The First 1 000 Days: Realising the potential of a head start

The first 1000 days of a child’s life – from pregnancy to the child’s second birthday – is the most critical time in development. This is a time of tremendous potential and enormous vulnerability. A child’s brain starts to develop in pregnancy and how well, or poorly, a foetus is nourished has a profound impact on their future ability to grow, learn and thrive. The first 1000 days are when the foundations for lifelong health are set. The first two years of life gives health workers an exceptional window of opportunity to realise the potential of a head start in building healthier and more prosperous futures for our children.

Good nutrition allows children to survive, grow, develop, learn, play, participate and contribute, while malnutrition robs children of their future potential. Malnutrition results in stunting (too short and small for age), wasting (too thin for height) or overweight/obesity. According to the Joint Child Malnutrition Estimates issued by UNICEF, the World Health Organisation, and the World Bank, Africa is the only region where the number of stunted children has risen. Stunting in particular, is a result of poor nutrition in-utero and early childhood, and can be prevented. Wasting in children is life-threatening and is primarily the result of poor nutrient intake.

According to Thousand Days, an estimated 149 million children under age five are developmentally stunted as a result of chronic malnutrition in the first 1000 days. Another 49 million children are susceptible to life-threatening diseases and infections due to acute malnutrition. WHO says that poor nutrition causes 45% of deaths in children under 5 – that is 3.1 million children every year. Children in sub-Saharan Africa are more than 15 times more likely to die before the age of 5 than children in high income countries.

USAID reports that the health and well-being of pregnant and lactating women is directly connected to the growth and health of their babies. As healthcare workers, we know that undernutrition during pregnancy is a major determinant of stunting and can lead to consequences such as obesity and nutrition-related non-communicable diseases like cardiovascular disease, Type II diabetes and cancer in adulthood. Globally, only 16% of babies and toddlers eat a nutritious daily diet. The impact is profound – on mothers, their children and the communities they live in.

Every year 3.1 million children die from malnutrition, and 21.9% of children are developmentally stunted as a result of chronic nutrition – yet this is 100% preventable. No matter where a mother and child live, whatever region, hemisphere or continent, the nutritional needs of the first 1000 days are the same. These needs are universal, so how can nutritionists and HCPs create change?

The building blocks for a healthy first 1000 days include a nutritious diet and healthcare for mothers during pregnancy; exclusive breastfeeding for the first six months; education for parents and caregivers about appropriate nourishment for babies and toddlers, including when the right times are to introduce new foods to babies. In many countries less than a fourth of infants 6 to 23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age. The nurturing, responsive care and feeding of babies and toddlers is something that needs to be taught to parents and caregivers.

Many people feel that nutritious, healthy food is the expensive option and that they simply cannot afford the luxury. In addition, exclusive breastfeeding is so critical that it could save the lives of over 820 000 children under the age of 5 years each year.

The WHO and UNICEF recommend:

• early initiation of breastfeeding within 1 hour of birth;
• exclusive breastfeeding for the first 6 months of life; and
• the introduction of nutritionally adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.

The relationship between eating a healthy diet and positive health outcomes is well established. We know that nurturing healthy eating among children has the potential to improve public health. As HCPs we should be teaching everyone about healthy eating and infant feeding as well as how to access the right foods at the right prices.

The Sustainable Development Goals (SDGs) adopted by the United Nations in 2015 were developed to promote healthy lives and well-being for all children. The SDG Goal 3 is to end preventable deaths of new-borns and children under 5 by 2030. Countries that don’t invest in the well-being of women and children in the first 1000 days lose billions of dollars to lower economic productivity and higher health costs. Foetal growth restriction and poor growth early in infancy are now recognised as important determinants of neonatal and infant mortality, stunting, and overweight and obesity in older children and adults.

The first 1000 days are the most crucial for a child’s cognitive and physical development. Nutrition in particular plays a foundational role – both for a pregnant mother and her child. We cannot reverse the damage to a child’s growing brain, or body but we can prevent it.