From conception to around the age of three years old – the first 1,000 days – is a crucial time in a child’s development. So what advice can pharmacy offer to help give children the best start?

By the age of three, a baby’s brain has reached 80 per cent of its adult size, and what happens in that time – from nutrition, protection from illness, exercise and life experience such as wellbeing and play – is crucially important. This is a vital message to communicate to families, as is offering support to women to ensure they have a healthy pregnancy and giving advice to parents after the birth of their baby. 

The best start from day one

Conception marks day one of the first 1,000 days of life and preparation for this is key. However, a review of preconception health, published in The Lancet in 2018, suggested that most younger women in the UK are in fact not “nutritionally prepared” for pregnancy. Women planning to conceive can be encouraged to: 

• Eat a balanced diet with at least five portions of fruit and vegetables a day
• Aim for a healthy weight
• Not smoke 
• Reduce alcohol intake – advice in the UK is to not drink while trying to get pregnant
• Start taking a 400g folic acid supplement and for the first 12 weeks of pregnancy.

Achieving a healthy diet may be a challenge during pregnancy if, for example, women suffer from morning sickness. Having to ‘eat for two’ during pregnancy is a myth and a focus on the quality, rather than amount, of food is more important. 

Notes on nutrition

Caring for a baby can be tiring, so looking after themselves is important for both parents, and particularly for breastfeeding mothers. The British Nutrition Foundation (BNF) states that new parents should “eat a healthy, varied diet, drink plenty of fluids and take some physical activity.” Breastfeeding women should be advised to drink around 10 to 12 glasses of fluid a day, rather than the usual eight glasses, and everyone – including breastfeeding women – is advised to take a 10 microgram supplement of vitamin D each day. 

Breastfeeding has long-term health benefits for infants, which are likely to continue to adulthood, and the NHS says that the longer women breastfeed, the longer the protection lasts and the greater the benefits.

Breastfeeding is recommended for at least the first six months following birth, yet rates remain low across the UK. In Scotland, a national infant feeding strategy and support for mothers to breastfeed while in hospital has resulted in a rise in infants receiving some breast milk at six months from 32 per cent in 2010 to 43 per cent in 2017.

In a study by Liverpool University, 67 per cent of mothers who formula fed their baby said they felt guilty about the decision. However, the Royal College of Midwives’ has emphasised the importance of supporting mothers to make an informed choice about whether or not to breastfeed or bottle-feed their baby, depending on what is right for them.

Vaccinations need priority

Childhood immunisation has had a significant effect in improving the health of the population by reducing the potential spread of key diseases, including: tetanus, polio, pneumococcal infections, diphtheria, meningitis C, haemophilus influenza type b (Hib), whooping cough, measles, mumps and rubella. But some parents may not see the necessity of having their child immunised, may be concerned about vaccine safety or simply forget to attend when invited. This is where the pharmacy team can offer important information, advice and reassurance about vaccinations.

The first dose of the measles, mumps, and rubella (MMR) vaccine is offered to babies at one year old, and a second, to complete the protection, at just over three years of age. But in the UK, the uptake of MMR dropped for the fourth year in a row, according to statistics from NHS Digital published in September 2018. 

This comes despite the warning from the World Health Organization that measles cases are rising in Europe and that the resurgence is “of serious concern”. People who have not had two doses of the MMR vaccine are at most risk, Public Health England (PHE) warns.

More positive results are however being seen from the recently introduced nasal spray flu vaccine, which is offered to all children in England aged two and three. Preliminary results from PHE in February 2019, suggest that the nasal spray is proving to be 39 per cent effective against the main flu strain circulating this winter and uptake has increased to 43 per cent of two-year-olds and 45 per cent of three-year-olds. Health secretary Matt Hancock commented: “More children have been vaccinated this year to protect against flu and it is a positive sign that the vaccine itself appears to be more effective than in previous years.”

Healthy toddlers

Research suggests that preschool children who followed baby-led weaning – allowing infants to feed themselves finger food from the beginning of weaning – are less likely to be overweight that those who were spoon fed and less likely to be fussy eaters, overeat or be overweight. 

Ensuring a variety of foods across the food groups is key advice as children get older, suggests Helena Gibson-Moore, nutrition scientist at the BNF. Eight per cent of children under five in the UK do not have enough vitamin A in their diet, and families in lower income groups tend to have less vitamin C in their diet, according to the Scientific Advisory Committee on Nutrition.

“Toddlers and pre-school children are growing and developing quickly and it’s an important time to make sure they are eating well to get all the energy, calories and nutrients they need. This is also an important time for children to learn about food and eating, so that they get into the habit of consuming a healthy, varied diet, enjoyed with the rest of the family,” says Helena. 

With better weather on its way, pharmacy teams can encourage families with young children to get out to play to increase their exercise levels. This is important, along with a healthy diet, even from an early age. National guidelines suggest that children should be encouraged to be active from birth and minimise the amount of time spent sitting. Children who can walk on their own should be physically active for at least three hours each day. This can include light activity such as standing up, moving around, rolling and playing, as well as more energetic activities like skipping, hopping, running and jumping.

Common health problems

There are many common ailments experienced by infants and young children and parents may well come into the pharmacy for advice.