“Children are most vulnerable in the first 3 years of life, and the greatest returns will be made by investment in early child development” (WHO (2014) Investing in Children: the European Child Maltreatment Prevention Action Plan 2015-2020, Written Evidence)
There is growing evidence regarding the importance of the first 1001 days, from conception to age two, in long-term development. Stressors such as maltreatment, trauma and abuse may impede the course of brain development, which in turn may reduce a child’s emotional and mental abilities to respond effectively to challenging circumstances (2). Under-development in parts of the brain may prevent young children forming a healthy range of coping responses to adversity and stress, in contrast to children who experience the caring and nurturing environment required for healthy brain development.
The evidence suggests that such stressors may adversely affect approximately 40% of all children during the first 1001 days of life (3). These interruptions may have lasting impact culminating in lower educational attainment, increased risk of mental and physical illness, drug and alcohol misuse, higher unemployment, reduced capacity for forming relationships (including parental relationships), difficulties in social functioning, antisocial and disruptive behaviour and chronic illness. These may all be linked to lowered quality of life and life expectancy (4). Studies show that prevention of such stressors can more than halve the development of drug misuse, violent behaviours and reduce teenage pregnancy by a third in some groups (4).
The cost to the economy of some of these problematic outcomes can be significant; the WHO for example estimates child maltreatment to be responsible for almost a quarter of the burden of mental disorders with the associated economic and social costs on a par with those for all non-communicable diseases e.g. cancer and heart disease (5). Studies have demonstrated that when combined together perinatal depression, anxiety and psychosis carry a long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK (6).
Interventions at a later stage, by which time such problematic outcomes may have developed, are often financially costly and less effective than those implemented early. Evidence does indicate that earlier interventions such as parenting classes are less costly and may be more effective (7). However, in the current economic climate, the number of suitable programmes available for children and families remains limited. For example, despite the evidence that maternal mental health issues can adversely affect neonatal and childhood health, at present only 3% of Clinical Commissioning Groups (CCGs) in England have a perinatal mental health strategy in operation (8).
Society needs to develop new, evidence-based and cost-effective approaches that ensure children receive the care they need in the first 1001 days of life. The establishment of such provisions of care will guarantee the best start in life that every child deserves.
“….love and nurture by caring adults is hard wired into the brains of children” Dame Sally Davies, Chief Medical Officer. (2016) The 1001 Critical Days: from Conception to Age Two Period.
The Need for Action
The first 1001 days of a child’s life, from conception to the age of two, are therefore critical for healthy infant development and may have lasting impact on a child’s mental and physical health for their lifetime. This time period is a window of opportunity to introduce vital changes which could lead to improved outcomes and have a transformative impact on their lives.
In these early days optimal neurological, emotional and intellectual development take place. These stages lay the foundation upon which a child’s capacity and ability to interact and respond to others is shaped. Given a sensitive, reliable environment, where caregivers respond to their needs, the developing infant may learn to feel safe, recognise others and interact responsively with them. This is the period when, in a supportive environment, the infant’s brain develops rapidly. Healthy nutrition and uterine environment are the first foundations.
Perinatal mental health, maternal stress on the foetus during pregnancy, traumatic birth, an adverse family environment as well as maltreatment can all affect the neurological, emotional and intellectual development of the infant. Childbirth will influence the first bonding between the mother and baby which may cascade into a chain reaction. A healthy active birth and associated feeling of empowerment may enable the mother-infant bonding, the establishment of breastfeeding and acquisition of vital immunity for the infant in the first hours after birth. Profound hormonal and other physiological changes at this time may create a sound basis for emotional interactions between child and mother during the following weeks. The infant learns to feel safe and loved. This period is where the personality begins to be shaped, along with the ability to thrive and acquire healthy emotional and mental tone and regulation. Events, experiences and conditions during this period can influence health and well-being throughout life.
An interrupted experience during childbirth, where the mother feels disempowered or out of control, may detract from her capacity during that first hour when crucial bonding begins. A woman who is unsupported, stressed or low in mood may find it harder to relate to her baby, to soothe and care for them and interact responsively. Breastfeeding can initially be tougher in these instances making it harder for the infant to gain the vital nutrition, parental attention and engagement all crucial for emotional, neurological and behavioural development. Further, infants who experience stress or trauma during this period can go on to have lowered levels of educational attainment, employment security, health, capacity to engage in relationships, quality of life and life expectancy in adult life.
The above factors reveal the key importance of the emotional, psychological, social and behavioural developmental stages occurring in the first 1001 days of life. Raising public, stakeholder and service provider awareness of these essential stages may lead to the development of new approaches designed to ensure essential growth is optimised during this time and prevent future problems before they arise. Focusing resources during this period, using evidence-based multidisciplinary programmes, can have significant impact not only on the child and its family but also on the wider community.
There is increasing awareness that too little is being done during this crucial 1001 days to promote child health and development. This has culminated in the 1001 Critical Days, the UK’s first cross-party children’s manifesto, founded by Andrea Leadsom, Member of Parliament for South Northamptonshire . The Manifesto brings together politicians from across the political spectrum to acknowledge the importance of this period of child development for the first time. The manifesto sets out a vision for the provision of services in the UK for the early years period with support from Sally Davies, Chief Medical Officer, Royal Colleges and over 100 leading child and family, health, education and social care organisations from across the UK in recognition of the science behind the policy drive.
The Zero2 Expo initiative offers an exciting, leading edge exhibition of art and science that will stimulate new approaches in how we treat babies from conception onwards. We aim to engage with the community to embrace these new ideas and excite key stakeholders to become involved and take action in the 1001 Critical Days Agenda. The Expo will encourage those involved and those who visit to consider new ways of thinking about pregnancy, birth and the first twenty four months of life, in such a way as to ensure every child has the best possible start in life.
The dialogue between art, science and people with lived experience shown through artistic imagery and pioneering information will stimulate and inspire individuals to become aware of and recognise the relevance of the 1001 critical day period in their own lives and those of their families. These new ideas may encourage individuals, families and communities to take initiative, create change in their lives and seek support that address their changing needs. The key stakeholder responses need to be harnessed to meet changing service need towards the provision of clear pathways for public access to these services in the UK for the early years period.
It is thought that by synergising art and science, we offer an effective way of engaging more couples to connect – the thinkers and the feelers. The expo will engage with all three levels: parents, practitioners, and policy makers/budget holders with one product that will harness their collective power to make a fast and significant impact. If all three start making changes simultaneously, then all three can make their own ‘demands’ of the other two groups. The fact that many of the practitioners and policy makers will also be parents will connect with them at multiple levels.
This inspiring, striking and thought provoking showcase starts in the autumn of 2017 and will roll out across the UK and internationally between now and 2020.
Potential Benefits to Society
- Better understanding and support for pregnant women of the causes and impact of stress during pregnancy, including domestic violence
- An increase in the number of midwives and health visitors, better quality training and a new focus on physiological birth that empowers women at the crucial time for optimal bonding with their baby
- Better understanding for pregnant women of nutrition and its importance for infant brain development
- Conscious birthing practices, less medical interventions (if not required) and more women centred approaches
- An increase in breastfeeding support and awareness of its importance
- A deeper understanding of the importance of attachment between mother and infant
- More supportive parenting programmes using tried and trusted techniques which encourage teamwork
- Greater support for parental relationships: calm parents = calm baby
- Women feeling more empowered to understand and state their needs to enable a healthy and happy baby – and society
- Men feeling empowered, supported and educated to understand their role as fathers
Key Policy Drivers
The following have played key roles as drivers in developing the Zero2 Expo
The Public Health Outcomes Framework Healthy lives, healthy people: Improving outcomes and supporting transparency (2016)
UK Government’s Early Years Policy Statement ‘Supporting Families in the Foundation Years’ (2011)
World Health Organisation. Investing in Children: the European Child Maltreatment Prevention Action Plan 2015-2020 (2014)
The 1001 Critical Days: the importance of the conception to age two period: A Cross Party Manifesto (2015)