Delivering a Healthy Start for pregnant women, new mums, babies and young children

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1 HS52A Delivering a Healthy Start for pregnant women, new mums, babies and young children Read more A guide for health professionals 2012/13

2 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? Nutrition, health and inequality:healthinequalities;howhealthy 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 Nutrition for growing babies:whentostartintroducingsolidfoods; Adviceformotherswhochoosetointroducesolidfoodsbeforesix months;vegetarianbabies;foodstoavoid;milk;otherdrinks;food allergies;peanutsandallergiesinthefamily Nutrition for young children:everydayeating;fat;ricedrink; Fussyeaters;Childrenoverfive;Vegetarianandveganchildren;Iron. Vitamin supplements for children Find out more:healthystartresources General resources Breastfeeding organisations References 2 / 3

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.

4 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 16,190orlessin2012/13. Womenalsoqualifyforthewholeoftheirpregnancyiftheyareunder 18whentheyapply,eveniftheydon tgetanyoftheabovebenefits ortaxcredits. * WorkingTaxCreditrun-onistheWorkingTaxCreditreceivedinthefourweeksimmediately afterapersonhasstoppedworkingfor16hoursormoreperweek. 4 / 5

5 What do Healthy Start beneficiaries receive? Healthy Start vouchers Pregnantwomenreceiveone voucheraweekworth Babiesundertheageofoneget twovouchersaweekwortha totalof Eachchildagedoveroneand underfourreceivesonevoucher aweekworth Vouchersarepostedouteveryfourweeks.Theycanbespentinawide rangeofparticipatinglocalshopsandgreengrocersaswellassupermarkets. Foralistofshopsbypostcode,visitwww.healthystart.nhs.ukanduse thepostcodecheckertofindlocalshops. Healthy Start vitamin coupons Everyeightweeksbeneficiariesalsoreceivevitamincoupons,which theycanexchangeforvitaminsintheirlocalarea.theircouponswillbe validforwomen stabletsand/orchildren sdrops,dependingontheir circumstances. Trustsandboardsmustensurethatarrangementsareinplacetosupply bothkindsofvitaminsupplements.maternityunitscanalsosupplythem iftheywish.moreinformationonhowtoordervitaminsandreclaimthe costofthosegivenoutthroughtheschemeisavailableonthehealthy Startwebsitewww.healthystart.nhs.uk

6 What beneficiaries can spend Healthy Start vouchers on HealthyStartvoucherscanbeacceptedaspaymentorpartpaymentfor milk, plain fresh or frozen fruit and vegetables,andinfant formula milk.therearemoredetailsbelow. Milk Plaincow 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 Anykindofplainfreshorfrozenfruitorvegetables,wholeor chopped,packagedorloose. Beneficiariescan tspendtheirvouchersonanyfreshorfrozenfruitandveg whichhasaddedsalt,fat,sugaroranyotheringredient.theyalsocan tspend themonpre-cooked,driedortinnedfruitandvegetables,fruitjuiceorsmoothies. Infant formula milk Infantformulamilkthatsaysonthepacketitcanbeusedfrombirth. Beneficiariescan tspendtheirvouchersoninfantformulasthataren t basedoncow smilk,suchassoyaformula.theyalsocan tspendthem onfollow-onformulasthataremadeforbabiesagedsixmonthsorolder. 6 / 7

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8 Healthy Start Recommendations and evidence Healthy Start replaced the means-tested elements of the Welfare Food Scheme throughout the UK in 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 They include: For pregnant women or those who may become pregnant Advisethemtotakeasupplementcontaining400micrograms(mcg) offolicaciddailypre-conceptionanduptothe12thweekofpregnancy; alsoprovideadviceonsuitablevitaminsupplementssuchashealthystart vitaminsforwomenandadvisethemtoeatfoodsrichinfolateandfolic acid. EnsurethateligiblewomenreceiveaHealthyStartapplicationleaflet (HS01)assoonaspossibleinpregnancy. ForwomenreceivingHealthyStartvouchers,providepracticaladviceon howtoincreasetheirintakeoffruitandvegetables. Duringthebookingappointment,offeradviceandinformationtoall womenaboutthebenefitsoftakingvitamindduringpregnancyand whilebreastfeedingandadvisethemofasuitablesupplementsuchas HealthyStartvitaminsforwomen;checkthatwomenatthegreatestrisk ofvitaminddeficiency(thosewhoarenotexposedtomuchsun,for examplethosewhocoveruptheirskinforculturalreasonsandpeople withdarkerskin,suchaspeopleofafrican-caribbeanandsouthasian origin)arefollowingtheadvice. 8 / 9

9 For mums and babies AdvisemothersaboutsuitablevitaminDsupplementssuchasHealthy Startvitaminsforwomen;checkthatwomenatthegreatestriskof deficiency(asbefore)arefollowingtheadvice. ForwomenreceivingHealthyStartvouchers,providepracticaladvice onhowtoincreasetheirintakeoffruitandvegetables. For families and carers of babies over six months and pre-school children OfferHealthyStartvitamindrops(A,CandD)toallchildrenaged fromsixmonthstotheirfourthbirthday,whoarehavinglessthan 500ml(apint)ofinfantformulaadayandwhosefamiliesareeligible forhealthystart. Provideparentsandcarerswithpracticaladviceonhowtheycan introducebabiestoavarietyofsolidfoods. AswellastheNICEguidance,theNational Service Framework for Children, Young People and Maternity Services(DH2004)statesthat maternityserviceprovidersshouldensurethatallpregnantwomenare offeredclearinformationontheavailabilityofhealthystart.

10 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 fromsixmonthsuntilfiveyearsofageunlesstheyaregettingmorethan 500mlofinfantformulaaday. In2007,SACNspecificallyreiteratedCOMA soriginalrecommendations onvitamindinitspositionstatementupdate on Vitamin D(SACN2007), recommendingthatallpregnantandbreastfeedingwomenshouldtake adailysupplementofvitamindinordertoensurethattheirown requirementforvitamindismetandtobuildadequatefetalstores forearlyinfancy,andallyoungchildrenshouldbegivenavitamind supplementuntilfiveyearsofageaspreviouslyrecommendedbycoma. NICE(2008)hasalsohighlightedtheimportanceofvitaminD supplementsforpregnantandbreastfeedingwomen. 10 / 11

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 duringantenatalconsultationsandencouragementshouldbegivento thoseleastlikelytobreastfeed(sacn2008b,paragraph128).

12 What to do next FindouthowHealthyStartvitaminsaredistributedbyyourtrustor boardandroutinelytellpregnantwomenandfamiliesonthescheme aboutthevitamins,whythey reimportantandhowtogetthem. OrderHealthyStartapplicationleaflets(HS01)andotherresourcesat MakesureHealthyStartisembeddedinyourlocalpoliciestopromote breastfeedingandhealthyeating. UseHealthyStartasanopportunitytosignpostlocalinitiativesfor pregnantwomenandyoungfamilies. VisittheHealthyStartwebsitewww.healthystart.nhs.ukformore informationabouttheschemeandyourrole,andtoviewtheinformation thatissentdirectlytobeneficiarieswiththeirvouchers. 12 / 13

13 Who can give out the application leaflet? Anyonecanorderbulksuppliesoftheapplicationleaflet(HS01)andgive themout,butitisespeciallyimportanttomakethemavailablewherever servicesforpregnantwomenandfamiliesarebeingprovided. Anymemberofthepubliccanalsorequesttheirowncopydirectlyfrom thehealthystarthelplineon ,ordownloadthe applicationleafletfromwww.healthystart.nhs.uk Bookingandhealthandsocialcareassessmentappointmentsaregood opportunitiestoprovidetheapplicationleafletinpersonbecausepregnant 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.

14 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). SACNalsorecentlypublisheditsreportThe Influence of Maternal, Fetal and Child Nutrition on the Development of Chronic Disease in Later Life, concludingthatimprovingthenutritionalstatusofwomenofchild-bearing age,infantsandyoungchildrenhasthepotentialtoimprovethehealthof futuregenerations(sacn2011). 14 / 15

15 Health inequalities Manypeoplefollowahealthybalanceddiet,butalargenumberdon t, particularlyamongthemoredisadvantagedandvulnerableinsociety (DH2005).TheIndependent Inquiry into Inequalities in Health(Acheson1998) emphasisedtheinfluenceofpoverty,educationandpoorearlynutritionon healthinequalities.thereportrecommendedpoliciestoimprovenutrition, reducefoodpovertyandpreventchildhoodobesity.the Low Income Diet and Nutrition Survey(2007)assessedthedietaryhabitsandnutritionalstatusofthe UKlowincomepopulation.Theareasofconcernhighlightedweresimilarto thosealreadyidentifiedinthegeneralpopulation,althoughsomeweremore marked.forexample,thesurveyfoundevidenceoflowfruitandvegetable consumptionandpoornutritionalstatusforsomevitaminsandminerals, includingvitamind(nelsonetal.2007).morerecently,recommendations havebeenmadebysacninanumberofitsreportsincludingthe Nutritional Wellbeing of the British Population (SACN2008a) anditsreviewofthekey findingsfromtheinfantfeedingsurvey2005,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.

16 How Healthy Start gives you the opportunity to help disadvantaged women Becausepregnantwomenandfamiliesneedtogettheirapplication leafletcountersignedbyahealthprofessional,theapplicationprocess offersanopportunitytoidentifythosewhoaremorelikelytobe disadvantaged,youngandlivinginvulnerablesituationsaswellasto engagewiththemandreferthemontorelevantservicesforadditional supportifrequired.forexample,awomanwhoqualifiesforhealthystart maybelesslikelytobreastfeed.asahealthprofessionalyoumaybeable todirecthertobreastfeedingeducationandsupport,peersupportand thelocalsurestartchildren scentreorfamilycentre. It sachancetodiscussbreastfeedingandnutritionandgivewomen generalhealthadviceatatimewhentheyarelikelytobemostreceptive toit.forinstance,youmightbeabletosuggestwhattheyspendtheir voucherson. TheUKHealthDepartmentsbelievethatmaternityservicesshouldbe proactiveinengagingallwomen,butparticularlythosewomenfrom disadvantagedgroupsandcommunities,earlyinpregnancyandmaintaining contactuptoandafterbirth(dh2004;welshassemblygovernment2005). SACNhasalsorecommendedthatadviceoninfantfeedingneedstobe tailoredaccordingtosocialgroup(sacn2008a).seealsopages30and31. The role of health professionals is crucial Recentresearchhasshownthattheroleofhealthprofessionalsinintroducing HealthyStartisincrediblyimportant.ParentswhoareintroducedtoHealthy Startthroughahealthprofessionalaremorelikelytoseethemselvesworking inpartnershipwithhealthystartforthebenefitoftheirchildrenasopposed toviewingtheschemesimplyasfinancialsupport(dhqualitativeresearch, October2009,unpublished). 16 / 17

17 Nutrition in pregnancy HealthyStartencouragespregnantwomenfromdisadvantagedgroups toincludemilkandavarietyoffruitandvegetablesintheirdiet.teenage girls,whohaveincreasednutritionalrequirements,areatgreaterriskof nutrientdeficienciesduringpregnancy,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.

18 What pregnant women should eat Theeatwellplate 1 shows howmuchofeachtype offoodisneededtohavea healthy,well-balanceddiet. Plenty 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,eggsandpulsessuch asbeansandlentils,whicharealsogoodsourcesofiron.pleasenote: pregnantwomenshouldtrytoeatatleasttwoportionsoffishaweek, 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 Foodssuchascakesandbiscuitsbecausethey rehighinfatandsugars andcancauseunnecessaryweightgaininpregnancy. Healthy snacks to recommend instead include: Maltloaf,lower-fatyoghurts,fruit includingfresh,tinnedor100% unsweetenedfruitjuice,andsmallhandfulsofdriedfruitsuchasraisins orapricots. 18 / 19 1 DepartmentofHealthinassociationwiththeWelshGovernment, thescottishgovernmentandthefoodstandardsagencyinnorthernireland

19 Foods to avoid during pregnancy Some types of cheese:mouldripenedandblue-veinedsoft cheeses(suchasbrie,camembertordanishblue).thesemaycontain listeria,whichcancausemiscarriage,stillbirthorsevereillnessinthe newbornbaby. Pâté:alltypesofpâté,includingvegetablepâtés,astheycan containlisteria. Uncooked or undercooked ready meals,includingraworpartially cookedmeat,especiallypoultry. Raw or partially cooked eggs,toavoidtheriskofsalmonella. Raw or undercooked meat. Liver, liver products, fish liver oil supplements and supplements containing vitamin A (retinol)(seepage28). Some types of fish:pregnantwomenshouldavoideatingshark, marlinandswordfishandlimittheamountoftunatheyeattono morethantwotunasteaks(170geachraw)orfourcans(140gdrained weight)perweek;thesetypesoffishcontainhighlevelsofmercury, whichcandamagethebaby sdevelopingnervoussystem. Raw shellfish. Unpasteurised milk andproductsmadefromunpasteurisedmilk. Alcohol(seepage23). A note on peanuts Previousadvicehasbeenthatwomenmaychoosetoavoideatingpeanuts duringpregnancyandwhenbreastfeedingifthereisahistoryofallergyintheir child simmediatefamily(suchasasthma,eczema,hayfever,foodallergiesetc). Thisadvicehasnowchangedasthelatestresearchshowsthatthereisnoclear evidencethateatingpeanutsduringpregnancyandwhenbreastfeeding affectsthechancesofababydevelopingapeanutallergy.sopregnantand breastfeedingwomenarenowadvisedthattheycaneatpeanutsaspartof ahealthybalanceddietiftheychoosetoandarenotallergicthemselves.

20 Caffeine Consuminghighlevelsofcaffeine duringpregnancycanresultinbabies beingbornwithlowbirthweight, whichcanincreasetheriskofhealth problemsinlaterlife.toomuchcan alsocausemiscarriages,sopregnant womenshouldlimittheircaffeine intake. Pregnantwomenshouldhaveno morethan200mgofcaffeineper day,i.e.nomorethanapproximately twomugsofinstantcoffeeorone mugoffiltercoffeeortwomugsof teaortwocansofenergydrink. Physical activity Regularphysicalactivityisimportant forallwomenanditisrecommended thattheyhave150minutesof moderateintensityactivityaweek, suchasbriskwalking.pregnant womenshouldaimtostayasactiveas possible,bearinginmindthestageof pregnancytheyareat.iftheytake partingymclassestheyshouldmake surethattheirinstructorknowsthey arepregnantandtaketheiradviceon appropriateactivity.contactsports andthoseactivitieswithariskof fallingshouldbeavoided.women whohaven tbeenundertakingregular physicalactivitypriortotheir pregnancyshouldconsiderlow-impact exercisetheywillenjoy,suchasbrisk walking,swimmingandaqua-natal classes,whicharegentleinmovement andintensity.theyshouldbeadvised tobuildupexercisegradually,for examplein10-minutelotsthroughout theday,andtoavoidsittingforlong periodsoftime. Physical activity for children Beforetheybegintocrawl,babies shouldbeencouragedtobephysically activebyreachingandgrasping, pullingandpushing,movingtheir head,bodyandlimbsduringdaily routines,andduringsupervisedfloor play,includingtummytime.once babiescanmovearound,theyshould beencouragedtobeasactiveas possibleinasafe,supervisedand nurturingplayenvironment. Childrenwhocanwalkontheirown shouldbephysicallyactiveeveryday foratleast180minutes(3hours).this shouldbespreadthroughouttheday, indoorsoroutside.the180minutes canincludelightactivitysuchas standingup,movingaround,rolling andplaying,aswellasmoreenergetic activitylikeskipping,hopping,running andjumping.activeplay,suchas usingaclimbingframe,ridingabike, playinginwater,chasinggamesand ballgames,isthebestwayforthisage grouptobephysicallyactive. 20 / 21

21 Under5sshouldnotbeinactivefor longperiods,exceptwhenthey re asleep.watchingtv,travellingbycar, busortrainorbeingstrappedintoa buggyforlongperiodsarenotgood forachild shealthanddevelopment. There sgrowingevidencethatsuch behaviourcanincreasetheirriskof poorhealth.allchildrenunderfive whoareoverweightcanimprovetheir healthbymeetingtheseactivity guidelines.toachieveandmaintaina healthyweight,theymayneedtodo additionalactivityandmakechanges totheirdiet. 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:

22 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) Smokeline(Scotland) StopSmokingWales SmokersHelpline(Wales) (NorthernIreland) 22 / 23

23 Alcohol and pregnancy Alcoholcanbeharmfultothedevelopingbabyandmayleadtoearly miscarriage.heavydrinkingisparticularlyrisky.itisadvisedthatpregnant womenorwomentryingtoconceiveshouldavoiddrinkingalcohol. Iftheydochoosetodrink,tominimisetherisktothebabytheyshouldnot drinkmorethanoneortwounitsonceortwiceaweek andshouldnotget drunk.additionally,nicerecommendsthatwomenshouldavoidalcoholinthe firstthreemonthsinparticular,becauseoftheincreasedriskofmiscarriage. Oneunitofalcohol=asingle (25ml)measureofspiritsat40% ABV(alcoholbyvolume),half apintofbeerat3.5%abv, orhalfa175mlglassofwineat 11.5%ABV.Largerorstronger drinksthanthesewouldcontain morethanoneunitofalcohol. Itcanbeparticularlyeasyto underestimateunitswhendrinks arepouredathome. Formoreadviceonalcohol andunitinformationvisit Orcall: Drinkline Drinkline(Scotland) Breastfeeding and alcohol Alcoholcanpassthroughthemother s milktobreastfedbabiesinverysmall amounts.itisunlikelythathavingan occasionaldrinkwillharmthemother orbaby,butitmightaffecthoweasily thebabyfeeds.breastfeedingwomen shouldbeadvisedtodrinkverylittle,for examplenomorethanoneortwounits onceortwiceaweek.ifabreastfeeding womanintendstodrinkmorethanthis, theycanexpressmilkinadvance. Ifabreastfeedingmotherdrinks alcoholbeforefeeding,itcanaffect thebabyinanumberofways: Themilkmaysmelldifferentandthe babymaynotfeedaswellasnormal. Thebabymaysleeplesswellfor somehoursafterfeeding. Itisnotadvisableforwomentoshare abedorasofawiththeirbabyif theyhavebeendrinking.ifthey sleepheavilytheycouldputtheir babyatrisk.

24 Illegal drugs Useofillegaldrugscanbeharmfultobothmotherandbaby.Women whomaygetpregnant,whoarepregnantorwhoarebreastfeeding shouldnormallyaimtobecompletelydrugfree.however,regulardaily usersofsomeillegaldrugsassociatedwithwithdrawalproblemsshould notstopusingabruptlywithoutseekingadvice. Mostnon-dependentdruguserswillcertainlybeabletostopusingillegal drugsontheirownwithlittleornodifficulty.forthosewomenwhoneedit, primarycareandspecialistdrugsservices canprovideadviceandsupportabout quitting.nicehasproducedguidance onthecarethatpregnantwomenwith complexsocialfactors,includingthose misusingdrugs,shouldreceive Womenatriskofdevelopingmarked withdrawalsymptoms,particularlydaily usersofdepressantdrugssuchas opiatesorbenzodiazepines,should obtainveryearlymedicaladvicebefore makinganylargeorabruptreductions intheirdruguse.whenmedically supportedwithdrawalisneeded,this Confidential advice for drug users FRANK(UK-wide) KnowtheScore(Scotland) DAN24/7(Wales) canthenbeproperlyplannedtobeassafeaspossibleforbothmother andbaby.somewomenwithmarkedheroindependencedoneedtostay onsomesubstitutemedicationthroughoutthefirsttrimester,andfor someforthewholepregnancy. 24 / 25

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.therearecertainsupplementstheyshouldtakewhich willhelppreventthemfrombecomingdeficient. How Healthy Start beneficiaries claim their free vitamins EachNHSorganisationorboardisresponsiblefordistributingvitamins locally.somemayalsochoosetosellorsupplythemfreeofcharge towomenandchildrenwhoarenoteligibleforhealthystart.formore informationaboutvitamindistributionineachukcountry,visit Beneficiariesreceiveavitamincouponandareadvisedtoasktheir midwife,healthvisitororpublichealthnurseaboutwheretheycan usethecoupon,andtotakeitwiththemtocollecttheirvitamins. So it s essential that health professionals know what the local arrangements are.

26 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)offolicacidperdaybothbeforeandup untilthe12thweekofpregnancycanhelppreventntdssuchasspina bifida,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. Therefore,takingfolicacidsupplementsisimportantwhentryingtoget pregnantandintheearlystagesofpregnancy. IfamotherhasalreadyhadapregnancyaffectedbyanNTDorhas diabetesoristakinganti-epilepticmedicines,sheisadvisedtoseek medicaladvicefromhergp. 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 an 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 as they will need to take a higher dose of folic acid. (AsrecommendedbyCOMA (2000),SACN(2006)andNICE(2008).) 26 / 27

Delivering a Healthy Start for pregnant women, new mums, babies and young children

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