Humans lived as hunter-gatherers for 95% of our 200 000-year history.1 Social scientists call our modern societies ‘WEIRD’: Western, Educated, Industrialised, Rich and Democratic.1 In evolutionary terms, the last 10 000 years that we have not lived as hunter-gatherers is brief.

Dobzshansky2 famously stated that ‘Nothing makes sense in biology, except in the light of evolution’. This is also true for medicine and for paediatrics. We suggest that it is important for paediatricians to consider the evolutionary view, as small adjustments from a public health perspective might make it easier for children to thrive.

See Box 1 for some key evolutionary concepts, which we discuss in greater detail in the following sections.

Evolutionary mismatch 13: arises when the modern environment is different to the environment to which humans are adapted. Children have adapted to expect being raised in a hunter-gatherer community. When this does not happen, there is a potential evolutionary mismatch. The current epidemic of childhood obesity is a prime example of an evolutionary mismatch, as our ancestors were never in a situation where calorie-rich food was ubiquitous and unlimited. We are the descendants of people who survived famines by overeating on the rare occasions that plentiful food was available. The evolutionary perspective suggests that putting all the onus on individuals to manage their weight is likely to fail and that public health measures are important.

Parent–offspring conflict 3: maternal care evolved to be context dependent. For example, if a mother had a baby while still breastfeeding an older child, she may have left the baby to die so that the older child could survive. We are the descendants of mothers who made difficult decisions in order to leave at least some surviving children. The care of a mother for her child lies on …