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How can we improve the public narrative on the early years, and support parents?

Insight from the #5BigInsights

“Parenthood isn’t a prerequisite to understand the importance of the early years”


These are the words of HRH the Duchess of Cambridge last week, in her Keynote Speech accompanying the presentation of the results from The Royal Foundation’s Landmark Study on the #5BigQuestions on the Early Years, now called 5BigInsights. I discussed the launch of the survey in my previous blog in February (pre-COVID times, it seems a lifetime ago!).

This is a UK-wide survey about the under 5 year old children that anyone could answer, launched with the idea to listen to the country as a whole, to hear what they have to say and start a national conversation on the under-fives.

Why are these questions so important? And what are the answers — what are the 5BigInsights?

And why do I like the Duchess’s words so much?


I am a psychiatrist, and for many years I have dedicated my clinical activity (and a lot of my research and educational activity) to perinatal mental health: helping mothers who are struggling with their mental health in pregnancy or in the first postnatal year, and studying the consequences of perinatal mental health problems for both the mothers and the babies.

Perfectly resonating with the Duchess’s words, I found myself — a man with no children — passionate about the importance of the early years, and an advocate for the notion that supporting pregnancy and childhood is a societal priority and a societal duty: that every pregnant woman and every child matter.

Research has clearly demonstrated that the early development of an individual, from the 9 months in mum’s tummy all the way to the first years of life, has the most profound effect on the future of that person: on their emotional and social development, on the way they will express their potential at school and in their working lives, on the type of close relationships they will develop, and on their vulnerability and resilience to mental health challenges.

Of course, our trajectory as an individual is not set deterministically and irrevocably in the first years of life: we remain capable of great shifts, and a difficult start can become a blossoming youth and adulthood, especially if we are lucky enough to encounter positive and supportive people in our later years.

But yet, at a ‘population’ level, when we are looking at big numbers, the effects of the early years are overwhelmingly clear.

Children born from mothers who are depressed in pregnancy are more at risk of developing depression themselves when they later reach youth or adulthood. As I have said, it is not deterministic and irrevocable: most children born from mothers depressed in pregnancy will not develop depression; but more of them will, compared with children born from a healthy pregnancy.

And this type of evidence is consistent across the early postnatal and childhood years. The research background summarised in the report accompanying the release of the #5BigInsights highlights the most important points. To mention just a few, more relevant to maternal mental health: nearly three-quarters of the cost associated with poor maternal health is related to adverse impacts on the child rather than the mother; there is a multitude of effects that poor parental mental health can have on children, including slower language development, poorer academic performance and emotional problems; and parents who report high levels of stress tend to use harsher forms of discipline and are more inconsistent in their parenting style.

So, this is what clinicians and academics think.

But what do people think?


Here is a nice info-graphic summary of the #5BigInsights:

The report draws not only on the survey of the general population (around 500 thousand individuals who decided to participate and as such were not representative of the UK population) but also on a face-to-face survey of a sample representative of the UK population, as well as in-depth interviews and observations of a smaller group of families, with an emphasis on parents of a 0 to 5-year-old child. This additional information allows us to better understand these answers to the #5BigQuestions, and to put them into context.

Some answers are remarkably aligned with expert knowledge.

Some are, surprisingly, not.

There is a general understanding that both nature and nurture play a role in the healthy development of a child. In fact, almost all participants (98%) believe that the experiences of a child in the early years (i.e., nurture) influence how a child develops from the start of pregnancy to age 5. A large proportion (42%) believe that nurture, rather than nature, plays the primary role in determining lifelong outcomes.

While the exact balance of the two is difficult to establish (even among scientists), and varies from trait to trait, it is absolutely true that genetics does not explain all of the trajectories of an individual’s development.

In fact, even considering the most genetically identical individuals — monozygotic twins — if one twin has a mental disorder the other twin does not always have a mental disorder, although the risk is higher than the general population.

So, yes, genetics (nature) is important, but it is not all.

More concerning is that parents who believe that child development is genetic or pre-determined have a fatalistic attitude which may reduce their efforts to interact with the child, as they seem to place less emphasis on the importance of playing, talking, or reading with the child.

Worryingly, this emphasis on a ‘predetermined’ child development is higher in those parents coming from an economically disadvantaged background — and this could constitute the basis of a self-fulfilling prophecy, exactly for those children who are more at risk of suffering and under-achieving at school.

The second concerning aspect of the survey is that only one in four participants recognises the specific importance of the first five years for providing lifelong health and happiness. Instead, most participants (57%) perceive all periods of a child’s life to be important for health and happiness in adulthood.

While I do not want to underplay the importance of all phases of life for the wellbeing of an individual — the trajectory of an individual can be changed at any time, as discussed above — yet research in all aspects of a person’s development, from the way the brain growth and brain connection forms, to the way that our basic emotional and rational understanding of the world consolidates, overwhelmingly emphasises the importance of the early years over and above the later periods.

Finally, around half (53%) of those providing a response believe it is the shared responsibility of parents and others in society to give children aged 0 to 5 the best chance of health and happiness. However, a sizeable proportion (46%) believe it is primarily the responsibility of parents.

So, what’s next?


The full report explores many more topics and it is definitely an interesting read, either in its full 50 pages or the abbreviated version.

As mentioned above, it touches on important factors affecting the experience of being a parent, including feeling judged by others, the lack of social support, and COVID.

Overall, the survey and the report show that a lot of new educational and dissemination work is needed to put across the importance of the early years, not only to policy-makers but also, and perhaps even more, to parents and the general population.

The conclusions of the report focus clearly on the area of concerns that I have highlighted here, indicating that there is a need for promoting education and dissemination of evidence on the primacy of the early years to the whole of society, for encouraging society as a whole to be more supportive of parents, carers and families in the early years, and for cultivating and sustaining more support networks for parents to enhance their mental health and wellbeing.

There is a lot of work to do in education and dissemination, in research and clinical care.

I am starting today, with this blog.



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