1 HS52A Delivering a Healthy Start for pregnant women, new mums, babies and young children Read more A guide for health professionals 1
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 16,190orlessin2011/12. Womenalsoqualifyforthewholeoftheirpregnancyiftheyareunder 18whentheyapply,eveniftheydon tgetanyoftheabovebenefits ortaxcredits. * WorkingTaxCreditrun-onistheWorkingTaxCreditreceivedinthefourweeksimmediately afterapersonhasstoppedworkingfor16hoursormoreperweek. 4 / 5
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
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 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
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.
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 fromsixmonthsuntilfiveyearsofage. In2007,SACNspecificallyreiteratedCOMA soriginalrecommendations onvitamindinitspositionstatementupdate on Vitamin D(SACN2007), recommendingthatallpregnantandbreastfeedingwomenshouldtake adailysupplementofvitamindinordertoensuretheirownrequirement forvitamindismetandtobuildadequatefetalstoresforearlyinfancy, andallyoungchildrenshouldbegivenavitamindsupplementuntilfive yearsofageaspreviouslyrecommendedbycoma. NICE(2008)hasalsohighlightedtheimportanceofvitaminD supplementsforpregnantandbreastfeedingwomen. 10 / 11
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 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.
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). 14 / 15
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.
16 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
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.
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,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 Foodssuchascakesandbiscuitsbecausethey rehighinfatandsugars andcancauseunnecessaryweightgaininpregnancy. Healthy snacks to recommend instead include: Maltloaf,lower-fatyoghurts,fruit includingfresh,tinnedor100% unsweetenedfruitjuice,andsmallhandfulsofdriedfruitsuchasraisins orapricots. 18 / 19 1 DepartmentofHealthinassociationwiththeWelshAssemblyGovernment, thescottishgovernmentandthefoodstandardsagencyinnorthernireland
19 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.
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:
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
24 Illegal drugs Useofillegaldrugs,particularlyheavyuse,canbeharmfulforboth motherandbaby.womenwhoarepregnantorbreastfeedingshould normallyaimtobecompletelydrugfree.healthprofessionalscanprovide encouragementtoquit. However,thosedependentonheroinorotheropiatesandsome tranquillisersneedtotakemedicaladvice;itmaybemuchsaferforthem toremainonsomeprescribedreplacementdrugsuntilafterdelivery. Confidential advice for drug users FRANK(UK-wide) KnowtheScore(Scotland) DAN24/7(Wales) / 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.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.
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)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
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).)
28 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
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.
32 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
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).
42 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
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.
44 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
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
46 Find out more Healthy Start resources AllHealthyStartresourcesareavailabletoorderordownloadat Youcanalso downloadthematwww.healthystart.nhs.uk HealthyStartapplicationleafletHS01 HealthyStartvitaminbookletHS52BE(Englandonly) HealthyStartgeneralposterHS50(orderonly) HealthyStartvitaminsformumsposterHS504(orderonly) HealthyStartvitaminsforchildrenposterHS505(orderonly) Quickguideforfirst-timemumsHS507 Quickguideforpregnantunder-18sHS / 47
47 General resources England NHSBirthtofive: planners/birthtofive/pages/ Birthtofivehome.aspx NHSbreastfeedingwebsite: NHSChoices: NHSDirect: ADAY: DepartmentofHealth: Start4Life: Change4Life: Publications OfftotheBestStart BottleFeeding IntroducingSolidFood Ifyouwanttoordertheseleaflets pleasecall orvisitwww.orderline.dh.gov.uk Scotland ReadySteadyBaby!: NHSHealthScotlandwebsite: NHS24: Breastfeeding Thefeedgoodfactor: Publications OfftoaGoodStart Allyouneedto knowaboutbreastfeedingyourbaby BreastfeedingandReturningtoWork FunFirstFoods Aneasyguideto introducingsolidfoods Wales WelshAssemblyGovernment Breastfeeding: NHSDirectWales: 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:
48 Breastfeeding organisations The following organisations and websites provide further resources and examples of service improvement and innovation which can support local breastfeeding initiatives. TheAssociationofBreastfeedingMothersisacharity runbymothersformothers,givingfriendlysupportandsupplyingaccurate informationtoallwomenwishingtobreastfeed.italsosupportsthenational BreastfeedingHelpline. breastfeedingactivityintheuk,andinformationforcommissionersonhow todelivertheunicefukbabyfriendlyinitiative(bfi).userscansubscribe to updates. aimstosavelivesandendavoidablesufferingcausedbyinappropriateinfant feeding.itworksgloballytostrengthencontrolsonmarketingbythebaby feedingindustry. 48 / 49
50 References AchesonD(Chairman)(1998)Independent Inquiry into Inequalities in Health Report. TheStationeryOfficeLondon:(TSO). BollingKetal.(2007)Infant Feeding Survey 2005.London:TheInformationCentre forhealthandsocialcrae. CMO(2005)MeetingtheneedforvitaminD.CMO Update42:6. 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: Opportunities for action.nationalheartforum.london:tso. DH(1991)Dietary Reference Values for Food Energy and Nutrients for the United Kingdom.ReportofthePanelonDietaryReferenceValuesofthe CommitteeonMedicalAspectsofFoodPolicy.ReportonHealthandSocial SubjectsNo.41.London:HerMajesty sstationeryoffice(hmso). DH(1994)Weaning and the Weaning Diet: Report of the Working Group on the Weaning Diet of the Committee on Medical Aspects of Food Policy.London:HMSO. DH(2002)Scientific Review of the Welfare Food Scheme: Report of the Panel on Child and Maternal Nutrition of the Committee on Medical Aspects of Food and Nutrition Policy.ReportonHealthandSocialSubjectsNo.51.London:TSO. DH(2003a)Infant Feeding Recommendation.London:DH. DH(2004a)Choosing a Better Diet: A food and health action plan.london:dh. DH(2004b)National Service Framework for Children, Young People and Maternity Services, Standard 11: Maternity Services.London:DH. FairbankLetal.(2001)Promotingtheinitiationofbreastfeeding. Quality in Healthcare 10(2): FoodStandardsAgency(2007)Low Income Diet and Nutrition Survey, London:TSO. WelshAssemblyGovernment(2005)The National Service Framework for Children, Young People and Maternity Services in Wales,Chapter3:Maternity Services.Cardiff:WelshAssemblyGovernment. 50 / 51
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