the WALK - The Andrea Harvey Memorial Fund

HS52A
Delivering a
Healthy Start for
pregnant women,
new mums, babies
and young children
Read
more
A guide for health professionals
www.healthystart.nhs.uk
1
Contents
What is Healthy Start?
Who qualifies?
What do Healthy Start beneficiaries receive?
What beneficiaries can spend Healthy Start vouchers on
Healthy Start: recommendations and evidence
What to do next
Who can give out the application leaflet?
utrition, health and inequality:Healthinequalities;HowHealthy
N
Startgivesyoutheopportunitytohelpdisadvantagedwomen;Therole
ofhealthprofessionalsiscrucial
Nutrition in pregnancy:Obesityandpregnancy;Whatpregnant
womenshouldeat...andcutdownon;Healthysnackstorecommend;
Foodstoavoidduringpregnancy;Caffeine;Physicalactivity
Dangers in pregnancy:Toxoplasmosis;Smoking;Alcoholand
pregnancy;Breastfeedingandalcohol;Illegaldrugs
Healthy Start vitamins for pregnant women and breastfeeding
mothers:HowHealthyStartbeneficiariesclaimtheirfreevitamins;
What’sinHealthyStartvitaminsforwomen?
The early postnatal period:Breastfeeding;Maintainingahealthydiet;
Infantformulamilk;Follow-onformulas;Non-milk-basedformulas
utrition for growing babies:Whentostartintroducingsolidfoods;
N
Adviceformotherswhochoosetointroducesolidfoodsbeforesix
months;Vegetarianbabies;Foodstoavoid;Milk;Otherdrinks;Food
allergies;Peanutsandallergiesinthefamily
utrition for young children:Everydayeating;Fat;Ricedrink;
N
Fussyeaters;Childrenoverfive;Vegetarianandveganchildren;Iron.
Vitamin supplements for children
Find out more:HealthyStartresources
General resources
Breastfeeding organisations
References
2 /3
Welcome
ThisHealthyStartguidehasbeencreatedtoassisthealthprofessionals
insignpostingtheschemeandgivingnutritionaladvicetoapplicants
andbeneficiaries.Italsosummarisesthecorehealthadvicefor
pregnantwomenandyoungchildrenasagreedbythefourUK
HealthDepartments:England,NorthernIreland,ScotlandandWales.
What is Healthy Start?
Healthy Start is a UK-wide government scheme which aims
to improve the health of pregnant women and families on benefits
or low incomes.
• Beneficiariesaresentvouchersthatcanbeusedtobuyliquidcow’s
milk,plainfreshorfrozenfruitandvegetables,andinfantformulamilk,
pluscouponsthatcanbeexchangedforfreevitamins(forpregnant
women,newmumsandchildren).
• Ongoingnutritionandhealthinformationrelevanttotheageoftheir
oldestchildissentwiththevoucherstoreinforcethescheme’srole
asapublichealthmeasureandtohelpbeneficiariesmakethemost
ofthescheme.
HealthyStartisalsoagreatopportunityforallhealthprofessionalsand
othersworkingwithpregnantwomenandyoungfamiliestoprovide
encouragement,informationandsupportaboutsubjectssuchashealthy
eating,breastfeeding,vitaminsupplementsandnutritionforpregnant
women,newmums,babiesandyoungchildren.
TheHealthyStartapplicationformhastobesupportedbyahealth
professional(usuallyamidwifeorhealthvisitor,butitcanbeany
registerednurseordoctor),soitalsoencourageslow-incomewomen
andfamiliestomakecontactwithlocalhealthservices.
Who qualifies?
Women more than 10 weeks’ pregnant, and families with
children under four years old, qualify for Healthy Start if the
family is receiving:
• IncomeSupport,or
• Income-basedJobseeker’sAllowance,or
• Income-relatedEmploymentandSupportAllowance,or
• ChildTaxCredit(butnotWorkingTaxCreditunlessthefamilyis
receivingWorkingTaxCreditrun-ononly*)ANDanannualfamily
incomeof£16,190orlessin2011/12.
Womenalsoqualifyforthewholeoftheirpregnancyiftheyareunder
18whentheyapply,eveniftheydon’tgetanyoftheabovebenefits
ortaxcredits.
* W
orkingTaxCreditrun-onistheWorkingTaxCreditreceivedinthefourweeksimmediately
afterapersonhasstoppedworkingfor16hoursormoreperweek.
4 /5
What do Healthy Start
beneficiaries receive?
Healthy Start vouchers
• Pregnantwomenreceiveone
voucheraweekworth£3.10.
• Babiesundertheageofoneget
twovouchersaweekwortha
totalof£6.20.
• Eachchildagedoveroneand
underfourreceivesonevoucher
aweekworth£3.10.
Vouchersarepostedouteveryfourweeks.Theycanbespentinawide
rangeofparticipatinglocalshopsandgreengrocersaswellassupermarkets.
Foralistofshopsbypostcode,visitwww.healthystart.nhs.ukanduse
thepostcodecheckertofindlocalshops.
Healthy Start vitamins
Everyeightweeksbeneficiariesalsoreceivevitamincoupons,which
theycanexchangeforvitaminsintheirlocalarea.Theircouponswillbe
validforeitherthewomen’stabletsorchildren’sdrops,dependingon
thecircumstances.
Trustsandboardsmustensurethatarrangementsareinplacetosupply
bothkindsofvitaminsupplements.Maternityunitscanalsosupplythem
iftheywish.Moreinformationonhowtoordervitaminsandreclaimthe
costofthosegivenoutthroughtheschemeisavailableontheHealthy
Startwebsitewww.healthystart.nhs.uk
What beneficiaries can
spend Healthy Start
vouchers on
HealthyStartvoucherscanbeacceptedaspaymentorpartpaymentfor
milk, plain fresh or frozen fruit and vegetables,andinfant formula
milk.Therearemoredetailsbelow.
Milk
P laincow’smilk–whole,semi-skimmedorskimmed.Itcanbe
pasteurised,sterilised,long-lifeorUHT.
Beneficiariescan’tspendtheirvouchersonflavouredmilk,colouredmilk,
evaporatedmilk,condensedmilk,goat’smilk,soyamilkorpowdered
milk–exceptinfantformulamilk.
Plain fresh or frozen fruit and veg
Beneficiariescan’tspendtheirvouchersonanyfreshorfrozenfruitandveg
whichhasaddedsalt,fat,sugaroranyotheringredient.Theyalsocan’tspend
themonpre-cooked,driedortinnedfruitandvegetables,fruitjuiceorsmoothies.
Infant formula milk
Beneficiariescan’tspendtheirvouchersoninfantformulasthataren’t
basedoncow’smilk,suchassoyaformula.Theyalsocan’tspendthem
onfollow-onformulasthataremadeforbabiesagedsixmonthsorolder.
6 /7
Frozen foods
Includingplainfrozenfruitandvegetablesintheschemefrom6April
2011meansthatfamiliesontheschemecanspendtheirvoucherson
productssuchasfrozenpeasorcarrotsaswellasfreshfruitand
vegetablesandmilk.
Plainfrozenfruitandvegetablesarebeingincludedtohelplow-income
familieseatmorefruitandvegetablesbygivingthemmorechoiceabout
thekindstheycanspendvoucherson.
Healthy Start
Recommendations and evidence
Healthy Start replaced the means tested elements of the Welfare
Food Scheme throughout the UK in 2006. Proposals for reform of
the previous scheme were based on recommendations made by the
Committee on Medical Aspects of Food and Nutrition Policy (COMA)
(DH 2002).
The National Institute for Health and Clinical Excellence (NICE) has
a number of recommendations for health professionals working with
women and young children that relate to Healthy Start. You can
see them in full at http://guidance.nice.org.uk/PH11. They include:
For pregnant women or those who
may become pregnant
• Advisethemtotakeasupplementcontaining400micrograms(mcg)
offolicaciddailypre-conceptionanduptothe12thweekofpregnancy;
alsoprovideadviceonsuitablevitaminsupplementssuchasHealthyStart
vitaminsforwomen.
• EnsurethateligiblewomenreceiveaHealthyStartapplicationleaflet(HS01)
assoonaspossibleinpregnancy.
• ForwomenreceivingHealthyStartvouchers,providepracticaladviceon
howtoincreasetheirintakeoffruitandvegetables.
• Provideinformationonfoodsanddrinksrichinfolicacid,e.g.fortified
breakfastcerealsandyeastextract,andfoodanddrinkrichinfolate
(thenaturalfromoffolicacid)e.g.peas,beansandorangejuice.
• Duringthebookingappointment,offeradviceandinformationtoall
womenaboutthebenefitsoftakingvitaminDduringpregnancyandwhile
breastfeeding;checkthatwomenatthegreatestriskofvitaminDdeficiency
(thosewhoarenotexposedtomuchsun,forexamplethosewhocoverup
theirskinforculturalreasonsandpeoplewithdarkerskin,suchaspeople
ofAfrican-CaribbeanandSouthAsianorigin)arefollowingtheadvice.
• ProvideinformationonsourcesofvitaminD,includingthemainsource
(sunlight)andfoodshighinvitaminD,e.g.oilyfish,eggsandfortifiedfoods
suchasbreakfastcerealsandmargarine.
8 /9
For mums and babies
• AdvisemothersaboutsuitablevitaminDsupplementssuchasHealthy
StartvitaminsforwomenofvitaminDdeficiency;checkthatwomen
atthegreatestriskofdeficiency(asbefore)arefollowingtheadvice.
• ForwomenreceivingHealthyStartvouchers,providepracticaladvice
onhowtoincreasetheirintakeoffruitandvegetables.
For families and carers of babies over
six months and pre-school children
• OfferHealthyStartvitamindrops(A,CandD)toallchildrenaged
fromsixmonthstotheirfourthbirthdaywhosefamiliesareeligible
forHealthyStart.
• Provideparentsandcarerswithpracticaladviceonhowtheycan
introducebabiestoavarietyofsolidfoods.
AswellastheNICEguidance,theNational Service Framework for
Children, Young People and Maternity Services(DH2004b)statesthat
maternityserviceprovidersshouldensurethatallpregnantwomenare
offeredclearinformationontheavailabilityofHealthyStart.
The Scientific Advisory Committee
on Nutrition (SACN) has made a number
of recommendations:
In1991theCommitteeonMedicalAspectsofFoodandNutritionPolicy
(COMA–SACN’spredecessor)recommendedthatcertainat-risk
individuals,orgroupsatriskofvitaminDdeficiency,shouldtake
supplementsof7–10mcgofvitaminDdaily(DH1991).TheChiefMedical
Officer(CMO)subsequentlyendorsedtheserecommendationsfor
vulnerablegroupsin2005(CMO2005).COMAhadalsorecommended
thatallchildrenagedonetofiveyearsshouldbegivenasupplement
containingvitaminsA,CandD(DH1994),andtheUKHealth
Departmentshavesincerecommendedthatallchildrenhavesupplements
fromsixmonthsuntilfiveyearsofage.
In2007,SACNspecificallyreiteratedCOMA’soriginalrecommendations
onvitaminDinitspositionstatementUpdate on Vitamin D(SACN2007),
recommendingthatallpregnantandbreastfeedingwomenshouldtake
adailysupplementofvitaminDinordertoensuretheirownrequirement
forvitaminDismetandtobuildadequatefetalstoresforearlyinfancy,
andallyoungchildrenshouldbegivenavitaminDsupplementuntilfive
yearsofageaspreviouslyrecommendedbyCOMA.
NICE(2008)hasalsohighlightedtheimportanceofvitaminD
supplementsforpregnantandbreastfeedingwomen.
10 / 11
SACNhasalsorecommendedthatallwomenwhocouldbecome
pregnantshouldtake400mcgoffolicaciddailyasamedicinalorfood
supplementpriortoconceptionanduntilthe12thweekofpregnancy.
Womenwithahistoryofneuraltubedefect(NTD)affectedpregnancyare
advisedtotake5mgperdaypriortoconceptionanduntilthe12thweek
ofpregnancy(SACN2006).
Intheirreviewofthekeyfindingsfromthe2005InfantFeedingSurvey,
SACNincludedthefollowingrecommendations:
• Increasetheawarenessofbreastfeedingamongyoungandlow-income
mothersbydiscussinginfantfeedingduringpregnancyandproviding
supportintacklingpracticalbarrierstobreastfeeding.Theprofileof
HealthyStartshouldberaisedandhealthprofessionals,atevery
opportunity,shouldofferpracticalsupportandadvicetothoseeligible
forthescheme(SACN2008b,paragraph125).
• Inequalitiesinaccesstoantenatalandpostnatalcareareapparent.
Identifyingsub-groupsofwomenwhodonotusematernalhealthservices
iskeytoimprovingpolicyadherence.Thereisaneedtomakeantenatal
andpostnatalservicesmoreaccessibleforwomenfromhard-to-reach
groupsandencouragethemtousetheseservicesmorefrequently.In
addition,thetopicofbreastfeedingshouldberaisedwheneverpossible
duringantenatalconsultationsandencouragementshouldfocusonthose
leastlikelytobreastfeed(SACN2008b,paragraph128).
What to do next
• FindouthowHealthyStartvitaminsaredistributedbyyourtrustor
boardandroutinelytellpregnantwomenandfamiliesonthescheme
aboutthevitamins,whythey’reimportantandhowtogetthem.
• OrderHealthyStartapplicationleaflets(HS01)andotherresourcesat
www.orderline.dh.gov.ukorbycalling0300 123 1002.
• MakesureHealthyStartisembeddedinyourlocalpoliciestopromote
breastfeedingandhealthyeating.
• UseHealthyStartasanopportunitytosignpostlocalinitiativesfor
pregnantwomenandyoungfamilies.
• VisittheHealthyStartwebsitewww.healthystart.nhs.ukformore
informationabouttheschemeandyourrole,andtoviewtheinformation
thatissentdirectlytobeneficiarieswiththeirvouchers.
12 / 13
Who can give out
the application leaflet?
Anyonecanorderbulksuppliesoftheapplicationleaflet(HS01)andgive
themout,butitisespeciallyimportanttomakethemavailablewherever
servicesforpregnantwomenandfamiliesarebeingprovided.
Anymemberofthepubliccanalsorequesttheirowncopydirectlyfrom
theHealthyStarthelplineon0845 607 6823,ordownloadthe
applicationleafletfromwww.healthystart.nhs.uk
Bookingandhealthandsocialcareassessmentappointmentsareagood
opportunitytoprovidetheapplicationleafletinpersonbecausepregnant
womencanreceivevouchersfromthe10thweekofpregnancy.Many
maternityunitsincludeacopyintheirmaternityinformationpack.It’salso
agoodideatorecordtheuptakeofHealthyStartinthewoman’snotes.
Countersigning the form
WhensomeoneappliesforHealthyStart,aregisteredmidwife,nurseor
medicalpractitionerhastocompleteandsignPartBoftheapplication
leaflettoconfirmtheexpecteddateofdelivery(EDD)and/orthedate(s)
ofbirthofanychildrenunderfouryearsold.It’s important that Part B
is fully completed, or the application cannot be processed.
Pleasenote:healthprofessionalsaren’trequiredtocheckthatan
applicantisgettingthebenefitstheyclaimtobe–we’lldothat.Nordo
healthprofessionalsneedtoreportanysubsequentchangesinpeople’s
circumstancesoncethey’reonthescheme–it’sthebeneficiary’s
responsibility.However,healthprofessionalsareaskedtoofferappropriate
adviceonbreastfeedingandhealthyeatingandtoindicatethattheyhave
donethisontheapplicationleaflet.It’salsoagoodideatousethe
opportunitytotalkaboutotherrelevantservicesandtoexplainwhy
HealthyStartvitaminsareimportant.
Nutrition, health
and inequality
There’s growing evidence to suggest that nutrition during pregnancy
and in the early years of a child’s life can help prepare them for
healthy adulthood. A healthy diet can also help reduce the risk
of obesity and chronic diseases such as heart disease and some
cancers later in life.
COMA’sPanelonChildandMaternalNutritionproducedaScientific
Review of the Welfare Food Scheme(nowHealthyStart),acknowledging
thatmaternalandchildnutritionmayaffectlong-termhealthoutcomes
(DH2002).
14 / 15
Health inequalities
Manypeoplefollowahealthybalanceddiet,butalargenumberdon’t,
particularlyamongthemoredisadvantagedandvulnerableinsociety
(DH2004a).TheIndependent Inquiry into Inequalities in Health(Acheson
1998)emphasisedtheinfluenceofpoverty,educationandpoorearly
nutritiononhealthinequalities.Thereportrecommendedpoliciesto
improvenutrition,reducefoodpovertyandpreventchildhoodobesity.
Morerecently,recommendationshavebeenmadebySACNinanumber
ofitsreportsincludingThe Nutritional Wellbeing of the British Population
(SACN2008a) anditsreviewofthekeyfindingsfromtheInfantFeeding
Survey2005,Infant Feeding Survey 2005: A commentary on infant feeding
practices in the UK (SACN2008b).
Women in disadvantaged groups are significantly less likely to:
• accessmaternityservicesearly
• stayintouchwithhealthservicesthroughouttheirpregnancies
• haveawell-balanceddiet
• breastfeedtheirbabies
• giveupsmokinginpregnancy
• introducesolidfoodsattherecommendedage.
Women from disadvantaged, vulnerable or excluded groups –
including pregnant teenagers – are more likely to have poorer
maternal and neonatal outcomes, for example:
• infantmortality
• lowbirthweight
• postnataldepression.
How Healthy Start gives you the
opportunity to help disadvantaged women
Becausepregnantwomenandfamiliesneedtogettheirapplication
leafletcountersignedbyahealthprofessional,theapplicationprocess
offersanopportunitytoidentifythosewhoaremorelikelytobe
disadvantaged,youngandlivinginvulnerablesituations;toengagewith
themandreferthemontorelevantservicesforadditionalsupportif
required.Forexample,awomanwhoqualifiesforHealthyStartmaybe
lesslikelytobreastfeed.Asahealthprofessionalyoumaybeabletodirect
hertobreastfeedingeducationandsupport,peersupportandthelocal
SureStartChildren’sCentreorfamilycentre.
It’sachancetodiscussbreastfeedingandnutritionandgivewomen
generalhealthadviceatatimewhentheyarelikelytobemostreceptive
toit.Forinstance,youmightbeabletosuggestwhattheyspendtheir
voucherson.
TheUKHealthDepartmentsbelievethatmaternityservicesshouldbe
proactiveinengagingallwomen,butparticularlythosewomenfrom
disadvantagedgroupsandcommunities,earlyinpregnancyandmaintaining
contactuptoandafterbirth(DH2004b;WelshAssemblyGovernment
2005).SACNhasalsorecommendedthatadviceoninfantfeedingneedsto
betailoredaccordingtosocialgroup(SACN2008a).Seepages30and31.
The role of health professionals is crucial
Recentresearchhasshownthattheroleofhealthprofessionalsinintroducing
HealthyStartisincrediblyimportant.ParentswhoareintroducedtoHealthy
Startthroughahealthprofessionalaremorelikelytoseethemselvesworking
inpartnershipwithHealthyStartforthebenefitoftheirchildrenasopposed
toviewingtheschemesimplyasfinancialsupport(DHqualitativeresearch
October2009,unpublished).
16 / 17
Nutrition in pregnancy
HealthyStartencouragespregnantwomenfromdisadvantagedgroups
toincludemilkandavarietyoffreshfruitandvegetablesintheirdiet.
Teenagegirls,whohaveincreasednutritionalrequirements,areatgreater
riskofnutrientdeficienciesduringpregnancy,whichiswhyevery
pregnant woman under 18 years old is eligible for Healthy Start.
Healthyeatingduringpregnancyisimportantforboththehealthofthe
motherandthedevelopmentandgrowthofthebaby.Also,womenare
mostlikelytoinfluencethedietarydecisionsofthewholefamilyandare
centraltothefuturehealthyeatingoftheirchildren.
Ahealthybalanceddietthatincludesatleastfiveportionsoffruitand
vegetablesadaycanhelpreducetheriskofheartdiseaseandsomecancers.
Obesity and pregnancy
It’simportantthatwomenaregivenadviceaboutweightgainduring
pregnancy.There’sanincreasedriskofcomplicationsiftheirbodymass
index(BMI)isabove35(orlessthan18),suchasincreasedbloodpressure
whichcanleadto,amongotherconditions,gestationaldiabetes.
Dieticiansmaybeabletoprovidesupport.
Womendon’tneedto
‘eatfortwo’whenthey
arepregnant.Evenwith
multiplepregnancies,
it’sthequalityandnot
thequantityofthediet
thatisimportant.
What pregnant women should eat…
Theeatwellplate1shows
howmuchofeachtype
offoodisneededtohavea
healthy,well-balanceddiet.
• P
lenty of fruit and vegetables(fresh,frozen,tinned,driedoraglass
of100%unsweetenedfruitjuice)–avariety,atleastfiveportionsaday.
• Plenty of starchy foods,suchaswholemealbread,potatoes,rice,pasta,
chapatis,yamsandbreakfastcereals,asthemainpartofeverymeal.
• Some protein,suchasleanmeatandchicken,fish,eggsandpulses–
suchasbeansandlentils,whicharealsogoodsourcesofiron.Please
note:pregnantwomenshouldtrytoeatatleasttwoportionsoffish
aweek,butshouldnothavemorethantwoportionsofoilyfishaweek.
• Plenty of fibre,whichhelpspreventconstipation–it’sinwholegrain
bread,wholegraincereals,pasta,rice,pulsesandfruitandvegetables.
• Some dairy foods,includinglower-fatversionsofmilk,cheeseand
yoghurt,whichcontaincalciumandarealsoagoodsourceofprotein.
There are some foods that pregnant women should avoid –
seepage19.
…and cut down on
F oodssuchascakesandbiscuitsbecausethey’rehighinfatandsugars
andcancauseunnecessaryweightgaininpregnancy.
Healthy snacks to recommend
instead include:
altloaf,lower-fatyoghurts,fruit–includingfresh,tinnedor100%
M
unsweetenedfruitjuice,andsmallhandfulsofdriedfruitsuchasraisins
orapricots.
18 / 19
DepartmentofHealthinassociationwiththeWelshAssemblyGovernment,
theScottishGovernmentandtheFoodStandardsAgencyinNorthernIreland
1
Foods to avoid during pregnancy
• Some types of cheese:mould-ripenedsoftcheesesandblue-veined
varieties(suchasBrie,CamembertorDanishBlue).Thesemaycontain
listeria,whichcancausemiscarriage,stillbirthorsevereillnessinthe
newbornbaby.
• Paté:alltypesofpaté,includingvegetablepatés,astheycan
containlisteria.
• Uncooked or undercooked ready meals,includingraworpartially
cookedmeat,especiallypoultry.
• Raw or partially cooked eggstoavoidtheriskofsalmonella.
• Raw or undercooked meat.
• Liver, liver products, fish liver oil supplements and supplements
containing vitamin A (retinol)(seepage24).
• Some types of fish:pregnantwomenshouldavoideatingshark,
marlinandswordfishandlimittheamountoftunatheyeattono
morethantwotunasteaks(170geachraw)orfourcans(140gdrained
weight)perweek;thesetypesoffishcontainhighlevelsofmercury,
whichcandamagethebaby’sdevelopingnervoussystem.
• Raw shellfish.
• Unpasteurised milk.
• Alcohol(seepage27).
A note on peanuts
Previousadvicehasbeenthatwomenmaychoosetoavoideating
peanutsduringpregnancyifthereisahistoryofallergyintheirchild’s
immediatefamily(suchasasthma,eczema,hayfever,foodallergiesetc).
Thisadvicehasnowchangedaslatestresearchshowsthatthereisno
clearevidencethateatingpeanutsduringpregnancyaffectsthechances
ofababydevelopingapeanutallergy.So,pregnantwomenarenow
advisedthattheycaneatpeanutsaspartofahealthybalanceddiet
iftheychoosetoandarenotallergicthemselves.
www.food.gov.uk/safereating/allergyintol/peanutspregnancy
Caffeine
oftheweek,isimportantforall
women,includingthosewhoare
Consuminghighlevelsofcaffeine
pregnant.Pregnantwomenshould
duringpregnancycanresultin
stayactiveandkeepuptheir
babiesbeingbornwithlowbirth
normaldailyexercise(within
weight,whichcanincreasetherisk
reason).Iftheytakepartingym
ofhealthproblemsinlaterlife.Too
classestheyshouldmakesurethat
muchcanalsocausemiscarriages,
theirinstructorknowstheyare
sopregnantwomenshouldlimit
pregnant.Contactsportsandthose
theircaffeineintake.
activitieswithariskoffalling
Pregnantwomenshouldhaveno
shouldbeavoided.Womenwho
morethan200mgofcaffeineper
haven’tbeenundertakingregular
day,i.e.nomorethanapproximately physicalactivitypriortotheir
twomugsofinstantcoffeeORone pregnancyshouldconsiderlowmugoffiltercoffeeORtwomugs
impactexercisetheywillenjoy,such
ofteaORtwocansofenergydrink. asbriskwalking,swimmingand
aquanatalclasseswhicharegentle
Physical activity
inmovementandintensity.They
shouldbeadvisedtobuildup
Regularphysicalactivityof
exercisegradually,forexample
moderateintensityforatleast
in10-minutelotsthroughtheday.
30minutes,onfiveormoredays
20 / 21
Dangers in pregnancy
Toxoplasmosis
This infection is rare but can have serious consequences.
Pregnant women should reduce the risks of contracting
toxoplasmosis by:
• washingfruit,vegetablesandsaladbeforeeating
• washinghandsbeforehandlingfood
• washingallsurfacesandutensils
• washinghandsafterpreparingrawmeat
• thoroughlycookingrawmeat
• heatingready-preparedmealsuntiltheyarepipinghotallthe
waythrough
• keepingleftoverscoveredinthefridgeandusingthemwithintwodays
• avoidingcontaminationwithcatfaecesinthecatlittertrayorsoil–they
shouldasksomeoneelsetotakecareofit,oratleastweargloves
• avoidingcontactwithabortedlambs,newbornlambsandafterbirth
• nothelpingwithlambingormilkingewes.
Formoreinformationvisit:
www.hpa.org.uk
www.hps.scot.nhs.uk
Smoking
Everytimeawomansmokesduringpregnancyitincreasestheriskof
miscarriage,prematurebirth,lowbirthweightandstillbirth.Italsotrebles
theriskofcotdeathandcanleadtochildrendevelopingasthmaand
respiratoryinfectionsinlaterlife.
Youshouldaskpregnantwomenwhattheirsmokingstatusis,advise
themofthehealthbenefitsofstoppingsmokingandthenprovidethem
withinformationandsupporttohelpthemquit,includingreferraltotheir
localstopsmokingservice.
Asmokefreehomeisbestforpregnantwomen,babiesandyoung
childrenasexposuretosecondhandsmokecanbeharmful.Youshould
providefamilieswithpracticaladviceabouthowtheycancreate
asmokefreehome.
If women want additional help
or advice to stop smoking in
pregnancy, direct them to:
NHSPregnancySmokingHelpline
(England)
0800 169 9 169
Smokeline(Scotland)
0800 84 84 84
StopSmokingWales
0800 085 2219
SmokersHelpline(Wales)
0800 169 0169
www.want2stop.info
(NorthernIreland)
22 / 23
Alcohol and pregnancy
Alcoholcanbeharmfultothedevelopingbabyandmayleadtoearly
miscarriage.Heavydrinkingisparticularlyrisky.Pregnantwomenor
womentryingtoconceiveshouldavoiddrinkingalcohol.
Iftheydochoosetodrink,tominimisetherisktothebabytheyshould
notdrinkmorethanonetotwounitsonceortwiceaweek–andthey
shouldnotgetdrunk.AdditionaladvicefromNICErecommendsthat
womenavoidalcoholinthefirstthreemonthsinparticular,because
oftheincreasedriskofmiscarriage.
Oneunitofalcohol=asingle
(25ml)measureofspiritsat40%
ABV(alcoholbyvolume),half
apintofbeerat3.5%ABV,
orhalfa175mlglassofwineat
11.5%ABV.Largerorstronger
drinksthanthesewouldcontain
morethanoneunitofalcohol.
Itcanbeparticularlyeasyto
underestimateunitswhendrinks
arepouredathome.
Formoreadviceonalcohol
andunitinformationvisit
www.drinking.nhs.ukor
www.drinkaware.co.uk
Orcall:
Drinkline
0800 917 8282
Drinkline(Scotland)
0800 7 314 314
Breastfeeding
and alcohol
Alcoholpassesthroughtobreastfed
babiesinverysmallamounts.Itis
unlikelythathavinganoccasionaldrink
willharmthemotherorbaby,butit
mightaffecthoweasilythebabyfeeds.
Breastfeedingwomenshouldbeadvised
todrinkverylittle–nomorethanone
ortwounitsaweek.Ifabreastfeeding
womanintendstodrinkmorethanthis
theycanexpressmilkinadvance.
Ifabreastfeedingmotherdrinks
alcoholbeforefeeding,itcanaffect
thebabyinanumberofways.
• Themilkmaysmelldifferentandthe
babymaynotfeedaswellasnormal.
• Thebabymaysleeplesswellfor
somehoursafterfeeding.
Itisnotadvisableforwomentoshare
abedorasofawiththeirbabyif
theyhavebeendrinking.Ifthey
sleepheavilytheycouldputtheir
babyatrisk.
Illegal drugs
Useofillegaldrugs,particularlyheavyuse,canbeharmfulforboth
motherandbaby.Womenwhoarepregnantorbreastfeedingshould
normallyaimtobecompletelydrugfree.Healthprofessionalscanprovide
encouragementtoquit.
However,thosedependentonheroinorotheropiatesandsome
tranquillisersneedtotakemedicaladvice;itmaybemuchsaferforthem
toremainonsomeprescribedreplacementdrugsuntilafterdelivery.
Confidential advice
for drug users
FRANK(UK-wide)
0800 77 66 00
www.talktofrank.com
KnowtheScore(Scotland)
0800 587 587 9
http://knowthescore.info/
DAN24/7(Wales)
0800 141 0044
www.dan247.org.uk
24 / 25
Healthy Start vitamins
for pregnant women
and breastfeeding
mothers
Women in families supported by Healthy Start can claim free
vitamins while they’re pregnant and up to their baby’s first
birthday. They’re sent a coupon every eight weeks that can
be exchanged for Healthy Start women’s vitamin tablets.
It’simportantthatwomengetallthevitaminsandmineralsthey
needforthemselvesandtheirgrowingbabywhilethey’repregnant
andbreastfeeding.Therearecertainsupplementstheyneedwhich
willhelppreventthemfrombecomingdeficient.
How Healthy Start beneficiaries claim
their free vitamins
EachNHSorganisationorboardisresponsiblefordistributingvitamins
locally.Somemayalsochoosetosellorsupplythemfreeofcharge
towomenandchildrenwhoarenoteligibleforHealthyStart.Health
professionalsshouldcontacttheirlocalHealthyStartleadformoredetails.
Beneficiariesreceiveavitamincouponandareadvisedtoasktheir
midwife,healthvisitororpublichealthnurseaboutwheretheycan
usethecoupon,andtotakeitwiththemtocollecttheirvitamins.
So it’s essential that health professionals know what the local
arrangements are.
What’s in Healthy Start vitamins
for women?
Healthy Start vitamins for women contain folic acid, vitamin D
and vitamin C. Here’s why they’re important for pregnant
women and new mums.
Folic acid
Taking400mcg(0.4milligrams)offolicacidbothbeforeandupuntil
the12thweekofpregnancycanhelppreventNTDsuchasspinabifida,
wherethespinedoesn’tdevelopproperlyinunbornbabies.
Eveniffolicacidisn’ttakenbeforeconception,it’sworthstartingassoon
asthewomanisawareofthepregnancy,anditshouldcontinuetobe
takenuntilthe12thweekofpregnancy.Folate,thenaturalformoffolic
acid,canbefoundinpeas,potatoes,broccoli,orangejuice,brussels
sprouts,asparagus,black-eyedbeans,spinachandkale,andit’simportant
forpregnantwomentoeatplentyofthesefoods.However,it’svery
difficulttomeetthisincreasedrequirementoffolatefromfoodalone.
Thereforetakingfolicacidsupplementsisimportantwhentryingtoget
pregnantandintheearlystagesofpregnancy.
IfamotherhasalreadyhadapregnancyaffectedbyNTDorhasdiabetes,
oristakinganti-epilepticmedicines,sheisadvisedtoseekmedicaladvice
fromherGP.
Recommendation: all women who are trying to get pregnant or
who are pregnant should take 400mcg of folic acid each day up
until they are 12 weeks’ pregnant. Women who have already had
a pregnancy affected by NTD need to take 5mg of folic acid each
day until the 12th week of their pregnancy. In addition, women
who have diabetes and those taking anti-epileptic medicines
should consult their GP for advice. (AsrecommendedbyCOMA
(2000),SACN(2006)andNICE(2008).)
26 / 27
Vitamin D
VitaminDisimportantforallpregnantandbreastfeedingmothers.
Thebestsourceissummersunlight.Theamountoftimeneededinthe
suntomakeenoughvitaminDisdifferentforeverypersonanddepends
onskintype,timeofdayandtimeofyear.Butsunbathingisn’tnecessary;
ittakeslesstimeinthesunforthebodytomakeenoughvitaminDthan
itdoestocausetanningorburning.Wearingahighfactorsunscreento
avoidskinturningredorburningisadvisedforthemajorityofthetime
spentoutdoors.
VitaminDisfoundinasmallnumberoffoods,includingoilyfish,eggs,
fortifiedbreakfastcerealsandmargarines.Thosewhoaremostatrisk
ofavitaminDdeficiencyincludepregnantandbreastfeedingwomen,
youngchildren,olderpeopleandthosewhoarenotexposedtomuch
sun,forexamplethosewhocoveruptheirskinforculturalreasons,who
arehouseboundorconfinedindoorsforlongperiodsandpeoplewith
darkerskin,suchaspeopleofAfrican-CaribbeanandSouthAsianorigin.
Thoselivingabove52°N(theUKisatalatitudeof50–60°N)maynot
getenoughvitaminDduringthewintermonths.
Takingasupplementduringpregnancyandwhilstbreastfeedingwill
ensurethatamother’sownrequirementforvitaminDismet,plus
itwillbuildadequatefetalstoresforearlyinfancy.
Recommendation: all women who are pregnant or breastfeeding
should take a daily vitamin D supplement of 10mcg.
(AsrecommendedbyDH(2004a)andSACN(2007).)
Vitamin C
VitaminCprotectscellsandhelpskeepthemhealthy.Inabalanceddiet
mostofthevitaminCrequiredcanbesourcedfromfruitandvegetables,
includingbroccoli,orangesandstrawberries,butasupplementwillhelp
ensurethatpregnantandbreastfeedingmumsgetenough–particularly
asitisn’tstoredbythebody.
Vitamin A
A vitamin to avoid during pregnancy
Pregnantwomenandwomentryingtoconceiveshouldavoid
supplementscontainingvitaminA(retinol)astoomuchcanhaveharmful
anddamagingeffectsontheunbornbaby(SACN2005).Theyshouldnot
consumeliverorliverproducts,includingfishliveroil,becausethey
haveahighvitaminAcontent.VitaminAisnotincludedinHealthy
Startwomen’svitamintablets.
28 / 29
The early postnatal
period
Breastfeeding
Breastfeedingcandeliversignificanthealthbenefitsforboththemother
andherbaby.
Exclusive breastfeeding (with no other food or drink) is all a baby
needs for around the first six months (26 weeks), continuing
thereafter alongside a variety of other healthy foods. It provides
all the nutrients a baby needs and helps to protect them from
a range of infections.
Evidencesuggeststhatinfantswhoarenotbreastfedaremorelikelyto
becomeobeseinlaterchildhood,developtype2diabetes,andtendtohave
slightlyhigherlevelsofbloodpressureandbloodcholesterolinadulthood.
Breastfeedingmothershavereducedriskofbreastandovariancancers.
Allpregnantwomenshouldhavetheopportunitytodiscussthebenefitsand
managementofbreastfeeding.Tailoringthisinformationtotheneedsofthe
mother,alongwithsourcesofpracticalhelpandsupport,willraiseawareness
ofbreastfeedingamongyoungandlow-incomewomen,helpingthemto
anticipateandovercomedifficultiessotheycanconsideritarealoption.
Anyamountofbreastfeedingmakesadifferenceandthelongerababyis
breastfedthelongertheprotectionlasts–evenafterbreastfeedingceases.
Infantformulamilkcan’tprovideallthesameingredientsorprotection.
Allmothersshouldbesupportedtocarryonbreastfeedingforaslong
astheywish,alongsidetheintroductionofavarietyofotherhealthy
foodsataroundsixmonths.TheWorldHealthOrganization
recommendsbreastfeedingfortwoyearsorbeyond.However,the
majorityofmothersstopbreastfeedingmuchearlier,withyounger,
moredisadvantagedmothersbeingleastlikelytofeedbeyondthefirst
fewweeks,ifatall.
Mothersfromdisadvantagedgroupsarelesslikelytostartbreastfeeding
andmorelikelytostop.Bysixweeks,73%ofmothersfrommanagerial
andprofessionaloccupationswerestillbreastfeeding,comparedwith
58%ofmotherswhohadneverworkedand49%ofmothersfrom
routineandmanualoccupations.Thisdifferencebysocio-economic
grouppersistedatsixmonths(Bollingetal.2007).
Womenshouldn’tbeexpectedtodecidewhetherornotthey’llbreastfeed
untilafterthebirth.However,there’sclearevidencethatacombination
ofinterventionsbyhealthprofessionalsduringpregnancyisthemost
effectivewaytoencouragewomentostartbreastfeedingandcarry
onforlonger(Fairbanketal.2001).
Interventions include:
• informingallwomenaboutthebenefitsofbreastfeeding
• involvingofpeersupporterswithpregnantwomen
• supportingandencouragingattendanceatantenatalgroupsand
breastfeedingeducationclassestomeetwithothermothersand
shareinformationandsupport
WhereatrustorboardisworkingtowardstheUNICEFBabyFriendly
Initiative,womenwillbesupportedtoinitiateandcontinue
breastfeedingthroughasetofevidence-basedbestpracticestandards.
www.babyfriendly.org.uk
30 / 31
Mothers who
Breastfed babies
• naturallyuseupto
500caloriesaday
• beadmittedtohospitalinthe
firstyearoflifewithinfections
suchasgastroenteritis
breastfeed:
• arelesslikelytodevelop
breastcancer
• arelesslikelytodevelop
ovariancancer.
Maintaining a
are less likely to:
• developrespiratorytract
infections
• developurinarytract
infections
• developeczema
healthy diet
• beconstipated
Breastfeedingmothersdon’tneed
tofollowaspecialdiet,like
everyone,theyshouldbeencouraged
toeatahealthybalanceddiet
consistingofplentyoffruitand
vegetablesandstarchyfoods,
preferablywholegrains,andsome
proteinrichfoodssuchasmilkand
dairyfoods,meat,fish,eggs,beans
andpulses.
• becomeobeseastheyget
older,whichmeanstheyare
lesslikelytodeveloptype2
diabetesorheartdisease
Certainvitaminsupplementsare
alsoimportant(seepages21–24).
Healthprofessionalsshoulddiscuss
freeHealthyStartsupplements
orreferwomentoaGPforan
appropriateprescription.
• befussyaboutnewfoods.
Infant formula milk
Babiesfedoninfantformulamilkhaveagreaterriskofillhealththan
breastfedbabies.It’sveryimportanttoensurethatpowderedinfant
formulamilkispreparedinthesafestwaypossible.It’snotsterile,and
eventhoughtinsandpacketsaresealed,theycontainbacteriasuchas
Enterobacter sakazakii (nowalsoknownasCronobacter)and,morerarely,
salmonella.
Make sure that all mothers who choose to feed their babies with
infant formula milk are told about:
• theimportanceofsterilisationofthefeedingequipment
• howtomakeupabottleofinfantformulamilk
• thestorageandhandlingofinfantformulamilkoncereconstituted.
To reduce the microbiological risks when making up feeds in the
home, advise mothers to:
• preparefreshinfantformulamilkforeachfeed
• reconstituteformulapowderinwaterhotterthan70°Cbyfillingthe
kettlewithfreshtapwater(notbottledwater)and,afterithasboiled,
coolingfornolongerthanhalfanhourbeforeusing
• ifafeedisrequiredforlater,keepfreshlyboiledwaterinasealedflask
andmakeupfreshformulawhenneeded
• ensurethatwaterisstillhotwhentheyuseittomakeuptheformula,
otherwisethebacteriaintheinfantformulamilkmaynotbedestroyed.
32 / 33
Follow-on formulas:
Non-milk-based
formulas:
• soya-basedinfantformulasshould
• haveahigherconcentrationof
onlybeusedontheadviceof
proteinthaninfantformulamilk
aGPandcanbeprescribed
andthereforearenotsuitabletobe
giventoinfantsundersixmonths
• milksbasedongoat’smilk
(DH1994)
proteinarenotsuitableforinfants
astheyhaven’tbeenlegally
• aren’tincludedintheHealthy
approvedforuseinEurope.
Startschemebecausethereare
noclearbenefitsfortheiruseas
alternativestobreastmilkorinfant
formulamilk(DH2002).
Neither can be purchased with Healthy Start vouchers.
Nutrition for
growing babies
Infancyisaperiodofveryrapidgrowthandthereforegoodnutritionis
paramount.Thequalityofdietintheearlyyearsofachild’slifemayaffect
thebaby’slong-termhealth.
When to start introducing solid foods
TheUKHealthDepartmentsrecommendintroducingsolidfoodsataround
sixmonths(26weeks)(DH2003a).Therearethreeclearsignsthatababy
isreadytostartonsolidfoods.
Theywillbeableto:
• stayinasittingpositionandholdtheirheadsteady
• co-ordinatetheireyes,handandmouthandlookatfood,pickitupand
putitintheirmouthallbythemselves
• swallowfood–babieswhoarenotreadytotakesolidfoodswilluse
theirtonguestopushbackfoodintheirmouths.
Beforethisagethebaby’sdigestivesystemisstilldeveloping,sostarting
themonsolidfoodtoosoonmayincreasetheriskofinfectionorallergies.
Babiesnotreadytotakesolidswillusetheirtonguestopushbackfood
placedintheirmouths.
Babieswhoarebornprematurelyshouldn’tbeintroducedtosolidfoods
justbecausetheyhavereachedacertainageorweight.Theywillneed
individualassessmentbyaregistereddieticianbeforebeingintroduced
tosolidfoods.
34 / 35
Advice for mothers who choose to
introduce solid foods before six months
Therearesomefoodsmothersshouldavoidgivingtheirbaby.Theseinclude:
• peanutsandpeanutproducts
• fishandshellfish
• othernutsandseeds
• softorunpasteurisedcheeses
• foodscontaininggluten,whichis
inwheat,rye,barleyandoats
• liverandliverproducts
• cow’smilk.
• eggs
Vegetarian babies
Ifparentswouldrathernotincludemeatandfishinababy’sdiet,that’s
fine.It’simportanttomakesurethatbabiesonavegetariandietare
gettingenoughenergyandironandaren’tgettingtoomuchfibre.Itis
alsoespeciallyimportanttogivevitamindropstobabieswhoareona
vegetariandiet.Aschildrengetolder,parentsmayneedtomakesure
theygetenoughproteinandiron(seepage41).Avegandietisnot
suitableforbabiesastheycannoteasilygetalltheenergyandnutrients
theyneed.
Foods to avoid
Nuts and peanuts
Honey
Wholenuts,includingpeanuts,
shouldnotbegiventochildren
underfiveyearsincasethey
choke,buttheycanbegiven
tochildrenearlieriftheyare
crushedorgroundup.
Babiesunderoneyearoldshould
notbegivenhoneybecauseit
containsatypeofbacteriathat
cansometimesproducetoxins
thatcauseinfantbotulism.
Seepage38formoreinformation
onfoodallergies.
TheGovernmentrecommendsthat
infantsundertheageofoneyear
shouldn’thavemorethan1gof
saltperday.Advisemothersnotto
addanysalttotheirbaby’sfood.
Mothersshouldalsoavoidgiving
theirbabiesprocessedfoodsthat
aren’tmadespecificallyforbabies,
suchasgravyandothersauces,
foodstinnedinbrineandcrispsand
othersaltysnacks–theycanall
containhighlevelsofsalt.
Sugar
Mothersshouldbeadvisednot
toaddsugartotheirbaby’sfood
orgivethemsugarysnacksin
ordertohelppreventtoothdecay.
Salt
Shark, swordfish and marlin
Thelevelofmercuryinthesecanaffectagrowingbaby’snervoussystem.
Raw fish and shellfish
Rawfishcanincreasetheriskoffoodpoisoning,soshouldnotbegiven
tobabies.
Low-fat foods
Fatisanimportantsourceofcaloriesandsomevitaminsforbabiesand
youngchildren.It’sbetterforbabiesandyoungchildrenundertwotohave
full-fatmilk,yoghurtorfromagefrais.
36 / 37
Milk
Babieswillneedbreastmilkorinfantformulamilkalongsidesolidfood
fromaroundsixmonthsuntiltheyareatleastoneyearold.Amilk
puddingormilkfeedcanbeofferedattheendofthemeal.
Cow’smilk,asadrink,isnotsuitableforbabiesunderoneyearas
itdoesn’tcontainsufficientironandothernutrients,althoughsmall
amountscanbeusedinthecookingandpreparationoffoods.
Afteroneyear,babiescancontinuetobreastfeedorchangetodrinking
wholecow’smilk.Aftertwoyearstheycandrinksemi-skimmedcow’s
milkifthey’reeatingwell.Skimmedmilkand1%fatmilksarenot
suitableforchildrenunderfiveyears.
Other drinks
Onceinfantshaveestablishedaneatingpattern,theycanbeoffered
waterwithmeals.Fruitjuiceshouldnotbegiventochildrenunder
sixmonthsofage.Aftersixmonths,ifjuiceisgivenitshouldbediluted
andonlygivenatmealtimes.
Cupsshouldbeintroducedfromsixmonthssobabiescantransferstraight
frombreasttocup.Ifformulafeeding,theaimistohaveababyoffthe
bottlebytheirfirstbirthday.Cupsarebetterforababy’steethand
comfortsuckingonabottlecanbecomeahabitthatishardtobreak.
Food allergies
Babiesaremorelikelytodevelopallergieswhenthere’safamilyhistory
ofeczema,asthmaorhayfever.Exclusivebreastfeedingisrecommended
forthefirstsixmonthsforallbabies,includingthosewithafamilyhistory
ofallergy.
Foodsthatareknowntocauseallergicreactionsinclude:
• peanuts
• othernuts
• wheat-basedfoodsandotherscontaininggluten
• seeds
• fishandshellfish
• soya
• eggs
• cow’smilk.
Ifparentsareconcernedthattheirbabymaydevelopanallergyit’sagood
ideatointroducethesefoodsoneatatime,startingwithasmallamount,
soanyreactioncanbeeasilyidentified.Theyshouldnotbeintroduced
beforeababyissixmonthsold.
Peanuts and allergies in the family
Childrenwithknownallergiessuchaseczemaorfoodallergies,orwitha
historyofallergyintheimmediatefamily,haveahigherriskofdeveloping
apeanutallergy.ParentsofthesechildrenshouldtalktotheirGP,health
visitorormidwifebeforegivingpeanutsorpeanut-containingfoods
totheirchildforthefirsttime.
38 / 39
Nutrition for young
children
Nutritioncanhaveafundamentalinfluenceonchildhealth,bothinthe
shortandlongterm.Havingahealthydietteacheschildrengoodeating
habitsthattheycanuseasyoungadultsandparentsthemselves.
Everyday eating
Youngchildrenshouldbeofferedawidevarietyofhealthyfoodsto
introducethemtodifferenttastesandtexturesandshouldincludefoods
fromthefollowingfoodgroups:
• fruitandvegetables
• bread,rice,potatoes,pastaandotherstarchyfoods
• milkanddairyfoods
• meat,fish,eggs,beansandothernon-dairysourcesofprotein.
Fat
Childrenundertwoyearsoldneedfull-fatdairyproductsbecausethey
providecaloriesandessentialvitaminssuchasA,DandE.Lower-fat
foods,suchassemi-skimmedmilk,lower-fatyoghurt,lower-fatcheese
orspreads,arenotsuitableforbabiesandchildrenundertwoyearsold.
Everyday,aftertheageofone,childrenshouldhaveaboutthreeservings
ofdairyproductssuchasmilk,cheeseandyoghurt.Forexample,aserving
couldinclude:
• about120ml(4floz)ofmilkinacup(notabottle)
• aservingofamilk-baseddishsuchasyoghurt,fromagefrais
orricepudding.
Rice drink
Youngchildrenagedonetofiveyearsshouldnotbegivenricedrinks,
inordertominimisetheirexposuretonaturallyoccurringinorganic
arsenic.Ifparentsarealreadyprovidingricedrinks,theyshouldstop
inordertoreducefurtherexposuretoinorganicarsenic.
Fussy eaters
It’snormalforchildrenbetweentheagesofoneandfivetogothrough
aphaseoffussyeating.Theyusuallygrowoutofit,though,andwillbe
helpedbyeatingwiththefamilyasoftenaspossible,aswellaswithother
children,e.g.atnursery.
40 / 41
Children over five
Childrenneedawiderangeofnutrientsforgrowthanddevelopment.
Fromtheageoffive,parentsshouldofferthemadietthatcaninclude
reduced-fatandmorewholegrainfoods,asrecommendedforadults
andolderchildrenintheeatwellplate.Fruitandvegetablesshouldbe
offeredateachmeal,sothatatleastfivesmallportionsadayareeaten
(DaveySmith1998).
TheLowIncomeDietandNutritionSurvey(2007)foundthatfruitand
vegetableintakewaspooramongchildrengrowingupindisadvantaged
families(1.6portionsforboysand2portionsforgirlsaged2–18years)
(FoodStandardsAgency2007).Researchhasfoundthatsocio-economic
statusinchildhoodcorrelatestotheriskofdevelopmentof
cardiovasculardiseaseinadulthood(RogersandSharp1997).
Vegetarian and vegan children
Children who don’t eat meat or fish need to eat two or three
portions of vegetable protein or nuts every day to ensure that
they are getting enough protein:
• pulses,suchaslentilsandbeans
• tofu
• soyapieces
• seedsandgroundorcrushednuts.
However,asthechildgetsolderthereisariskthattheirdietmaybelow
inironanditisimportantthattheyeatfoodscontainingiron(seepage43).
VitamindropscontainingvitaminsA,CandDareespeciallyimportantfor
veganandvegetarianchildrenandshouldbegiventothemuntiltheyare
fiveyearsold.
Avegandietcanbebulkyandhighinfibre,whichcanmeanthatchildren
getfullupbeforetheyhavetakeninenoughcalories.Becauseofthisthe
childmayneedextrasupplements.Energy-dense,high-calorieveganfood
shouldbeincludedinthediet,forinstance:
• tofu
• nutandseedbutters(allergyadviceshouldbeconsideredbefore
includingtheseinanydiet)
• pulses
• fortifiedsoyadrinksandyoghurts
• fortifiedbreakfastcereals
• flaxseedandrapeseedoil(whichcontainsomeomega-3fattyacidsbut
notthesameasthosefoundinfish).
42 / 43
Iron
Childrenneedironandparentsshouldmakesuretheyaregettingenough
byencouragingthemtoeatavarietyofthefollowingfoods:
• greenvegetables,suchaswatercress,broccoli,springgreensandokra
• pulses,suchaslentilsandbeans
• driedfruits,suchasapricots,figsandprunes
• darkgreenvegetables
• wholemealbread
• fortifiedbreakfastcereals
• redmeat.
It’sthoughtthatit’seasiertoabsorbironifeatenwithfoodsthatcontain
vitaminC,sochildrenshouldbeofferedvegetablesandfruitthatarerich
inthis,suchascitrusfruit,tomatoes,peppersandstrawberriesordiluted
100%unsweetenedfruitjuices.
VitamindropsforchildrencontainingvitaminsA,CandDareespecially
importantandshouldbeincludedwithinthediet.
Vitamin supplements
for children
Growingchildren,especiallythosenoteatingavarieddiet,oftendon’tget
enoughvitaminA,vitaminCand,especially,vitaminD–asitisdifficult
togetenoughthroughfoodalone.
TheUKHealthDepartmentsrecommendthatchildrenfromsixmonths
tofiveyearsoldaregivensupplementscontainingvitaminsA,CandD.
FamilieswithbabiesorchildrensupportedbyHealthyStartaresent
couponseveryeightweekstoexchangeforHealthyStartchildren’s
vitamindrops.Couponsareissuedfrombirthsothatthedropscanalso
beclaimedforbabiesundersixmonthsoldifthereisanydoubtaboutthe
mother’svitaminDstatus.
Vitamin Dhasanumberofimportantfunctions.Forexample,
ithelpstoregulatetheamountofcalciumandphosphateinthebody.
Theseareneededtohelpkeepbonesandteethhealthy;infantswhodon’t
getenoughcangetsoftenedboneswhichcanleadtorickets.Thebest
sourceofvitaminDissummersunlight,butmostpeopleintheUKhave
limitedexposuretoit.
Vitamin A helpswithvisionindimlightandhelpsimmunity,
aswellassupportinghealthyskin.
44 / 45
Vitamin Cprotectscells,helpskeepthemhealthyandmayassist
thebodytoabsorbironfromfood.Inabalanceddietmostofitcanbe
sourcedfromfruitandvegetablessuchasbroccoli,orangesandkiwifruit.
However,asupplementwillhelpensurethatchildrengetenough–
particularlyasitisn’tstoredbythebody.
Recommendation: All children aged from six months to five years
should take a vitamin supplement which contains vitamins A, C and D
unless they are having 500ml (a pint) or more of formula a day.
Wherethereisanydoubtaboutamother’svitaminDstatusinpregnancy,
breastfedbabiescanbenefitfromHealthyStartvitaminsfromonemonthold.
Babieshavingformuladonotneedtohavevitaminsuntiltheyarehaving
lessthan500ml(apint)offormulaaday.(AsrecommendedbyDH(1994)
andSACN(2007).)
Formoreinformationvisitwww.healthystart.nhs.uk
Find out more
Healthy Start resources
AllHealthyStartresourcesareavailabletoorderordownloadat
www.orderline.dh.gov.ukorfrom0300 123 1002. Youcanalso
downloadthematwww.healthystart.nhs.uk
• HealthyStartapplicationleafletHS01
• HealthyStartvitaminbookletHS52BE(Englandonly)
• HealthyStartgeneralposterHS50(orderonly)
• HealthyStartvitaminsformumsposterHS504(orderonly)
• HealthyStartvitaminsforchildrenposterHS505(orderonly)
• Quickguideforfirst-timemumsHS507
• Quickguideforpregnantunder-18sHS506
46 / 47
General resources
England
• NHSBirthtofive:
www.nhs.uk/
planners/birthtofive/Pages/
Birthtofivehome.aspx
• NHSbreastfeedingwebsite:
www.nhs.uk/breastfeeding
• NHSChoices:
www.nhs.uk
• NHSDirect:0845 46 47
• 5ADAY:
www.5aday.nhs.uk
• DepartmentofHealth:
www.dh.gov.uk
• Start4Life:
www.nhs.uk/start4life
• Change4Life:
www.nhs.uk/change4life
Publications
• OfftotheBestStart
• BottleFeeding
• IntroducingSolidFood
Ifyouwanttoordertheseleaflets
pleasecall0300 123 1002
orvisitwww.orderline.dh.gov.uk
Scotland
• ReadySteadyBaby!:
www.readysteadybaby.org.uk
• NHSHealthScotlandwebsite:
www.healthscotland.com
• NHS24:08454 24 24 24
• Breastfeeding–Thefeedgoodfactor:
www.feedgoodfactor.org.uk
Publications
• OfftoaGoodStart–Allyouneedto
knowaboutbreastfeedingyourbaby
• BreastfeedingandReturningtoWork
• FunFirstFoods–Aneasyguideto
introducingsolidfoods
Wales
• WelshAssemblyGovernment–
Breastfeeding:
www.wales.gov.uk/breastfeeding
• NHSDirectWales:0845 46 47
Publications
• FeedingYourBaby–Startingoffwell
• Breastfeeding–Thebeststartfor
yourbaby
• SaferBottlefeeding
• EasytoCookFamilyFoodsfor
yourBaby
• BreastfeedingandReturningtoWork
Northern Ireland
• PublicHealthAgency–
BreastFedBabies.org:
breastfedbabies.org
Publications
• The Pregnancy Book
• Birth to Five
• OfftoaGoodStart
• FeedingYourBaby
• BottleFeeding
• WeaningMadeEasy
• NutritionMattersforEarlyYears
UK
• HealthyStart:
www.healthystart.nhs.uk
Breastfeeding
organisations
The following organisations and websites provide further resources and
examples of service improvement and innovation which can support
local breastfeeding initiatives.
www.abm.me.uk TheAssociationofBreastfeedingMothersisacharity
runbymothersformothers,givingfriendlysupportandsupplyingaccurate
informationtoallwomenwishingtobreastfeed.ItalsosupportstheNational
BreastfeedingHelpline.
www.babyfriendly.org.ukProvidesup-to-dateinformationonresearchand
breastfeedingactivityintheUK,andinformationforcommissionersonhow
todelivertheUNICEFUKBabyFriendlyInitiative(BFI).Userscansubscribe
toemailupdates.
www.babymilkaction.orgBabyMilkActionisanon-profitorganisationthat
aimstosavelivesandendavoidablesufferingcausedbyinappropriateinfant
feeding.Itworksgloballytostrengthencontrolsonmarketingbythebaby
feedingindustry.
48 / 49
www.nct.org.ukTheNationalChildbirthTrustisaleadingcharityforparents,
supportingpeoplethroughpregnancy,birthandearlyparenthood.
www.nice.org.ukKeydocumentsreferencedinthisguidecanbedownloaded
fromtheNationalInstituteforHealthandClinicalExcellencesiteasPDFfiles.
Furtherinformationrelatingtothetopicareawillbesignpostedfortheuser.
www.rcm.org.ukTheRoyalCollegeofMidwivesprovidessupportand
informationtotheUKmidwiferysector,bothNHSandprivate.
www.rcog.org.ukTheRoyalCollegeofObstetriciansandGynaecologists
encouragesthestudyandadvancementofthescienceandthepracticeofobstetrics
andgynaecology.
www.rcpch.ac.ukTheRoyalCollegeofPaediatricsandChildHealthhas
amajorroleinpostgraduatemedicaleducationandprofessionalstandards.
www.sacn.gov.uk TheScientificAdvisoryCommitteeonNutritionis
acommitteeofindependentexpertsthatprovidesadvicetotheDepartment
ofHealth,aswellasothergovernmentagenciesanddepartments.
www.ukamb.orgTheUnitedKingdomAssociationforMilkBankingis
aregisteredcharitythatsupportshumanmilkbankingintheUK.Thecharity
givespracticalsupporttomilkbankstaff,whoco-ordinatetheprovisionof
donorbreastmilktoprematurebabies.Thecharitysharesexpertiseandgood
practicewithmilkbanksandbreastmilkdonors.
www.unitetheunion.com/cphvaAprofessionalorganisationforhealth
visitors,schoolnurses,nurserynursesandothercommunitynursesworking
inprimarycare.
References
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COMA(2000)Folic Acid and the Prevention of Disease: Report of the Committee
on Medical Aspects of Food and Nutrition Policy.ReportonHealthandSocial
SubjectsNo.50.London:TSO.
DaveySmithG(1998)Influencesthroughthelifecourse:fromearlylifeto
adulthood,inSharpI(ed)Social Inequalities in Coronary Heart Disease:
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DH(2002)Scientific Review of the Welfare Food Scheme: Report of the Panel on
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DH(2004b)National Service Framework for Children, Young People and
Maternity Services, Standard 11: Maternity Services.London:DH.
FairbankLetal.(2001)Promotingtheinitiationofbreastfeeding. Quality in
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FoodStandardsAgency(2007)Low Income Diet and Nutrition Survey,
London:TSO.
WelshAssemblyGovernment(2005)The National Service Framework for
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NICE(2008)Improving the Nutrition of Pregnant and Breastfeeding Mothers and
Children in Low-income Households.NICEPublicHealthGuidance11.London:NICE.
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SACN(2005)Review of Dietary Advice on Vitamin A.London:TSO.
SACN(2006)Folate and Disease Prevention.London:TSO.
SACN(2007)Update on Vitamin D.London:TSO.
SACN(2008a)The Nutritional Wellbeing of the British Population.London:TSO.
SACN(2008b)Infant Feeding Survey 2005: A commentary on infant feeding
practices in the UK.PositionstatementbySACN.London:TSO.
Additional publications
DysonLetal.(2006)Promotion of Breastfeeding Initiation and Duration:
Evidence into practice briefing.London:NICE.
HamlynBetal.(2002)Infant Feeding2000,London:TSO.
NICE(2005)The effectiveness of public health interventions to promote the
duration of breastfeeding: Systematic review.London:NICE.
RenfrewMetal.(2009)Breastfeedingpromotionforinfantsinneonatalunits:
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www.hta.ac.uk/1611
WorldCancerResearchFund(WCRF)(2009)Recommendation9(outof10)to
preventcancer.WCRFUKrecommendsthatitisbestformotherstobreastfeed
exclusivelyforuptosixmonthsandthenaddotherliquidsandfoods.
www.wcrf-uk.org/preventing_cancer/recommendations.php
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