Policies to reduce undernutrition include child development.

The Lancet Series on Maternal and Child Undernutrition highlights the damaging eff ects of undernutrition during the fi rst 2 years of life on children's survival, health, attained schooling, and ultimately their human capital. The Series also points out that, although there are eff ective nutritional interventions, the international nutrition system, comprising international and donor organisations, academia, civil society, and the private sector, is fragmented and in need of reform. An improved nutrition system will undoubtedly improve the lives of the millions of children who are undernourished. But there would still be major gaps in the educational success and improvement of human capital of millions of children in developing countries because nutritional adequacy alone is insufficient. The mechanisms underlying educational failure and adverse economic consequences operate through poor early cognitive and social development. 1–3 The loss of developmental potential in the first 5 years of life, partly caused by undernutrition, results in late entry into schooling, poor educational attainment, early drop-out, and low earning potential. The first 2–3 years of life are crucial for both nutrition and child development. Rapid growth, including brain development, places high demands on nutrition. However, early brain development also requires environmental stimulation. 4 Inadequate cognitive or social stimulation during these early years has lifelong negative consequences on educational performance and psychological functioning. In countries where children are adequately nourished, children without early opportunities for cognitive and social stimulation develop poorly cognitively and socially, which puts them on a trajectory toward low school attainment, early exit from education, and limited economic potential. 5 Experience in Jamaica shows the synergistic eff ects of integrating nutrition and stimulation. 6 9–24-month-old stunted children who received weekly supplements of milk and cognitive or social stimulation at home for 2 years had higher developmental scores than those who received neither or only one intervention. Long-term follow-up showed that the children who received early cognitive or social stimulation had better cognitive, educational, and psychosocial functioning in late adolescence than those who did not. Also, there were no long-term eff ects of nutritional supplementation, either alone or in combination with cognitive or social stimulation. 7–9 Although the nutritional intervention may have been too little too late, the long-term eff ects of the cognitive or social stimulation are consistent with evidence from middle-income and high-income coun­ tries on the benefi cial eff ects of early intervention. The extent of undernutrition and loss of developmental …