/ 9 December 2016

​Your first 1000 days shape the rest of your life

Your early experiences shape the structure of your developing organs.
Your early experiences shape the structure of your developing organs.

The basis of lifelong health, wellbeing and productivity is established during the first 1 000 days of our lives. In that surprisingly short period — 270 days of pregnancy, and up till the age of two — our environment activates our genetic potential in ways that will determine our lifelong learning, earning and happiness.

The nutrition the foetus absorbs in the womb, the stress hormones that jolt it, and the emotional tone of the mother’s voice, among other experiences, initiates our phenotypical development: how our genetic potential is expressed. The type and process of birthing, close contact with the mother’s skin, breastfeeding, and emotional nurturance, protection and stimulation provided by the family continue these gestational processes beyond birth.

These early experiences not only shape the structure of our developing organs and our physiological pathways, they also create templates for how we process experiences in the future. For example, if during pregnancy a foetus does not receive the nutrition it requires, its biological systems adapt to store nutrients to safeguard against future deprivation. This may explain what appears to be the paradoxical link between being born small and the later tendency to obesity, diabetes and cardiovascular disease.

Similar processes are triggered with respect to emotional reactions, which are also primed by early events. When we experience stress and fear, cortisol helps us cope by readying us for flight or fight. It’s important though, that once the fear or stress is over, cortisol levels returns to normal. During pregnancy and infancy, the developing child’s homeostatic mechanisms are still being established. If babies are exposed to high levels of enduring (or what is called toxic) stress, as might occur if their mother is under threat or if young children are neglected or abused, they become primed to expect stress. Their cortisol levels stay high, are their stress responses are galvanised by even low levels of threat. This puts them at risk of developing a range of physical, mental and social health problems as they pass through adolescence and into adulthood.

What we know about how these early epigenetic and developmental mechanisms work, and what their implications are for improving health and wellbeing, is explored in a new global health series in The Lancet, called Advancing Early Child Development: From Science to Scale (http://www.thelancet.com/series/ECD2016). The series was launched in early October in Washington DC, linked to a flagship event at the World Bank-IMF annual meeting of finance ministers entitled The Human Capital Summit: Investing in the Early Years for Growth & Productivity.

Discussions about improving socioeconomic development at the highest levels take these early child development processes very seriously. A poor start in life can cut potential adult earnings by as much as a quarter. With some 43% of children younger than five years of age in low and middle income countries being at risk of poor early development, the potential loss to highly affected countries can run into billions. We estimate that educational under-achievement in South Africa attributable to poor early infant growth reduces potential future earnings by about 1.3% of Gross Domestic Product or R62-billion a year. Some countries, such India and Pakistan, lose more as a proportion of GDP in anticipated adult earnings to poor child growth than they currently spend on health.

So what can be done about it? The series examines approaches that promote early child development on a number of levels. Government recognition of the importance of early child development finds expression in a range of policies that support families in their caring for young children. Parental leave, guaranteed financial security through a minimum wage or social assistance, free and/or subsidised mother and child health services all help to prevent families from falling into dire poverty and becoming victims of the kind of stress and hardship that threatens the healthy growth and wellbeing of their young children.

Other important factors include ensuring that children are planned and wanted, and are born at expected birth weight and at term. Exclusive breastfeeding gives newborns the best start in life, promotes their health and is associated with increased intelligence in adulthood. Nutritious weaning food and protection from contaminants is critical to preventing a vicious cycle of infection and diarrhoea that erodes young children’s health, growth and ability to explore and learn about their world.

Most important of all to the development of young children, and operating in every second of their life, is the devotion and protection they elicit from their parents and families. The unbridled love we feel towards our offspring is hardwired into our human nature. Big eyes in a round face, and babies’ signals of distress and delight among other things, draw us into a relationship and commitment that sees us enabling and anticipating their needs and opening their opportunities for the future. It is this nurturing care that above all provides children with singular benefits well into adulthood.

The South African launch of the Lancet series, linked to the DST Science Forum South Africa, takes place on December 7 2016 in the Diamond Auditorium at the CSIR International Conference Centre in Pretoria, starting at 5pm. Minster of Science and Technology Naledi Pandor will deliver the keynote address.