A new study led by researchers at the University of California, Davis, shows that caregiving programs are five times more effective than nutrition programs in supporting smarter, not just taller, children in low- and middle-income countries.

The research, published in the journal The Lancet Global Health, examined 75 early intervention programs and their effects on children’s growth and brain development. Researchers have known adequate nutrition during pregnancy and childhood improve both conditions. But children growing up in poverty face a variety of risk factors that could govern growth and development differently.

“Our study found that we can’t just focus on nutrition. Other aspects of nurturing care are just as, if not more important in supporting healthy brains,” said lead author Elizabeth Prado, assistant professor of nutrition at UC Davis.

Prado says interventions that promote caregiving and learning, such as parents playing games, singing songs and telling stories with their children, have far bigger effects on children’s cognitive skills, language skills and motor development.

“We knew that nurturing care was important but were struck by how big its benefits were compared to nutrition and growth,” added Leila Larson, a lead collaborator from the University of Melbourne.

Investing in caregiving and learning

Global health programs typically focus on preventing stunting, when children are not growing in height the way they should for their age. Stunted growth has also been associated with lower than average school achievement and cognitive scores.

“The association has been influential in prioritizing a global agenda to promote nutrition and growth,” said senior author Anuraj Shankar, with the Center for Tropical Medicine and Global Health at Oxford University. “However, our true goal isn’t just for children to grow taller but for them to fulfill their developmental potential. The study shows that won’t happen unless we target caregiving to nurture thriving individuals and communities.”

Globally, an estimated 156 million children younger than 5 years have stunted growth and an estimated 250 million are at risk of not fulfilling their developmental potential.