Literature Review

Nutrition Early in Life Has Long-Term Effects on Neurodevelopment

A policy statement from the American Academy of Pediatrics emphasizes the importance of nutrition from conception to age 2 and includes 10 recommendations regarding patient care and nutrition assistance programs.


Nutrition during a child’s first 1,000 days—from conception to age 2—is pivotal for a child’s neurodevelopment and lifelong health, according to an American Academy of Pediatrics (AAP) policy statement.

“Healthy, normal neurodevelopment is a complex process involving cellular and structural changes in the brain that proceed in a specified sequence,” said Sara Jane Schwarzenberg, MD, and Michael K. Georgieff, MD, both of the University of Minnesota Masonic Children’s Hospital, Minneapolis, and the AAP Committee on Nutrition, in the statement. “Changes that are too rapid or too slow in one part of the brain may result in the failure of crucial pathway connections to other parts of the brain. Timing is crucial; once a particular developmental sequence fails, it may not be possible to retrieve all the lost function.”

The policy statement was published in the February issue of Pediatrics.

A Crucial Period

Research shows that the most active period of neural development is in the first 1,000 days. During this time, structures and processes develop that influence behavior and provide a basis for later-developing structures, including auditory and visual systems, myelination, and brain circuits involved in social development.

The importance of macronutrients for development was highlighted in a study of rural Guatemalan children between 1969 and 1989. Children in some villages received a high-calorie, high-protein supplement, and some children received a low-calorie supplement without protein. Both supplements contained vitamins and minerals. Children who received the high-calorie, high-protein supplements before age 2 had higher test scores, better reading and vocabulary skills, and faster information processing, compared with children who received the low-calorie supplements.

Many populations lack access to high-quality macronutrient sources, however. In the United States in 2015, 16.6% of households (6.4 million) were food insecure (ie, their access to adequate food was limited by a lack of money or other resources). In households with incomes below 185% of the poverty line, 36.8% were food insecure, according to the Department of Agriculture.

Food insecurity extends to micronutrients such as vitamins and minerals like zinc; iron; choline; folate; iodine; vitamins A, D, B6, and B12; and long-chain polyunsaturated fatty acids. A lack of any of these micronutrients in early childhood can lead to neurodevelopmental issues later in life, the authors said. An important source of micronutrients is human milk, provided by breastfeeding. Studies have shown that infants who are fed human milk have improved cognitive performance, compared with infants who consume formula.

Government-sponsored programs exist that provide nutritional support to women, infants, and young children. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the most important programs, helping 53% of children under age 1, the authors said. The Supplemental Nutrition Assistance Program (SNAP) provides economic aid to buy food; it kept approximately 4.9 million children out of poverty in 2012, the authors said. SNAP Nutrition Education is intended to help people make healthy food choices with limited money.

10 Recommendations

The AAP policy statement includes the following 10 recommendations:

  • Be knowledgeable about breastfeeding, and help breastfeeding mothers. The AAP recommends exclusive breastfeeding for the first six months and continued breastfeeding with the addition of food for at least the first year.
  • Advocate at the local, state, and federal levels to preserve and strengthen programs focused on maternal, fetal, and neonatal nutrition.
  • Be familiar with food sources that supply nutrients necessary for brain development, and make appropriate dietary recommendations. Know which nutrients are at risk in the breastfed infant after six months, such as zinc, iron, and vitamin D.
  • Nutritional advice should convey that eating healthy is a positive choice, not just an avoidance of unhealthy foods.
  • Existing assistance programs should aim to improve micro- and macronutrient offerings. For example, food pantries and soup kitchens can create food packages and meals that target the needs of pregnant women, breastfeeding women, and children up to age 2.
  • Encourage parents to use programs that provide early childhood nutrition (eg, WIC), and advocate for the removal of barriers to enrolling or staying enrolled in these programs.
  • Oppose changes in eligibility or financing structures that would adversely affect programs providing early childhood nutrition.
  • Anticipate neurodevelopmental issues in children with early nutrient deficiency.
  • Work with obstetricians and family physicians to encourage improvements in maternal diet and identify clinical situations that may limit the availability of crucial micronutrients to the fetus.
  • Advocate to reduce hunger at the local, national, and global levels. The statement lists organizations focused on hunger, such as Feeding America, 1,000 Days, and Share Our Strength.

—Ian Lacy

Suggested Reading

Schwarzenberg SJ, Georgieff MK; Committee on Nutrition. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2). pii: e20173716.

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