Complementary feeding • UK advice says: • Introduce complementary food alongside breast milk at ‘about’ 6 months of age in the first year of life • Breastfeed throughout first year and as long after that as mother wishes • ‘about 6 months’ • Despite current rumours, this is unlikely to change
Impact of poor nutrition in early life • Growth stunting • Poorer immune system • Impaired cognitive development • Childhood obesity and type 2 diabetes • Tooth decay • Poorer development oromotor skills • Fussiness around food type and texture leading to more limited diets
Introducing solids Key factor is ‘readiness for solids’ www.nhs.uk/start4life/solid-foods
Key messages: • Between 6 months and 1 year babies need to get used to lots of different flavours and textures and learn to feed themselves. • Simple ‘family’ foods low in salt and sugar are fine – meat, fish, eggs, pulses, fruits, vegetables, starchy roots, cereals should be main components of meals. Diet quality matters. • Milk or water to drink • Appetites will vary day to day and week to week • Keep offering foods even if not eaten • Elements of baby led weaning – but needs to meet individual needs • Commercial baby foods are poor value for money and are generally too soft and too sweet.
Fussy eating • Parental attitudes to feeding children in many western countries becoming anxiety driven • C oncern that children ‘not liking’ food is a problem, leading to medicalisation of early feeding and search for ‘solutions’ • This has been stimulated by baby food industry.
Tiny Tastes programme • Developed by psychologists at UCL (www.weightconcern .com) • Uses principles of repeated exposure and familiarisation
Who to take nutrition advice from? • Code compliant, policy based organisations/programmes. • Dietitians or AfN registered nutritionists with a specialism in public health. • Schemes which support eating well in early years settings should be free of commercial involvement – e.g. HENRY, Food for Life EY Award
Things to look out for: • A ‘Healthy Weight, Healthy Nutrition ’ training pack will be cascaded to HV nationally during 2016/2017 by The Institute of Health Visiting.
Childhood obesity strategy • No-one knows when this will come out – will have to include some statements related to pre-conception to five • In the meantime we have the WHO ECHO recommendations which provide a clear framework for action
www.firststepsnutrition.org helen@firststepsnutrition @1stepsnutrition Sign up to the newsletter for monthly updates and alerts to new information
Better Start Bradford Networking Event
Bradford Nutrition – the local hot potatoes and how we can manage them. Clare Gelder Principal Dietitian
Aim • To provide an overview of local nutritional issues affecting women of child bearing age and young children in Bradford • Consider the and the management strategies as well as the difficulties faced when dealing with these issues
Learning Outcomes At the end of the session, delegates will have an understanding of ; – The common nutritional problems observed in these population groups – How these issues are managed – Strategies and practical interventions – Signposting to further resources and support
Drivers for Change • National Institute for Health & Care Excellence – Antenatal care CG62 – Antenatal & Postnatal Mental Health CG45 – Diabetes CG63, – Maternal and Child nutrition PH11 – Quitting smoking in pregnancy PH26 – Weight Management before, during and after pregnancy PH27 – Pregnancy & complex social factors CG110 • Every Baby Matters Strategy
Nutritional issues in women and pregnancy
Bradford • The average number of babies per mother in Bradford is 2.24 (2013: 8,039 babies born) • National Total Fertility Rate is 1.82 (Office National Statistics, 2014) • In the UK: 1 in 5 women diagnosed ‘clinically obese’ in pregnancy • In Bradford its 1 in 4 women
Bradford Infant Mortality • 8,322 live births district wide (B&A) • Infant Mortality Rate (IMR) is the number of deaths under 1 years old per 1000 live births. • National = 4.0. Bradford = 5.8 (2016 health profile) • Was 7.0 (2010-2012) • Bradford was 8.3 (2005-7), 7.9 (2008-10) 5.1 (2014-15) • 69 infant deaths in 2010, 59 recorded 2010-12 • 58% births in poorest 40% of Bradford
Importance of good nutrition in pregnancy • ↓ risk of foetal and maternal deficiencies • ↑ chance of healthy pregnancy (mother and baby) • Preparation for breastfeeding • Improved development and long term health (mother and child)
Preparing for pregnancy Women with BMI 30 or more • Encourage weight loss before pregnancy • Discuss health risk • Highlight benefits of weight loss • Support from weight loss programmes • Aim for 5-10% weight loss initially • Encourage a BMI in healthy range • Advise folic acid supplements
Pregnancy Women with BMI 30 or more • Biggest risk is from being obese rather than weight gained during pregnancy • Dieting is NOT recommended • Appropriate weight gain:
Pregnancy: Women with BMI 30 or more • Discuss health risks • Benefits of healthy diet and physical activity for mum and baby • Address concerns – diet and activity • Advice from a reputable source • Offer referral to a dietitian • Dispel myths – eating for two • Healthy Start Scheme
After childbirth: Women with BMI 30 or more • 6-8 week postnatal check - opportunity to discuss weight • If not ready, offer further appointment in 6 months • Realistic expectations for weight loss • Take account of demands of caring and health issues • Family support • Encourage breastfeeding • Physical activity – check with GP/midwife first • Support from structured weight management groups
Effective weight loss programmes – before and after pregnancy • Based on balanced, healthy diet • Encourage regular physical activity • Incorporate behaviour change advice • Identify and address people’s barriers • Practical and tailored to individuals • Sensitive to the person’s concerns • Realistic weight loss of 0.5 – 1 kg per week
Who is at risk of vitamin D deficiency? • Those with someone else in the family with vitamin D deficiency • People from South Asian, African, African Caribbean and Middle Eastern backgrounds • Those that have a low exposure to sunlight due to wearing concealing clothing or spending time indoors • Teenagers (growth spurt) • Strict sunscreen users • People who are obese (BMI>30) • Pregnant or breastfeeding women • Breastfed and some formula fed babies • Children during periods of rapid growth such as in infancy • Children with chronic conditions (malabsorption, juvenile idiopathic arthritis, rheumatic conditions, chronic steroid use, diabetes, disability and reduced mobility) • People on medications interfering with Vit D metabolism: phenytoin, carbamazepine, steroids, rifampicin
Discretionary Vitamin D Supplementation Policy • All pregnant women booked with a midwife in B+A receive free vitamin D supplements • All infants in B+A receive free vitamin D supplements from birth to 6 months (some will continue to receive free up to 2 years) Healthy Start vitamin tablets and drops are the preparation of choice
Gestational Diabetes • TBC
Nutritional issues in the under 5’s
Reason for Referral to Dietetics Based on referrals in to dietetics 15/16, BD3, 4, 5
Childhood obesity • 20% under 5’s (OW/O) • Associated with fussy eating, early weaning and deprivation • Genetics • Lifestyle factors (activity, labour and time saving devices and choice of leisure activities) Solution • Healthy, balanced diet and adequate activity
Rickets • 67 cases of Rickets were diagnosed between 2007 and 2010 ( NHS B&A, 2010). • 20 cases were diagnosed between 2012 and 2015 (Source: SystmOne). These figures are suggestive of a decrease in the incidence of Rickets
Iron Deficiency Anaemia • 40% of under 5’s in Bradford (diet) • Immigrants and deprived areas (most effected) • Infections, poor weight gain, development and cognitive delay and behavioural disorders • Late weaning, inappropriate weaning, early weaning and excessive cows milk Solution • Improving maternal nutrition, appropriate weaning and a balanced diet
Faddy Eating • High prevalence (70% of 2yr olds) • Deprived areas most effected • Decreases with age (by 5yrs 1%) • Associated with Vit D and Iron deficiency and late or inappropriate weaning • Frequent drinks, snacking behaviour, lack of routine, unclear boundaries, neophobia, parental expectations and anxieties, parental depression,
Faddy Eating Solution • Parental education – meal routine, portion sizes and menu planning • Realistic expectations – children are not little adults • Reassurance – most children grow out of faddy eating behaviours • Consistency – parental confidence, establish new norms • Peer support for children – positive role models • Healthy Start vitamin supplements
Faltering growth • Commonly, infants may show some weight faltering in the first 2 years of life but it can also affect older children. • Under-nutrition accounts for 95% of the faltering growth causes e.g. impaired absorption, increased requirements, insufficient energy given. • 5% of the faltering growth comes from major organic disease.
Faltering Growth Pathway • It is estimated that of the children who have faltering growth, only 5% will have significant safeguarding concerns, e.g. abuse, neglect • Children who are severely undernourished from whatever cause may suffer long term growth, developmental, behavioural and emotional problems.
Faltering Growth Pathway • Developed in Bradford as part of the EBM working group on nutrition • To be rolled out to GP and HV asap • Provides a clear schematic of what to do and when
Complimentary Feeding • Exclusive breastfeeding for six months confers several benefits on the infant and the mother, • Complementary foods should be introduced at 6 months of age (26 weeks) while continuing to breastfeed. • The DH Guidelines recommend the introduction of solid food ‘at around six months’
Weaning - Born in Bradford • Older, better educated mums -> less chips and potatoes. • Later weaning -> less processed meat. • Breastfeeding, older mums, higher education -> more vegetables. • Similar for fruit. • Older mothers -> less sweet snacks. • Later weaning, older mums, better education -> less savoury snacks. • Earlier weaning, younger mums, less education -> more sugar-sweetened drinks. • Overweight & older mothers -> low-sugar drinks. * Adjusted for maternal age, parents’ education, ethnic group, energy intake, & infant age Pink Sahota, BiB, 2013
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