First 1,000 Days

    Lifelong deficits in brain function occur without proper nutrition

    Good nutrition in the first 1,000 days can have a lifelong impact

    Focusing on adequate nutrition—that is, neither undernutrition or overnutrition—during the first 1,000 days may shape the rest of a child’s life.

    This stage has an impact on risk programming of a variety of health issues. There is also rapid neurologic development during this time. Supporting that growth is critically important. Providing key nutrients is absolutely essential at a time when a child’s brain may be at its most vulnerable period.

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    Important developments in the first 1,000 days

    Proper nutrition from key macro- and micronutrients help support brain scaffolding throughout the first years. Early developments in structures and processes provide the basis for later development of more complex functions. Some of the notable developments during the first 1000 days include2:

    Neurotransmitter systems that impact reward centers

    Prefrontal Cortex functions like planning, attention and inhibitions

    Hippocampus functions, such as memory and learning

    Sensory systems , especially auditory and visual

    Social Development Centers

    These early stages provide a key development opportunity to have a lifetime impact on cognitive function.

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    What nutrients contribute to cognitive development?

    The American Academy of Pediatrics policy statement challenges healthcare providers to go beyond simply recommending a “good diet.” Practitioners need to understand how optimized nutrient delivery impacts brain development in the first 1,000 days of life1.

    Key nutrients that support neurodevelopment include protein, zinc, iron, choline, folate, and long chain polyunsaturated fatty acids. DHA and ARA, help promote neuronal growth and white matter development. Higher cognitive scores have been associated with higher amounts of choline, folic acid, sphingomyelin and phosphatidylcholine.2 While many of these are found naturally in human milk, differences in nutrient composition among infant formulas need to be considered.

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    Nutrition is very important in the first 1,000 days

    Vitamins and minerals are important for supporting growth, immune system development and neurodevelopment. Yet, patients are often at risk for deficiencies for these nutrients for a number of reasons.

    Iron is the world’s most common single nutrient deficiency3. In the U.S., iron deficiency affects about 2.4 million children3,4.

    Only 1/3 of infants consume enough formula to get 400 IU of vitamin D per day—most are aged 4-6 months5.

    If maternal status for vitamin A is poor, breastfed infants are likely to be deficient by 6 months of age6.

    Experts recommend pregnant and nursing women get at least 200 mg of daily DHA, but the average U.S. intake is only 54 mg/day7-10.

    Every stage in development offers unique nutritional challenges

    Throughout the first 1,000 days, rapid growth must be fueled by proper nutrition. Nutritional deficiencies can develop, resulting in possible lifelong implications and developmental shortfalls.

    Prenatal & Postnatal

    Optimizing maternal health and fueling rapid prenatal and postnatal growth are important.

    During the first weeks of pregnancy, maternal nutrition status influences foundational growth of the fetus, including organogenesis and neural development. For example, maternal conditions, such as anemia, hypertension with intrauterine growth restriction or gestational diabetes, can result in low fetal iron reserves in term and preterm infants3.

    Carotenoids (lutein and zeaxanthin), choline, folate, iodine, iron, omega-3 fatty acids and vitamin D are all important in fetal development. Nutrient accretion in utero, especially during the last trimester, attempts to buffer the transition to postnatal life. Nutrients such as these must be supported through proper postnatal diet to help optimal growth and development.

    During Breastfeeding

    Exclusive breastfeeding for six months, or longer if desired, is recommended by experts. However, regardless of their nutritional status, many mothers are unable to meet their babies’ needs for vitamin D, and supplementation is recommended. Lactating mothers have increased nutritional needs for zinc, for example. Yet, postnatal maternal supplementation may not ensure an adequate amount for the infant3.

    Breastfeeding with Supplementation

    Breastfeeding is the gold standard for infant nutrition, as it provides nutrients, growth factors and other cells that formula lacks. However, iron, vitamin D and omega-3s may not be available in sufficient amounts, particularly if the mother is deficient.

    For example, if you have patients who are breastfeeding, partially breastfeeding, or consuming less than 27 fluid ounces of formula in a 24-hour period, then they will likely need vitamin D supplementation to meet the AAP recommendation of 400 IU per day11.

    Establishing Eating Habits

    The introduction of complementary foods usually occurs around 4 to 6 months of age, right as infants begin to lose nutrient stores accumulated in utero. In term infants, for example, iron stores are usually depleted by 6 months of age. Breast milk provides adequate zinc for infants 0-6 months of age, but not for those 7-12 months of age. Growth and development continue at a rapid pace, and essential nutrients are still required for skeletal mass accretion and brain and eye development.

    As table food is offered, children may assert their budding free will, becoming “picky eaters.” In fact, in one study, 20-30% of parents with children under 1 year of age considered their child to be a picky eater12. Providing the appropriate nutrients to support rapid growth and development continues to be important during this time.

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    A Baby’s Immune System Isn’t Fully Developed at Birth

    Learn the Stages of Infant Immune Health

    Neonatal and newborn immune system development

    A baby's cells start dividing and specializing weeks into pregnancy; some of these cells will go on to form the immune system13.

    Newborns enter the world with immature and untested immune systems, which initially leaves them at an increased risk of certain bacterial infections13.

    There are two types of immune responses and both play crucial roles in the body’s ability to ward off infections.

    Innate immunity

    • The body’s immediate and non-specific reaction to threats of infection
    • Inherited from mom and present at birth

    Adaptive immunity

    • The body’s more specific and prolonged immune response
    • Develops over time as we are exposed to the world around us13,14

    As children grow and encounter more foreign pathogens, their adaptive immune system matures and acquires memory15


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    The immune system through infancy and beyond

    By the time an infant reaches 2-3 months in age, his or her immune system is often mature enough to initiate an appropriate physiological response to combat an infection13.

    But the maturation of an infant’s immune system is an ongoing process, and parents can help support development during this crucial period by promoting proper nutrition.

    How Do the Infants in Your Practice Obtain Optimal Nutrition?

    During the routine wellness visits, it's important to discuss the many ways parents can bolster their baby's immunity through proper nutrition.

    Maternal breast milk and the microbiome

    In addition to providing nutritional value to newborns and infants, breast milk contains many components that influence microbiome maturation and immune development16.

    Immunoglobulins (IgG, IgM, and isoforms of SiGA), non-digestible Human Milk Oligosaccahrides (HMOs), and anti- inflammatory cytokines are just a few elements of breast milk that influence microbiome and immune development17.

    Prebiotics and probiotics

    Breast milk is also a major source of prebiotics and probiotics, two of the most significant factors in shaping microbiome development18.

    Different prebiotic oligosaccharides, including polydextrose (PDX) and galacto-oligosaccharides (GOS), are also added to some infant formulas to help support immune health19.

    Depending on the strain, certain probiotics may also help support infant immune health20. Some probiotic strains most commonly used in infant nutrition include:

    Lactobacillus rhamnosus GG (branded LGG®)

    The most widely studied probiotic with a well-documented safety and efficacy profile, LGG has been used in food and dietary supplements for close to 30 years

    Lactobacillus reuteri (DSM 17938)

    This strain was isolated from the breast milk of a woman living in the Andes

    Lactobacillus reuteri (RC-14®)

    Originating from healthy vaginal sources, this strain has been used safely since 2004

    Bifidobacterium lactis (BB-12®)

    Also well-studied, BB-12 may have beneficial effects on gastrointestinal and immune function

    Other key nutrients from various sources

    There are numerous key nutrients that have been shown to support infant immunity, including:


    • Omega-3 fatty acids, including DHA, help macrophages, a major component of the innate immune system, patrol for invading pathogens and initiate an appropriate response21

    • In healthy infants, incorporating formula containing DHA and ARA was associated with lower incidence of common respiratory symptoms and illnesses, as well as diarrhea22

    Milk fat globule membrane (MFGM)

    • A naturally occurring membrane found in breast milk that may aid in the formation and maturation of a baby’s gut microbiota23


    • A multifunctional protein found in breast milk that contributes to innate immune system activation and helps direct adaptive immune system responses24

    Vitamin D

    • Helps protect against infection-causing pathogens by stimulating immune cell proliferation and cytokine production25

    • The active form of vitamin D, vitamin D3, regulates cathelicidin and defensin, two antimicrobial proteins that can directly kill pathogens and bacteria25


    • Instrumental in forming highly toxic hydroxyl radicals that help neutrophils kill bacteria25

    Whether breastfeeding or formula-feeding, or through a combination of both, proper nutrition can help support infant immune development and may lower a baby's risk of infection.





    1. Schwarzenberg SJ, Georgieff MK, Committee on Nutrition. Pediatrics. 2018;141. pii:e20173717. Doi:10.1542/peds.2017-3716
    2. Deoni S et al. NeuroImage. 2018;178:649-659
    3. Prado EL, Dewey KG. Nutrition Reviews. 2014;72(4):267-284.
    4. Baker RD et al. Pediatrics. 2010;126:1040-1050.
    5. Brotanek JM et al. Pediatrics. 2007;120:568-575.
    6. Perrine CG et al. Pediatrics. 2010;125:627-632.
    7. Stoltzfus RJ et al. Bulletin of the World Health Organization. 1995;73:703-711.
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    11. Benisek D et al. Obstet Gynecol. 2000;95(suppl):77S-78S.
    12. Hoppu U et al. Eur J Clin Nutr. 2005;59:123-128.
    13. Development of the Immune System. April 2019. Accessed August 3, 2020.
    14. Malka D Jonathan. Immune System & Nutrition: Impacts of COVID-19 Today & Beyond. Published May 21, 2020. Accessed August 3, 2020.
    15. Simon AK et al. Proc Biol Sci. 2015;282:20143085. doi:10.1098/rspb.2014.3085
    16. Jackson KM, Nazar AM. Breastfeeding, the Immune Response, and Long-term Health. J Am Osteopath Assoc. 2006;106(4):203-207.
    17. Ballard O, Morrow AL. Human Milk Composition: Nutrients and Bioactive Factors. Pediatr Clin North Am. 2013;60(1):49-74. doi:10.1016/j.pcl.2012.10.002.
    18. Moossavi S, Miliku K, Sepehri S, Khafipour E, Azad MB. The Prebiotic and Probiotic Properties of Human Milk: Implications for Infant Immune Development and Pediatric Asthma. Front Pediatr. 2018;6:197. Published 2018 Jul 24. doi10.3389/fped. 2018.00197
    19. Vandenplas Y. De Greef E, Veerman G. Prebiotics in infant formula. Gut Microbes. 2014;5(6):681-687. doi:10.4161/19490976.2014.972237.
    20. Nocerino R et al. Aliment Parmacol Ther. 2020;51:110-120.
    21. Gutiérrez S et al. Int J Mol Sci. 2019;20:5028. doi:10.3390/ijms20205028
    22. Lapillonne A et al. BMC Pediatr. 2014;14:168. doi:10.1186/1471-2431-14-168
    23. Lee H et al. Front Pediatr. 2018;6:313. doi:10.3389/fped.2018.00313
    24. Actor JK et al. Curr Pharm Des. 2009;15:1956-1973. doi: 10.2174/138161209788453202
    25. Maggini S, Pierre A, Calder PC. Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients. 2018;10(10):1531. doi:10.3390/nu10101531