health are affected by interactions environments we create and the experiences among experiences, genes, age, and the we provide for young children and their environments in which young children live. families affect not just the developing brain, These interactions influence every biological but also many other physiological systems, system in the body, with especially powerful from cardiovascular function and immune effects in the earliest years.6,7 Systems responsiveness to metabolic regulation. All of relating to brain development, heart and these systems are responsible for our lifelong WWW.DEVELOPINGCHILD.HARVARD.EDU Connecting the Brain to the Rest of the Body 1 NATIONAL SCIENTIFIC COUNCIL ON THE DEVELOPING CHILD health and well-being. apply to every individual, but how these The brain and all other organs and systems systems adapt and interact can vary, and these in the body are like a team of highly skilled differences are essential for developing effective athletes, each with a specialized capability that prevention and intervention strategies based complements the others and all of whom are on 21st-century science. dedicated