Timing is everything

Matching the timing of individual, family, and community interventions to the critical stages of child development is essential for the future health of the public.1 Even in an affluent nation like England, professional help such as specialist public health nursing rarely seems to reach the most disadvantaged children when and where it is needed, or on terms that parents and elected local councils can grasp.2

Hertzman and colleagues recognise the role that good environments in the early years play in later physical and mental health.3 However, successful “programmes to support early child development” need to incorporate responses to parental illness and disability, as well as the economic gradients in society. In England, roughly 10% of households with young children have at least one parent with untreated mental illness (mainly depression); this figure is 8% for untreated alcohol dependence and 7% for disabilities detected when in school but still unresolved in adulthood (including mild learning disabilities). All of these problems are more common and less likely to get medical attention in the poorest communities. Assuming some overlap (comorbidity) within poor households, perhaps 20% of children are dependent on parents with these unresolved conditions. It is not surprising that, in our profile of diverse parenting programmes across a county (population 1.7 million), we found that long serving “parenting practitioners” requested additional training and supervision for problems with alcohol or disability; and they also found that entrenched parental behaviours like domestic violence affected their work across many interventions to improve local childhoods.4