During a baby’s first 1000 days of development, an incredible amount of growth occurs and studies show that it is far more effective to support brain development by preventing nutritional deficits than to rely on replacement therapy once the deficit has occurred. ¹ Nutrition during the first 1,000 days affects not only a child’s growth, cognition and subsequent school attainment, but also impacts on lifelong risk of developing chronic disease ² There is evidence to suggest that maternal microbial environment during pregnancy is important in childhood immune programming, and the first microbial encounters may already start in utero. During pregnancy, there is a close immunological interaction between the mother and her baby, which provides important opportunities for the maternal microbial environment to influence the immune development of the child ³

Extreme poverty increases children’s likelihood of exposure to multiple adversities, including family stress, child abuse and neglect, food insecurity, and exposure to violence. Early intervention has the potential to decrease inequality and interrupt intergenerational cycles of poverty, although this will only be realised if interventions are specifically targeted at the most vulnerable children ² In order to support mothers in caring for their babies and offering them the best care they can, the following factors should be dealt with ¹:

• improved nutrition for adolescent girls and young women before, during and after pregnancy;
• addition of supplements such as probiotics ^3,4
• timely uptake of prevention of mother to child transmission (PMTCT) services by HIV-positive pregnant women and their babies;
• screening for TB and retention in care;
• exclusive breastfeeding during the first six months of the infant’s life;
• provision of nutritious, safe and appropriate food to complement breastmilk as the baby grows;
• availability of safe water; improved hygiene and sanitation practices;
• regular monitoring to track growth and development
• complete immunizations and adequate complementary feeding.
• preventing diarrhoeal and respiratory illnesses through handwashing with soap,
• ensuring mental stimulation through play and affection

A study of children under the age of five years with stunted growth or to be living in poverty showed that an approximately 38% are at risk of poor physical and cognitive development. Internationally maternal and infant mortality rates have fallen, yet they remain high for  middle-income countries such as South Africa. High levels of stunting persist with approximately one quarter of children under five years of age being short or stunted. Stunting and poor cognition have been found to correlate well at a population level, and high levels of stunting are therefore a strong predictor of poor educational attainment. In South Africa, these issues are further compounded by the HIV epidemic – not only are children with HIV infection at high risk of poor growth and development, but increasing evidence suggests that this is also the case for the almost one third of South Africa’s children who are HIV exposed but uninfected ² In the case of allergic diseases such as atopic dermatitis (AD), itch is the most burdensome symptom of AD, followed by skin redness and sleep loss (5). If in the first 1000 days of life, symptoms such as these can be reduced by simply adding probiotics to mom’s diet ^3,4, quality of life could be significantly improved.

With the right nutritional support during the first 1000 days children:

• are 10 times more likely to overcome the most life threatening child diseases
• complete 4.6 more grades at school
• go on to earn 21% more in wages as adults
• are more likely as adults to have healthier families

Through the combined efforts of the healthcare system, and mothers seeking out information for themselves, childhood nutritional deficits can be reduced by:

• Educating families and providing support to mothers for exclusive breastfeeding
• Scaling up infant and young childhood feeding programmes
• Raising awareness on the importance of growth monitoring, expanding
• Expanding immunization coverage and uptake
• Training communities on the importance of handwashing with soap to prevent illness,
• Ensuring eligible households receive their child support grants and have sufficient money to buy food
• Novel use of mobile health technology (such as Mom Connect) to deliver direct communication to parents and caregivers on their mobile phones, which educates them on the needs of their babies, and supports them to get the health care they need
• Nutritional supplementation where available ⁴