This project was funded by
the Department of Health
A Quick Guide to
Conception to age 2:the age of opportunity
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A Quick Guide to
Conception to age 2:
the age of opportunity
In 2013, WAVE Trust and the Department for Education
(supported by the Department of Health) jointly produced
this 134-page major report as an addendum to the
Government’s vision for the Foundation Years.
The full text is available to download free at:
http://www.wavetrust.org/sites/default/files/reports/
conception-to-age-2-full-report_0.pdf
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Why is the Age of Opportunity report
worth my attention?
What are the headlines from Age of
Opportunity?
It has already been influential.
In Westminster, a new All Party Parliamentary
Group on Conception to age 2 is now active
(with WAVE serving as its secretariat). This APPG
published the 1,001 Critical Days Manifesto and
launched it at all major party conferences in
2013, the launch being led by current and former
Health Ministers Dr Dan Poulter (Conservative),
Paul Burstow (Lib Dem) and Andy Burnham
(Labour): http://www.andrealeadsom.com/
downloads/1001cdmanifesto.pdf. Within Big
Lottery England, Age of Opportunity played a
significant role in the development of a new
£165 million investment in its primary prevention
initiative ‘Fulfilling Lives: A Better Start” https://
www.youtube.com/watch?v=QlFYXWdGapI. Some
public bodies have started using AoO as a practical
roadmap.
Some of our society’s most vexing and costly
problems are neither inevitable nor intractable.
From interpersonal violence to substance abuse,
and from education/employment deficiencies to
poor physical and mental health, there is too often
a counterproductive sense of fatalism about these
blights upon individual lives and societal success.
This report offers a realistic sense of possibility and
pragmatic hopefulness that challenges these selffulfilling negative prophecies.
Focusing on ‘root causes’ and primary
prevention (i.e. keeping bad things from
happening in the first place) will result in better
outcomes and cost savings.
Many adult problems have their roots in what
happened (or failed to happen) during the first
1,001 days from pregnancy through toddlerhood.
Cleaning up messes after the fact is rarely as
effective as anticipating and preventing them. And
yet, most public services continue to be reactive
and wait too long to provide assistance. Reliable
estimates note that 40% of public funds are
currently being spent on problems that could have
been prevented . . . but were not.
It consolidates and translates the best available
scientific research and international evidence
on the earliest years.
In the recent past, the ‘early years’ were treated by
policymakers as beginning at age 8 – and then at
age 5 – and finally at age 3. However, there has
been an explosion of compelling data and findings
about the need for, and value of, prevention and
early intervention starting from pre-birth to preschool. These first 1,001 days of life (and learning)
have a deep and lasting impact upon the current
wellbeing and future prospects of all children.
Getting them right for children, parents and
practitioners is imperative.
There is robust evidence within the UK and
internationally about how to make a positive
difference in the lives and life chances of
children from conception to age 2 (as well as for
their mothers, fathers and carers).
A greater investment in first-rate antenatal care,
improved birth outcomes, infant nutrition and the
emotional, social and intellectual development
It offers practical advice and assistance.
of very young children is no longer simply a
An increasing number of people and agencies ‘get’ matter of guesswork and good intentions. This
that the earliest years are very important. But, there report provides an analysis of what works based
is often confusion about what specific actions to
upon practical experience, sound research and
take and which strategies merit priority attention
a burgeoning scientific understanding of child
and investment. Not all ‘prevention’ and ‘early
development – as well as a clear set of next steps
intervention’ approaches and activities are created that could, and should, be taken to reap the
equal. This report offers clear ways through this
rewards of effective early action.
maze.
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What are evidenced-based
examples of the science behind its
recommendations?
POSITIVE, TWO-WAY RELATIONSHIPS are the
cornerstone of success.
First, and foremost, everything possible must be
done to promote and achieve healthy, secure
connections between babies/toddlers and the
adults caring for them (and to prevent insecure/
disorganised ‘attachment’) between them. Second,
attention needs to be accorded to improving not
only the quantity of the early years’ workforce, but
also its quality -- particularly in terms of knowledge
about holistic child development and skills in
building and maintaining healthy relationships
of trust with parents/carers/families. Third, good
relationships leading to the meaningful integration
of relevant, multi-agency services for children and
families during this initial ‘age of opportunity’ are
crucial to both efficiency and effectiveness.
Investing wisely in the pre-birth to pre-school
period yields impressive social and economic
returns in the short, medium and long terms.
Fortuitously, doing the morally right thing by
strongly supporting the healthy development
of our nation’s youngest children and their
mothers, fathers and carers also turns out to be
the financially and societally right thing to do.
The documented benefits range from reduced
inequalities in key areas to fewer problems being
passed from one generation to the next within
families and communities. Primary prevention
during the ‘age of opportunity’ proves to be a
welcome case of ‘doing well by doing good’.
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•
In addition to consuming alcohol or smoking
regularly, mental health concerns during
pregnancy – such as stress, anxiety and
depression – have a markedly negative effect
on birth outcomes. Poor birth outcomes also
often have a lingering, significantly detrimental
impact upon children’s behaviour, physical/
mental health and educational success.
These initial ‘environmental’ problems can
also trigger the activation of harmful genetic
predispositions that might otherwise remain
dormant.
•
Conversely, excellent infant nutrition during
pregnancy (and then, post-natally, through
breastfeeding) offers direct health benefits to
mother and child, as well as lasting protection
against a range of later problems, from obesity
to some diseases.
•
During the first three years of life, a child’s brain
is adding connections at a rate of more than one
million per second. The nature and quality of
interaction between a child and parents/carers
throughout this period largely shapes the child’s
emotional world and establishes the lifelong
architecture of the brain.
•
Every child’s life and life chances could, and
should, be improved at any age. However, it is
both much more difficult and costly to repair the
damage done by child maltreatment during the
first 1,001 days of life -- when the foundations of
a baby’s stress responses, behavioural patterns,
communications and intellectual development
are first created -- than it is to get these right
from the start.
•
Adverse Childhood Experiences (ACEs) such as
abuse, neglect, witnessing domestic violence
and growing up in a household with a substance
abuser, affect millions of children. 1 in 7 children
experience at least 4 categories of ACEs.
•
•
Which strategies and actions during
this ‘age of opportunity’ merit priority?
Those children who have suffered 4 or more
ACEs have higher levels of adult heart disease,
lung disease, liver disease, diabetes, obesity,
depression, alcoholism, smoking and drug
abuse.
Providing accurate, helpful information,
support and services to all expectant mothers
and fathers/partners, as and when needed,
should become the norm.
Sometimes referred to as ‘proportionate
universalism’, the idea is that everyone who will be
having a baby needs some help to have a healthy
pregnancy and to increase the chances of a good
birth outcome. However, who needs what can
differ greatly. Relevant public bodies should act,
and be perceived by expectant parents, as trusted
and effective resources that can and will meet their
needs.
The same adult interactions (such as talking
extensively and affectionately with babies and
toddlers) that are essential to healthy social and
emotional development also produce robust
language development. This, in turn, is key to
later success in school, as well as in overcoming
inequalities arising even at a very young age.
Fulfilling this role means that the antenatal
workforce should be particularly skilled at
positive, relationship-based communications
and services.
In turn, this requires both a sufficiently large, welldistributed workforce to enable relationship-based
work to occur – and, adequate initial preparation
and continuing professional development to
support this workforce. Success also depends upon
an ability to engage with traditionally underserved
parental populations (in order to avoid creating or
perpetuating inequalities even before birth).
Comprehensive early assessments during
pregnancy are crucial to primary prevention.
These should focus on significant risks to the
overall wellbeing of the expectant parents and
their unborn child. For instance, greater attention
should be accorded to the mental health
dimensions (e.g. depression and stress/anxiety);
family circumstances (e.g. domestic violence); and,
behavioural factors (e.g. smoking, drinking and
poor eating habits) than has traditionally been the
case during the antenatal period.
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Proportionate universalism, relationship-based
support/services and comprehensive, regular
assessments are equally important from birth
until age 2.
The points made above about antenatal care apply
throughout the first 1,001 days of life. However,
the composition of the relevant workforce and
the specifics of the assessment process change
once the baby has arrived. The Age of Opportunity
recommends more frequent and more holistic
interactions with parents/carers and their very
young children in order to offer support, as well
as to identify concerns and institute preventative
measures before significant problems develop.
This guide only imparts a basic overview and
a glimpse of the direction of travel within
Conception to age 2: the age of opportunity.
In addition to this summary and the full
report, WAVE Trust also produced a 20-page
Framework for Local Area Service Commissioners:
http://www.wavetrust.org/sites/default/files/
reports/conception-to-age-2-framework_0.
pdf. This framework offers the specific tools,
programmes and approaches recommended
to help policymakers and practitioners take
effective action based upon the best evidence
and advice available today.
Assessments must be backed up by ways of
meeting the needs identified.
This means integrating multi-agency services and
harmonising the communications and activities
of the early years’ workforce in support of babies,
toddlers and their mothers, fathers and carers. The
WAVE/DfE/DH report offers a variety of examples
and evidence-validated programmes that show
how this goal can be reached. It also explains
the different types and levels of appropriate and
proportionate response -- from brief interventions
to intensive targeted assistance.
Preventing insecure – and especially,
disorganised – attachment between babies/
toddlers and their parents/carers is a top
priority.
These undesirable forms of attachment (and lack of
proper ‘attunement’) are markers of possible child
maltreatment, as well as parental impairment. If
allowed to become the dominant pattern, affected
children can suffer significant long-term negative
consequences.
Preventing harm and promoting wellbeing
should be accorded equal priority during these
critical 1,001 days.
Supporting both parents and the early years’
workforce to be optimally beneficial to babies
and very young children means identifying and
building upon its strengths, emotional intelligence,
capabilities and good intentions, instead of
simply focusing upon (and trying to minimise) its
limitations and problems. To cite one of numerous
examples, video feedback is one technique that
(when properly employed) helps those involved
to see what they are doing well and provides an
effective platform for building greater competence
and confidence.
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This project was funded by
the Department of Health
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