朝向高等级证据：中国儿童早期发展领域的知识演进及贡献

doi:10.16382/j.cnki.1000-5560.2024.11.005

摘要/Abstract

摘要：

投资儿童早期发展已成为全球共识。我国早在20世纪初期就开始重视0—3岁儿童早期发展，该领域的发展经历了萌芽、奠基、扩展、制度化以及调整与创新五个阶段。自2010年以来，我国借鉴国际有效经验，开展了多种策略的探索与实践，提供了一些实践证据来推动儿童早期发展领域的进步。项目团队从2012年开始着眼于影响儿童早期发展的两个关键因素——营养和养育，在我国农村地区对5000名0—3岁婴幼儿及其家庭进行不同类型和模式的随机干预实验研究。通过梳理儿童早期发展领域的知识发现过程，评估相关研究对儿童和家庭的影响，可总结出由不同主体实施的营养干预和养育干预的模式与操作方案，并形成具体的操作手册。这些基于高等级证据的实证研究不仅为我国的儿童早期发展模式提供了高质量的证据，也为国际社会探索和总结儿童早期发展模式提供了重要的参考方案。建议我国制定并推广全国性儿童早期发展干预计划，确保不同地域和经济背景的家庭获得适宜的营养和养育干预支持。同时，建议加强跨部门协作与资源整合，共同推动儿童早期发展事业。

关键词: 儿童早期发展, 知识演进, 知识贡献, 中国高等级证据

Abstract:

Investing in early childhood development (ECD) has become a global priority. China recognized the significance of ECD for children aged 0-3 as early as the early 20th century. The evolution of ECD in China has progressed through five key stages: emergence, foundation, expansion, institutionalization, adjustment and innovation. Since 2010, China has actively integrated international best experiences, exploring and implementing various strategies to generate practical evidence that advances the field of ECD. Beginning in 2012, research teams have concentrated on two critical factors influencing ECD—nutrition and parenting—by conducting randomized controlled trials (RCTs) involving 5,000 children aged 0-3 and their families in rural China. These studies have mapped the knowledge discovery process in the ECD field, evaluated the impact on children and families, and developed comprehensive models and operational plans for nutrition and parenting interventions executed by diverse stakeholders. These efforts culminated in the creation of detailed operational manuals. The evidence generated from these empirical studies not only provides robust support for China's ECD models but also serves as a valuable resource for the global community in exploring and refining ECD approaches. It is recommended that China develop and implement a nationwide ECD intervention plan to ensure that families across various regions and socioeconomic backgrounds have access to appropriate nutrition and parenting support. Furthermore, enhancing cross-sector collaboration and resource integration is essential for advancing the ECD agenda collectively.

Key words: early childhood development, knowledge evolution, knowledge contribution, high-level evidence in China

史耀疆, 宋倩楠, 张馨月, 高源, 梁世斌, 张亚丽, 岳爱. 朝向高等级证据：中国儿童早期发展领域的知识演进及贡献[J]. 华东师范大学学报(教育科学版), 2024, 42(11): 74-94.

Yaojiang Shi, Qiannan Song, Xinyue Zhang, Yuan Gao, Shibin Liang, Yali Zhang, Ai Yue. Towards High-level Evidence: The Evolution and Contribution of Knowledge in Early Childhood Development in China[J]. Journal of East China Normal University(Educational Sciences), 2024, 42(11): 74-94.

图/表 8

表 1

中国儿童早期发展的知识贡献"

时期	认识	方法	证据	模式
萌芽阶段（19世纪末至20世纪初）	1. 从家庭走向社会 2. 确定近代学制系统	1. 引进国外先进理念与实践 2. 本土化初步探索和改革	1. 康有为提出儿童公育体系； 2. 1903年，张之洞等人在武昌创办中国首所公立儿童早期发展机构–湖北武昌幼稚园，全套办院方针均采用日本模式； 3. 1904年，张之洞等人制定我国近代首个学前教育法规《奏定蒙养院章程及家庭教育法章程》，确定近代学制系统，包括蒙养院制度。	1. 公育思想 2. 蒙养院
奠基阶段（1912— 1949）	1. 完善学制体系 2. 开办近代化学前机构，开发课程 3. “活教育”、 “行为即课程”、“创造教育”理论	开始实验研究，分月龄展开科学研究，开启中国化教育实践探索	1. 1912—1913年，南京临时政府颁布《壬子癸丑学制》； 2. 1923年，陈鹤琴创办南京鼓楼幼稚园； 3. 1927年，陶行知创办中国首个乡村幼稚园。1928年，陶行知等提出《各省开办试验幼稚师范案》和《各省师范学校急需设幼稚科案》； 4. 1932年，国民政府教育部公布《幼稚园课程标准》。	1. 胎教院 2. 乳儿院 3. 幼稚园
扩展阶段（1930— 1949）	1. 政策支持 2. 注意儿童营养和保育 3. 师资队伍建设	采用符合儿童身心发展特点的直观教学法、比较教学法、三化教学法等	1. 1934年，中央人民内务委员部颁布《托儿所组织条例》，这是中国共产党建党后首个有关托儿所的纲领性文件，被称为红色政权下第一个托幼文献，标志着老解放区儿童早期发展事业的制度建设的开端； 2. 提出“孩子第一”方针，《新华日报》1944年报道每个孩子每月营养标准； 3. 1940年，创立首所独立的公立幼稚师范学校江西省立实验幼稚师范学校。	1. 寄宿制保育院 2. 多种类型的托儿所 3. 游击式托幼幼稚园
制度化阶段（1949— 1990）	1. 国家全面领导养育工作，面向全体幼儿实施全面发展教育 2. 学习苏联的学前教育经验 3. 推广出版科学研究成果 4. 国家对0—3岁托儿所全面重视	1. 开展不同精细领域实验性探索 2. 修订国外量表进行测验 3. 开展分组实验研究	1. 1954年，在苏联专家指导下，教育部召开新中国第一次幼儿教育经验交流会； 2. 1976年，林传鼎、张厚粲修订韦克斯勒量表，1981年确定中文版； 3. 1950年，中福会幼儿园运用科学方法进行幼儿研究，分组实验； 4. 中福会通过实验研究出版儿童早期发展相关的书籍和论文； 5. 1989年，国家和企业提供90%以上的公共托育服务。	1. 制度化下的集体化或单位托幼方式 2. 社会组织创办的托儿所
调整与创新阶段（1990— 2010）	1. 0—3岁托育服务迅速萎缩，照护责任逐步回归家庭化 2. 儿童早期照护和教育政府投入有限，市场化早教机构迅速发展	1. 项目式试点探索 2. 加强心理行为发育监测与评估，对生长迟缓和贫血等进行重点管理和干预	1. 市场化改革，作为职工福利的托幼服务逐渐萎缩。据教育部2005年第二期《教育统计报告》显示，相比于2000年，短短五年间，集体性托幼机构减少56668所，锐减70%； 2. 2000年数据显示，国拨经费仅占学前教育总经费的1.3%，主要用于幼儿园； 3. 1998年，我国第一家早教机构红黄蓝亲子园在北京诞生，此后，早教市场在一线、二线城市获得充分发展。	1. 托儿所 2. 早教机构 3. 项目式儿童早期发展试点

表 1

图 1

表 2

我国基于营养干预的实践与探索（不包括本项目团队项目）"

序号	样本地区	样本量	样本儿童年龄段（干预时长）	方法	干预内容	结果	结果变量
1	甘肃（农村）（Chen et al., 2010）	978名干预组1 500名干预组2 127名对照组	4—12月龄（18个月）（1.5—2年）（2.5—3年）（3.5—4年）	随机干预实验	干预组1：每天发放含大豆粉和五种微量元素的营养包，并每6个月接受维生素A的补充；干预组2：与1相比不含微量元素，仅有0.7 g蛋白质，并每6个月接受维生素A的补充	1. 干预组1和干预组2对婴幼儿贫血、生长发育、低体重和运动能力均有明显的改善作用（P<0.05），并且有持续显著正面影响 2. 干预组1儿童粗大运动技能得分显著较高（P<0.001） 3. 在干预3.5—4年后，干预组1智商比干预组2和对照组分别高3.1和4.5分（P<0.05）	身高，体重，贫血，运动，语言，社会，适应，智商
2	江西（农村）（丁小婷等，2016）	483名干预组 248名对照组	6—18月龄（6个月）	随机干预实验	给干预组儿童发放免费的营养包（辅食营养补充品）	婴幼儿的消瘦率、生长迟缓率、低体重率（P<0.01）和贫血率（P<0.05）与对照组儿童相比均显著降低	身高，体重，贫血
3	乐都（农村）（李尚明，2014）	387名干预组 240名对照组	0—36月龄（21个月）	随机干预实验	给干预组儿童发放免费的营养包（辅食营养补充品）	干预儿童生长迟缓率、低体重率显著降低（P<0.005），贫血率下降	身高，体重，贫血
4	河北涞水县（农村）（Shi et al., 2010）	294名干预组 305名对照组	2—4月龄（干预截止婴幼儿12月龄）	随机干预实验	使用当地可获得、负担得起且营养丰富的食物，如蛋、番茄、豆类、肉类、鸡肉和肝脏，制作增强的辅食食谱	干预组婴儿的身长和体重得到了明显改善（P<0.05）	身长，体重
5	广西壮族自治区（农村）（韦萍等，2016）	236名干预组 268名对照组	6—24月龄（8个月）	随机干预实验	干预组接受了营养补充剂，包括铁、锌、维生素C、维生素B1、维生素B2、维生素B6、烟酰胺、维生素A、维生素D、维生素E、叶酸；健康教育：通过讲座、宣传资料、海报等，对婴幼儿的科学喂养知识进行教育，强调营养知识的重要性	1. 在干预4个月和8个月后，干预组婴幼儿的血红蛋白水平提高了，尤其是12至24月龄的婴幼儿，干预后血红蛋白水平显著高于对照组（P<0.01） 2. 血红蛋白增值在补充营养素补充剂组（A组和B组）中比只进行健康教育的C组和正常喂养的D组要高	贫血
6	陕西省宁强县（农村）（李丽祥等，2012）	634名干预组无对照组	6—24月龄（6个月）	准实验	每天给婴幼儿一包营养包，包含大豆粉、铁、锌、钙、多种维生素（维生素A、B1、B2等）和其他微量元素	1. 血红蛋白平均值提高了7.4 g/L、身长平均增加了3.3 cm、体重平均增加了1.2 kg、年龄别体重评分（WAZ）和身高别体重评分（WHZ）均提高了0.6分（P<0.01） 2. 贫血患病率下降了25.1%、生长迟缓率下降了1.0%、低体重率下降了5.4%、消瘦率下降了4.0%	贫血，身长，体重
7	重庆（农村）（蒋秋静等，2016）	1306名干预组无对照组	6—24月龄（12个月）	准实验	营养包补充：每天补充一包国家统一标准的营养包，包括蛋白质、维生素和矿物质	1. 体重和身长的增加（P<0.05） 2. 低体重率下降2.6个百分点（P<0.05） 3. 血红蛋白水平的提高（108.2 g/L—110.4 g/L），贫血率降低（51.7%—38.7%）	身长，体重，贫血
8	云南省西畴县（农村）（Sheng et al., 2019）	461名肉类组 419名强化谷物组 436名本地谷物组	6月龄（12个月）	随机干预实验	肉类组：每天提供50克猪肉；强化谷物组：每天提供20克富含维生素B12、铁和锌的强化米谷物；本地谷物组：每天提供20克本地非强化的米谷物	1. 肉类组和强化谷物组的同型半胱氨酸水平显著低于本地谷物组 2. 肉类组和强化谷物组的认知得分更高（P<0.001） 3. 维生素B12水平与认知得分和精细运动得分呈正相关	贫血，认知，维生素B12水平，半胱氨酸水平

表 2

图 2

图 3

表 3

表 4

我国开展的儿童早期发展中心项目（不包括本项目团队项目）"

序号	项目名称	样本地区	样本量	样本年龄段及时长	方法	干预内容	结果	结果变量
1	农村早期儿童发展社区服务项目（席卫平等，2002）	山西省襄垣县3乡6村	干预组：324名儿童对照组：0	0—3岁（2年）	准实验	每村成立儿童玩具活动中心，同时开展儿童保健工作，指导家长科学育儿、促进儿童智力开发，家长和儿童自主前往活动	项目村儿童两年四病发病率降低，儿童发育异常和可疑率降低，家长具备了一定营养知识	四病（营养性贫血、佝偻病、肺炎、腹泻）发病率，儿童发育筛查，村层面照养人辅食添加（是否添加蛋类、肉类、维生素D和钙）
2	深圳儿童早期发展项目（冯承芸等，2013）	深圳市宝安区所属4个街道，共用1个儿童早期发展中心	干预组：244名儿童对照组：0	12—36月龄（6个月）	准实验（自愿参与）	基于儿童早期发展中心开展每周1—3次不等亲子课程，每次50分钟，每班不超过8对亲子，儿童月龄相差不超过3个月；开展胎教、儿童早期发展课程、儿童心理咨询、定期讲座和公益活动	参与项目儿童情绪社会性四域阳性检出率降低	情绪社会性
3	“爱在开端”项目（徐梓婧等，2021）	湖南、湖北、河北、山西、贵州省和新疆维吾尔自治区的146个村庄和社区	干预组： 38528名儿童对照组：0	0—3岁（5年）	准实验	基于儿童早期发展中心开展每周至少3个半天的集体亲子活动，每次活动约40分钟，8—10对亲子参与；定期开展知识讲座，入户服务和社区宣传；中心每周免费开放5天，为家庭提供游戏和育儿空间	促进了参与项目24—29月龄儿童发展，减少了父母对儿童的忽视，改善了家庭学习环境、父母教养方式和教养观念，增加了亲子互动，增长了家长教养知识	儿童发展、忽视、教养方式、教养观念、亲子互动、家庭学习环境和教养知识

表 4

图 4

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序号	样本地区	样本量	样本儿童年龄段及干预时长	方法	干预内容	结果	结果变量
1	云南省昭通鲁甸县（农村）（国际救助儿童会， 2021）	1024名儿童干预组分配未提及	6—24月龄（12个月）	随机干预实验	每月两次的入户家访服务及每月一次的集体亲子活动	1. 干预组婴幼儿认知、语言、运动和社会情感测试能力得到显著提高 2. 认知、语言和社会情感能力滞后比例显著降低11%、 5%和 8%	儿童认知、语言、运动和社会情感
2	安徽（农村）（Jin et al., 2007）	50名干预组 50名对照组	0—24月龄（6个月）	随机干预实验	6个月内提供两次入户养育指导	对发育商、运动、社会适应性和社会情感有显著的正向影响（P<0.05）	儿童粗大动作、精细动作、语言和社交技能
3	甘肃省华池县（农村）（卜凡， 2021）	未提及	6—36月龄（24个月）	随机干预实验	每周一次入户养育指导，并分发微量营养素	1. 营养与家访相结合的综合干预，使早期发育筛查正常率提高50%以上 2. 干预组儿童中有84%表现好于对照组儿童 3. 干预组儿童通过家访获得技能提升，未来大学入学的机率将提高38%	身高、体重、头围、血红蛋白值；儿童发展指标
4	贵州省七星关区（农村）（卜凡， 2021）	未提及	6—36月龄（24个月）	随机干预实验	每周一次入户养育指导，并分发微量营养素	干预组儿童在家访一年后筛查“正常”的概率比对照组高18.4%	身高、体重、头围、贫血、儿童发展指标

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