Joint strategic needs assessment

1001 days: From conception to age 2 (2019)

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Topic title	1001 days: From conception to age 2 (2019)
Topic owner	Healthy Child and Early Childhood Integrated Commissioning Group
Topic author(s)	Helena Cripps
Topic quality reviewed	June 2019
Topic endorsed by	Healthy Child and Early Childhood Integrated Commissioning Group
Topic approved by	Health and Wellbeing Board September 2019
Current version	September 2019
Linked JSNA topics	Teenage pregnancy (2017) Breastfeeding and healthy start programme (2014) Excess weight in children, young people and adults (2016) Diet and nutrition (2015) Domestic Abuse (2019) Avoidable injuries in children and young people (2019) Tobacco (2014) Substance Misuse: Young people and adults (2018) Early Years and School Readiness (2019)

Executive summary

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Introduction

‘The foundations for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood. What happens during these early years (starting in the womb) has lifelong effects on many aspects of health and well-being - from obesity, heart disease and mental health, to educational achievement and economic status’^[I]

- Michael Marmot

In particular, the first 1001 days - from conception to the age of 2, are widely recognised as a critical period of development^[ii]. This is because the earliest experiences, starting in pregnancy, shape a baby’s brain development: during the first two years of life the brain develops a remarkable capacity to absorb information, and adapt to its surroundings^[iii], and by 2 years of age the brain will be about 80% of its adult size^[iv].

Pregnancy is a critical period during which the physical and mental wellbeing of the mother can have lifelong impacts on the child. Maternal stress, diet and alcohol or drug misuse can place a child’s future development at risk^[v].

Loving, secure and reliable relationships with parents, together with the quality of the home learning environment, support a child’s emotional wellbeing, brain development, language development, ability to learn, and capacity to develop and maintain good relationships with others⁵.

This chapter explores the factors from conception to the age of 2, ‘the critical 1001 days’ that influence a child’s development, helping us to identify which children will be at greater risk of poorer development, school readiness, and life chances.

A child’s physical, social, emotional, and brain development from conception to the age of 2 is shaped by these key factors:

good maternal mental health
parent-infant interaction: sensitive and attuned parents
secure attachment
healthy pregnancies and the protection and promotion of health in infancy
quality of the home learning environment

A parent’s ability to support their child’s health and development can be adversely affected by a range of issues, including:

domestic abuse
maternal stress
level of income
teenage parenthood
their own adverse childhood experiences
having multiple vulnerabilities or complex social needs

Unmet need and gaps

Unmet needs and service gaps are explored fully in section 2. Gaps and opportunities have been identified in relation to a number of key areas:

maternal mental health, parent-infant interaction and attachment: there are opportunities to better identify and support women with mild to moderate mental health needs and those with parent-infant interaction difficulties
healthy pregnancies and the promotion and protection of health in infancy: smoking in pregnancy rates are very high in some areas of the county, and breastfeeding rates low
child development: some families decline 1- and 2-year development reviews, and some children are not achieving ‘a good level of development’ at 2
families with multiple vulnerabilities: there are opportunities to strengthen pathways of care for these groups, and to improve information sharing

Recommendations for consideration by commissioners

Recommendations	Lead organisation (s)
Recommendations	Local Authority	Local Maternity and Neonatal System	Provider organisations	Clinical Commissioning Groups	Other partners
System-wide:
1. Recognising the importance of the first 1001 days in supporting child development, school readiness and the life-long impact on health, wellbeing and prosperity: · Prioritise the earlier identification of need and provision of evidence-based support for families in the 1001 days. Ensure interventions currently delivered reflect best available evidence. · Establish a multi-agency, strategic Best Start Group and accompanying strategy to ensure every child in Nottinghamshire has the best possible start in life, beginning in pregnancy and across their early years,	/
2. Local Maternity Systems, public health leads, Healthy Family teams, children’s centres services should work in close partnership to support health and wellbeing in pregnancy, with a specific focus on: · Smoking in pregnancy: to reduce the proportion of women smoking in pregnancy in line with locally agreed trajectories · Breastfeeding: to increase the proportion of women breastfeeding at 6 to 8 weeks · Continuity of care: to increase opportunities for women to receive continuity of carer across maternity services, and to improve communication and handover of care between maternity services and Healthy Family teams · Information sharing and partnership working, including information technology · Maximising opportunities to improve health and wellbeing between pregnancies · Promoting and supporting early access to maternity care	/	/	/	/	/
3. Review and strengthen pathways of care and partnership working for women with complex social needs or vulnerabilities.	/	/	/
4. There are inequalities in outcomes across districts, most likely linked to levels of household income, which should be considered when planning and targeting services and interventions.	/			/
5. Continue to recognise the skill and expertise of the early year’s workforce and further invest in evidence-based training to support a wide range of professionals to recognise the importance of the 1001 days and to work to engage and support families collaboratively, building relationships based on trust.	/		/
Health promotion:
6. Ensure women are accessing maternity care early, ideally by 10 weeks, but usually by 12 weeks and 6 days.		/	/	/
7. Radically improve the uptake of Healthy Start vitamins by pregnant women and infants from the age of 4 weeks.	/	/	/
8. Develop pathways of care between maternity services, Healthy Family teams, children’s entre services and the new integrated wellbeing service in relation to weight management, smoking cessation and alcohol use in pregnancy and infancy.	/	/	/	/
9. Continue efforts to improve breastfeeding prevalence, focused on areas of the county with the lowest rates.	/	/	/
10. Increase the awareness and uptake of vaccinations in pregnancy and early childhood.	/	/			/
Maternal, mental health, attachment and parent-infant interaction:
11. Improve uptake of the antenatal review by better understanding the barriers to this.	/		/
12. Ensure the actions identified to strengthen the pathway of care for women with perinatal mental health needs are implemented, including the implementation of a new assessment tool in maternity services, improved referral pathways to psychological therapy services and a rolling training programme.		/	/	/
13. Develop clear and consistent universal messages about the importance of sensitive, attuned and face-to-face interactions from birth onwards	/
14. Identify opportunities to assess parent-infant interaction in the first few weeks and consider how interventions to support this could be delivered. Please note: this recommendation may have significant resource implications, for further exploration.	/		/
15. Support clinicians working in neo-natal units to identify maternal mental health needs.		/
Child development:
16. Support parents to develop good home learning environments from birth, targeted at at-risk groups such as families with low incomes / those living in areas of multiple deprivation. Consider developing clear and consistent universal messages about the importance of home learning, from birth.	/		/		/
17. Replicate the robust pathways from the 2 year review to sources of appropriate support e.g. children’s centre programmes, for the antenatal, new birth, 6 to 8 week and 1 year reviews, and identify any gaps in appropriate support.	/		/
18. Review, and wherever possible, implement the recommendations from PHE’s pathway for children aged 0-5 with speech, language and communication needs, once published.	/