The first 1,000 days: A window of opportunity for a brighter future for children

How can we help create a healthier and more equitable future for all pregnant people and their children? The infant and maternal mortality rates in the US are among the highest of any wealthy country, with glaring racial and ethnic disparities. There is significant room to develop a unifying plan for the right policies and systems to improve nutritional security and well-being for vulnerable families.

A new essay published in the American Journal of Public Health by Dr. Heather Hamner—a health scientist at the Centers for Disease Control and Prevention—reveals numerous gaps between the dietary intake of pregnant people, infants, and toddlers and the US Department of Agriculture and the Department of Health and Human Services’ Dietary Guidelines for Americans, 2020–2025, with race and ethnicity disparities persisting across the spectrum. The average consumption of sugars, saturated fat, and sodium are higher than the recommendations of the Dietary Guidelines. The article also reveals that nearly 75% of infants are not exclusively fed human milk for the first 6 months of their lives and 1 in 3 of them are started on complementary foods (other than human milk or infant formula) before the recommended age. Most children between 12 and 23 months do not consume the recommended amounts of vegetables, dairy, and fruits.

How do we set about addressing these nutritional deficits? The essay states “Advancing efforts related to research and surveillance, programs and communication, and dissemination could help positively, and equitably, influence the health and well-being of mothers and children.” It also outlines a framework by which current federal policies and programs can be strengthened and how access to and participation in programs can be improved.

Another paper in the collection, authored by Blythe Thomas, Initiative Director of 1,000 Days, an initiative of FHI Solutions, points out that a clear plan that unifies maternal and early childhood nutrition policy and systems has eluded implementation in the US. The paper emphasized four sectors where immediate actions can be taken, and where long-term investment can make a significant impact on maternal and child health: early childhood development, health care, philanthropy, and US government relations. “Achieving nutrition security during the first 1000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather,” says Thomas, in her editorial.

A third paper in the collection—authored by Dr. Kofi Essel, community pediatrician, Children’s’ National Hospital, discusses the limited focus on nutrition-related medical education as a significant constraint on the ability of pediatricians to deliver sound feeding and nutritional guidance during the first 1,000 days. Using examples from the author’s own experience during his pediatric residency, the editorial explains that a paradigm shift on the importance of nutrition and nutrition guidance is important to enhance clinical care. According to Dr. Essel, “This shift requires a collective effort that activates pediatricians to work in cross-sector collaboratives to influence change alongside industry, researchers, and even early childhood educators. It requires pediatricians to use their voices to support local policy that shifts the food landscape, supports national policy that enhances nutrition security for our families, and transforms medical education for current and future providers.”

These three papers are part of a special series, sponsored by 1,000 Days of FHI Solutions, that will appear in AJPH on October 26, 2022. The full series will present the state of science, research needs, and a policy agenda for optimal maternal and child nutrition in the United States. Never before has a journal series brought together papers on these topics during pregnancy, birth, the postpartum period, and early childhood for the US population.

To learn more, please visit: https://thousanddays.org/updates/ajph-series/

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Reference

DOI:    

1. https://doi.org/10.2105/AJPH.2022.307028
2. https://doi.org/10.2105/AJPH.2022.306999
3. https://doi.org/10.2105/AJPH.2022.307063

Titles of original papers:

1. Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective
2. The First 1000 Days—A Missed Opportunity for Pediatricians
3. From Evidence to Action: Uniting Around Nutrition in the 1000-Day Window

Authors:

1. Heather C. Hamner, PhD, MS, MPH, Jennifer M. Nelson, MD, MPH, Andrea J. Sharma, PhD, MPH, Maria Elena D. Jefferds, PhD, Carrie Dooyema, MPH, MSN, RN, Rafael Flores-Ayala, DrPH, MApStat, Andrew A. Bremer, MD, PhD, Ashley J. Vargas, PhD, MPH, RDN, Kellie O. Casavale, PhD, RD, Janet M. de Jesus, MS, RD, Eve E. Stoody, PhD, Kelley S. Scanlon, PhD, RD, and Cria G. Perrine, PhD
2. Kofi Essel, MD, MPH
3. Blythe Thomas, BS