Bledidoc Advice

A child is a growing miracle. Through subsequent stages of childhood, a child will acquire different developmental milestones, transitioning from full parent-dependent infant, to a growing self-confident toddler, to a creative schooler child, to a stubborn dreaming adolescent, and finally to a full responsible independent adult. So, children grow up and develop rapidly in their first years of life across the four main areas of development. These areas are motor (physical), cognitive (communication and language), social and emotional. In fact, all aspects of child development are interconnected, (see figure), so many common factors should be affecting these aspects to get the full integral child development.

When parents are asked about their child’s development they’ll often talk about speech and language development, gross motor skills or even physical growth. But a child’s social development is a critical piece of the development puzzle.

Social development refers to the process by which a child learns to interact with others around them. As they develop and perceive their own individuality within their community, they also gain skills to communicate with other people and process their actions.

Healthy social development is important. It can help child develop language skills, build self-esteem, strengthen learning skills, resolve conflicts, and establish a positive attitude. It also influences a child’s self-confidence, empathy, the ability to develop meaningful and lasting friendships and partnerships, as well as a sense of importance and value to those around him/her. Children’s social and emotional development also influences all other areas of development and is similarly influenced by all other aspects of development as they are all interconnected.

Many factors may affect the way toddlers express their social skills and emotional competencies or affect the rate at which they acquire these skills and competencies. These factors include:

Family factors:

Risk factors such as maternal depression or mental illness in the family, parental substance abuse, family violence, poverty, etc. negatively influence child socialization. Parental conflict, stressful and impoverished neighborhoods and chronic illness also predispose children to shyness and difficulty with social development. However, the textbook "Child Psychology" argues that some stress can have a positive impact. Children who witness their parents effectively resolving conflict for example, often are better able to resolve conflict themselves. Kids who periodically face moderate stress while receiving parental support tend to be more resilient than children who grow up in completely stress-free environments.

Parental interactions with children can have a largely positive or negative effect on child development. Parents who spend time playing and teaching their kids through reading and by performing various types of games and activities can have a positive impact on their child’s development. On the flip side, parents who ignore or neglect to interact with their children in a positive way may, be hindering their healthy development according to the Royal Children’s Hospital of Melbourne, Australia.

Parents also model social skills to their babies even before they begin talking. Shy parents tend to raise shy children because the children witness fewer social interactions and may see other people as sources of stress. Parents who are interested in raising children with strong social skills and outstanding personalities should expose their children to a variety of people even during infancy. This helps children become accustomed to new faces and decreases their likelihood of struggling with shyness and social anxiety

Environmental factors:

Risk factors such as living in an unsafe community, receiving care within a low-quality childcare setting, lack of resources available in the community or lack of policies supporting children and families, etc. can negatively affect a child social development.

Conversely, children who are surrounded, both at home and at school/daycare facilities, by a strong learning environment that is both informative and supportive, may improve their development.

Different cultures may have various expectations about the age at which children will achieve socially mediated milestones. It is therefore important to ask not only what the child can do, but also what the family expects and allows. The culture of the family and community provide a framework within which the socialization process unfolds. Children are heavily influenced by the culture, opinions, and attitudes of their families as they are taught to act, believe and feel in ways that are consistent with the values of their communities.

Social development is also strongly correlated with exposure to a stimulating environment. For example, the American Academy of Pediatrics advises that exposure to television prior to the age of two can stunt developmental growth, particularly social and intellectual development. Access to a variety of toys including blocks, dolls and games encourages children to develop a variety of skills that can improve social interaction. Social isolation or lack of socialization with other children, such as neighbors, classmates or family members can lead to early childhood development issues, such as speech problems or an inability to socialize with others in a civilized way.

Nutrition is an environmental factor as it represents access to resources from the environment (i.e., food and water), but in contrast to other environmental resources like medical care, education or experiences, nutrition can directly modify gene structure and mediate the expression of genetic factors by providing the specific molecules that enable genes to exert their potential or targeted effects on brain growth and development.

The brain is a specialized tissue in which functionality depends upon the generation of electrical potentials and their conduction through long axonal components of cell-bodies and through the synaptic gaps between these cell-bodies. These special functions of the brain are reflected in a higher need for certain nutrients such as choline4, folic acid, iron, zinc and special fats (e.g. gangliosides, sphingolipids and docosahexaenoic acid (DHA)).

Thus, nutrition plays a critical role at the crossroads of the biological and nurturing factors that mediate brain growth and therefore whole child development.

Nutrients provide building blocks that play a critical role in cell proliferation, DNA synthesis, neurotransmitter and hormone metabolism, and are important constituents of enzyme systems in the brain(1,2,3,5,8). Although it is important to investigate nutrients individually, deficiencies of nutrients rarely occur in isolation, and an inadequate diet typically causes multiple micronutrient deficiencies. In addition, nutrients interact with each other and do not work separately9.

By the age of 2, the brain reaches 80% of its adult weight and has twice as many synapses as it will have in adulthood. Of the human brain’s dry weight, 60% is comprised of lipids, of which 20% are DHA (which is an omega- 3 fatty acid) and AA (an omega-6 fatty acid). These represent the two core fatty acids found in gray matter(9,6).

Essential fatty acids play a central functional role in brain tissue. They are not only the basic components of neuronal membranes, but they modulate membrane fluidity and volume and thereby influence receptor and enzyme activities in addition to affecting ion channels.

In recent years, there has been an increasing interest in the association between vitamin B12, folic acid, choline metabolism, and cognitive development. Folate affects neural stem cell proliferation and differentiation, decreases apoptosis, alters DNA biosynthesis, and has an important role in homocysteine and S-adenosylmethionine biosynthesis(3,10). It is believed that choline has similar roles in brain development as folate (11,12, 3, 13). Therefore, choline and folate deficiency may result in DNA hypomethylation, thereby altering gene transcription(3).

In children, the association between vitamin B12 and cognitive development has been mainly observed in infants born of vegetarian/vegan mothers or mothers on a macrobiotic diet. These diets can result in vitamin B12 deficiency, as vitamin B12 is largely found in animal products. After vitamin B12 treatment, a rapid improvement in neurological symptoms is reported in deficient infants, but many of these infants remained seriously delayed in cognitive and language development in the longer term(14).

Iodine is necessary to produce thyroid hormones in the body; 70–80% of it is found in the thyroid gland. Thyroid hormones play an important role in neurodevelopment and numerous neurological processes including neuronal cell differentiation, maturation and migration, myelination, neuro- transmission, and synaptic plasticity(7,8,15).

It is also believed that zinc is a vital nutrient for the brain, with important structural and functional roles(1,16,19,22,23). More specifically, zinc is a cofactor for more than 200 enzymes that regulate diverse metabolic activities in the body including protein, DNA and RNA synthesis. In addition, zinc plays a role in neurogenesis, maturation, and migration of neurons and in synapse formation(1,16).

It is also believed that iron is involved with different enzyme systems in the brain, including the cytochrome c oxidase enzyme system in energy production, tyrosine hydroxylase for dopamine receptor synthesis, delta-9- desaturase for myelination, and fatty acid synthesis, and ribonucleotide reductase for brain growth regulation(17,18,19,20). Anemic children have lower levels of mental development than non-anemic children in case-control studies and differences remain over the long term. Anemic children show socially isolating behaviors, such as wariness and sleepiness. Iron therapy alone is not adequate to raise a child a mental development; they also need stimulation in the home environment(21).

In conclusion, understanding child development and the application of its principles sets the care of children apart from that of adults. Infants grow to be children, adolescents and then adults. Understanding the importance of social development in a toddler’s life, taking into consideration several factors affecting this important aspect of a child’s development supports the healthy transition of a toddler to an independent future adult, and giving that nutrition is an important factor influencing brain development to reinforce social skills, so that special attention should be given to a well-balanced diet, preventing any nutritional deficiency that could influence development. A balanced diet should be well-studied and include all necessary vitamins and nutrients in the adapted quantities in relation to the child’s age. That is why parents should make sure to provide a rich mixture of grains, proteins, vegetables, fruits and choose milk adapted to the child’s age, because it is rich in vitamins and nutrients and is proven to cover an important part of a child’s daily needs.

You can always refer to your child’s healthcare provider for closer guidance following your child’s specific needs.

Dr. Bilal DHAYNI

M.D. Pediatrician

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^{6- De Souza, A. S., Fernandes, F. S., and Do Carmo, M. G. (2011). Effects of maternal malnutrition and post- natal nutritional rehabilitation on brain fatty acids, learning, and memory. Nutr. Rev. 69, 132–144.}

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^{8- Zimmermann, M. B. (2011). The role of iodine in human growth and development. Semin. Cell Dev. Biol. 22, 645–652.}

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^{10- Zhang, X.-M., Huang, G.-W., Tian, Z.-H., Ren, D.-L., and Wilson, J. (2009). Folate stimulates ERK1/2}

^{phosphorylation and cell prolifera- tion in fetal neural stem cells. Nutr. Neurosci. 12, 226–232}

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^{13- Signore, C., Ueland, P. M., Troendle, J., and Mills, J. L. (2008). Choline con- centrations in human maternal and cord blood and intelligence at 5 y of age. Am. J. Clin. Nutr. 87, 896–902.}

^{14- Dror, D. K., and Allen, L. H. (2008). Effect of vitamin B12 deficiency on neurodevelopment in infants: cur- rent knowledge and possible mech- anisms. Nutr. Rev. 66, 250–255.}

^{15- Melse-Boonstra, A., and Jaiswal, N. (2010). Iodine deficiency in pregnancy, infancy and childhood and its consequences for brain development. Best Pract. Res. Clin. Endocrinol. Metab. 24, 29–38.}

^{16- Black, M. M. (2003a). The evidence linking zinc deficiency with chil- dren’s cognitive and motor func- tioning. J. Nutr. 133, 1473S–1476S.}

^{17- Deungria, M. (2000). Perinatal iron deficiency decreases cytochrome c oxidase (CytOx) activity in selected regions of neonatal rat brain. Pediatr. Res. 48, 169–176.}

^{18- Lozoff, B., and Georgieff, M. K. (2006). Iron deficiency and brain develop- ment. Semin. Pediatr. Neurol. 13, 158–165.}

^{19- Georgieff, M. K. (2007). Nutrition and the developing brain: nutrient priorities and measurement. Am. J.Clin. Nutr. 85, 614S–620S.}

^{20- Rioux, F. M., Bélanger-Plourde, J., Leblanc, C. P., and Vigneau, F. (2011). Relationship between maternal DHA and iron status and infants’ cognitive performance. Can. J. Diet. Pract. Res. 72, 76.}

^{21- Aboud, F., E. & Yousafzai A., K. (2016). Very Early Childhood Development. Work R. E. Black, R. Laxminarayan, M. Temmerman & N. Walker (edit.), Re- productive, Maternal, Newborn, and Child Health (241—255). Washing- ton: International Bank for Reconstruction and Development / The World Bank. Available 5.2.2018. https://openknowledge.worldbank.org/bitstream/handle/10986/23833/9781 464803482.pdf?sequence=3&isAllowed=y}

^{22- Bryan BA, et al. (2004) Evidence for control of nitrogen metabolism by a START-dependent mechanism in Saccharomyces cerevisiae. Mol Genet Genomics 271(1):72-81}

^{23- Shah and Sachdev, 2006}

^{Related sites:}

^{https://www.cdc.gov/ncbddd/childdevelopment/facts.html}

^{https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=55022719&bookid=990}

^{https://www.northshore.org/pediatrics/ages-and-milestones/toddler--2---4-years/}

^{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776771/}

^{https://www.unscn.org/layout/modules/resources/files/Brief1-12EN.pdf}

^{https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_HealthyNutrition.pdf}

^{https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_HealthyDevelopment.pdf}

^{https://www.scanva.org/support-for-parents/parent-resource-center-2/social-development-in-children/}

^{https://www.sciencedaily.com/releases/2016/05/160510160320.htm}

^{https://www.researchgate.net/publication/236083927_The_Role_of_Nutrition_in_Children's_Neurocognitive_Development_From_Pregnancy_Through_Childhood}

^{Bledina is not the author of this article, as it has been written by Dr Bilal DHAYNI who is the owner of the content.}