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Commentary From the Council on Early Childhood

June 13, 2023

Early childhood–focused leadership groups have long existed at the American Academy of Pediatrics (AAP). The current Council on Early Childhood (COEC) was formed in 2013 from the merger of the Section on Early Education and Child Care and the Committee on Early Childhood. Its mission is “to relentlessly lift up infants, young children and their families in programs, practice, and policy.” This is the AAP’s home for early childhood–focused areas, including early education and child care, early literacy, infant mental health, early childhood systems, and early childhood research. A group of COEC members selected seminal articles from Pediatrics for review, reached consensus on those to highlight, and then a subgroup produced this commentary. While only scratching the surface of the literature, this tells a story of pediatrics and early childhood to date and sets the stage for future work.

Ab Initio: Lifting Up Infants, Young Children, and Their Families Over the Past 75 Years

Dipesh Navsaria, MPH, MSLIS, MD1, Jill M. Sells, MD2, Victoria Chen, MD3, James Guevara, MD, MPH4

Affiliations: 1Associate Professor of Pediatrics and Human Development & Family Studies, University of Wisconsin–Madison, Madison, WI; 2Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA, Distinguished Scholar, Education Development Center, Waltham, MA; 3Assistant Professor of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, Steven and Alexandra Cohen Children’s Medical Center, New Hyde Park, NY; 4Professor of Pediatrics & Epidemiology, Perelman School of Medicine at Penn, Children’s Hospital of Philadelphia, Philadelphia, PA

The importance of supporting early childhood health and development has been recognized since the founding of the AAP. The related evolution of research, policy, and practice is reflected in Pediatrics’ publications over the past 75 years. Two major concepts are foundational to this work: first, what happens early in life strongly influences future outcomes in a child’s life. Second, while innate factors such as genetics matter, relational and environmental influences are also critical. An understanding of these concepts reveals a multitude of opportunities for pediatricians who have sought to influence both clinical and systems approaches to promote optimal child health and development.

By the time Pediatrics began publishing in 1948, prior historical views of children as incomplete or “defective” adults had been replaced with the recognition that infancy, toddlerhood, and the preschool years are distinct developmental periods. These periods presented opportunities for assessment, support, coaching, modeling, reinforcement, and intervention to improve childhood development. This realization set the stage for pediatricians to implement strategies that support communities and families in ways that mitigate risk, reinforce strengths, and actively protect and promote early childhood development. Highlighting several key articles from 3 time periods encompassing Pediatrics’ 75-year history demonstrates important areas of impact within early childhood to date.

First Quarter Century (1948 to 1973)

Highlighted Articles From Pediatrics

First, the 1969 policy statement by Alpert et al regarding lead poisoning made a remarkable contribution to health and well-being across the life course.1 This policy statement recognized the profound impact of lead poisoning on the cognitive development of young children and on the subsequent older children, adolescents, and adults they become. Additionally, a historic examination of the drop in average blood lead levels in US children over the ensuing decades indicated the immense value of this work. Therefore, it set the stage for pediatricians to sound the alarm when lead levels rose in places like Flint, MI in 2014.

Two other notable articles from this same period include the 1954 publication on day care of children and Martha Eliot’s Grover Powers’ lecture on “Public Responsibility for the Health and Welfare of Children.”2,3 Both expand the role of pediatricians to include offering advice, consultation, and guidance on children’s health care outside the traditional clinical encounter and providing a vision of societal responsibility for the health and well-being of all children.

Second Quarter Century (1973 to 1998)

Highlighted Articles From Pediatrics

Susan Aronson and Leona Aiken’s research built on this work by delineating the importance of health and safety evaluation and training in early childhood centers.4 This finding brought to the fore the twin concepts of quality in early care and education settings and the role of pediatrician expertise in this arena. Similar themes were laid out in the paper by David Olds et al, which is cited frequently even to this day.5 This latter paper provides the seminal evidence showing the clinical impact of home visiting, which has led to the creation of federal structures for the support and funding of maternal, infant, and early childhood home visiting programs.

The policy statement on infant positioning and SIDS outlined the Back to Sleep principle for infant sleep.6 This publication highlighted how careful epidemiological research drove guidelines to direct messaging and clinical anticipatory guidance to reduce the incidence of SIDS. This may have been one of the first policy statements that led to constant, daily behavior modification in parent and caregiver practice and overcame resistance to change. The effects have been substantial, with a drop in infant mortality due to SIDS, allowing many infants to have an early childhood and beyond.

Third Quarter Century (1998 to 2023)

Highlighted Articles From Pediatrics

The theme of improving the quality of child health was represented in the 2005 policy statement on early care and education settings.7 This policy statement took earlier-articulated principles further and reiterated the need to support and promote quality in these settings.

The theme of child development evolved in a different way. A stronger immunization schedule, better prenatal care, and other efforts reduced infant mortality and enabled pediatricians to focus more on the developmental elements of early childhood. The 2006 developmental screening policy statement summarized the work of incorporating both simple surveillance checklists and validated, normed tools to improve developmental screening.8 This statement used a detect-and-intervene model, which offered a scaffold for inquiry, support, coaching, and modeling of parent-child interactions to improve pediatric outcomes in a proactive way, especially in language development. This was also exemplified in the 2014 early literacy policy statement.9

Finally, “The Lifelong Effects of Early Childhood Adversity and Toxic Stress” policy statement transformed the vernacular of pediatric health by describing the impact of early trauma.10 It highlighted the prevalence of trauma in the child population and linked trauma to chronic health problems. This offered a framework for understanding intractable problems that start in early childhood and provided strategies to address them. These strategies ranged from clinical medicine, to daily parenting and caregiver interactions, to broad social policy.

Implications for 2023 and Beyond

When early childhood is viewed through the last 75 years of Pediatrics, there are both significant changes and constancies. First, it is remarkable to see how much has changed; there is now a broader understanding of health risk factors, which now include the social-ecological context that children live in. In addition, there is now knowledge of the importance of pediatricians’ roles in the clinical visit (surveillance, screening, and anticipatory guidance) and in the community (as health consultants in early education and child care settings, and as partners in community-level collaborations across disciplines). At the same time, it is notable how much has remained the same. Early publications demonstrate a surprisingly modern outlook on the role of pediatricians in society in terms of advice, consultation, and advocacy, and a commitment to the health of all children, from the first days of life onward.

The COVID-19 pandemic has highlighted the challenges and opportunities in health care across early childhood in profound and complicated ways. The pandemic left many children at significant risk for poor outcomes in early childhood and beyond. The concepts outlined in the articles highlighted here provide a foundation for continued research and can lead to actionable steps in clinical practice, community collaboration, advocacy, and policy that are urgently needed across the nation to ensure that current and future generations have equitable opportunities to thrive.


  1. Alpert JJ, Breault HJ, Friend WK, et al. Prevention, diagnosis, and treatment of lead poisoning in childhood. 1969;44(2):291–298; doi: 10.1542/peds.44.2.291
  2. Public health, nursing and medical social work: day care of children. 1954;13(4):376–379; doi: 10.1542/peds.13.4.376
  3. Eliot MM. Public responsibility for the health and welfare of children: Grover Powers lecture. 1958;22(1):145–153; doi: 10.1542/peds.22.1.145
  4. Aronson SS, Aiken LS. Compliance of child care programs with health and safety standards: impact of program evaluation and advocate training. 1980;65(2):318–325; doi: 10.1542/peds.65.2.318
  5. Olds DL, Henderson CR, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. 1986;77(1):16–28; doi: 10.1542/peds.77.1.16
  6. AAP Task Force on Infant Positioning and SIDS. Positioning and SIDS. 1992;89(6):1120–1126; doi: 10.1542/peds.89.6.1120
  7. Committee on Early Childhood, Adoption, and Dependent Care. Quality early education and child care from birth to kindergarten. 2005;115(1):187–191; doi: 10.1542/peds.2004-2213
  8. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics. 2006;118(1):405–420; doi: 10.1542/peds.2006-1231
  9. Council on Early Childhood. Literacy promotion: an essential component of primary care pediatric practice. 2014;134(2):404–409; doi: 10.1542/peds.2014-1384
  10. Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. 2012;129(1):e232–e246; doi: 10.1542/peds.2011-2663


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