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Review of the theoretical frameworks for the study of child development within public health and epidemiology
  1. B I Avan1,2,
  2. B R Kirkwood3
  1. 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
  2. 2Immpact, Division of Applied Health Sciences, University of Aberdeen, Scotland, UK
  3. 3Nutrition and Public Health Intervention Research Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Bilal Iqbal Avan, Immpact, Division of Applied Health Sciences, University of Aberdeen, Foresterhill, Scotland, AB25 2ZD; bilal.avan{at}


Background Care for child development has gained international momentum in research and community-based programming. It encompasses various domains including cognitive, psychomotor, emotional, behavioural and social development, and a multitude of factors that have the potential to influence its trajectories. However, the multidisciplinary nature of child development initiatives is marred by a lack of unified perspectives across disciplines, especially basic conceptual understanding generated in the fields of education and psychology, which are not effectively exploited in public health programmes and epidemiological research.

Methods The article suggests a four-point evaluation criteria to child development theories based on the ability to communicate in (1) Cross-disciplines, (2) an Overarching facility to address various developmental domains, (3) the capacity to link child development with Lifelong developmental potentials and, most importantly, (4) Epidemiological capability to provide supporting empirical evidence for community-based public health interventions (COLE criteria).

Results Key child development theories have been reviewed by broadly grouping them into three categories on the basis of content and approach, such as descriptive theories, psychological construct-based theories, and context-based theories. The strengths and challenges of these theories have been evaluated on the basis of COLE criteria.

Conclusion Although most of these theories can contribute at different levels in child development initiatives, context-based theories have been particularly proposed to practitioners, researchers and policy makers for community-based programming, principally for its potential to address issues of social inequality, poverty and childcare practices, which are at the core of public health initiatives, and provide multiple level of opportunities to intervene.

  • Child development
  • child health
  • early intervention
  • community health services
  • social environment
  • public health epidemiology
  • social factors

Statistics from

The World Health Organization's care for development initiative has more than ever pushed the boundaries in the quality of child survival initiative and created excitement in the realm of public health, especially health promotion.1 Care for development curriculum and modules are in their early stages, and any major research or public health outcome has yet to materialise. In practical terms, this will require a major collaboration of professionals with an in-depth understanding of child development, which can test and roll out this initiative in diverse community settings. Incorporation of relevant theoretical framework from humanities and social sciences into epidemiological research is highly recommended, but popularising this practice is considered a major challenge.2 3 However, child programme developers and epidemiological researchers have a long way to go to fully appreciate its extent and the inclusion of existing conceptual developmental frameworks to create strong research-based evidence with sound theoretical underpinning, for what works in community settings to optimise child development and potentials.

Child development is a scientific study devoted to developing a comprehensive understanding of child growth and development, directed towards lifelong promotion of psychomotor, intellectual, emotional and social development.4–6 It is multidisciplinary in its nature, integrating medicine, psychology, education, sociology and public health, especially epidemiology, within that. But in the real-world scenario, there is a lack of integration between these disciplines, with professionals usually working in silos. Even within public health, vertical programming in child health is still a norm.7 Although the Integrated Management of Childhood Illness initiative targets childhood physical ailments, which—one assumes—provides the basis for better child development, the fact remains that child development is not an explicit component in its agenda. This also implies that there are different versions of identical developmental phenomena, but there is lack of coordination in terms of utilising each other's professional expertise and body of knowledge. One of the main reasons could be that the majority of theoretical frameworks developed by psychologists and educationists are primarily tested in clinical or facility-based settings. In addition, systematic efforts to understand these theories and to evaluate their potential for public health programmes and epidemiological research have been limited.

The basic purpose of this paper is to understand the main theoretical frameworks of child development and to assess their usefulness for public health and epidemiology professionals who are involved in child development undertakings. Indirectly, this work also intends to equip them with a set of criteria to gauge theoretical knowledge in related disciplines and use them in their work.

Criteria to evaluate theoretical frameworks

Several child development theoretical frameworks exist in the scientific literature which analyse, rationalise and predict diverse aspects of child development. These theories can be broadly grouped into three categories on the basis of contents and approach: whether they primarily describe the observed developmental phenomenon alone or whether they also try to explain the mechanism behind the phenomenon. Furthermore, the explanation mainly focuses on the child's internal processes, or significant value is also given to the external influences.

  • Descriptive theories

  • Psychological construct-based theories

  • Context-based theories

Each of the main theories in these categories is described in the sections below. We have evaluated these categories for their potential to contribute to our understanding of child development using the following four- point (COLE) criteria, which is straightforward and simple enough to address the practical challenges:

  1. Cross-disciplinary perspective: clear and non-overlapping conceptual domains with reasonable cross-disciplinary comprehension

  2. Overarching perspective: the ability to address all the important domains of child development (ie, cognitive, psychomotor, emotional, social and behavioural)

  3. Lifelong perspective: the ability to address and link with all other phases of human development (ie, newborn, infancy, toddlerhood, middle and late childhood, adolescence, early, middle and advanced adulthood)

  4. Epidemiological research perspective:

    1. potential to be assessed empirically

    2. potential to easily create research based evidence for public health interventions.

They have the ability to provide practical guidance in solving daily concerns regarding child rearing for caregivers. Although the discipline of developmental psychology recognises the significance of nature and nurture both in terms of determination of primary agents influencing the development of the child, theories in general are either inclined towards nature (predeterministic, ie, genetic) or nurture (probabilistic, ie, social influences). Ideally, theories that acknowledge nature but give emphasis to the role of nurture are more suitable for public health initiatives because of their modifiable characteristics.

The critical appraisal of the three groups of theories on the basis of the given criteria is stated in the following section; included is a general description of the group, some examples of the relevant theoretical frameworks and summary remarks for that group. This evaluation is also summarised in table 1.

Table 1

Theoretical frameworks to study child development: comparison from public health perspective

Descriptive theories

According to the descriptive theories, the underpinning of human development is a biological process which is principally genetically determined, that is it automatically results in the appearance of sequential developmental stages over time in a predictable manner on the basis of genetic potentials.

Gessell's framework is the prime example of descriptive theories. The suggested descriptive developmental gradients are about the observable changes in child growth and behaviour from birth into adolescence.8–10 Among others, it includes motor abilities, play, emotional expression, fears, sex, interpersonal relations and ethical point of views. The primary achievement of the theory was the systematic observation and cataloguing of age-specific developmental norms and behaviours. These normative studies are helpful in identifying “normal development”, that is what to expect for a specific age group, but are unable to give guidance on how to intervene in order to improve developmental trajectories. For example, it can be concluded that successively advanced motor milestones in children emerge with maturation of the body and the brain. Consequently, underdevelopment is interpreted as a child requiring more time to achieve a specific milestone as compared with normally developed children.

Descriptive theories are important for understanding the patterns of maturation from birth to adolescence. They are based on direct observation and therefore verifiable through observational studies.11 12 However, these theories lack the epidemiological potential to identify the associated risk factors that can affect child development.

Psychological construct-based theories

Psychological construct-based theories (PCB) theories focus on generic principles to explain the layout of child development based on psychological structures (constructs) and usually do not address the reasons behind developmental changes. The proposition is that a child periodically moves up from one identifiable development stage to another, rather than development by undetectable small augmentations. Moreover, the role of social influences is assumed but not explained explicitly. They primarily address learning and behavioural aspects of development; Piaget, Kohlberg, Freud and Erikson are the main theorists in this category.

Piaget's theoretical framework has cognition as its central point and primarily refers to how children acquire knowledge, but it also touches upon social and emotional development.13 14 Cognitive development has been hypothesised as an impulsive process that results in modifications to and reorganisation of abstract psychological structures (constructs), that is schema, assimilation, accommodation and adaptation. Development is seen as a discontinuous process of spontaneous changes; cognition evolves by interrelated yet independent achievements in a series of four stages: sensory motor, preoperational, concrete operational and formal operational.

This theory of cognitive development is limited to 0–16 years. It cannot account for the complexity and developmental domains and is even limited in explaining the diversity of human thought phenomena. Basic concepts are abstract, difficult to comprehend and cannot be empirically assessed. In terms of child learning, the theory, which has generated tremendous interest among educators and professionals, required communication with children15–18 but had limited practical guidance about a variety of issues and challenges that confront parents and other caregivers.

Kohlberg19 adopted Piaget's approach to the concept of moral judgement. He considers only one domain of child development: the process of socialisation by which children learn to conform to the ethical expectations of their culture. He has hypothesised six stages of orientation of moral reasoning from childhood to adulthood: obedience and punishment, naive instrumental, good boy/good girl, law and order, social contract and universal ethical principle.20 21

The theory assumes cognitive prerequisites for the moral reasoning but does not directly address any other developmental domains.22 It is even limited in its basic construct of “moral”, as it is primarily based on the theme of righteousness or justice, while ignoring the several other important components of morality such as kindness, valour and sympathy,23 and assumed to represent predominantly male perspective.24 Moral reasoning follows a consistent developmental sequence throughout the life cycle, but most researchers have been unable to find such uniqueness in the moral stages cross-culturally or in older age groups.

Freud's theory of psychoanalysis proposed two central arguments about human development. First, the initial few years of life are the most important for the formation of basic personality. Second, this development primarily involves sexual desires as impetus and follows five psychosexual stages: oral, anal, phallic, latent and adult genital periods. The process of desire and gratification in each stage delineates the basis of personality formation. The interaction between the psychological structures (constructs) known as child drives, that is id, ego and superego, and his social environment during early years set the blueprint for social, behavioural and emotional adjustment later in life. Emphasis is on biological drives, but recognition is also given to the contribution of social experiences.25 26

Freud's perspective on human nature differs from Piaget's theory of cognitive development. Piaget focuses on the rational child, calmly searching for truth and comprehension. Psychoanalytical theory focuses on emotions and on antecedence and the consequences of irrational thought processes of the child. In general, this theoretical perspective is helpful in dealing with the emotional development of children but provides no information regarding their cognitive or psychomotor development.27

There are several inherent drawbacks in the theory including overemphasis on childhood sexuality.28–30 Overall, it focuses on deviant behaviours (neuroses), rather than directly identifying normative pattern of social development. Social factors are considered imperative theoretically, but there is no explicit demonstration of their role. The theory is based on subjective assumptions and inadequate scientific methodology including limited data. Freud's model of childhood personality development and related psychological structures are difficult to validate empirically; in addition, no rationale is known for the sequence, timing and occurrence of stages. The theory has practical implications for psychologists especially psychoanalysts in terms of addressing neuroses31 32 but little value for the wider perspective of community-based care providers.

Erikson's psychosocial theory suggests that a person passes through eight stages of emotional development in the life cycle. In each stage, there is a psychosocial crisis with two possible opposing possibilities such as (1) trust versus mistrust, (2) autonomy versus shame and doubt, (3) initiative versus guilt, (4) industry versus inferiority, (5) identity repudiation versus identity diffusion, (6) intimacy and solidarity versus isolation, (7) generativity versus stagnation and self-absorption and (8) integrity versus despair.33

This psychosocial theory is an extension of Freudian work in many ways.34 First, the psychosocial development has been conceptualised in a much broader sense and encompasses Freud's psychosexual framework. Second, the same psychological constructs are used in the explanations, which were originally popularised by Freud (eg, ego). Third, psychological development has been proposed as the consequence of the interaction between biological needs and societal demands. The position of social influences has been explicitly identified on personality formation. Fourth, focus is on development of the healthy personality (normality), in contrast to Freud's emphasis on addressing deviant behaviours. Finally, the proposed framework is based on observations of a diverse sample of all age groups.35 36 However, the theory lacks a specific mechanism of development and is unsystematic: one developmental stage is not conceptually linked to the other. Moreover, child developmental domains are not addressed comprehensively.37

In summary, PCB theories primarily address only one or other domain of child development, while some of them have a potential to explain specific developments from a lifelong perspective.

Primarily, these theories are derived from the psychology discipline and therefore address the clinical needs of similar professionals, not the community-level care providers. It is difficult to empirically validate most of the psychological structures, as they are imprecise and not very clearly spelt out. In addition, it is not clear how they are translated into behaviour. In the absence of identifiable linkage and pathways between concepts and behaviour, it is difficult to identify points of intervention from public health perspective.

Context-based theories

Context-based theories (CBT) have received significant recognition in recent years. From a contextualism perspective, developmental changes occur on the basis of give-and-take (bidirectional) relations between the child and the context, that is the environment changes the child and the child changes the environment. It implies that children are the product of their social environment, and they have the potential to influence their own environment and are thus producers of their own environment. CBT explain how children develop, rather than what they are at different stages of development. Prominent theorists in this category are Bandura, Vygotsky and Bonfenbrenner.

Bandura's social learning theory emphasises social variables as the primary determinants of learnt behaviours and personality.38 39 Human behaviour is described as a product of persistent bidirectional interactions between social environment and cognitive and behavioural aspects of the child. Children are more eager to replicate a behaviour if it results in outcomes they value, that is the role model is related to them and has well-liked status and the behaviour has functional value. The process of observational learning from modelling (imitation) has five underlying component processes: (1) attention, (2) memory coding, (3) memory retention, (4) motor reproduction and (5) overarching concept of motivation. Thus, it signifies the observation and modelling behaviours and attitudes on the basis of patterns derived from persons present in the social sphere of the child.40

The social learning theory has given way to social cognition theory, which is very unequivocal in giving due recognition to personal factors (eg, cognition) and environment in shaping up human behaviour and motivation in terms of triadic reciprocal causation,41–43 but inadequate attention to child mental and physical processes as an outcome, apart from those involved in imitation. It thus limits its scope in holistic child development but has been successfully used as a basis for behaviour modification techniques mostly targeting adults in diverse clinical and non-clinical settings.44–49

Vygotsky's social development theory emphasises the essential role of social interactions, the development of cognition. The initial research was done specifically in language, and thought acquisition among children due to socialisation and applications of the theory have been easily adaptable to other developmental domains and age groups.50 51

First, it is based primarily on two principles: first, at any given age, the possibility of development is defined by genetic potentials, and second, social interactions are mandatory for genetic potentials to achieve optimal development. The prospective for development is reliant upon the “zone of proximal development”, that is the existing developmental status of the child when new environmental stimuli are provided determines the direction, magnitude and nature of response of child development. Being CBT, generally, Bandura and Vygotsky's propositions are supportive and expand the horizon of influence of social environment on human development.52–54

Bonfenbrenner's bioecological theory for human development is an extension of Vygotsky and Bandura's work especially in terms of a more structured description of environment and social interactions.55 56 It proposes development as a gradual and reciprocal adjustment between an active, growing child and the evolving characteristics of the contextual settings.

The child's social environment is visualised as five distinct concentric systems: microsystem, mesosystem, macrosystem, exosystem and chronosystem (for details, see Appendix 2.1). Each layer has its own specific set of determinants, which form the basis of the interaction with the child. The quantity and quality of these interactions between the child and the environment determine the input stimuli and are necessary for child growth and development. This explicit visualisation of the social environment provides multiple venues to examine and modify child caring practices.

The underscoring feature of this theory is that it suggests that child development should be explored and explained in its ecological context: the actual environments in which children live their lives. It is the interaction between the child and the environment that is considered as the primary mechanism for producing development in children. It is important to note that, conceptually, these categories could be overlapping, and a characteristic can change its class with change in the hypothesis considered. It is important to emphasise that this model is generic in its nature and is applicable to lifelong human development. However, the content of this model can be made specific by stipulating age groups and developmental domains.

From a functional perspective, this model has four components: process, person, context and time.57 58 In order to explain child development related phenomena, these components should be simultaneously studied. It is a transactional process, and intricate reciprocal feedback of interactions occurs between a developing child (person) and constituents of immediate external environment (context). To be effective, the interaction must occur on a fairly regular basis over an extended period. In other words, childcare practices including sensory stimulation (proximal processes) will differ in their effect on the various domains of development and physical growth (child outcomes) depending on the nature and quality of the neighbourhood and socioeconomic inequalities (context) and nature of periodicity (time).

The primary assumption is that social context provides different opportunities and challenges for growth and development. Therefore, it will be important to identify context-specific proximal processes, a prerequisite to conceptualise socioculturally relevant interventions for promotion of child development.

In summary, CBT—especially the bioecological model—have evolved into a framework that is relevant for all the domains of child development. The concepts are comprehensive but simple enough that they can be effortlessly communicated from policy makers to grassroot workers in early child development (ECD) programmes. However, it is fundamental to highlight that CBT has a vital value in laying out the general structure of the ECD programmes, but other theories might be equally important in contributing to the content of ECD curriculum development—for example, knowledge of developmental milestones and related supportive activities. Another distinguishing feature of CBT is that they assume child development as a continuous process, while most of the descriptive and PCB theories understand that child development occurs in discrete stages. In practical terms, it means that interventions based on CBT can provide support to children for prolonged durations and more sustained integration with community-based services. Hence, it is more likely to create successful multidisciplinary and cross-sector partnerships.

CBT recognises the importance of “nature” (child characteristics), but their main emphasis is “nurture” in the form of environmental context and proximal processes, which are modifiable factors in terms of public health interventions. It is noted that, although these concepts are already independently in use in epidemiological research, only CBT has successfully established the linkage between the concepts in an organised way to predict child growth and development outcomes.

Final comments

From the evaluation criteria, it is fairly straightforward to conclude that, among the theoretical frameworks of child development, CBT and especially its bioecological model can contribute more to public health programmes owing to its ability to attend to all the facets and phases of child development and consequently human development. Epidemiological researchers can develop their projects based on this framework and empirically verify it in community-based research. Last, but not least, it focuses on the exploration of the social environment and provides opportunities to develop effective interventions to address child development needs, thus enabling researchers to think critically about the origin of the problem and the systematic means to address it.59

From policy perspective, this approach is important to establish the relationship of social inequality and community functioning with child growth and development, followed by development of interventions to positively influence this linkage. In the backdrop of millennial development goals, the social determinants of health have gained high importance and provide a mechanism to achieve these goals.60 Social determinants of health are the economic, social and cultural conditions, which have the potential to influence children living under these circumstances. CBT provide a vital framework which aptly conceptualise and address the social determinants of health and development of children. Understanding the dynamics of environmental systems and spotting the differential potency of the contextual factors are the means to success. Context-based thinking and approach highlight the fact that social resources and interactions at community and family levels ultimately influence the child outcomes.

For multisectorial child health and development initiatives, this approach has a potential to communicate explicitly, particularly among health, education and social sectors, hence supporting a framework of community-based programming where each one of them collaborates to maximise mutual and respective benefits.

At the end, it is important to clarify that the purpose of this critical appraisal was to assess the child development theoretical frameworks for their adaptability to the epidemiology and public health disciplines. It is not our intention, by any means, to rank any theory as intrinsically superior or challenge its contribution in their respective disciplines.

What is already known on this subject

  • Child development is a multidimensional concept and requires multidisciplinary approaches for community-based programming.

  • The public health programmes and research on child development are usually overshadowed by the limited use of holistic theoretical frameworks, which primarily represent work from the disciplines of psychology and education.

  • There has been no systematic effort to bring together public health practitioners and policy makers to develop a common understanding and maximise contributions in child development initiatives from other relevant disciplines.

What this study adds

  • This paper suggests the four-point COLE criteria to review child development theories for public health programmers and epidemiological researchers.

  • CBT provide comprehensive framework which are highly compatible with the dominion of the public health programmes and have the ability to identify a broad range of factors amenable to interventions.


We sincerely thank Bushra Khan for her support and useful feedback on an earlier draft.



  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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