THE FIRST 1,000 DAYS OF LIFE: Taking advantage of these vital formative days.

The first 1000 days of a life from conception until roughly a child’s second birthday, is the brains window of opportunity to establish the foundations of optimum health, growth, and neuro-development across the lifespan. Yet too frequently in developed countries, nutrition is not prioritized as being the major attendant, causing what we term malnutrition during gestation and in early childhood. The future foundations for health and neuro-development potential are weakened and this is becoming a major concern in the modern era. Where once malnutrition was due to poverty, humans are faced with the negative effects of overnutrition in the form of obesity and poor nutrition due to inbalanced diets or diets based on artificial ingredients including formula feeds and processed convenience foods.

These were the main points made at the recent Paediatric Conference in Dubai well attended by nutritionists, dietitians and Paediatricians. The loss of developmental potential due to poor diets in this very critical time-frame is in fact something we can control.

In 2008, the Lancet reported “the critical or sensitive periods of brain development susceptible to specific nutritional deficiencies are increasingly well defined, making prevention of long-term deficits with well-timed nutritional interventions during the fetal period and first years of life a true possibility”.

The human brain continues to develop and change throughout life, however, the most rapid period of brain growth and its period of highest plasticity is in the last trimester of pregnancy and the first two years of life. Vision, hearing, language, attention, coordinated movements develop as the brain cell numbers increase, along with exponential growth. This time period provides the greatest opportunity to provide optimal nutrition to ensure normal development and also the time of greatest brain vulnerability to any nutrient deficit.

While we’ve always known that an infant needs good nutrition to grow in their early years, the understanding that nutrition in the first 1000 days will influence health many years down the track is relatively new and research in this area continues to grow as we see children now with increased risk of what used to be regarded as adult diseases, and an increase in children on the autism spectrum.

While all nutrients are important for brain development and function, optimal overall brain development depends on providing sufficient quantities of key nutrients during specific sensitive time periods in these first 1,000 days. A critical nutrient at one time period may have little or no effect in another. However, identification of key nutrients and timing of the introduction of new foods, guides mothers to work with what we know to provide for adequate nutrition and support brain growth to ensure full developmental potential.

What is important to understand is the mother’s nutrient status is what influences fetal health. When we consider the most common nutrient deficiencies worldwide, a strong link exists between the mother and child.

We are all so eager to see our children develop according to chronological age, growth and weight gain day by day, the first smile, clasping fingers, rolling over, sitting up and crawling. The brain requires all nutrients from foods for growth, however certain nutrients are particularly critical.

Protein including all amino acids

Polyunsaturated fatty acids and particularly omega 3 fatty acids

Vitamins and minerals – iron, zinc, copper, iodine, choline, folate and vitamins A, B6, and B12.

Of these, iron, typifies the necessity of adequate nutrition at specific times of brain growth to ensure full developmental potential which is why at six months, baby moves onto some solid food which is recommended to be iron fortified.

According to the World Health Organisation, WHO, iron is the most common nutrient deficiency in the world across women and children, as well as athletes. Dietary preferences such as vegetarian and vegan diets, malnutrition, digestive problems, over exercising, poor nutrition and other chronic diseases influence iron status.

Iron is a key nutrient involved in brain interactions, growth and energy. Globally, an estimated 47% of all preschool-aged children and 42% of all pregnant women are anemic, with approximately half caused by iron deficiency (WHO, April 2013). Walker et al (2007) related the peak brain requirement for iron and protein was between 6 months and 3 years. They found 19 out of 21 studies reported impaired mental, motor, socio-emotional, or neuro-physiologic functioning in infants with iron deficiency anemia compared to infants without iron deficiency anemia. Authors Christian. P et al, the Journal of American Medical Association (2010) reported that supplementation of children with iron and folic acid deficiency from age 22 months until 36 months with mothers with poor nutrient status did not catch up with their peers on aspects of intellectual or motor function suggesting that the window of opportunity was missed.

Based on what is now known about the importance of brain development in the first 1,000 days, it is not surprising that our most complex behaviors and potential are laid down well before there is obvious expression of behavior. It is also noted by nutritional neuroscience, that early life nutrient deficiency can affect brain function in adulthood, despite adopting a normal healthy diet. Children are reliant on obtaining their nutrient status from the mother from conception, in feeding from birth and the timeliness of the right nutrients after 6 months of age.

The American Dietetics’ Association recommend exclusively breastfeeding for the first 6 months and only if necessary, moving onto what is now referred to as an artificial feed that is hydrolysed dairy based, not soy, and one that is iron fortified. Soy based feeding is only used if the baby is intolerant to hydrolysed dairy or is vegan. The start of solid food begins after 6 months gradually adding good omega 3 fats and easily digested grains, plant/meat protein. Meat is rich in iron, zinc and protein and a perfect brain food. Cow’s milk and all dairy foods are left until 12 months allowing for digestion to mature and be able tolerate dairy proteins better. Egg allergy is not common and it is now recommended that egg yolk be one of baby’s first foods. It is also rich in protein and a great brain fat called choline. Omega 3 fatty acids vital building blocks of the fetal brain and retina of the eye.

Other key points are to avoid added sugar and salt to foods, consume only water taken where many parents are giving fruit juice and sweetened beverages. Sugar intake in children over the last few decades has increased and is the main driver of obesity.

While the young brain is enormously plastic in its ability to recover from nutritional highs and low and hopefully, it is never too late to at least partially correct a deficit, however, science suggests that a window of opportunity exists to build the brain which narrows with advancing age. Early feeding in the first 1000 days is not just about growth but about key nutrients involved in the performance of the young child’s brain and consciously good nutrition is the best ways we can achieve this goal.

Another key point highlighted from the conference is the importance of “responsive” parenting as opposed to “permissive”. Permissive parenting is where the child dictates the food which is never going to fall into line with healthy guidelines as the long term effects are not understood.

Having said that, we can only do our best as parents with the information we have. If you have older children and are expecting again, be assured that changes to better eating and nutrition are still possible and advice is available to help deal with picky eaters.

UNICEF, the World Bank and other partners have launched alliances to focus greater attention on the importance of early childhood development and to drive greater action to reach the children at greatest risk. Everyone benefits from the investment into promoting childhood health, starting with nutrition.

I wrote my masters thesis on “Maternal diet and the measurable influence on new-born health” (2002).