Almost 250 million children worldwide are exposed to stunting or extreme poverty, being at risk of not reaching their full developmental potential, new research shows. According to a series of papers published in the medical journal The Lancet, 43% of children younger than 5 years of age in low-income and middle-income countries are falling short of their potential because of adversities they face in early life. The period between conception and a child’s second birthday, the first 1,000 days of life, are crucial to development. If children suffer from chronic undernutrition during early life, they are likely to end up to short for their age and brain development may be seriously affected. “Some catch-up is possible in height-for-age after 24 months, with uncertain cognitive gains,” warns one paper. According to the authors, extreme poverty increases children’s likelihood of exposure to “an accumulation of adversities”, including family stress, child abuse or neglect, food insecurity, and exposure to violence, which are often compounded by living in communities with limited resources. The series of papers “introduces evidence that successful policies for early childhood development focus on equipping families with the time, resources, knowledge, and skills they need to provide nurturing care,” writes Dr Margaret Chan, Director-General of the World Health Organisation, in a comment article. She said that the research “emphasises the importance of well coordinated efforts across sectors, including health, nutrition, education, welfare, social protection, environmental safety and conservation, agriculture, and water and sanitation.” If no action is taken now, societies around the world will have to pay a high price. The scientists warn that “for the 43% of children estimated to be at risk of poor development due to extreme poverty and stunting, their average percentage loss of adult income per year is likely to be 26%.” This is exerting a strong downward economic pull and trapping families in poverty. The scientists estimate that the cost of not acting immediately to some countries can be twice their spending on healthcare. That studies found that progress to reduce the number of children under 5 years exposed to stunting or extreme poverty has been distributed unevenly across regions. In sub-Saharan Africa, 66% of children are estimated to be at risk of poor development because of stunting and poverty. In South Asia, the figure is 53%. “The science shows us that biology is not destiny – and that what children experience in the earliest days and years of life shapes and defines their futures,” said UNICEF Executive Director Anthony Lake. “We need to turn that science into an alarm bell because the development of millions of children is at urgent risk.” World Bank president Jim Yong Kim told the Guardian that he would use the World Economic Forum in Davos each year to name and shame countries that fail to tackle their high stunting rates. Decisive action will be needed if the Sustainable Development Goals (SDGs) are to be met. In September 2015, the international community pledged to end all forms of malnutrition by 2030, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age. (ab)