Infant anemia, a form of undernutrition widespread across rural communities, is likely preventing China’s rural children from developing as they should.

The link between anemia and ECD is known: field studies found anemia levels ranging from 40% to 70% in rural mountainous communities where cognitive deficiencies are more prevalent.

Randomized control trials (RCTs) in rural areas have shown that giving babies iron supplements with their porridge led to small, but statistically significant improvement in development outcomes (BSID scores).

But while existing trials within China found only positive impacts from iron-supplementation, this has only resolved a relatively small portion of slow development, indicating other elements involved in hindered ECD.

Many rural caregivers are not interacting with their children in methods proven to further healthy development. In some of these communities, more than 50% of families do not use toys to play with their kids, 75% do not sing to them, and 96% do not read to them—parenting practices all linked to higher developmental outcomes.

What’s more, RCTs within China found that training parents to engage in these behaviors had statistically significant impacts on child development scores. This may suggest that the absence of stimulation is the primary barrier to healthier development in these communities.

Research within China is still ongoing, but it largely suggests that the most successful early childhood interventions generally work synergistically to address the many potential barriers to a child's ability to thrive, including both lack of nutrition and stimulation.