New Delhi: The focus on a child’s health should not end after the widely recognised first 1,000 days of life. Rather, the next 1,000 days, which carry a child from the second birthday till the start of school, matter almost as much for brain development, immunity, emotional wellbeing and long-term disease risk, a senior paediatric expert has said.
Dr Jitender Nagpal, senior paediatrician and Deputy Medical Director at Sitaram Bhartia Institute of Science and Research in Delhi, said the first 1,000 days run from conception to a child’s second birthday and are widely accepted as the foundation for growth and nutrition.
Doubling that window to 2,000 days brings the count to a few months short of the fifth birthday, which is roughly when most Indian children enter formal schooling.
“The brain reaches close to 90 per cent of its adult volume by about five years of age, and the circuits formed in that period are shaped by what a child eats, hears, sees and experiences,” Nagpal said.
“That does not mean development is finished at five. Attention, impulse control and judgement continue to mature well into the twenties. But the scaffolding is laid early, and it is far easier to build it properly than to repair it later,” he said.
Nagpal said the Nurturing Care Framework issued by the WHO, UNICEF and the World Bank sets out five things young children need together – good health, adequate nutrition, responsive caregiving, opportunities for early learning, and security and safety.
Nutrition on its own is not sufficient.
“Children who are fed adequately but who are not spoken to, played with or comforted may still show delays in language and social skills. In the clinic we regularly see well-grown three-year-olds who are not yet forming sentences,” he said.
Diet quality in these years extends well beyond calories, he added.
“In predominantly vegetarian households, vitamin B12 and iron deficiency remain common, and both affect the developing nervous system. Anaemia in preschool children is still among the most under-recognised and under-treated conditions we encounter,” Nagpal said.
He said the period after a child’s second birthday is often overlooked because families assume that the decisive phase has passed.
“In reality, this is when language, memory, problem-solving and social skills expand the fastest. These are not only educational milestones; they are health outcomes, and they predict schooling, employment and even cardiovascular risk decades later,” he said.
Nagpal also highlighted that rising screen exposure is a growing concern for preschool children.
The Indian Academy of Pediatrics advises avoiding screen exposure altogether below the age of two, apart from video calls with family, and keeping it under an hour a day of supervised, shared viewing between two and five years. The WHO advice for this age group is similar.
“The harm is largely one of displacement. Every hour in front of a screen is an hour not spent in conversation, play, movement or sleep, and those are precisely the inputs a young brain requires,” Nagpal said.
“Young children learn language from turn-taking with a responsive adult, not from passive viewing.”
He also cautioned against the growing consumption of ultra-processed foods, saying preferences formed in the first five years tend to persist.
“Food acceptance is being set during the preschool years. Regular sugary drinks, packaged snacks and processed foods raise the risk of obesity, type 2 diabetes and cardiovascular disease in later life, and India is now dealing with rising childhood overweight alongside persisting undernutrition in the same communities,” he said.
“Home-cooked meals built around pulses, dairy or eggs, fruit, vegetables and whole grains remain the most reliable option available to most families.”
Developmental screening should be as routine as growth monitoring and immunisation, Nagpal said.
Current paediatric practice recommends developmental surveillance at every well-child contact, standardised screening at defined ages, and autism-specific screening at 18 and 24 months.
In India, the Rashtriya Bal Swasthya Karyakram already provides a national platform for identifying defects at birth, deficiencies, diseases and developmental delays.
“Parents typically notice delayed speech or behavioural difficulty only when the child starts school, by which point several productive years have been lost. Screening at routine visits allows hearing loss, visual impairment, developmental delay and autism spectrum disorder to be picked up when intervention works best,” he said.
Sleep and outdoor play deserve the same seriousness as diet, he said.
Children aged one to two years need 11 to 14 hours of sleep in 24 hours, including naps, and those aged three to five need 10 to 13 hours.
The WHO recommends at least 180 minutes of physical activity daily for three and four-year-olds, of which at least 60 minutes should be moderate to vigorous.
Investment in the first 2,000 days through nutrition, preventive care, responsive parenting and early learning would improve children’s immediate wellbeing and reduce the later burden of non-communicable disease and learning difficulty, he said.
“The economics are not in dispute. Money spent on a three-year-old returns more than the same money spent on a 13-year-old. What we lack is a system that treats the preschool years as a health priority rather than a gap between infancy and school,” Nagpal said.
