Maternal and child nutrition

1. Maternal and child nutrition Implementing NICE guidance 2nd edition March 2012 NICE public health guidance 11

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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?

14. 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

15. NICE Pathway • This NICE Pathway covers: • strategy, policy and commissioning • training • primary, secondary and community health services • advice for pre-school settings • advice for manufacturers Click here to go to NICE Pathways website

16. NHS Evidence • Visit NHS Evidence for the best available evidence on maternal and child nutrition and care Click here to go to the NHS Evidence website

17. 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

18. 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

19. What do you think? • Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? • We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form. • If you are experiencing problems accessing or using this tool, please email implementation@nice.org.uk To open the links in this slide set, right click over the link and choose ‘open link’.