Melissa Gladstone: To move forwards from ensuring children globally not only survive but thrive, we need better ways of measuring child development 

The sustainable development goals (SDGs) create an impetus for international agencies to drive forward interventions that enable children to thrive and to meet their potential; to be happy, healthy, and to develop well. These goals move us in a positive direction away from a sole focus on child survival, to one that promotes wellbeing—good health, nutrition, safety, security, responsive caregiving, and opportunities to learn. 

In reaching the SDGs we must, however, ensure that tools for measuring thriving of children are meaningful, culturally relevant, age appropriate, and cover the spectrum of what we consider important. Furthermore, we must ensure that we have valid and reliable ways of measuring the provision of evidence based interventions for children in the early years around the world so that we know whether we are making headway. 

A new study published in BMJ Global Health, which forms part of the collection “Leaving no one behind,demonstrates that some progress may have been made in the goal to improve access to early child education across low and middle income countries. However, by using multiple indicator cluster surveys (MICS), the study is only measuring quantity of access to early childhood education and not addressing the quality of this education. Measuring quality would be much more meaningful and should be considered within a wider framework of measurement in the future.

The study by Lu and colleagues may also demonstrate some progress in levels of child development in children from 3 to 5 years, using data from 135 demographic and health surveys and MICS from up to 85 countries. The limitations raised by the authors of this article rightly make it clear that the tools presently used within UNICEF’s MICS are very limited in terms of the data they provide—particularly in the authors’ definition of “developmentally on track.” 

The authors use a 10 item tool for children aged between 3 and 5 years; where only 50% of three out of four domains need to be answered “yes” for the child to be termed “on track,” it is hard to see that much meaningful data can be gained. By using this methodology, only four out of 10 items need be positively answered and of those, some could be ones that are relevant for a younger age range. This includes items more relevant to 2 to 3 year olds, such as “picks up a small object with two fingers,” or socioemotional items, such as “does x get along well with other children?”. The levels quoted for children not being “developmentally on track” (according to data from ECDI) in the study are therefore likely to be a substantial underestimate of the number of children who are not where they should be in terms of their development. 

Findings such as these highlight the need for better tools, which can measure and provide information for child development at population and programmatic levels in a way that is meaningful, culturally relevant, age appropriate, and which covers areas across the spectrum of the nurturing care framework. We may be missing a trick if we are not measuring more feasible outcomes. These could include developments such as changes to policy and programmes within a country, numbers of good quality early childhood education programmes funded and provided, and legislation for better family care at home. Progress on such metrics could actually be more beneficial for children, simpler to do, and feasible for countries. 

A number of tools are presently being developed that address some of these issues relating to child development measurement at a population based level. The Global Scales of Early Development (GSED) (also see this rating study) for children from 0-3 years is a joint initiative, using data on more than 100 000 children to create items for measuring development, which are age discriminatory across settings. This work is being led by a team with members who worked on the WHO IYCD (Infant and Young Child Developmental Indicators), CREDI (Caregiver Reported Early Developmental Indicators), and the D-Score. This tool is currently being tested on more than 1500 children per country in three countries (Tanzania, Pakistan, Bangladesh), with a further three countries joining (Ivory Coast, Holland, Brazil).

This data-driven process will enable strong data to be provided for validating a tool that aims to be rigorous and interpretable for children from 0-3 years. Furthermore, due to concerns about the previous ECDI, UNICEF are presently revising the ECDI for 2-5 year olds with items in the 2-3 age group linking with the GSED. It is obvious from the nature of this work that agencies realise the need for better, more rigorous, actionable tools to measure developmental wellbeing in these critically important years. 

In order to truly progress with the SDG’s child development goal, which aims to improve the number of children “developmentally on track,” it is critical that we consider better measurement of thriving and wellbeing for children, but also the “inputs”—quality of early childhood and healthcare, nutrition, responsive caregiving, and safe and secure environments.

Melissa Gladstone is professor of international child health and neurodevelopmental paediatrics at the University of Liverpool. Twitter: @mjgladstone  

Conflict of interest: Melissa Gladstone has worked as an expert adviser both on the development of the new UNICEF ECDI and presently as part of the team on the Global Scales of Early Development. She has funding for research from MRC, Wellcome, and Autism Speaks currently for research on tool development and outcomes in early child development.