Where it all starts

Where it all starts

Access to good food and nutrition in the first thousand days of a child’s life are the single most important determinants in preventing growing social inequality and ill-health, a recent global study concludes.

By Jane Renton

The early years of an infant’s life are critically important and the first thousand days are the most critical of all. A major report by a team of researchers at Oxford University, the Intergrowth-21st Project, which was funded by the Bill & Melinda Gates Foundation, concludes that healthy babies from healthy mothers will grow at remarkably similar rates, regardless of ethnicity, genetics or social class. The study tracked the growth and neurodevelopment of more than 1,300 children in five countries, including Brazil, India, Italy, Kenya and the UK in the womb and up until the age of two.

“It doesn’t matter where you are living, it doesn’t matter what the colour of your skin is, it doesn’t matter what your race and ethnicity is, receiving decent medical care and nutrition is the key,” asserts Professor Stephen Kennedy who co-lead the project, in an interview with the Telegraph.

The emphasis on decent medical care and nutrition is what makes this report so fascinating and yet at the same time deeply disturbing. The point about this particular study is that the children involved came from urban mothers who were educated, well-nourished with a healthy BMI, and non-smokers.

The study’s findings are controversial on two counts: firstly, that they contradict existing medical assumptions about genetic variations between races. The findings also produces perhaps the strongest body of proof that public nutritional intervention needs to start far earlier than at school if growing social inequality is to be tackled successfully.

The real differentiator is decent medicine and food. Most children will grow up equally able if they are given good nutrition in the first thousand days of their life, when the brain undergoes its most rapid development and accounts for two thirds of its adult weight.

In Britain there are some four million children living below the breadline, whose health and prospects in life are being harmed by lack of decent food. With one in five children arriving at primary school either overweight or obese, it is self-evident that food education needs to start a whole lot earlier.

“Leaving food education until primary school is too late,” asserts Annie Denny, nutrition development manager at the Early Years Nutrition Partnership, an organisation that helps promote the importance of good nutrition and training to providers of Early Years care.

“Children’s eating patterns are generally set for life by the age of two. After that is extremely difficult to get kids to eat well after that if they’ve not been exposed to healthier foods,” asserts Denny.

The government currently provides all three-to-four-year olds in England with 15 free hours of childcare a week over 38 weeks. Children from low-income families may be eligible for 30 hours of free nursery or registered childcare a week, and there is funding available for disadvantaged two-year-olds.

Inadequate funding levels, however, have led to an uncomfortable trade-off between provision for disadvantaged two-year-olds and the recent introduction of 30 hours of funding for three and four-year-olds for working parents, according to a recent report by the Education Policy Institute. It seems that the take-up for disadvantaged two-year-olds fell in areas – or increased less – where there were higher numbers of three and four-year-olds using 30 hours of childcare. Plus, many providers struggle to accommodate growing numbers of children on free entitlement places.

Figures from CEEDA, the early years research agency, suggest that the delivery cost of two-year-old places was underfunded by 31% last year and three- and four-year-old places by 17%. Even the Department for Education acknowledges that more than half of all nursery businesses have had to increase their prices for at least one age group since October 2017.

It is hardly surprising given these funding shortfalls that so many nursery schools have been closing. Analysis by the National Day Nurseries Association revealed that 121 nurseries closed in the last 12 months to the end of August last year, compared to 73 the previous year – a 66% rise in closures. It has been suggested that four out of every 10 providers fear closure in the coming year.

Many parents of children on 30-hour places are being increasingly asked to pay additional fees for non-funded places since taking up the offer, such is the financial difficulties faced by many providers.

Yet as Denny points out, nursery schools provide an important setting in which to educate both children and parents about the crucial importance of good nutrition.

“At the moment it’s pretty mixed picture. In the main early year settings such as these do a good job of influencing children and their parents about the importance of good food.”

But increasingly, many providers are resorting to packed lunch provision brought in from home. There are no statutory guidelines to govern food provision in nurseries, only various voluntary guidelines and there is little such providers can do to enforce better nutritional standards.

“Much more needs to be done on this front,” says Denny. “We know that more and more mothers are accessing food banks and that some nurseries are still providing squash and biscuits because that is often the only thing that some of these small children will actually eat.”

Where nursery schools do provide hot meals, there is sometimes an over-emphasis on just three sweet and starchy vegetables: carrots, sweetcorn and peas, rather than on nutritionally important leafy green vegetables such as broccoli, kale and spinach. More generally needs to be done to control portion size.

“The portion you serve to a four-year-old is very different to what you might give a much younger child and nurseries do have to cater for a wide range of differing ages, with very difference nutritional requirements,” says Denny.

The Soil Association in its most recent State of the Nation report has called on the government to provide free school meals for disadvantaged nursery school children, in the same way as it provides for those children in primary and secondary schools from low-income families.

“The investment by the government in Free School Meals and Universal Infant Free School Meals has been fantastic, but that investment needs to kick in far earlier during the Early Years,” asserts Denny.

Access to decent, healthy food and an education is a basic human right, but those basic rights are kicking in rather too slowly and at too late a stage. We need to begin tackling growing social inequality from the cradle, rather than waiting for a child to reach five before we begin. Deprivation is something that needs to be tackled before a child is even born.