Children's First 1000 Days

1. POST-PREGNANCY NUTRITION
AND INFANT CARE
Maria Isabel M. Atienza, MD, MHPEd, FPPS, FPAPP
Pediatric Pulmonologist
Dean and Chief Academic Officer
St. Luke’s Medical Center – College of Medicine

2. 50 Low- and Middle-Income Countries
National Survey Data: 2000 to 2015
56%
46%
Undernutrition in
Low-Income
Countries
26%
22%
Undernutrition in
Middle-Income
Countries
MIMAtienza, MD January 2024

3. 150million
stunted
45.4 million
wasted
In year 2020: children under 5 years of age
94% of children with stunting
live in Asia and Africa
97% of children with wasting
live in Asia and Africa
MIMAtienza, MD January 2024

4. Philippine Data (Phil Pediatric Society, 2017)
National prevalence of stunting
Pocket areas at ≥40% (4 out of 10):
MIMAROPA, Bicol region, SOCSARGEN
and ARMM.
Rank
3 out of 10
Children under 5 years old who are
moderately or severely stunted.
MIMAtienza, MD January 2024
9th

5. Due to COVID-19 pandemic (UNICEF, 2020)
14.3% increase
in prevalence of
moderate or
severe wasting
Additional 6.7 million children
Under 5 years of age
MIMAtienza, MD January 2024

6. Linear (Height) Growth Deficit:
Global Evidence from 51 National Surveys
• Steep drop during
ages 18–24 months,
followed by a leveling
off of the curves
• 30% of the total
deficit in height at 60
mo. was accrued by
age 24 months
LeRoy, et.al. Journal of Nutrition. 2014

7. Beluska-Turkan, et.al. Nutrients. Nov 2019 MIMAtienza, MD January 2024

8. Martorell. American Journal of Human Biology. Dec 2016 MIMAtienza, MD January 2024

9. Cusick & Georgieff. The Journal of Pediatrics. Aug 2016
The vulnerability of the developing brain
Linear (height)growth rate
before 12 months of age
AND
Infant weight before 4
months of age
Significantly
predicts child IQ at
age 9 years
MIMAtienza, MD January 2024

10. First 1000 days: PPS Position Paper 2017
• National prevalence of stunting (being short for age) is
now the preferred indicator for measuring outcomes in
nutritional interventions.
Children who get
the right nutrition
In the 1st 1000 days
• 10x more likely to overcome
the most life-threatening
childhood diseases
• Complete 4.6x more grades in
school
• Earn 21% more in wages as
adults
MIMAtienza, MD January 2024

11. The cost of inaction can be enormous.
MIMAtienza, MD January 2024

12. What can we do?
First 1000 days: PPS Position Paper 2017
• Immediate initiation of breastfeeding after birth
• Kangaroo mother care to support the mother and
child dyad
• Exclusive breastfeeding for the first 6 months of life
• Breastfeeding to 2 years or beyond
1 Breastfeeding
Technical Guidance Brief. USAID MIMAtienza, MD January 2024

13. What can we do?
First 1000 days: PPS Position Paper 2017
• Breast milk is not enough to meet the nutritional
demands of infants by 6 months of age
• Offer complementary foods with a variety of flavors
and textures
• Early and frequent exposure to vegetables can play a
role in the long-term receptivity of their unique flavors
2 Start appropriate complementary feeding (e.g.,
dietary diversity) at age 6 months
MIMAtienza, MD January 2024

14. What can we do?
First 1000 days: PPS Position Paper 2017
• Delayed cord clamping 1-3 min after birth results in
significant increase in newborn hemoglobin
• Maternal milk will not meet the needs of the child
after 6 months of age, thus will require iron
supplementation: 12.5 mg from 6-24 months
(age 2 – 24 months for preterm or low-birth weight babies)
3 Avoid micro-nutrient deficiency “hidden
hunger”: Iron deficiency
MIMAtienza, MD January 2024

15. What can we do?
First 1000 days: PPS Position Paper 2017
• Preventive zinc supplementation in populations
at risk: daily dose of 10 mg for 24 weeks
• Benefit: reduction in risk morbidity from
diarrhea and acute lower respiratory infections
4 Avoid micro-nutrient deficiency “hidden
hunger”: Zinc deficiency
MIMAtienza, MD January 2024

16. What can we do?
First 1000 days: PPS Position Paper 2017
5 Avoid micro-nutrient deficiency “hidden
hunger”: Vitamin A deficiency
MIMAtienza, MD January 2024

17. What can we do?
First 1000 days: PPS Position Paper 2017
• AAP Handbook on Nutrition: children
consuming a well-balanced diet do not need
nutritional supplementation.
• Particular attention may need to be paid to
vitamin and micronutrient status if the parental
diet is assessed as risky.
6 Avoid micro-nutrient deficiency “hidden
hunger”: Multiple vitamin deficiency
MIMAtienza, MD January 2024

18. What can we do?
First 1000 days: PPS Position Paper 2017
7 Mandatory Immunization
MIMAtienza, MD January 2024

19. What can we do?
First 1000 days: PPS Position Paper 2017
• Height z-score: < -3 severe stunting
Height z-score: < -2 moderate stunting
• Community-based treatment with food
provisions (or Ready-to-use therapeutic food)
8 Prevention of severe acute malnutrition
MIMAtienza, MD January 2024

20. American Academy of Pediatrics Screening Tool for Food Insecurity
2 question-tool has 97% sensitivity
1. Within the past 12 months, we worried whether our food
would run out before we got money to buy more.
Yes or No
2. Within the past 12 months, the food we bout just didn’t
last and we didn’t have the money to get more.
Yes or No
MIMAtienza, MD January 2024

21. What can we do?
Thomas B. Am J Public Health. 2022.
9 Advocacy and Medical Education
• Doctors and allied health professional can
actively support programs that enhance
nutrition security
• Incorporate more nutrition-related topics in
undergraduate medical education
MIMAtienza, MD January 2024

22. Roger Thurow, author of The First 1000 Days:
“If we want to shape the future, to truly improve the world, we
have 1000 days to do it, mother by mother, child by child.”
If you had 1000 days to change the world,
how would you do it?
MIMAtienza, MD January 2024