What about China?

In the past decade, China made remarkable progress reducing the number of children vulnerable to poor childhood development.

But at least 17 million children aged 0-3 are still at risk.

This is predominantly a rural problem. Of the 50 million children under 3 in China, nearly half live in vulnerable, rural communities, and nearly 80% of those suffer developmental delays.

While China’s urban children mostly meet international standards for child development, field studies in poor, rural communities find that up to 90% of children harbor delays in at least one domain.

It’s not only remote villages: these deficits pervade all kinds of rural communities.

Which families are affected?









Undernutrition and lack of stimulation are major factors behind delayed ECD.


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.

What are the dangers if nothing is done?

However, it's not just individual children at risk. As China’s economy changes in the next few years, human capital is going to be more and more important. With two-thirds of China’s next generation growing up in poor rural areas, the prevalence of delayed development amounts to a national crisis.

The future of the entire country depends on giving these children the tools they need to learn, to thrive, and to contribute to China’s growing economy.