Early Childhood Education
What is early childhood education?
Early childhood education (ECE) aims to improve the cognitive and social development of children ages 3 or 4 years.[1, 2] ECE interventions can improve all children’s development and act as a protective factor against the future onset of adult disease and disability. Children disadvantaged by poverty may experience an even greater benefit because ECE programs also seek to prevent or minimize gaps in school readiness between low-income and more economically advantaged children.
All ECE programs must addresses one or more of the following: literacy, numeracy, cognitive development, socio-emotional development, and motor skills. Some programs may offer additional components, including recreation, meals, health care, parental supports, and social services. ECE programs may be delivered in a variety of ways and settings. State and district programs may be available to all children regardless of income. For example, Georgia and Oklahoma have implemented universal preschool programs for all 4-year-olds. Other programs, including federally funded Head Start and evidence-based model programs, such as the Abecedarian and Perry Preschool programs, are provided specifically for low-income and at-risk children.[2, 7, 8] The Child-Parent Center program is another example of a widely-implemented model program; it expanded into 33 sites in Minnesota, Wisconsin and Illinois through a University of Minnesota project funded by the U.S. Department of Education.
What is the public health issue?
Childhood development is an important determinant of health over a person’s lifetime. Early developmental opportunities can provide a foundation for children’s academic success, health, and general well-being. Preschool-aged children experience profound biological brain development and achieve 90 percent of their adult brain volume by age 6. This physiological growth allows children to develop functional skills related to information processing, comprehension, language, emotional regulation, and motor skills. [11, 12] Experiences during early childhood affect the structural development of the brain and the neurobiological pathways that determine a child’s functional development.
Positive experiences support children’s cognitive, social, emotional, and physical development, and conversely, adverse experiences can hinder it.[13, 14] Additionally, strong associations have been found between the biological effects of adverse early childhood experiences and numerous adult diseases, including coronary artery disease, chronic pulmonary disease, and cancer.[13, 14]
Children in low-income families often are exposed to more adverse early childhood experiences and environmental factors that delay or compromise their development and place them at a disadvantage for healthy growth and school readiness.[3, 15, 16] In the United States, 15.5 million children (21%) lived in families with incomes below 100% Federal Poverty Level in 2010. Also in 2010, less than half of children in families in the lowest income quartile were enrolled in center-based early childhood education programs.
What is the evidence of health impact and cost effectiveness?
Early childhood education interventions can improve children’s development and act as a protective factor against the future onset of adult disease and disability. ECE can counteract the disadvantage some children experience, improve their social and cognitive development, and provide them with an equal opportunity to achieve school readiness, and lifelong employment, income, and health.[2, 3] Systematic reviews of studies examining the effects of ECE programs, found that they were associated with
- Improved cognitive development[2, 19, 20]
- Improved emotional development
- Improved self-regulation
- Improved academic achievement
Additional longer-term benefits included:
- Reduction in teen birth rates
- Reduction in crime rates
Additional studies have found that ECE is associated with other positive health effects, including healthier weight (such as fewer underweight, overweight, and obese children) and reduced child maltreatment.
Cost analyses of different types of ECE found that they are associated with positive benefits-to-cost ratios. Benefit-cost analyses conducted by the Washington State Institute for Public Policy resulted in the following benefit-to-cost ratio estimates: 
- State and district early childhood education programs: $5.19:1 
- Head Start: Benefits to cost ratio $3.09:1. 
A review of additional analyses examining the benefit-cost ratios of model ECE programs found that they too were associated with positive benefit-to-cost ratios:
- Child-Parent Centers: $5:1 
- Perry Preschool: $5:1 
- Abecedarian Project: $3:1. 
ECE benefit estimates, both short- and long-term, included some or all of the following major components:
- Increases in maternal employment and income
- Reductions in crime, welfare dependency, and child abuse and neglect[2, 27]
- Savings in remedial education and child care costs
- Improvement in health outcomes associated with education
- Earnings gains associated with high school graduation[2, 27]
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- Blackman JA. Early intervention: a global perspective. Infants & Young Children 2002;15(2):11-19.
- Community Preventive Services Task Force. Promoting health equity through education programs and policies: center-based early childhood education. 2015. Available from: Promoting Health Equity Through Education Programs and Policies: Center-Based Early Childhood Education. Accessed 2015 November 30.
- Halfon N, Hochstein M. Life course health development: an integrated framework for developing health, policy, and research. Milbank Q 2002;80(3):433-79.
- Anderson LM, Shinn C, Fullilove MT, et al., The effectiveness of early childhood development programs: a systematic review. American J Prev Med 2003;24(3):32-46.
- Robert Wood Johnson Foundation, University of Wisconsin Population Health Institute. County health rankings & roadmaps: universal pre-kindergarten. 2015. Available from: Universal pre-kindergarten. Accessed 2016 March 7.
- Barnett WS, Friedman-Krauss AH, Gomez RE, et al. The state of preschool 2015: State preschool yearbook. Rutgers (NJ): Rutgers Graduate School of Education, National Institute for Early Education Research; 2016. Available from: The State of Preschool Yearbook 2015. Accessed 18 June 2017.
- Campbell FA, Ramey CT, Pungello E, Sparling J, Miller-Johnson J. Early childhood education: young adult outcomes from the Abecedarian Project. Applied Developmental Science 2002;6(1): 42-57.
- Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. Lifetime effects: the HighScope Perry Preschool study through age 40. Ypsilanti (MI): HighScope Press; 2005.
- University of Minnesota, College of Education and Human Development. Federal $15M grant supports one of the most comprehensive childhood education programs in the nation. 2011. Available from: CE+HD News: Federal $15M grant supports one of the most comprehensive childhood education programs in the nation. Accessed 2016 June 15.
- VanLandeghem K, Curtis D, Abrams M. Reasons and strategies for strengthening childhood development services in the healthcare system. Portland (ME): National Academy for State Health Policy; 2002.
- Brown TT, Jernigan TL. Brain development during the preschool years. Neuropsychology Rev 2012;22(4):313-33.
- Purves D. Neural activity and the growth of the brain. New York (NY): Cambridge University Press; 1994.
- Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA 2009;301(21):2252-59.
- Boyce WT, Ellis BJ. Biological sensitivity to context: I. An evolutionary–developmental theory of the origins and functions of stress reactivity. Dev Psychopathol 2005;17(02):271-301.
- Hahn RA, Rammohan V, Truman BI, et al., Effects of full-day kindergarten on the long-term health prospects of children in low-income and racial/ethnic-minority populations: A Community Guide systematic review. American J Prev Med 2014;46(3):312-23.
- Duncan GJ, Ziol‐Guest KM, Kalil A. Early‐childhood poverty and adult attainment, behavior, and health. Child Dev 2010;81(1):306-25.
- Jiang Y, Ekono MM, Skinner C. Basic Facts about low-income children, children under 18 years, 2014. New York (NY): National Center for Children in Poverty, Mailman School of Public Health, Columbia University; 2016.
- Duncan GJ, Magnuson K. Investing in preschool programs. The Journal of Economic Perspectives 2013;27(2):109-32.
- Burger K, How does early childhood care and education affect cognitive development? An international review of the effects of early interventions for children from different social backgrounds. Early Childhood Research Quarterly 2010;25(2):140-65.
- Camilli G, Vargas S, Ryan S, Barnett WS. Meta-analysis of the effects of early education interventions on cognitive and social development. Teachers College Record 2010;112(3):579-620.
- Lumeng JC, Kaciroti N, Sturza J, et al. Changes in body mass index associated with Head Start participation. Pediatrics 2015;135(2): e449-e456.
- Mersky JP, Topitzes JD, Reynolds AJ. Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago Child–Parent Center preschool program. Children and Youth Services Review 2011;33(8):1454-63.
- Washington State Institute for Public Policy. Benefit-Cost technical documentation: Washington State Institute for Public Policy Benefit-Cost Model. Olympia (WA): Washington State Institute for Public Policy; 2015.
- Washington State Institute for Public Policy. Benefit-cost results: state and district early childhood education programs. December 2015.Available from: State and District Early Childhood Education Programs. Accessed 2016 June 6.
- Washington State Institute for Public Policy. Benefit-cost results: Head Start. December 2015. Available from: Head Start. Accessed 2016 June 20.
- Isaacs JB. Cost-Effective Investments in Children. Washington, DC: The Brookings Institution; 2007. Available from: Budget Options Series: Cost-Effective Investments in Children. Accessed 2017 June 18.
- Reynolds AJ, Temple JA, White B, Ou S, Robertson DL. Age 26 cost–benefit analysis of the Child‐Parent Center early education program. Child Dev 2011; 82(1):379-404.