This is the full transcript of Johan Morreau’s TEDx Talk titled ‘The First 1000 Days’ at TEDxTauranga conference.
Listen to the audio version here:
TRANSCRIPT:
Dr Johan Morreau – Paediatrician
How important are the first 1,000 days of a child’s life? Do we in New Zealand care enough about our children?
“There can be no keener revelation of a society’s soul than how it cares for its children,” is a quote from Nelson Mandela. “Ahakoa he iti, he iti pounamu” is a New Zealand proverb that reflects the value of a child. Although it is small, it is precious.
Thanks for listening to this talk. I’m going to dedicate it to the children I’ve had the privilege of caring for. I’m a paediatrician from Rotorua, a father, and a grandfather, and I have, since the early 80s, with colleagues, been doing my best to ensure that the children of our community are as healthy and as capable as they can be. We would love it if they could all fulfil their potential.
In health, we’ve done lots of good things, improved standards of care in our maternity services and newborn departments. Surgical care of children is fantastic. Care of children with cancer is beautifully done. Immunisation has changed the face of child health medicine. We don’t see a fraction of the sick, dying, and damaged children that we used to.
So you’d think we’d feel pretty good about this. And we sort of do, but there’s an elephant in the room. So I’m going to try and explain.
Some of this is a grandfather’s treat, and others reflect the issues that bother so many of us working in child health. Take a look at this picture. What do you see? A little girl enjoying connection with her uncle. What’s he feeling? Warmth, pleasure, connection, and protection. When I took that picture, I could see the quality of the eye contact. I could see rocking, and I could hear cooing.
What do you see in this picture? A little girl enjoying connection with her father. Attachment, bonding, connection. It’s this connection which will grow and develop an infant’s brain. We often say that it’s love and connection that grow and develop an infant’s brain.
This is the same little girl two and a half years later with her three-year-old cousin. They’re clearly having fun. They’ve already got it. Their brains are largely grown and developed.
After that critical first thousand days (timing starts from conception) and with good enough, because you don’t have to be perfect, parenting, a child acquires the ability to form the quality of relationship that they’re going to need over the rest of their lives. They’ve got their primary attachment figure, usually their mum. They’ve learnt empathy and understanding. They’ve learnt how to have fun and feel good about themselves, and they can tolerate boundaries, which means that they can be taught and they can be educated.
Interesting, isn’t it, that the first thousand days will determine the quality of the next 32,000. That if things don’t go well, that can significantly compromise a person’s future lifelong. That first thousand days are a window of opportunity for a child, for a family, and for a country.
In contrast to the pictures of the children that you’ve just seen, we in child health are increasingly seeing the impacts of poverty: financial poverty, poverty of parenting, and poverty of spirit and hope. All with significant lifelong implications for the well-being of a child.
What are we actually seeing? Struggling, stressed, tired parents, no time to give to their children. Often young, sometimes addicted, lacking their own parental models and lacking parental support. No money means that accessing health care is difficult, no car, no petrol. Housing is frequently cold, damp, and crowded. Food is often inadequate. We recently asked one of our early childhood centres how we could help them. Their answer was food.
All of this is translating into preventable illnesses in children. Unnecessarily complicated pregnancies, severe prematurity, growth retardation, occasionally complicated tragically by a disability, a huge cost to a child, to a family, and to a country. Unnecessarily sick children with lung infections that can go on to cause serious lung issues, long-term lung issues like bronchiectasis. Difficult to manage asthma, difficult to manage skin problems. Can you imagine trying to look after these if you live in a cold and damp and crowded house and you’ve got no money?
We’re seeing increasing problems with neglect and child abuse, increasing serious behavioural issues and mental health issues, almost certainly a reflection of the needs of those first thousand days not having been met. Problems with attachment, bonding, and for some brain growth. These are the children that are going to struggle with education, and some will later populate our prisons.
I’ll never forget a child I once saw. Dad was at home looking after this baby of just a few months of age. Mum was at the supermarket. The child was crying constantly. He was holding the baby like this. The child was crying, and he couldn’t cope, and he shook the child. The child continued to cry. He shook the child again. The child went pale, stopped crying, and a few minutes later had a convulsion.
He brought the kiddie straight to the hospital. When I explained to him that his child had just had a brain bleed, he leant over his baby, and he wept and he wept. No one had taught him how to deal with the situation he’d found himself in. I wonder if he’d ever met a child health worker.
Increasing numbers of grandparents are bringing up their grandchildren. I had in clinic with me recently a grandmother who’s transformed the lives of seven children, now aged between three and fourteen. She’d just received a letter from our welfare agencies indicating that she had to go and find a job.
New Zealand has high youth suicide rates, and they’re not coming down. There’s nothing that I find more distressing than to sit on a committee that reviews those deaths, to go back to the newborn notes and to find that that situation was predictable and preventable.