Maternal and child nutrition

Implementing NICE guidance

2nd edition March 2012

NICE public health guidance 11

Guidance review

This guidance was originally issued in 2008. It was reviewed in July 2011 where it was decided it should not be updated at this time.

During the review, three recommendations were amended:

• infant formula

• checking babies weight

• pre-school settings: infant feeding

What this presentation covers

Scope

Key priorities for implementation

Costs and savings

Discussion

NHS evidence and NICE pathway

A local practice example, and find out more

Scope

Maternal diet and nutrition: pre-pregnancy, during and post-pregnancy

Infant feeding: infant formula and breastfeeding

Diet and nutrition for babies from 6 months old

and pre-school children: including weaning, weight monitoring, allergy prevention and oral health

Addresses disparities in low-income and

other disadvantaged groups

Key priorities for implementation

• Promote the Healthy Start scheme• Train staff in maternal and child nutrition• Advise women to take folic acid and vitamin

D supplements, as appropriate• Promote and support breastfeeding

• Encourage all those who may be eligible to apply: ensure forms and vitamin supplements are available

• Offer Healthy Start vitamin supplements to all women and children who are eligible

• Offer eligible parents tailored support and advice on using Healthy Start vouchers, on breastfeeding and on how to introduce infants to solid foods

• Audit local uptake

Training

Caring for women who may become (or who are) pregnant and children under 5 requires training in:

• their nutritional needs • the rationale for recommending supplements • how to provide dietary advice• breastfeeding management (BFI minimum standard)• practical ways of changing eating behaviour

Vitamin D for pregnant and breastfeeding mothers

Ensure health professionals know about the importance of vitamin D supplements

Offer pregnant women information and advice at first booking appointment, on the benefits of taking a suitable daily 10 mcg supplement – such as Healthy Start

Ensure those at greatest risk of a deficiency are taking vitamin D

Breastfeeding promotion

• Use a multi-faceted approach or coordinated programme of interventions across different settings

• Use the Baby Friendly Initiative (BFI) as a minimum standard

• Develop a written, audited and well-publicised breastfeeding policy that includes support for staff who are breastfeeding

• Identify a health professional responsible for implementing this policy

Breastfeeding support

Peer supporters should:

• receive externally accredited training

• receive ongoing support as part of a multidisciplinary team

• contact new mothers within 48 hours of their transfer home (or 48 hours of a home birth)

• offer mothers ongoing support according to need

Folic acid

Advise women who may become pregnant and those up to 12 weeks pregnant to follow a folate rich diet and take a 400 mcg folic acid supplement daily

Prescribe 5 mg a day if they have a family history of neural tube defect (NTD), have given birth to a baby with NTD or have diabetes

Ensure local initiatives stress the importance of folic acid and the availability of suitable supplements

Costs & savings

This guidance is unlikely to have a significant impact on costs. Locally, additional resources may be required for breastfeeding peer support, staff trainingand link workers, the provision of Healthy Start vitamins and family nutrition programmes.

Implementing this guidance may reduce:

- childhood illnesses such as gastroenteritis- the rate of obesity among adults and children - the risk of some cancers among mothers - neural tube defects

Correct at March 2008. Cost and savings assumptions were not

updated for 2nd edition

Discussion: breastfeeding

• To what extent have we implemented the BFI standard or its equivalent?

• How do we train our peer supporters?

• How well are peer supporters working as part of a multi-disciplinary team?

Discussion: diet and nutrition

• How do we encourage healthy eating among women who are (or who may become) pregnant and pre-school children?

• How can we improve uptake of Healthy Start?

• How can we improve awareness of the importance of vitamin D and folic acid supplements?

• How can we improve uptake of vitamin D/folic acid?

Click here for an article on vitamin D deficiency on the

NICE website

NICE Pathway

Click here to go to NICE Pathways website

This NICE Pathway covers:

•strategy, policy and commissioning

•training

•primary, secondary and community health services

•advice for pre-school settings

•advice for manufacturers

NHS Evidence

Click here to go to the NHS Evidence website

Visit NHS Evidence for the best available evidence on maternal

and child nutrition and care

Kirklees local extension of the Healthy Start scheme

• During 2007-2008, out of 3531 potential beneficiariesin Kirklees only 10 maternal and 228 children's vitamin supplements were claimed

• In 2010, 52 children were diagnosed with rickets in Kirklees at an annual treatment cost of £135,200

• This local extension project provided Healthy Start supplements to those not eligible for the national scheme.

Click here to go to the local practice example

Find out more

Visit www.nice.org.uk/PH011 for:

• Other guidance formats

• Commissioning guide: breastfeeding peer-support programme

• Costing statement

• Audit support

• Shared learning

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