Congratulations to Prof. Mark Tremblay on his work on the Lancet Series on early childhood development and the next 1,000 days!

Building on the foundation of the first 1,000 days of life (conception until two years old), the next 1,000 days (from aged two to aged five) is a crucial window of opportunity to provide nurturing care to children. Nurturing care is defined as the overall health, nutrition, security and safety, responsive care-giving and learning at an early age for every child. 

In low-income and middle-income countries (LMICs), 181.9 million children – almost three quarters of all children aged three or four years old – currently do not have access to adequate nurturing care, putting their healthy development at risk.

During the next 1,000 days, children are often not in direct regular contact with health or education services. Fewer than one in three children aged three or four years old attend early childhood care and education (ECCE) programmes in LMICs, despite evidence they improve children’s development. 

Currently, approximately 80% of interventions to promote healthy development are taking place in ECCE settings which offer a platform to integrate annual screenings and growth monitoring, food assistance and nutrition supplements, and caregiver support.

New analysis as part of the Series shows providing one year ECCE for all children would cost on average less than 0.15% of LMIC countries’ current gross domestic product. The potential benefits of providing these programmes are on average 8–19 times larger than the cost of implementing them. 

The Series authors recommend policymakers increase investment in the next 1,000 days – especially in LMICs – with a particular focus on increasing access to high quality ECCE which should include adequately paid and trained teachers, reasonable teacher-student ratios, child-centred play, evidence-based curricula, and warm, stimulating, and responsive classroom interactions. 

Authors also call for wider investment to ensure children in the next 1,000 days receive: 

  • continuity of parenting and caregiver support  
  • attention to adequate nutrition  
  • access to healthcare  
  • universal developmental screenings followed by the necessary referral and support services 
  • provision of financial support to the most vulnerable  
  • engagement and support for caregivers by all sectors to provide safe and nurturing environments for children in their homes and communities 

The two Series papers and linked comment are available on the Lancet website:

Congratulations to all involved!