A leading children's doctor wants a "First 1000 Days" target for welfare agencies to improve New Zealand's horrendous child abuse record.

To achieve this, Dr Johan Morreau advocated for midwives to be working closer with social workers to help find warm housing, healthcare and financial support for families.

This support needs to be in place during pregnancy until the child reaches school, said Morreau.

The senior paediatrician at Rotorua Hospital is giving evidence at the inquest of Moko Rangitoheriri as an expert witness.


Moko died after suffering severe beatings by his caregivers in August 2015. He was nearly 3.

Morreau said he was disturbed by the level of violence that Moko suffered.

"During my career I've not seen a comparable case," said Morreau. "For me this is symptomatic of the level to which we as a country has undervalued our children and significant proportions of our people."

Morreau, like Detective Inspector Mark Loper who gave evidence earlier in the hearing, was also an expert witness at the inquest of Nia Glassie, who died in 2007.

His thoughts had not largely changed since then.

"We have as a society not been committed to resolving our issues and have made little or no impact."

While the development of the Ministry for Vulnerable Children Oranga Tamariki was positive, Morreau said New Zealand needed to invest more in children and their parents.

Just $1 spent on early intervention, said Morreau, saves $17 later in life.

He was a strong believer in the importance of the "First 1000 Days" of a child's life, starting from conception, as a critical factor to their long-term well-being.

Mothers needed to be supported during pregnancy to be drug and alcohol free and become attached to their baby.

"It's really important that a baby acquires their primary and permanent attachment figure by the time they reach six months of age," said Morreau.

"Close personal, face-to-face contact and sufficient time spent by a loving parent with their child then grows a little person's brain."

He referred to the first 1000 days as a "window of opportunity" for a child to be cared for.

"If they don't receive it, or they are abused and neglected, neurodevelopmental, behavioural and mental health issues result."

While most New Zealand children grow up in a safe and positive home, Morreau said there was a significant proportion of children for who "this is seriously not the case".

The parents are often isolated, struggling financially, with limited support from family or parenting skills.

Addressing these wider social issues, said Morreau, will save lives.

To do this, he recommended an initiative where midwives identify pregnant mothers who need help and work with social workers, or whanau ora, to get support in housing, health care and finance.

"New Zealand has for some time been at a 'tipping point' in regards to the ongoing negative impact of child neglect, family violence, abuse and poverty," said Morreau.

"Now is new 'window of opportunity' to make a difference. If we don't, too many children and young people will continue to be damaged and die."