Early Childhood Development
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Heather Rahimi
Hanwen Zhang
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On March 27–29, 2026, researchers, policymakers, and practitioners from across China, the United States, and Europe gathered at the Irish College Leuven for the third annual International Symposium on Early Childhood Development in Rural China. Co-sponsored by KU Leuven and the Stanford Rural Education Action Program (REAP), the three-day event brought together leading voices in early childhood development (ECD) to cultivate connections, share evidence, exchange perspectives, and explore pathways for scaling effective interventions to improve child development in rural communities.

Presentations and discussions over the two days coalesced around several interconnected themes: reaching families through China's existing primary healthcare infrastructure, supporting the caregivers at the heart of child development, scaling proven interventions through technology and implementation science, and translating research into meaningful policy action.

Reaching Families Through Primary Healthcare


China's primary healthcare system is both far-reaching and well-structured, and a growing body of research suggests it represents one of the most promising vehicles for delivering ECD interventions to families in rural areas. A central thread running through the symposium was that the infrastructure already exists; the challenge lies in making better use of it. This view was echoed by local pediatricians and preventative care representatives among the attendees, who brought frontline perspectives to the conversation.

Presentations from researchers at Shanghai Jiao Tong University explored how caregiver training group activities can be embedded within routine primary child healthcare services, and how digital technologies can be deployed within clinic settings to extend the reach and consistency of ECD support. Research from Zhejiang University complemented this by examining how child growth monitoring, a standard feature of preventive care, can be strengthened as both an evidence base and a practical touchpoint for developmental support.

Not only are preventive care and early intervention more cost-effective than reactive approaches in the long run, but they also provide better safeguards for the wellbeing of mothers and children. China's existing primary care infrastructure has the potential to deliver such preventive care at scale.

Supporting Children by Supporting Caregivers


Another strong theme presented was the importance of directing attention and resources toward caregivers themselves, not only the children in their care. This focus is central to REAP's own intervention work, and it was reflected throughout the symposium's presentations and discussions. Multiple speakers highlighted that the wellbeing, knowledge, and confidence of parents and other caregivers are among the most important determinants of early childhood outcomes.

Importantly, conversations went beyond training primary caregivers of children, who in Chinese households are typically mothers or grandmothers . Speakers discussed how to help different caregivers work together more effectively, and how to bring other family members — especially fathers and other male relatives — more meaningfully into the picture. This broader conception of caregiver support recognizes that child development happens within families and households, not just in the hands of a primary caregiver.

Several presentations underscored the need for integrated approaches that treat caregiver mental health and wellbeing as a core component of ECD programming rather than an afterthought, with evidence suggesting that well-designed interventions can produce durable changes in caregiver behavior and child outcomes. Research on complementary feeding practices added a further dimension, demonstrating how behavioral nudge approaches can shift caregiving practices around infant nutrition. The consistent message across these sessions was that investing in caregivers is investing in children.

Scaling What Works: The Role of Technology and Implementation Science


Perhaps the most forward-looking dimension of the symposium concerned the question of scale. A recurring challenge in ECD research is the gap between what works in controlled settings and what can be sustained and expanded across vast, heterogeneous rural populations. In a country as large as China, even the most cost-effective intervention will fall short of its potential without government funding and commitment to sustain it. Several presentations tackled this challenge directly, with a shared understanding that the responsibility of researchers is not only to develop effective programs, but to build the evidence base that demonstrates their value to policymakers.

Researchers from Stanford University presented findings from  two randomized controlled trials, examining how digital support tools and group parenting models can help upscale parenting interventions while retaining their effectiveness. A presentation from Sean Sylvia at the University of North Carolina, Chapel Hill introduced the Healthy Future Platform, which uses AI-enhanced curriculum delivery to support community health workers. The researchers share the vision that technology can deliver behavioral interventions more consistently and better tailor them to the needs of individuals.

Implementation science featured prominently too, with researchers presenting a framework for evaluating ECD programs not just on their outcomes but on the conditions that enable real-world adoption. Complementing this, cost-effectiveness analysis from researchers at Shanghai Jiao Tong University offered policymakers a concrete basis for prioritizing investments in primary-level ECD support — an increasingly important contribution as the field makes its case for government-backed scale-up.

Policy Dialogue: Building Bridges Between Evidence and Action


The symposium brought together not only academics but analysts from China's National Health Commission and other implementing organizations. This mix of voices gave the event a practical orientation that went beyond the research findings themselves. The participation of government representatives was itself a meaningful signal, reflecting both the importance China places on ECD and a genuine openness to hearing what scientists have to say about how to improve outcomes for young children and their families.

Discussions returned repeatedly to the question of how evidence generated in research settings can be translated into durable government policy and frontline practice. The presence of international participants underscored the global relevance of the questions being asked, and the value of cross-national dialogue in shaping the field.

Looking Ahead


The formal program of the symposium closed on March 28, but conversations continued on March 29 as participants strengthened old friendships and formed new connections on the group visit to Brussels. These conversations reflected a shared recognition that the challenges ahead — scaling proven interventions, sustaining political commitment, and bridging research and practice — require not just strong evidence, but strong networks of people committed to acting on it.



About the Organizers


The Stanford Rural Education Action Program (REAP) conducts research aimed at improving the lives of rural residents in China, with a particular focus on education, health, and early childhood development. KU Leuven is one of Europe's leading research universities and a longstanding partner in international development research.

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The symposium brought together leading voices in early childhood development from across the world to cultivate connections, share evidence, exchange perspectives, and explore pathways for scaling effective interventions to improve child development in rural China.

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The massive flow of migrants from rural to urban areas in China over the past decades has sparked concerns about the development of left-behind children. Drawing on a six-round, longitudinal cohort survey in rural China from 2013 to 2023 that follows children from 6 months to 11 years of age, we analyse the effects of two maternal migration patterns – persistent migration (migration without return) and return migration (migration followed by return) – on the cognitive development and nutrition of left-behind children from infancy to early adolescence. The results show that persistent maternal migration has adverse effects on the cognitive development and increased the BMI of left-behind children. In contrast, maternal migration had no significant effect on either cognitive development or any indicator of nutrition when the mother later returned. Persistent maternal migration had a strong, long-term negative effect on the cognitive development of left-behind children especially when mothers migrate within one or one and a half years after childbirth; maternal migration also had a short-term, negative effect on cognitive development when mothers migrate when the child is between 2 and 3 years old. These effects are likely driven by the lower levels of stimulating parenting practices and dietary diversity provided by the stand-in primary caregivers of left-behind children.

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World Development
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Scott Rozelle
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Purpose: Previous research has found an association between with early childhood development (ECD) and paternal beliefs and evidence suggests that paternal beliefs about their own role in child rearing might affect parental involvement. However, there has been no such empirical study in rural China. This study examines the interrelationships among paternal beliefs, parental involvement and ECD among rural Chinese children.

Design/methodology/approach: Data used for this study were collected from 6-to-42-month-old children and their primary caregivers in southwestern China in 2020. ECD was assessed by the Bayley Scales of Infant and Toddler Development-III. Paternal beliefs were assessed with the Role of the Father Questionnaire. The non-parametric regression methods were used to construct the factor scores of ECD. The ordinary least squares models, the mediation models and the bootstrapping approach were employed to investigate the interrelationships of paternal beliefs, parental involvement and ECD.

Findings: A large share of the sample children displayed delays in cognitive, language and social-emotional development. Paternal involvement significantly mediated the link between paternal beliefs and child cognitive and social-emotional development, while maternal involvement mediated the associations between paternal beliefs and child language and social-emotional development.

Originality/value: This study provides a unique contribution by utilizing unique data fathers' beliefs and their involvement in parenting to investigate the underlying mechanisms of how the role of fathers in parenting can lead to the improvement of early child developmental outcomes. This study also provides the first empirical evidence on the role of paternal beliefs in fostering human capital formation during the early stages of life in rural China. This study suggests that shifting paternal beliefs and improving parental involvement are effective pathways to benefit rural children in their early development.

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China Agricultural Economic Review
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Scott Rozelle
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China’s urbanization has created growing peri-urban communities, where children face challenges to early childhood development (ECD) despite proximity to developed urban areas. Little is known about how the environmental factors of ECD differ between rural migrants and new urban residents. To address this, we sampled 77 peri-urban households with 18–24-month-old Han Chinese children to examine the associations between early cognitive and language development, parental self-efficacy, stimulating parenting practices, and the home language environment measured with Language Environment Analysis (LENA). We find that rural migrants and new urban residents exhibited no significant difference in any child or household characteristic except parental residency. There was no significant difference in the family environment factors or early cognitive or language development, either. However, parental self-efficacy and stimulating parenting practices both predicted better cognitive and language development in rural migrant households, whereas only conversation turn counts predicted better language development in new urban resident households.

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Applied Developmental Science
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Hanwen Zhang
Scott Rozelle
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Background
The quality of parenting can affect the developmental outcomes of young children. This study aims to investigate the associations between parenting quality and the early childhood development of children under age 3 across four major rural subpopulations in China.

Methods
Using a stratified cluster sampling method, 760 children aged 6–36 months and their primary caregivers in four rural subpopulations from four provinces and a metropolis in China were surveyed. Child development was assessed by the Third Edition of the Bayley Scales of Infant and Toddler Development. Parenting quality was measured using the Family Care Indicators. Data were analyzed using descriptive statistics, t-tests, multivariable regression analysis, and linear regression analysis.

Results
Across the four subpopulations, prevalences of delays of the sample children in four domains — cognition, language, social-emotional, and motor development are 52%, 45%, 52%, and 19%, respectively. The proportion of children with any type of delay is 82%, while over half (53%) have delays in at least two areas, and 27% have delays in three or more areas. Child’s mother as the primary caregiver, maternal education levels, and family asset values are all positively associated with the quality of parenting. Notably, low levels of parenting quality in rural China are linked to high rates of developmental delays.

Conclusions
This study demonstrates that the level of parenting quality is significantly associated with early childhood developmental outcomes. Results highlight the need for raising investments in family care to improve early childhood development in different rural subpopulations in China.

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BMC Psychology
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Scott Rozelle
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Heather Rahimi
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For years the Rural Education Action Program (REAP) has been working to improve early childhood development outcomes across rural China. One of the most impactful programs has been the development and implementation of  REAP’s parenting curriculum and parenting centers. The centers expand upon our parenting curriculum by providing free and accessible spaces where caregivers and their young children can read, play, and explore together using developmentally appropriate toys and books that promote cognitive development. REAP has now supported the development of over 150 centers at county, township, and village levels across multiple provinces. 

Recently, REAP helped establish a parenting center at the Zhengzhou Foxconn Facility serving migrant factory employees and their families. Since opening, the center has already hosted over 10,000 child visits and supported over 350 families. Following the REAP model, this parenting center combines a research-based curriculum for early childhood development with local needs. The new center has received positive media attention across several outlets in China, including Henan DailyGlobal Times, and Zhenggang News. The success of this parenting center introduces new opportunities for future parenting center collaborations that better serve manufacturing communities across China. 
 


Discover more REAP research projects on early childhood development (ECD).

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REAP helped establish a parenting center at the Zhengzhou Foxconn Facility serving migrant factory employees and their families. The center implements a research-based curriculum for early childhood development to better meet local needs. The new center has recently received positive media attention across several outlets in China.

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The number of acutely food insecure people worldwide has doubled since 2017, increasing demand for early warning systems (EWS) that can predict food emergencies. Advances in computational methods, and the growing availability of near-real time remote sensing data, suggest that big data approaches might help meet this need. But such models have thus far exhibited low predictive skill with respect to subpopulation-level acute malnutrition indicators. We explore whether updating training data with high frequency monitoring of the predictand can help improve machine learning models’ predictive performance with respect to child acute malnutrition by directly learning the dynamic determinants of rapidly evolving acute malnutrition crises. We combine supervised machine learning methods and remotely sensed feature sets with time series child anthropometric data from EWS’ sentinel sites to generate accurate forecasts of acute malnutrition at operationally meaningful time horizons. These advances can enhance intertemporal and geographic targeting of humanitarian response to impending food emergencies that otherwise have unacceptably high case fatality rates.

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Proceedings of the National Academy of Sciences (PNAS)
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Achieving minimum dietary diversity (MDD), a crucial indicator of infant and young child diet quality, remains a challenge in rural China, especially for infants aged 6–11 months. This study examined the rate of MDD attainment in rural China, identified its determinants using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Bayesian network analysis, and estimated the potential impact of improving each modifiable determinant. A multi-stage sampling design selected 1328 caregivers of infants aged 6–11 months across 77 rural townships in China. Data were collected through a cross-sectional survey via in-person household interviews. Bayesian network analysis identified key factors influencing MDD attainment and their interrelationships, while Bayesian inference estimated MDD attainment probabilities. Results showed that only 22.2 % of the sample infants attained MDD. Bayesian network analysis revealed that caregiver knowledge (a proxy of capability), self-efficacy and habits (proxies of motivation), and infant age directly influenced MDD attainment. Social support (a proxy of opportunity) indirectly promoted MDD attainment by boosting self-efficacy and habit. Notably, simultaneous improvements in knowledge, self-efficacy, and habit could increase MDD attainment by 17.6 %, underscoring the potential effectiveness of interventions focused on enhancing caregiver capability and motivation. The critically low MDD attainment rate among rural Chinese infants highlights the urgent need for targeted interventions. Strategies should prioritize enhancing caregiver feeding knowledge, self-efficacy, and habit formation to improve infant dietary diversity. Addressing these key factors could substantially boost MDD attainment in rural China.

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Journal of Appetite
Authors
Hanwen Zhang
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Background: The content of children’s screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children’s development is crucial for promoting healthy screen use among children.

Objective: This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction.

Methods: The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver’s presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted.

Results: In total, 28.23% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills.

Conclusions: The type of content viewed and how caregivers engaged in children’s screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas.

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Journal of Medical Internet Research
Authors
Yuyin Xiao
Hanwen Zhang
Scott Rozelle
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Background: Micronutrient powder (MNP or Yingyangbao, a dietary supplement that contains multiple vitamins and minerals) programs can reduce the risk of anemia among children. One such program in China distributed free MNP to children aged 6–24 months in poor rural areas. However, there are indications that the generation of primary caregiver (i.e., parent or grandparent) may influence MNP feeding behavior. The purpose of this study was to investigate the prevalence and influencing factors of effective MNP feeding behavior among parents and grandparents in a rural developing setting.

Methods: We conducted a cross-sectional study of 884 caregivers and children in formerly impoverished rural areas of Sichuan Province using multi-stage random sampling. Data were collected on caregivers’ MNP feeding behavior, their core perceptions and health beliefs about MNP, children’s responses to MNP, MNP delivery patterns, and demographic characteristics. Influencing factors of parents’ and grandparents’ MNP feeding behavior were analyzed using two-level logistic regression.

Results: Total effective MNP feeding behavior rate among caregivers was 40.95%. Grandparents demonstrated higher MNP adoption than parents (χ2 = 4.445, P = 0.035). After controlling for sociodemographic characteristics, grandparents were more likely than parents to achieve effective MNP adoption (OR = 1.360, P = 0.035); child’s preference for MNPs (ORparental subgroup = 1.736, ORgrandparental subgroup = 1.496; P < 0.050) and caregiver’s self-efficacy (ORparental subgroup = 1.157, ORgrandparental subgroup = 1.393; P < 0.050) were influencing factors of feeding behavior for caregivers of both generations. Parents were also influenced by perceived barriers to feeding MNPs (OR = 0.904, P = 0.040), while grandparents were more strongly influenced by child’s discomfort to MNPs (OR = 0.240, P = 0.023) and caregiver’s knowledge about MNPs (OR = 1.557, P = 0.014).

Conclusion: Future efforts to improve the feeding behavior of caregivers in MNP programs both in China and abroad should improve children’s preference for MNP by changing its composition and taste, and increase caregivers’ feeding self-efficacy through health education. Moreover, parents should be taught to cope with time and ability barriers that may limit MNP adoption, while grandparents should be emphasized the importance and potential side effects of MNP.

Journal Publisher
BMC Public Health
Authors
Scott Rozelle
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