First 1000 days of life Contents

2The first 1000 days from conception to age 2

6.The first 1000 days, from a child’s conception to age 2, is a critical period. During this time of heightened vulnerability, the foundations of a child’s health and development (physical, cognitive, social and emotional, and behavioural development) are laid and a trajectory is established.4 As Barnardo’s told us:

When a baby’s development falls behind the norm during the first year of life, for instance, it is much more likely that they will fall even further behind in subsequent years than catch up with those who have had a better start.5

7.With targeted and specialist support, it is possible to rebuild the brain properly and put children back on a course of healthy development,6 but doing so is very challenging.7Sir Michael Marmot’s review of health inequalities in 2010 stressed that “what happens in these early years, starting in the womb, has lifelong effects” on a person’s health, wellbeing and life chances.8

8.In focusing on the first 1000 days of life, we do not mean to downplay the importance of intervention at other stages. The Early Intervention Foundation argued that it is important not to create a narrative where all opportunities to support child development are lost at the end of infancy.9 Interventions from age 2 can redress problems that occur during the early years of a child’s life.10 Development continues throughout childhood and into adolescence. Risks and adversities children encounter later in childhood (e.g. parental conflict in the home or bullying at school) can prove detrimental to their future health, development and life chances.11 Similarly, before conception, a parent’s health can affect their child’s health and development. Parents who are fit and healthy at the start of pregnancy tend to have healthier babies, as the Department of Health and Social Care point out.12 To give every child the best start in life, intervention must begin before conception and continue throughout childhood.

9.Indeed, when thinking about interventions to improve health, development and life chances of future generations, it helps to take a transgenerational view,13 especially with regard to the prevention of the reoccurrence of abuse and trauma.14 Children are more likely to experience adverse experiences if their parents were also subject to abuse and trauma in childhood.15

10.Nevertheless, the first 1000 days is a critical period that deserves more attention from policymakers than it currently receives. During the late 1990s and the early 2000s, up to 2010, support for the early years was prioritised, according to the Marmot Review.16 A report by the Children’s Commissioner and the Institute for Fiscal Studies highlights that from 2000/01 to 2009/10 public spending on children rose rapidly, with increased spending on benefits for families and children’s services.17 During the late 1990s and early 2000s the Government prioritised reductions in child poverty, introduced the Healthy Child Programme and expanded the provision of SureStart centres across the country.18

11.According to the Marmot Review, published in 2010, these years resulted in a revolution in early years and parenting support. However, the review argued that continued investment and political commitment in the early years was needed to deliver long-term reductions in inequality.19 Instead, public spending on children has fallen, reversing some of the increases seen during the 2000s.20 According to a report by the IFS and the Children’s Commissioner in June 2018 about public expenditure on children, child poverty (both relative and absolute poverty) had increased since 2010 and was projected to rise over the rest of the decade, in part due to planned cuts in benefit spending.21

12.Recently the Government has tended to focus on intervening later in childhood. The Government’s approaches to children’s mental health, obesity and even early childcare care focus more on intervening after age 2 than earlier in the crucial first 1000 days.22 A similar trend is evident locally. Clinical commissioning groups are responsible for commissioning mental health services for children aged 0–19, but very few provide services below age 5.23 Where Government and public services do intervene in the early years, we have found that it has done so in a fragmented way, without any overarching strategic framework and with little join-up. The evidence we have received suggests much more can be done in the early years to tackle some of the major problems affecting children in our society today.

13.A child’s health and development are influenced by individual characteristics (e.g. genetics, personality and gender).24 However, a child’s family, particularly their parents, their home, the community they live in and the wider society they are part of, all contribute significantly to their future health, development and life chances. These characteristics interact in a variety of often complex ways.25 The characteristics that promote a child’s health and development (i.e. protective factors) and the characteristics that put their health and development at risk (i.e. risk factors) tend to be two sides of the same coin.26 For instance, the Early Intervention Foundation point out that “poor parental mental health may pose a risk to a child’s healthy development, while good parental mental health may provide a protective factor against other negative child outcomes, such as behavioural problems or poor academic attainment.”27

14.The influence of a child’s parents during these early years cannot be overstated. A child’s health and development is influenced by their parents’:

15.Parental conflict, alcohol and substance misuse, mental health problems and a parent’s own experience of trauma in childhood all increase the risk of adverse experiences in childhood.34 These behaviours and experiences act against a parent’s ability to interact, and form a healthy relationship, with their baby, which is vital for infants to form a secure attachment. Insecure or disorganised attachments are associated with a series of negative outcomes throughout childhood and across the life course.35 The Children’s Commissioner’s report on vulnerability estimated the number of children in England living in families with adults who exhibit the key risk factors of domestic violence and abuse, alcohol and substance misuse and mental health problems. Over 1 million children aged 0–5, and almost 200,000 under the age of 1, live with an adult who has experienced domestic violence or abuse; just under 2 million children aged 0–5 live with an adult who has a mental health problem, including around 300,000 children under the age of 1; and over 600,000 children age 0–5 live with an adult with a reported substance misuse issue or who is dependent on drugs or alcohol, including over 100,000 children under the age of 1.36

16.Risks to a child’s health and development have some important characteristics. The risks to children in this early period are often not immediately identified, but can have lifelong consequences. These risks are often:

17.The risks to children from conception to age 2 and the outcomes they achieve are strongly linked to their social circumstances.43 According to the Health Foundation:

Good development in the first 1000 days is also strongly socially patterned, with clear inequalities evident by socio-economic position from an early age. By the time children get to school, there are already big differences in their levels of development which persist and amplify over time.44

18.Poverty, poor housing and unstable, low paid work are examples of social stresses that act against the ability of parents to provide a secure, healthy, nurturing environment during the early years of a child’s life.45 Poverty is a major factor for other risks too. Smoking in pregnancy, breastfeeding rates and obesity in pregnancy all adversely affect a child’s health and are all more prevalent among poorer households.46

We had to move into rented accommodation when my first daughter was small. I had had no idea how unsecure rented accommodation was, especially for those who are not well off. We’ve negotiated and worked ourselves into a better position now, but many can’t, or haven’t, yet. Unsecure housing is such a stress for parents and children suffer as a result. Source: Mumsnet survey

19.A child’s home environment exerts an important influence over their future health and development.47 A child’s home, family and community environment is a place where a lot of learning takes place during these early years. As the National Children’s Bureau explain, “parents who engage in meaningful activities that encourage thinking and talking to stretch a child’s mind as part of everyday life can enhance their child’s development significantly.”48 We were told that enhancing the provision of home visits, especially for children in low-income families, should be a priority for future investment.49

Improving support for children, parents and families in the first 1000 days

20.The challenge of giving every child the best start in life begins before conception and continues throughout childhood. The first 1000 days of a child’s life represent a critical phase of heightened vulnerability, but also a window of enormous opportunity. Many of the factors that influence a child’s health, development and life chances are amenable to policy intervention. By intervening in this period policymakers, working together with parents, services and local communities, can make a positive difference both to the lives of individuals and to society.

21.The multifaceted nature of the risks to children in this early period requires a holistic rather than a fragmented response, both nationally and locally. A long-term, holistic and coordinated approach to the first 1000 days should consist of interventions across, and between, the four pillars of population health outlined by The King’s Fund: people’s healthy behaviours and lifestyles; the places and communities where people live; the health and social care system people use; and the wider social determinants that impact on their health.50

22.Services play an important role in supporting and empowering parents to take care of their children and themselves. However, the evidence we have seen in the course of this inquiry demonstrates that improving service provision is not sufficient. Social stresses—low income, poor housing and low paid insecure employment—act against the ability of parents to provide a safe, stable and nurturing environment for their children during this vulnerable period. Improved service provision will provide only a sticking plaster if the underlying circumstances in which some children grow up, particularly the poorest, are not improved. We recommend that the Government consider the needs of vulnerable families in all policies.


4 Q3 Anne Longfield, Lifestart Foundation (FDL0036), Barnardo’s (FDL0020),Parent Infant Partnership (PIP) UK (FDL0016)

5 Barnardo’s (FDL0020)

6 Early Intervention Foundation (FDL0085),Big Lottery Fund (FDL0069)

7 Q3 Anne Longfield

8 Professor Sir Michael Marmot, Fair Society, Healthy Lives. The Marmot Review, 2010

9 Early Intervention Foundation (FDL0070)

10 Early Intervention Foundation (FDL0070)

11 Early Intervention Foundation (FDL0070), Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018

12 Department of Health and Social Care (FDL0067)

13 Q145 Dr Alain Gregoire

14 WAVE Trust (FDL0073)

15 WAVE Trust (FDL0073)

16 Professor Sir Michael Marmot, Fair Society, Healthy Lives. The Marmot Review, 2010

17 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018

18 Professor Sir Michael Marmot, Fair Society, Healthy Lives. The Marmot Review, 2010

19 Professor Sir Michael Marmot, Fair Society, Healthy Lives. The Marmot Review, 2010

20 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018

21 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018; Institute for Fiscal Studies, Living standards, poverty and inequality in the UK: 2017/18 to 2020/21, November 2017

22 Frank Field (FDL0083), Parent Infant Partnership (PIP) UK (FDL0016),Maternal Mental Health Alliance (FDL0006), NCT (FDL0052), HENRY (FDL0037), Royal College of Paediatrics and Child Health (FDL0074)

23 Parent Infant Partnership (PIP) UK (FDL0016), Association of Child Psychotherapists (FDL0022),

24 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018

25 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018

26 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018

27 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018

28 Public Health England (FDL0077), Nuffield Trust (FDL0048), Royal College of Paediatrics and Child Health (FDL0074), The Royal College of Midwives (FDL0051), WAVE Trust (FDL0073), Early Intervention Foundation (FDL0070), Association of Directors of Public Health (FDL0059)

29 WAVE Trust (FDL0073), Maternal Mental Health Alliance (FDL0006), Association of Directors of Public Health (FDL0059), Royal College of Psychiatrists (FDL0039)

30 Royal College of Psychiatrists (FDL0039), Tavistock Relationships (FDL0071), WAVE Trust (FDL0073), Early Intervention Foundation (FDL0070), The Royal College of Midwives (FDL0051), Institute of Health Visiting (FDL0031)

31 Early Intervention Foundation (FDL0070), Association of Directors of Public Health (FDL0059),

32 WAVE Trust (FDL0073), Association of Directors of Public Health (FDL0059), Action for Children (FDL0044), National Children’s Bureau (FDL0050),Insight Parenting/GroBrain (FDL0064)

33 The Royal College of Midwives (FDL0051), Nuffield Trust (FDL0048), Royal College of Paediatrics and Child Health (FDL0074), Unicef UK (FDL0004)

34 Royal College of Psychiatrists (FDL0039)

35 WAVE Trust (FDL0073)

37 Unite the union (FDL0066)

38 Frank Field (FDL0083)

39 See Annex 1

40 Institute of Health Visiting (FDL0031), Barnardo’s (FDL0020)

41 See Annex 1

42 The Health Foundation (FDL0081), Early Intervention Foundation (FDL0070), Royal College of Paediatrics and Child Health (FDL0074), Nuffield Trust (FDL0048)

43 The Health Foundation (FDL0081), Early Intervention Foundation (FDL0070), Royal College of Paediatrics and Child Health (FDL0074)

44 The Health Foundation (FDL0081)

45 Q2 Dr Angela Donkin, Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018, The Health Foundation (FDL0081)

46 Nuffield Trust (FDL0048),Royal College of Paediatrics and Child Health (FDL0074),The Royal College of Midwives (FDL0051)

47 Frank Field (FDL0083)

48 The National Literacy Trust, National Children’s Bureau (NCB), Peeple and the Foundation Years Trust, Home Matters: making the most of the home learning environment, March 2018

49 Frank Field (FDL0083), Early Intervention Foundation (FDL0085)

50 The King’s Fund, A vision for population health: towards a healthier future, November 2018




Published: 26 February 2019