To improve our advocacy and nutrition education efforts, 1,000 Days strove to understand sources of nutrition information during the first 1,000-day window and gaps in culturally relevant communications about healthy diets. Through a combination of qualitative research methods, including surveys and an environmental scan, we listened to over 224 Black pregnant and birthing people about their perceptions of their health, when and how they received nutrition information related to their pregnancy, and their preferred sources of information.
American Journal of Public Health: Nutrition in the First 1,000 Days
Our nation has one of the highest infant mortality rates and maternal mortality rates of any wealthy country, with notable disparities along racial and ethnic lines. We also rank among the worst of our peers on key child health metrics: 1 in 10 babies is born too early, 1 in 6 babies is never breastfed, and 1 in 8 toddlers is overweight.
Unfortunately, the medical and public health communities in the United States have been unable to reach consensus about when and which interventions are most critical to support the health and well-being of vulnerable families. This has led to misinformation, confusion, and a lack of a clear, unifying plan for policy, systems, and environmental change to improve nutrition security.
This American Journal of Public Health (AJPH) series with 1,000 Days, an Initiative of FHI Solutions, begins to present the state of the science, research needs, and a policy agenda for optimal maternal and child nutrition in the United States. Never before has a journal series brought together papers on these topics during pregnancy, birth, the postpartum period, and early childhood.
Find the full series and other resources below.
- Nutrition in the First 1000 Days: The full American Journal of Public Health 1,000-day window special issue.
- Communications Toolkit: Media assets to help promote the series through your own channels.
- Press Release: A rundown highlighting key points of the series.
- Advocacy Agenda: Our priority advocacy agenda for 2021–2024 is centered on ensuring parents and children have access to the nutrition, supports, and care they need to thrive.
Articles from the Series
Severe Malnutrition Resource Hub
Severe malnutrition occurs when a child reaches the most serious stage of any form of malnutrition and is at the greatest risk of death, disease, and long-term disability. High-risk forms of malnutrition include children who are too thin (wasted), too short (stunted), too small (underweight). Risks increase when you have combinations of these in the one child, when a child is sick, or when a baby is born malnourished.
- Every year, millions of children worldwide are severely malnourished, and roughly 3 million children die because of severe malnutrition.
- Not only are severely malnourished children much more likely to die than their well-nourished peers, those who survive are also much more likely to suffer from lifelong illness and impaired cognitive development.
- Severe Malnutrition is the number one killer of kids under 5, killing more kids every year than AIDS, malaria, and tuberculosis combined.
- Severe malnutrition stunts potential and wastes lives, but it doesn’t have to. Scaling up proven nutrition interventions will allow children around the world to escape these preventable deaths.
After years of steadily declining rates around the world, malnutrition is on the rise again.
- We know that implementing proven nutrition interventions at scale will reduce malnutrition rates, but the number of severely malnourished children is growing.
- These children’s deaths are preventable and their increase is a tragedy we can act to avoid.
How Can We Help the Children Who are Dying Malnutrition has many root causes including poverty, lack of education, erratic seasonal crop cycles, climate change, women’s inequality, and poor access to water, sanitation, and hygiene. As the world works to tackle these major challenges, which will help end child malnutrition in the long-term, there are four essential actions we can take now to prevent children from dying of severe malnutrition. These interventions span the course of the critical 1,000-day period between a woman’s pregnancy and a child’s second birthday when there is a unique window of opportunity to build healthier and more prosperous futures for mothers and their babies.
- Supply all pregnant women with prenatal vitamins Despite the proven benefits of supplying pregnant women with a full dosage of multiple-micronutrient supplements (MMS), the majority of women do not have access to these critical supplements. MMS increases the chances a baby will be born at a healthy weight and survive to his or her second birthday.
- Support breastfeeding mothers Babies get the best start at life when they drink nothing but breastmilk until they are 6 months old, and continue breastfeeding until they are 2 years old while also consuming other nutritious complementary foods. Even though breastfeeding is the best way to protect newborns from malnutrition, infections, and disease, only 41% of babies around the world are exclusively breastfed. Many mothers who would like to breastfeed cannot access the support and information they need to be successful. One-to-one and group breastfeeding counseling helps provide mothers with the support they need to reach their breastfeeding goals.
- Continue large-scale Vitamin A Supplementation Supplying a child with two high doses of Vitamin A every year is one of the most cost-effective ways to protect children from blindness, diarrhea, and other fatal illnesses. Until recently, Vitamin A supplementation was routine and easily accessible because it had been paired with national polio vaccination efforts. However, now that polio has been mostly eradicated, these vaccination campaigns are being phased out. After years of increasing, the number of children who have access to Vitamin A coverage has started to drop alarmingly. Transitioning national Vitamin A supplementation efforts to a sustainable delivery platform is essential to ensuring children continue to receive this critical preventive regimen.
- Expand coverage of specialized foods for treatment The first priority of any nutrition program should be to make wasting treatment unnecessary by preventing children from ever becoming wasted. Unfortunately, millions of children every year still require wasting treatment. Ready-to-Use Therapeutic Food (RUTF) is an energy-dense, life-saving product that gives wasted children the nutrients they need to survive. Yet we are reaching less than a quarter of even the most severely malnourished children. Expanding coverage of services will help ensure no child dies because they don’t have access to the fundamental treatment they need to stay alive.
Development plays a critical role in America’s response to a range of economic, humanitarian, and geopolitical issues – and the crisis of hunger and malnutrition is at the center of each of these. Nutrition is a powerful booster shot for U.S. investments across global health and development. Nourish the Future is a proposal for a five-year, U.S.-led effort to link and strengthen global health and food systems – producing dramatic, tangible results on a global scale. The Biden Administration has made COVID-19 and equity among its top priorities alongside climate change. Nutrition should be a central part of the administration’s plans and bold leadership will accelerate progress. Read about Nourish the Future (abbreviated version or full proposal) and learn more about how to get involved here.
Research & Analysis
Key research and technical publications distilled into easy-to-follow points, quotes and stats to inform your advocacy
August 1 marks the beginning of National Breastfeeding Month and World Breastfeeding Week, celebrating the benefits of breastfeeding for families in the United States and around the world. All month long, 1,000 Days, an Initiative of FHI Solutions, and its fellow advocates will highlight breastfeeding in different communities and how we can build a landscape of breastfeeding support. Join us!
You’ve got questions, so we talked with infant and toddler feeding experts at the Centers for Disease Control and Prevention (CDC) to help answer them! As 1,000 Days released 12 bite-sized videos for parents about the introduction of solid foods, we quickly discovered that there are even more questions to answer. So we compiled the most frequently asked questions from our community and invited our friends at the CDC to help answer them. Dr. Heather Hamner, a health scientist, and Chloe Barrera, a CDC fellow, both played a lead role in developing CDC’s new Infant and Toddler Nutrition website, so they are very familiar with all things infant and toddler feeding. We are excited to share their answers to your questions!
My baby shows all of the developmental milestones of being ready to start solid foods, but he/she is not 6 months old yet. Is it important to wait until 6 months old?
The American Academy of Pediatrics recommends waiting until your child is about 6 months old to begin introducing solid foods, but every child is different. If you notice your baby is able to sit with little or no support, has good head control, reaches for food or seems eager to eat, and can move objects toward his or her mouth then your baby may be ready for solid foods. Talk to your baby’s doctor or nurse to find out if your baby is ready to be introduced to solid foods. Visit CDC’s When, What, and How to Introduce Solid Foods to learn more.
What foods should I introduce my baby to first?
The American Academy of Pediatrics says that for most babies, you do not need to give foods in a certain order. Your baby can eat a variety of foods from different food groups and can try meats, cereals, fruits, and vegetables all within the first month of introducing solid foods. Visit CDC’s When, What, and How to Introduce Solid Foods to learn more.
Is meat considered a good first food?
Meat is an excellent first food for your baby because it is high in iron and zinc. Iron and zinc are important nutrients that support growth and brain development. To provide these nutrients, pediatricians often recommend feeding infant cereals and small pieces of meat like beef, turkey, and chicken.
What are other foods besides meat that are rich in iron and appropriate for first foods?
Iron comes in two forms: heme and non-heme. Heme iron is most easily absorbed by the body. Good sources of heme iron include red meats, fatty fish, poultry, and eggs. Good sources of non-heme iron include iron-fortified infant cereals, tofu, beans and lentils, and dark green leafy vegetables. All of these are appropriate first foods for your baby. Visit CDC’s Iron page to learn more.
Should parents skip feeding their babies rice cereal all together?
There is no reason to skip feeding your child infant cereals. Infant cereals contain vitamins and minerals that are important for your child. Choose an infant cereal that is iron-fortified. If your child is eating infant cereals, it is important to offer a variety of infant cereals such as oat, barley, and multi-grain instead of only rice cereal. Only providing infant rice cereal is not recommended by the Food and Drug Administration because there is a risk for infants to be exposed to arsenic. Visit the US Food and Drug Administration to learn more.
At what age should my child be ready to try soft finger foods?
At about 6 months of age, you can begin introducing your child to solid foods. It’s important to give your child food with different textures to help him or her define fine motor skills, develop chewing skills, and to learn to accept a variety of foods. After 6 months, you can let your child try foods that are smooth, mashed or lumpy, and finely chopped or ground. Your child may start out with smooth or mashed foods and then begin to eat soft finger foods as he or she gets older. Encourage your child to pinch or pick up foods as he or she develops these skills. By the time your child is 12 months old, he or she should be able to easily feed themselves with his or her fingers. Visit CDC’s Fingers, Spoons, Forks, and Cups page to learn more.
Why is honey bad for infants? Is it okay to cook with honey or give my child foods with honey in it?
Honey may cause botulism, a serious type of food poisoning, in children younger than 12 months. Before your child is 12 months old do not give him or her any foods containing honey including yogurt with honey and cereals or crackers with honey, such as honey graham crackers.
Is it okay to give my baby prune juice for constipation before they are 12 months old?
In some instances, pediatricians may suggest babies drink juice to help with constipation. Parents should talk with their child’s doctor to see if this is needed.
Is watered down juice OK for babies to drink?
The American Academy of Pediatrics recommends that children should not drink any juice (even 100% juice) before they are 12 months of age. This includes watered down juice. After 12 months, pediatricians recommend 4 ounces or less of 100% juice a day. Visit CDC’s Foods and Drinks to Limit to learn more.
Is any type of milk safe for my baby to drink before 12 months old?
No, your child should not drink cow’s milk or other animal or alternative milk (including soy milk, almond milk, oat milk, coconut milk, etc.) before he or she is 12 months old. Before your child is 12 months old, drinking cow’s milk may put him or her at risk for intestinal bleeding. It also has too many proteins and minerals for your infant’s kidneys to handle and does not have the right amount of nutrients your child needs. The only types of milk your child needs before 12 months are breast milk or infant formula. Learn more about when to introduce your baby to cow’s milk by visiting CDC’s Fortified Cow’s Milk and Milk Alternatives
Is cow’s milk an ingredient in infant formula?
The ingredients in infant formula can be found on the formula label. Some infant formulas contain cow’s milk as their protein base and other infant formulas contain soy as their protein base. Talk to your baby’s doctor or nurse about the type of formula that is best for your baby.
If I let my baby decide how much he wants to eat, wouldn’t he eat too much or too little?
Before your child can talk, he or she will show signs of hunger or fullness by using sounds and movements. Understanding your child’s signs are important to help you know when and how often to feed your child. Letting your child decide how much he or she wants to eat is best. Some days your child will eat more than others, that’s okay. Talk to your child’s doctor or nurse if you are concerned about how much or how little he or she is eating. Visit CDC’s Signs Your Child Is Hungry or Full to learn more.
Do you really need to wait a few days before introducing a new food? Or is this recommended only for common allergenic foods?
The American Academy of Pediatrics recommends that you start by introducing one food at a time and waiting 3 to 5 days between each new food. This helps you see how your child reacts to a new food. This is recommended for every type of food, not just for the common allergens.
What are common allergenic foods? When and how should they be introduced?
The most common allergenic foods associated with infant allergies are cow’s milk, eggs, fish, shell fish, tree nuts and seeds, peanuts, wheat, and soy. There is no evidence that waiting to introduce allergenic foods will prevent food allergies and some evidence shows that delaying the introduction of the food may actually increase the risk of allergy. Talk with your child’s doctor to find out what is best for your baby when it comes to introducing allergenic foods.
Every child deserves a strong start to life. In particular, infancy and toddlerhood provide an important opportunity to build long-lasting healthy habits, including a healthy beverage pattern. What children drink during the early years can help set them on a path for healthy growth and development.
In the United States today, multi-generational living is on the rise, and more grandparents are caring for their grandchildren. The purpose of this resource is to provide information and content for organizations that support older adults to inform and inspire them about small steps they can take to nourish the young kids in their lives.
In this update to our 2019 report, The First 1,000 Days: The Case for Paid Leave in America, we present the latest research and data from the last two years on the opportunity to reduce racial and ethnic disparities in maternal and child health through the passage of a universal, comprehensive paid family and medical leave policy in the United States.
Supplying a child with two high doses of Vitamin A every year is one of the most cost-effective ways to protect children from blindness, diarrhea, and other fatal illnesses. Learn more about Vitamin A supplementation for kids, a Power 4 nutrition intervention.
Millions of children every year require wasting treatment. Ready-to-Use Therapeutic Food (RUTF) is an energy-dense, life-saving product that gives wasted children the nutrients they need to survive. Learn more about specialized foods for wasting treatment, a Power 4 nutrition intervention.