Childhood mortality in developing countries remains the most dramatic issue confronting the public health and pediatric communities; each year there are more than 8 million deaths in children younger than 5 years.1,–,3  Mortality, however, is “the tip of the iceberg” of the serious problems that face children in the developing world. Importantly, it is conservatively estimated that more than 200 million children younger than 5 years (∼40% of those living in developing countries) do not reach their potential in cognitive development because of problems associated with extreme poverty: malnutrition severe enough to lead to growth retardation; iodine and iron deficiency; inadequate cognitive and social-emotional stimulation; and other less well-documented factors (social risk, environmental toxins, and infectious diseases).4,5  Inadequate early childhood development leads to poor school performance, low adult incomes, intergenerational transmission of poverty, and negative impact on national development.

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