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The present article is a discussion of the lessons that a paediatrician has learned from the evidence on early childhood development. The information that has been gathered is being used for advocacy for the creation of more efficient and higher quality programming that is accessible to all children. It is believed that by providing access to centralized and consolidated programming within neighbourhoods, more individuals will be reached earlier and more effectively.
Le présent article est un exposé des leçons qu’un pédiatre a tirées des données probantes sur le développement de la petite enfance. L’information colligée est utilisée pour prôner la création d’un programme plus efficace et de plus grande qualité accessible à tous les enfants. Le pédiatre croit qu’en donnant accès des programmes centralisés et consolidés dans les quartiers, plus de personnes seront jointes plus rapidement et avec plus d’efficacité.
Experience-based learning, a major focus of the early childhood development agenda, has been a critical factor in my own personal and professional development. My practice has been influenced by my own childhood experiences, education and training, while my experiences in my day-to-day work continue to shape my approach to situations.
With a nurse-educator mother and a father with a PhD in adult education, my early environment stressed that caring for others and lifelong learning were incredibly important. Caregiving and education were often subjects of dinner conversations. I was also fortunate to have had wonderful mentors during my medical training. As a resident, I accompanied staff on visits to schools and community services, where I discovered that the clinic is not the only place to learn about the children and families you work with.
A significant part of my current practice includes children with developmental challenges, those with difficulties with attachment and behaviour, and those who have experienced abuse. Their experiences have brought the importance of early childhood years to the forefront for me. It is very frustrating to observe a suffering school-age child or teenager when many of their difficulties could have been prevented by effective interventions and care during their early years.
A critical lesson that I have come to appreciate is that early childhood development programming is not only advantageous for families at risk, but also beneficial to people from all walks of life (1,2). While it is true that a higher proportion of children living in poverty are more likely to have problems, more than 60% of vulnerable children in Canada are not considered poor (2). This evidence has helped me, and those I work with, communicate to decision makers the importance of universal services. Programs targeted to the poor or disadvantaged will miss the majority of the children and families who require support.
When I first heard about epigenetics, I was fascinated. Epigenetics is the study of how genes are altered by experience. Intuitively, I knew that so-called nature was affected by ‘nurture’, but was amazed to find that ‘nurturing’ can even affect developing children at the molecular level (2). This research has provided even more impetus to advocate for programming directed toward young children and their families.
The High/Scope Perry Preschool Study (3) and two Canadian studies (Early Years Study 2: Putting science into action  and Early childhood education and care: Next steps. Report of the Standing Senate Committee on Social Affairs, Science and Technology ) demonstrate the economic benefits of investing in early childhood programs and provide more solid evidence to make a strong case for change.
Working in multisectoral coalitions with individuals from our business community, government and nonprofit agencies has shaped how I approach challenges. Advocacy has become integral to my approach to care. Although I continue to see children of all ages, I prioritize time spent with preschoolers while also attempting to connect with their families as early as possible. Most of my afternoons are spent outside the hospital and in the community. In addition, I am organizing a team-based model for children reaching out to public health nurses, social workers, psychologists and teachers to pull together our limited resources to improve our effectiveness.
Most of my work has been redirected to prevention. My practice, although challenging at times, is very meaningful and rewarding. When I am engaged with children and their struggling families, I am not as discouraged. More efficient and higher quality programming that is accessible to all children is being implemented. This is a result of the hard work of my community supported by the evidence that change can be achieved by investing in young children and their families. By making better use of resources and providing access by centralizing and consolidating programming within the neighbourhood, we will be able to reach more children earlier and more effectively, and maximize their potential.