The First 1,000 Days of Children

Introduction

The first 1,000 days of a child's life are critical to a child’s health and well-being, both during that initial period and throughout the rest of their life. This is when the foundation is laid for physical, psychological and social development. These ‘1,000 days’ start before conception and continue until a child's second birthday.

The ‘First 1,000 Days of Children’ dashboard displays the health status of Utrecht's children and their families in figures during this period. The neighbourhood figures can also be displayed. These dashboards give Utrecht professionals and other interested parties pointers on which themes and neighbourhoods need additional effort. They are based on the latest available data from Utrecht's Youth Health Care Services (JGZ), Perined, the National Institute for Public Health and the Environment (RIVM), the Key Register of Persons and the Municipality of Utrecht's population forecast. The dashboards are only available in Dutch; the conclusions and recommendations drawn from these dashboards have also been translated into English.

Conclusion

Following a decline in the number of young children, the number of births is expected to increase slightly

The number of 0 to 2-year-olds in Utrecht has declined over the past ten years, from around 14,200 to nearly 12,500 young children. In line with the national prognosis, the number of young children (0 to 3 years old) in Utrecht is expected to increase. Births are expected to start increasing slightly from 2024, exceeding 5,000 in 2028 and 6,000 in 2037. Leidsche Rijn has the most 0 to 2-year-olds.

10% of pregnant women have mental health problems

One in ten pregnant women in Utrecht had mental or psychiatric problems in 2020. Between 2015 and 2018, the percentage of pregnant women in Utrecht with mental health problems increased from 7.6% to 10.0%; it stabilised around 10% in 2019 and 2020. On a national level and in Amsterdam and Rotterdam, the percentage of pregnant women with mental health problems increased between 2015 and 2018/2019.

Decline in pregnancy counselling before the 10th week of pregnancy during the COVID pandemic 

There was a decline in antenatal care before the 10th week of pregnancy between 2019 and 2020 (77.8% to 74.8%). This did not decrease further in 2021.

To give as many children as possible a promising start, it is important for expectant parents to start pregnancy counselling before the tenth week of pregnancy. A later start increases the risk of negative birth outcomes.

Stable percentage of children born prematurely or at low birth weight

The percentage of children born prematurely or at a low a birth weight in Utrecht has been stable at around 15% in recent years. This is lower than other major cities and similar to the Dutch average.

Preterm birth (before 37 weeks of gestation) and low birth weight (birth weight below 10th percentile) have a significant impact on whether a child has a promising start. Children born prematurely are more likely to have mental or motor delays and physical problems. Babies with a low birth weight are more likely to suffer from issues such as diabetes, high cholesterol, cardiovascular disease and osteoporosis.

Mothers stop exclusive breastfeeding relatively often in the three months after birth

Seven out of ten children in Utrecht are exclusively breastfed after birth. At three months, four in ten children are still exclusively breastfed. 12% of children are exclusively artificially fed after birth; this increases to 40% after three months.

reastfeeding stimulates the mother-child relationship and the child's health and development. Breastfed children are less likely to develop allergies, infections, obesity and diabetes. The World Health Organization recommends exclusive breastfeeding for children up to six months. NCJ research shows that many women stop breastfeeding sooner than planned. Midwives, maternity care, youth health workers and lactation consultants can support parents with breastfeeding.

Children with migrant parents are more likely to be exposed to tobacco smoke at home

5% of 0 to 2-year-olds are exposed to tobacco smoke at home. This number increases to 8% when their parents are migrants. Smoking in the home is particularly prevalent in the neighbourhoods of Overvecht (13%), Zuidwest (8%) and Zuid (8%).

Children from Overvecht and Zuidwest have a less promising start

Children from Overvecht and Zuidwest are more often born prematurely or at a low birth weight. They are also relatively more likely to die around birth (10.4 per 1,000 births in Zuidwest and 8.7 per 1,000 in Overvecht) and are more likely to grow up in poverty.

Children of parents with primary or VMBO education have the greatest disparity

Clear health disparities are already evident in children aged 0 to 2 according to their parents' educational attainment. Children of parents with primary or VMBO education have the greatest health disparity. Their mothers are more likely to smoke during pregnancy, they are more often monitored with extra attention by JGZ due to developmental risk factors, and they are more often overweight. Children of parents with educated up to HAVO, VWO or MBO are also at a disadvantage compared to children of parents with a college or university degree, but to a lesser extent.

JGZ monitors more children with extra attention because of developmental risk factors

The percentage of children monitored with extra attention by JGZ increased between 2016 and 2019. This applies regardless of the children's parents’ educational attainment. The percentage of children of parents with primary education or VMBO monitored with extra attention decreased between 2019 and 2021. The percentage of children monitored with extra attention continued to rise for children of parents with a college or university degree during the same period. We will talk with professionals to find an explanation for this.

JGZ monitors children's development. When speaking to parents, JGZ examines whether there are any risk factors in the child, parent or family that could impact the child’s development. Developmental risk factors can occur in the social environment, may include health problems among family members or risk factors around pregnancy and childbirth. JGZ monitors children with extra attention when parents may need support to deal with risk factors.

Six out of ten children with developmental risk factors have parents with a college or university degree

Despite the fact that children of parents with a college or university degree have a lower chance of being monitored with extra attention, more than six in ten 0 to 2-year-olds monitored with extra attention by JGZ have parents with a college or university degree. This is because 79% of parents in Utrecht have a college or university degree. The accumulation of risk factors tends to be less complex in children of these parents than in those with other educational backgrounds, as they are often limited to a single domain (JGZ, 2021).

Health disparities increase as children age

A major concern is that health disparities increase as children get older. We see differences in excess weight by parental educational attainment as early as age 2, and these widen further as children get older. This highlights the importance of investing in the first 1,000 days of children's lives.

Recommendations

The first 1,000 days of a child's life are critical to a child’s health and well-being, both during that initial period and throughout the rest of their life. This means the prevention of problems is vital. Based on the conclusion, the following recommendations were formulated for Utrecht professionals:

1. Anticipate increasing capacity needs for the care for pregnant women and 0 to 2-year-olds, as these demographics will increase.
2. Explore what is needed to further support breastfeeding in the first three months after birth, as the percentage of exclusively breastfed infants falls sharply during that period.
3. Continue to invest extra in existing and upcoming families with young children from Overvecht and Zuidwest and existing and upcoming families with young children of parents with an educational 
4. Focus on reducing smoking among migrant parents and families in Overvecht, Zuidwest and Zuid.
5. Invest in healthy weight in children's first 1,000 days, because at ages 2 and 3, there are already disparities in overweight by parents' educational attainment, and these disparities widen at primary school age.

Date of publication: june 2024