Scotland's chief medical officer has issued an urgent wake-up call for a change of direction in policies to support children in the first years of their lives.
Improving the early experiences of children through individual support rather than "broad" approaches to poverty was the key to helping children at risk, Harry Burns told Catholic secondary heads at their annual conference in Crieff last week.
Dr Burns went so far as to suggest that a more important factor than poor health and poverty in the way children developed was whether they were able to take charge of their surroundings.
"A complete inability to control your environment is really damaging, not just psychologically, but physiologically," he commented.
Dr Burns said there was even evidence that the brain became "wired up differently". Contrasting scans of two three-year-old children showed that the brain of the child who had experienced more stressful conditions was smaller.
He underlined the importance of early support by pointing out that children who are likely to commit murder or other serious crimes could often be picked out at a very early age, even by other children.
Dr Burns claimed that "broad processes", focusing on issues such as poverty, drugs and alcohol, had proved relatively ineffective; improvements to housing in Glasgow's Castlemilk estate, for example, had not improved health.
"If we are really going to make a long-term difference to health, we've got to start supporting children most at risk, and it's got to be done on an individual basis."
Dr Burns drew the parallel between early childhood experiences and a game of tennis, where a serve led to a return shot: if a baby cried, it quickly learned that its nappy got changed; if it smiled or said "dada" or "mama", it got cuddles.
But, he added, there were serious implications for children who did not experience this ability to control their environment. The absence of a mother or carer could have a "significant effect" on children and inconsistent parenting was a "bad, bad thing".
For children adversely affected in this way, the process of "serve and return" would take on a different form: they were more likely to respond to their environment with aggression. "I've come to the conclusion that it's not a case of 'madness or badness'," Dr Burns said. "These kids have been broken."
A ministerial task force, chaired by Shona Robison, the Minister for Public Health, is currently considering health inequalities, including how to support "a good start in life for all children in Scotland".