 Today we're going to talk about first thousand days and nutrition first thousand days. What is first thousand days? I'm sure we all know it, but just, you know, I'm going to reiterate to why it is important. And when we think of first thousand days, forget about other children. Let's talk about us, right? A lot of us are women, men, and you know, some of you are very young and probably thinking of future of having children and you know, thinking about their growth and their career. So when we think of that, we always think of short term goal and long term goal. So what is a short and long term goal for children? You know, not only children, but for ourselves. So obviously in short term, we want our children to be healthy. We want them to be doing well in school and, you know, succeed of course. And in long term, we want them not to have any diseases, you know, to have good immunity, no blood pressure, no diabetes. And of course, you know, we all want healthy aging for all of us, right? That's our long and short term goal by and large, right? So basically our, I mean, health comforts, right? Health is wealth. As you know, you know, we all are stuck at home because our health is at stake. So if we don't have good health, you know, nothing else matters really. So, literally, our goal is to have lifelong health, right? Why first thousand days critical? We need to kind of understand why is it critical? Why, why those thousand days? You know, so first thousand days is basically conception to second birthday of a child. And it offers the opportunity to build healthier and more prosperous future as good nutrition during this phase is building block for brain and physical development. Okay. So what is happening during this thousand days is baby's brain has been developed. Okay. Not only baby's brain has been developed, but basically there is a full physical growth. Can you imagine from literally from, you know, small little ovum from sperm and that ovum you're having, you know, an earthquake is about 3 kg and by the time child is about two years of phase or more 12 kg, 12 and a half kg, right? So you have tremendous growth in this first thousand days. And not only physical growth, but brain. I mean, brain is the most important part of a body, right? So it's very important that we take care of this thousand days. Okay. If you have, if you want a brainy child and if you want a really healthy robust child, and if you look at the growth, brain grows to about 80% of adult size, okay, by age three, and it reaches 90% by age five. So body time child goes to schools around four and a half, five years of age, 90% of brain development has already taken place. So you can imagine that mother needs to know so much, right? Not only, you know, when she's pregnant, but even before she is pregnant, she needs to know what I need to do so that my child will be tall and, you know, intelligent, right? And what are the, my right nutrients that she needs? Okay. And those are very important because, and those are needed at the right time because child's brain is developing so fast and at every stage child requires different micronutrients. So it is important and we'll talk about it, what is required. Okay. So the right nutrition during this period, it means the difference between a life of productivity or struggle and between life and death. I mean, you know, we work in tribal areas, we work in slums and most of the time you will see that Sam children, you must be knowing Sam, severe good malnourished children, those are mainly under one year of age, under two years of age, mainly under one year of age and even predominantly they are less than six months of age. So if you don't have proper nutrition during first thousand days, that that's basically that, you know, that's you're taking away life from the child, literally. Okay. And at that child, if suppose child is survived, and if child grows up, but the body is so stunted and with that body, child's brain is stunted. So basically that child will struggle for the whole life to survive. Okay, just not life and that in the beginning, but if child survives, basically they will have a, you know, a child will have a very poor productivity, not only school, but even when he grows up. So it's important that we think of not only surviving the child, but also giving him good life. So what does it decide? It decides how healthy the child will be. So less infection, better immunity, reduce risk of chronic condition like diabetes and blood pressure. How brainy the child will be? What do you mean brainy? So brainy means you have good combination, misintelligence, your memory. So child has a sharp memory. We all want, right? Like, believe me of all, all your mothers must be asking you, what grades did you get? How many marks did you get? Did you come? Did you come first? Did you come second? And for that, for everything to learn, not only you need intelligence, but what else do you need? You need memory, right? So this is important that why some children in a class, they remember everything and some children, they just don't remember anything. So that's important to have a good memory. Concentration, if you can't concentrate, that means you will not be able to do well. You know, so it's very important that child have a good concentration. Judgment, judgment with judgment. We all know what is judgment, whether something a child is doing, taking decision, whether it's, you know, taking good judgment will call. Those are very important. Mood is important. Sometimes you find the children are very moody. They are upset, they're all the time irritable. So your mood also depends upon how child was brought up in the first 1000 days. Okay. And then lastly, your skeletal growth, how tall the child will be. So these are the three important aspects that we need to take care of when child is growing in first 1000 days. So let's talk about brain. Brain is my favorite topic. So I'm going to talk about brain a little bit and see how, how we can make this child intelligent. Okay. So I'm sure you guys know about neural tube. This is basically a tube. Here, this is a picture. So this is your neural tube. Okay. So at around three weeks of age, your body starts developing in the form of neural tube. So this is a tube. Okay. Now here, this part is basically is going to develop into brain. And this part is going to develop into your spinal cord. Okay. So here, then what happens during this time? Suppose if you don't have enough nutrients which are required for this neural growth, you will have problems. So what are the micronutrients which are required for development of this neural tube? One is your folic acid. I think everybody knows about folic acid. But what we don't know, there are two or three other micronutrients which are required for a neural tube defect. I mean neural tube development. One is your vitamin B12. The second is your choline. So you require this choline, you know, your vitamin B12 and folic acid. So we only talk about folic acid, but how about B12 and your, and I know that a lot of you are nutritionists and we know that B12 is hardly available any vegetarian food. So what are you going to tell mother who is not even having milk? Like for example, a lot of these tribal mothers, they don't drink milk. They don't have access to milk. So how will she get B12? Right. So we have to think of what are the nutrients that she or what all food that you can give them. So they'll have initially, I mean, this is three weeks. So she doesn't even know that she's pregnant. Right. So you need to start this nutrients, not when she's pregnant, but when she is, when she gets married, when she's planning a child, that's when you need to start food, which is high in all this nutrients. I'll talk about choline later. And when you don't have this most three important micronutrients for neural tube, what will happen? This tube will not develop well. So do you see these tubes? These are not basically you will see the gap in there. Okay, so this all the gap and this is called neural tube defect. This is a tube neural tube. There's a neural tube defects. Okay, so then what happens when you have a neural tube defect, say, posteriorly, like towards the lower part, right, then you will have a little bit of spinal cord coming out. Okay, because because the spinal canal is not developed well. Right. So then what happens that basically you will see some amount of spinal cord here. Now, many times what happens, you may not have such a big bump over here, but you may just have a little bit of whole tiny, mighty hole over here. Okay, so what does pediatrician we have to do? We always have to examine when the baby is born with a child has little hole and if child has a hole, that means it's called basically spinal bifida and we have to get the MRI done. And that particular hole if if it if it is worse, then child has paralysis for the whole life. Okay, they have problem with the urination, they you know, we have, they have to go through surgery. So imagine a follic acid, a choline and a B12 is so important. Okay, and if child has hole in the front part, you know, right, but their brain is then this is called an end capillie. Okay, we nowadays, if we don't see it much, but you know, they do have when they're born, obviously, they don't survive. So this all basically totally, you know, you can prevent all this condition. And that's why follic acid is being done compulsory. Okay, now, this is basically anatomy of brain. Now I'm going to go a little bit in detail that what happens in child's brain when the brain is developing. Okay, so just all basically different parts of your brain. This is the frontal cortex frontal part front of your brain. This is the back part. Okay, this is your side part parietal. This is your occipital lobe temporal lobe. This all different kind of lobes, right? This is a cross section. This is cross section, right? This is a front part. This is a back part. So here, if you look at it over here. So this is again, you know, your prefrontal cortex, right? Your primary motor cortex is all the different parts of your brain. Okay, now if you look at the function of brain, so here is your front part of your brain. Okay, so do you see over here, this is this particular frontal part, it is involved in motivation and executive function, motivation. If you don't have motivation to do anything, you can't, you know, you can't succeed, right? So it's very important that this this part of brain is developed well, because it is all it functions for execution and for motivation. Okay, now a little bit about the interior singular cortex over here, this part over here, that is involved in your social interaction, affection, attention. So look at this, this part is also so important, because that will help with the tension, right? Do you see over this red part over here? It's called amygdala. Amygdala is important for stress and for learning. So the whole time what happens is, you know, lots of children, they get a lot of anxiety, stress, you know, or they have learning problems. That is because of problem with amygdala. And this is your hippocampus hippocampus remember is for learning and memory. If you want good memory, you make sure that anything which is required to develop this hippocampus, you work on that and you know, child will have good memory. Okay, so this is how you're developed by your basically brain development. So at fourth week of pregnancy, the brain has about 10,000 cells. Okay. And by 24th week, it contains about 10 billion. So you can imagine in just matter of 20 weeks, look at the number of cells being developed, right? So nutrition is absolutely important, but there are so many other things which are important. Okay. This is your neurons. Do you see all these neurons? These are basically connection. So as brain is developing, neuron cells are developing. And do you see there's this layer of, you know, my lean sheet, this is called my lean sheet. My lean sheet is your fat is made up of fat. So when you have a good my lean, strong, my lean sheet, what happens that the message passing through is very fast, the message, the signal, you know, the signals, those are very rapid signals, right? So you want to make, you want to make sure that when mother is pregnant, that she gets good amount of fat. Okay, because baby's brain is made up of fat. This is all basically, it's all fatty sheet. And most important, you know, cholesterol is important, saturated fat is really important. This is your, what is this neurotransmitters? Remember your synapses, there's a synaptic conjunctions and there are your neurotransmitters. So neurotransmitters are also really, really important basically to pass on the signal, right? So you want to make sure that you have to learn that which are these nutrients which are important for formation of neurotransmitters, one of the neurotransmitters is acetylcholine. If you remember acetylcholine, now choline, remember choline I spoke about. So we need to know what, how do this mother get choline, so that baby gets beautiful amount of neurotransmitters. Okay, now this is another beautiful graph, what what we have shown over here. This is basically, you know, from conception from nine months to birth. Okay, this is your first two years of life. So from this our first thousand days in this green box is first thousand days, then it here is your child growing up becoming adult. And this is just 70 years of so that's your basically, you know, your lifespan, right? So you hear around say eight months of age, I mean, after one month of pregnancy, your child developed neuralation here that that means that child is developing neural tube. Okay, once a neural tube is developed here for next few months, they it causes cell migration means different parts of the brain are being formed frontal lobe, occipital lobe, right? And then just before two months of birth, child start developing myelination. Myelination means, you know, you saw those neurons, right? So it start developing that, you know, myelin sheet around those neural cells. So if you look at at around zero month at birth, you know, some of the myelination is already started. You see all this, there are some amount of myelination already started. But then it starts picking up. So if you look at birth over here, the green color graph over here, you know, so that is mainly your so when you when the baby is born, what does baby do? Right? Baby can see, baby can hear, right? So those parts of your brain is getting myelinated. You're seeing hearing so visual cortex is for saying and auditory cortex is for hearing. Okay, so those parts of your brain start getting myelination, right? Then if you look at your orange graph, this speaks at around eight to nine months of age. Do you see around nine months of age? So what happens at nine months of age? Do you remember what happens in the child? They start developing language. So they start speaking a word or two. So there is a receptive language, they can understand what you're saying. Okay, and they can also start producing speech. They'll say mama, dad, they'll say a word. So around nine months of age, that area get myelinated, you know, these are the areas of brain. Okay, and this one, the last line, the red line, that is yet around 12 months to one year of age, and that is your higher coordination. So by one year of age, two years of age, children have good amount of high, high cognition function. You know, they can understand what you're saying, they can respond, you know, they become extremely smart. So do you see what this, this is the most important part. And after two years of age, you can see myelination going down. But it is very important that child continues to have good nutrition. Otherwise, what will happen if, if we get myelination problem, we will have a cognition issue means we will forget, we will have a forgetting, well, maybe we'll get worse. So it's important that we take care of a myelination. Okay, so this two, two, as you, as you could see, 1000 days are extremely important for brain development. Okay, now what are the other external factors which affects, as I told you, nutrition is good. But, but because there's, you know, a lot of this neural cells are developing, you want to make sure that there is reduction of toxic stress in mothers. Okay, so tomorrow, if you want to, if you're planning to become, you know, when you get married and plan to become pregnant, you make sure that you don't have stress, you know, you don't have any inflammation in the body. So you want to make sure that, you know, you don't have any diseases. Okay, no, and of course, presence of strong social support and secure attachment, very important. Okay, so just make sure those are, physical health is absolutely important, but your mental health is also important in provision of optimal nutrition. Okay, now this is some of the nutrients which are required for brain development. Okay, so I'm going to go quickly, because I'll, I'll come back to it. But mainly look at it. This is vitamin B6. What happens when you don't have vitamin B6? In fact, those are important for brain development function. Those are important for neurotransmitters. You know, we talked about acetylcholine, but also, you know, your serotonin and so many other neurotransmitters. Okay, they know that in a friend, which also influences mood. And if you don't have B6, they will, there are chances that child can have difficulty concentrating. Okay, then B12, as I talked about B12, right, neurodictive effect. Okay, then poor cognition, if child doesn't have B12 when baby is growing in the womb, you know, they will have poor cognition in younger children. In fact, what we find is we find children have tremors, children can have lifelong problem, neurological problem. So it's important that, you know, we always think of vitamin B12 because this is quite deficient in the vegan children. Okay, mothers who are vegan. Colina I spoke about if you want your child to have a lifelong good memory and learning function, make sure the child gets mothers get enough colin. Okay, copper is important for late. We talked about for late is important. We also talked about iodine. I think iodine is important because iodine can prevent mental retardation. You know, long chain polyunsaccharide fatty acid. So mainly I'm talking about DH&EPA. Okay, LA can get converted to DH which I'll come back later. But it's the, you know, it's probably a 4% to maximum 10% get, you know, converted. So if it is, if mother is non-veg, please offer her factory fish. Okay, that will really help child to become really look at this. If you don't have enough DHA and there's poor attention, hyperactivity, problem learning, right? So DH&EPA is extremely important. Protein is important, selenium, zinc, right? Why is zinc? Look at this. Remember hippocampus I talked about memory. You want your child to have good memory. Your zinc is really important. Okay, vitamin K, we give it at birth. It's compulsory. We give it all over the world because children don't have enough vitamin K. So we give injection at birth. Okay, iron is, I mean, iron is one topic that we can talk about for hours really. It's so important. You know, it impacts my nation of nerves. Okay, and we have also found there are a lot of studies which says that it shouldn't have, if they don't have enough iron, it does affect their mental health. You know, so they have high level anxiety and depression later in life. So it's important that, you know, we take care of food, which is high in iron. Okay, now, this is some of the studies that I wanted to talk about. So one of the study is what is the influence of prenatal and postnatal growth on intellectual functioning, because we all want our children to be intelligent, right? So what they found, actually, I love the study really. So what they found that when child had beautiful linear growth, linear means tall, right? So when the child was growing quite tall in first year of age, before, not after, before 12 months of age, and weight. So this was the, this was the length part before 12, and the weight of the child before four months of age, if child was growing beautifully in first four months, weight-wise, and height up to 12 months of age, those children had a higher IQ at nine years of age. Okay, so you, you can imagine, many times, you know, mother said, oh, my child is not gaining weight. My child is not gaining weight. And if we don't do anything right away, then if you missed those first three months of, you know, weight gain where, you know, children grow tremendously, you know, when you look at a WHO growth chart, and because they don't grow well, you know, their height will also not grow well. Those other children will have poor IQ, right? So many times mother said, oh, my child is not doing good in math, my child is not doing, because they must not have gained good amount of weight, not only during room, not only during pregnancy, but also in first few months of life. So this is, this is a really good study that, you know, we read all the time in pediatrics. Okay. And also another thing is your IOGR. So you know, a lot of time, I mean, in India, we see a lot of low birth weight babies, right? So here, what they found that children who were born small for gestational age, small for gestational age means, you know, for that term or preterm baby, that weight was not enough. Okay. For whatever gestational age baby was born. So here, if the baby was born, say at around 35, 35 weeks of gestation, 35 is basically a premature baby, or later, they scored lower score on your neurodevelopmental assessment means they did not do well neurodevelopment. Okay. So it is important that basically, you know, children grow very well in the room during pregnancy. Okay. This is another very good study where there was a critical period of brain growth and cognitive function. So this is what they found is a brain growth during infancy early childhood is more important than growth during fetal life and determining cognitive function. This means that even if child is born, says small, you know, but if child has beautiful growth in first says 12 months, 18 months, then that we can basically rescue the child. Okay. So even, even you go in the field and you see children are born to 2.3 kg, 2.4 kg, but you know, you focus on the breastfeeding scale, you focus on the complementary feed and children do beautifully. So this was another very good study which was done. Now timing of growth faltering is very, very important. Okay. Because what we found, this is one study which was done. They basically took 700,000 children, okay, from zero to six years of age and they took it, they took this data from 57 different countries. Look at this huge study and very recent 2018, right. And what they found that basically most linear growth faltering, linear growth means height and the wasting, which is your acute malnutrition, it takes place prior to 23 months of age means most of your malnutrition, undernutrition takes place under, under 1000 days. Okay. So here is the growth. Here is a chart that they shown in their publication. So here, this is your boys. So this are your boys. Okay. This is your mean, zero is mean. Most of the 50 percent children should be over here. Okay. But here, as you see, this is your zero month, six months, 12 months, 18 months. Do you see how boys, and this is your height for height, okay, your height for age, the Z score. So look at how children are growing, going down in 18 months, right? These are boys and these are girls. So girls are not so small to begin with. But basically they fall, right? Boys fall definitely much more. And then by, by 16 months, pretty much they're pretty much equal, right? So girls have advantage in the beginning. Now this is your waist, weight for height means this is your sand man, your acute malnutrition, right? So here this is your boys, this is your mean zero. Okay. So children, children overall in 57 different countries, children are not bad begin with. But look at this, how badly they fall, right? And then they come up. So everything, whenever you see it, this growth faltering occurs in first 24 months and generally wasting occurs much early on. That means children not getting weight. So in first year of age, look at this in first year of age, children are not growing well. You know, they are not putting on weight and eventually they become stunted also, right? So what happens to all these children who are not growing well, they were nutrition will lead to stunting, they will become short. Okay. So if you're thinking that, you know, oh my God, this child is so short. And if you see them at three years of age, four years of age, the stunting is irreversible. So it's irreversible if you don't tackle it within one year. Okay. In my experience, if child came to me after six months of age, I could not do much about the stunting part. Really, they had to bring those children up or a reversal of stunting, I could do it just if they came before six months of age. So that first six months is extremely important. Okay. As they were losing height, they were also losing IQ. Okay. So there is a loss of IQ, which is which is very, very detrimental to child's life. Right. Then what happens the stunting when you are stunted, you will be stunted as an adult. Right. And if you're a woman, and if you're only five feet tall, then you will be basically passing on the stunting, stunted girl child, a two will give birth to a low birth weight baby. So your risk of getting a low birth weight baby is very high. Okay. If you're stunted. Okay. So, so basically you're passing on that, you know, that I wouldn't call it gene, but epigenetic expression to that child. Okay. And then that stunted child has a very high risk of developing metabolic syndrome later on. Okay. So you don't want that child to develop blood pressure diabetes. So then you work on them in first thousand days and you know, of course, continue on the children will not develop metabolic syndrome. Okay. And sometime it takes about two to three generation of combat stunting. So suppose child is stunted, mother is stunted, grand, grandmother is stunted. So that girl child, it may take maybe one or two generation for the child to become five, eight, five, nine. I'm talking about a girl child. Okay. And we have a lot of cases now the children are really girls are very tall even in India. Okay. And but that takes a two to three generation of good nutrition. Okay. So there is a journalist, Mr. Roger Thoreau, he was in India and he did a lot of study, you know, on malnutrition is a beautiful paper. You guys must read it. And he wrote a beautiful, he quoted the sir, he wrote that if you want to improve the future, to truly improve the world, we have thousand days to do mother by mother, child by child for what happens in those thousand days through pregnancy to second birthday, it determines to a large extent, the course of child's life, his ability to grow, learn, work, succeed. And by extension, the long term health, stability and prosperity of society in which the child lives. Okay. So if you want to improve the world, you can't leave a single child and single mother. Okay. If you want a beautiful world where no child is malnourished, you have to basically go and help each and every mother who comes to your door. Okay. Or you have to go to her door. So I'm sure you understood the importance of first thousand days and how if first thousand days are not taken care of, then child will go into stunting and, you know, wasting and also underweight. So and of course, brain development is so important because it's very rapidly growing during first thousand days and also the physical growth, you know. So now we will start with our tutorials. So thank you. Welcome to the spoken tutorial on the importance of the first thousand days of life. In this tutorial, we will discuss the benefits of good nutrition during these days. Also, we will learn how to nourish a baby during these days. Some key topics mentioned in this tutorial are explained in other tutorials. Please visit our website for more details. Let us first understand what are the first thousand days of life. The first thousand days of life start on the first day of pregnancy. They end on a child's second birthday. How well a child grows in these thousand days decides the future. If nourished well, the child can have a healthy future. Good nutrition is necessary for a child's early development. It plays a foundational role in enabling a child to grow, learn and succeed. Let's discuss the role of nutrition at every stage in the first thousand days. The first stage is pregnancy. The brain of the fetus begins to grow from the third week of pregnancy. Thereafter, it develops at a very high speed during the entire pregnancy. Most of the mothers are not even aware of their pregnancy during this time. Therefore, all women in their reproductive age should consume nutritious food. It is especially important for women planning a pregnancy. Healthy lifestyle, body fat and muscle percentage before pregnancy are crucial. Adolescent and pre-pregnancy nutrition is explained in other tutorials. Please visit our website for more details. During the third trimester, the brain cells begin to be covered by a layer of fat. It is called the myelin sheath. This helps in passing the messages through the brain cells quickly. By seventh month, brain of a fetus takes on a form that resembles an adult's brain. In the seventh, eighth and ninth months, there is a rapid growth of the fetus's brain. This rapid growth is not possible without one thing. It is the nutrition that a baby gets from the mother's diet. Mother's diet decides the baby's body fat and muscle percentage. It also decides the baby's food preferences. Mother should consume a variety of nutrient-dense, local, seasonal foods. Adequate amounts of iron, folate and calcium should be present in her body. Consumption of iodine sources is necessary during pregnancy. She must eat adequate protein, good fats and essential nutrients. Sources of these nutrients are given in other tutorials of the same series. Otherwise, vital brain development processes can be impaired. The baby could also have birth defects and cognitive defects. A well-known example is neural tube defects. Folate, B12 and choline are needed for early development of the brain and spine. Mother must take sufficient folate during pre-pregnancy. She should take it in the early weeks of pregnancy as well. Otherwise, the development of the neural tube can go wrong. It leads to birth defects of the brain and spine. The rate of a mother's weight gain during pregnancy decides the baby's health. High weight gain in mothers who are not underweight is not good. It increases the risk of childhood obesity. Obesity during pregnancy puts women at risk for gestational diabetes. This increases the baby's risk to be obese and diabetic later in life. A mother's lifestyle during pregnancy also plays an important role. Severe stress, depression or violence during pregnancy must be avoided. Such negative experiences can deeply affect a developing fetus. Smoking can cause low birth weight or premature delivery. It can also increase the baby's risk of obesity later in life. Alcohol and tobacco should not be consumed. Diseases should be prevented or treated immediately to minimize nutrient loss. After the two 70 days of pregnancy, infancy is the second stage of the first thousand days. During infancy, the child's brain develops motor functions such as balance. It also develops the ability to create new memories and remember them later. At this stage, proper newborn care is required. Newborn care is explained in detail in other tutorials in the same series. Breast milk is the best food for a newborn's brain development. It contains a variety of nutrients, growth factors and hormones. It is made up of unique components for each mother and her baby. No formula milk available in the market can be the same as mother's milk. Its impact on brain development is incomparable. Mother's milk has a high level of DHA and EPA. They are important for brain development of the baby. Exclusive breastfeeding for six months has many benefits. Breastfeeding is associated with an increase in IQ. It is also associated with getting more education and earning a better income. This is true for children and adolescents across all income levels. This brain development is not just because of breast milk. The experience of breastfeeding also contributes to it. Breastfeeding involves plenty of mother-child interaction and nurturing. It helps in strengthening a baby's sensory and emotional control. These are critical for both cognitive and socio-emotional development. To get these benefits, breastfeeding must be done using the proper technique. Next, let's discuss brain development in the toddler stage. A child's brain continues to grow and develop at a rapid pace. During toddlerhood, a child's brain develops the ability to do complex tasks. A toddler's brain is busy forming new connections between the brain cells. At this time, such connections are created faster than at any other time in life. This has many benefits. It helps the child to learn new things faster. It also helps the child to adapt to changing environments and circumstances. In the second year of baby's life, parts of the brain's language areas develop. This leads to a sharp increase in a child's language abilities. It also develops language learning capacity and the ability to learn new skills. Nutrition during this period means critically important. Protein, iron, zinc and iodine are essential to the toddler's developing brain. Other important nutrients are DHA, EPA, colon, B12, etc. Iron plays a significant role in brain development throughout the first thousand days. Damage caused due to iron deficiency in these thousand days can be irreversible. It leads to impaired learning and socio-emotional behaviour. This includes less social interaction and alertness, increased irritability, increased cautiousness, less interest in indoor and outdoor games. This can reduce the amount of attention and interaction given by caregivers. This further contributes to the poor development of the child. Iron deficiency also appears to affect the chemical substances in the brain. It is associated with higher levels of anxiety and depression later in life. It impacts consequent job potential. Toddlers need to be fed iron-rich foods. Otherwise, they are unlikely to consume enough iron. Hence, after six months of age, complimentary feeding is necessary. Damage caused by malnutrition in the first thousand days is permanent. It causes loss of IQ. Chronic malnutrition during this critical period leads to stunting. Loss of height or stunting in the first two years of life cannot be reversed. It affects the child's future generations too. Malnourished women give birth to malnourished sons and daughters. Later on, these malnourished daughters grow up to become malnourished mothers. Therefore, they create a continuous cycle of malnourishment. It takes two to three generations to combat stunting in future generations. This is why the average height of a 19-year-old man in India is only 5 feet. The average height of a 19-year-old man in India is only 5 feet 4 inches. All this can be prevented by improving nutrition during first thousand days. This brings us to the end of this tutorial. Thank you for joining.