Bledidoc Advice

Cognitive development in preschoolers involves the maturation of higher mental functions such as attention, memory, learning and perception; and is predictive of later school achievements(1).

Skills such as taking a first step, smiling for the first time, and waving “bye-bye” are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move.

Children develop at their own pace, however milestones for cognitive skills give a general idea of the changes to expect as a child gets older, help follow the child’s development and diagnose any delay on time.

At 3 years, a child has a vocabulary of several hundred words, speaks in sentences of 3 words, counts 3 objects and asks questions, he also knows his own name, age, and gender. He can dress with help, feeds easily, starts to share and can engage in play activities. He becomes less afraid when separated from his mother or caregiver for short periods of time, but fears imaginary things. Temper tantrums are common at this age.

The typical 4-year-old has a vocabulary of more than 1,000 words, easily puts together sentences of 4 or 5 words, can count to 4, will be curious and ask a lot of questions, learns and sings simple songs. He tries to be very independent, may show increased aggressive behavior and lacks moral concepts of right and wrong. He commonly has imaginary playmates, has an increased understanding of time and is able to tell the difference between two objects, based on things like size and weight.

At 5 years, a child has a vocabulary of more than 2,000 words, speaks in sentences of 5 or more words, can count to 10, can properly name the primary colors, and can answer "why" questions.

He is more responsible, shows less aggressive behavior and outgrows earlier childhood fears. He has a group of friends and likes to imagine and pretend while playing.

Starting 6 years, a child shows more independence from parents and family. He starts to think about the future, understands more about his place in the world. He pays more attention to friendship and teamwork and wants to be liked and accepted by friends. He shows rapid development of mental skills, learns better ways to describe experiences and talks about thoughts and feelings. He has less focus on one’s self and more concern for others(2).

To achieve a normal neurocognitive development, children need a safe and healthy environment.

Nutrition plays a major role in postnatal brain and behavior development.

Brain development is known to be faster in the early years of life compared to the rest of the body; which make it more vulnerable to dietary deficiencies, and both under and over nutrition are responsible of negative impact on the child ability to learn(1,3).

In addition, the brain is the most metabolically active organ in the body, yet it has very limited stores of energy, so it relies on the diet for a continuous supply of sugar and an adequate supply of micronutrients(4).

Malnutrition in the first year of life has a lasting effect on both behavior and cognition(4). Older children with a poor diet may be tired and unable to learn at school, this will weaken their immune system and make them prone to recurrent infections and school absenteeism.

Breakfast is very important. Children may feel tired and unmotivated if they do not eat a good breakfast and the relationship between breakfast and improved learning has been clearly shown(4).

Some nutrients play a key role in brain development such as the omega 3 fatty acids, critical for brain development and function. Adequate levels of vitamin B12, folic acid and choline are associated with better cognitive performance, as well as multivitamins and minerals. Vitamin A will help vision and the skin, vitamin C is needed for bone growth and vitamin D for bones, teeth and general growth. Zinc supplementation has a positive effect on the immune status of children and may positively influence cognitive development. The relationship between iron and cognitive development has been well researched in children; furthermore, if iron deficiency occurs in very early life, the damage may be irreversible. Iodine is important for thyroid function, a gland that is responsible of brain development and maturation, and iodine deficiency causes neurodevelopmental delay(1,4).

It is therefore important to ensure a balanced diet to young children, and a good source of nutrients and vitamins is milk if it is adapted to the child’s age, such as growing up milk.

Obesity is a special form of malnutrition, because the diet is likely to have low nutrient-density in conjunction with a high fat and carbohydrate content. It may result in poorer academic performance, probably through metabolic changes but mediate by socio demographic factors that include discrimination and isolation(5).

In summary, childhood is a critical stage in the establishment of physical and mental abilities and a balanced diet positively affects all aspects of the cognitive development in children.

Dr. Dina HELOU KAHI

General Pediatrics and Vaccinology

^{1- Anett Nyaradi, Jianghong Li et Al, The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Front Hum Neurosci. 2013; 7: 97.}

^{2- CDC, child development.}

^{3- Francisco J. Rosales, J. Stevens Reznick and Steven H. Zeisel, Understanding the Role of Nutrition in the Brain and Behavioral Development of Toddlers and Preschool Children: Identifying and addressing Methodological Barriers. Nutr Neurosci. 2009; 12(5): 190-202.}

^{4- David Benton, The influence of dietary status on the cognitive performance of children. Mol. Nutr. Food Res. 2010; 54(4): 457-470.}

^{5- Sherry A. Tanumihardjo et Al, Poverty, obesity and malnutrition: An International Perspective Recognizing the Paradox. J Am Diet Assoc. 2007; 107(11): 1966- 1972.}