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Scottish Perspective on NICE public health guidance 11: Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households July 2009. Introduction. NICE public health guidance. Produced by the National Institute for Health and Clinical Excellence, for England

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Scottish Perspective on NICE public health guidance 11:

Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households

July 2009

NICE public health guidance
  • Produced by the National Institute for Health and Clinical Excellence, for England
  • Aimed at promoting good health and preventing ill-health
  • Evidence-informed, using a highly developed and rigorous process; also takes account of stakeholders’ views, and fieldwork
  • No formal status in Scotland, but a valuable source of evidence-informed recommendations
The Scottish Perspectives
  • Intended to help organisations and individuals in Scotland make appropriate use of NICE public health guidance
  • Do not themselves constitute formal guidance
  • Contain:
    • summary or overview of recommendations (or key action points) for Scotland
    • full recommendations for Scotland
    • information to support implementation (including Scottish contextual points)
Scottish Perspective on NICE public health guidance 11
  • Intended for NHS/other professionals who have a direct or indirect role in – and responsibility for – the nutrition of pregnant and breastfeeding mothers and pre-school children
  • May also be of interest to members of the public
  • 22 recommendations under 15 headings
  • 6 of these recommendations ‘key priority’, under 5 headings:
    • Healthy Start
    • Training
    • Vitamin D
    • Breastfeeding
    • Folic acid
Healthy Start (1)
  • Promote the Healthy Start (HS) scheme
  • Ensure an adequate supply of both types of HS vitamin supplements
  • Ensure an adequate supply of HS application forms, and regular audit of uptake of HS benefits
  • Advise pregnant women and parents of children under 4 years about the scheme; ensure all possibly eligible women receive an application form as early as possible in pregnancy
  • Offer eligible parents information, support and advice
Healthy Start (2)
  • Offer the maternal HS vitamin supplement to pregnant women who are/may be eligible
  • Offer children’s HS vitamin supplements to all children aged 6 months to 4 years in families receiving the HS benefit
  • Consider distributing the maternal HS vitamin supplement to all women who receive HS benefit for children aged 1–4 years, particularly those who may become pregnant
  • Ensure the HS maternal vitamin supplements are available for purchase by women who are not eligible to receive them free of charge
  • Involve the voluntary sector in improving access to fruits and vegetables under HS
  • Ensure health professionals have appropriate knowledge and skills to give advice on a range of relevant aspects of diet, nutrition (including breastfeeding) and eating behaviour
  • Train midwives, health visitors/public health nurses, and support workers in breastfeeding management, using Baby Friendly Initiative (BFI) training as a minimum standard
  • Train health professionals to promote and support breastfeeding, using BFI training as a minimum standard; offer such training to a wide range of community-based staff, e.g. nursery workers and childminders
Vitamin D
  • Educate health professionals about the importance of vitamin D supplements for all pregnant and breastfeeding women
  • During the booking appointment, offer every woman information and advice on the benefits of taking a vitamin D supplement during pregnancy and while breastfeeding
  • Check that women at greatest risk of deficiency are following advice to take a vitamin D supplement
  • Advise all pregnant and breastfeeding women about availability of suitable vitamin D supplements
  • Include information with relevant products
Breastfeeding (1)
  • Adopt a multifaceted approach or coordinated programme of interventions across different settings to increase breastfeeding rates
  • Implement a structured programme that encourages breastfeeding, using BFI as a minimum standard; subject it to external evaluation
  • Ensure a written, audited and well-publicised breastfeeding policy, with an identified health professional responsible for implementing it
Breastfeeding (2)
  • Provide local, easily accessible breastfeeding peer support programmes, with peer supporters part of a multidisciplinary team
  • Ensure peer supporters: attend a recognised, externally accredited training course; contact new mothers within 48 hours of transfer home/home birth; offer mothers ongoing support according to needs; can consult a health professional and have ongoing support; and gain appropriate child protection clearance
  • Consider training peer supporters and link workers to help mothers, parents and carers follow professional advice on feeding infants aged 6 months +
Folic acid (1)
  • Advise women who may become pregnant on reducing the risk of neural tube defect (NTD) by taking folic acid (FA) supplements; encourage women who may become pregnant and women in the first 12 weeks of pregnancy to take FA supplements and consume foods/drinks rich in FA/folate
  • Ensure local education initiatives for health professionals include information on the importance of FA supplements; provide the maternal HS vitamin supplements for eligible women; and ensure women who are not eligible for HS can obtain them from their local pharmacy
Folic acid (2)
  • Prescribe FA for women planning/in the early stages of pregnancy if: they (or their partner) have NTD or a family history of NTD; or they have had a previous baby with NTD; or they have diabetes
  • Include with relevant products information on the importance of FA supplements before and during pregnancy
Some general considerations
  • Importance of ensuring that mothers and their babies are well-nourished: benefits to maternal health, and to child health, growth and development; and may influence the health of the child in adulthood
  • Various established and possible benefits of breastfeeding to the health of mother and child
Equality and diversity

considerations (1)

  • Statutory duties and good practice principles
  • Adverse links between socioeconomic disadvantage and maternal and child nutrition
  • Healthy Start (Recommendation 4) is open to pregnant women and families with children under the age of 4 who qualify on welfare benefits/low income grounds, and to all pregnant women under 18
  • Services need to be accessible and applicable to everyone
Equality and diversity

considerations (2)

  • Shortage of evidence relating to different socioeconomic, ethnic or vulnerable groups; but evidence that dietary interventions recognising the specific circumstances facing people who are disadvantaged are likely to be more effective than generic ones
  • Equality and diversity dimensions: age, disability, gender (including transgender), language, marital status, race/ethnicity, religion or belief, sexual orientation, social origin/socioeconomic factors
  • Targeting, tailoring, etc.
  • Relevant recommendations for research
Scottish contextual points:breastfeeding (1)
  • NHS 'HEAT' target: Increase the proportion of new-born children exclusively breastfed at 6–8 weeks from 26.6% in 2006/07 to 33.3% in 2010/11
  • Rates for breastfeeding (exclusive and overall) relatively stable since 2001
  • Provisional 2008 data –
    • at First Visit review, 45.0% of mothers breastfeeding: 37.0% exclusively, 8.0% both breast milk and formula milk
    • at 6–8 week review, 36.1% of mothers were breastfeeding, including 26.7% exclusively
    • younger mothers in most deprived areas least likely to breastfeed
Scottish contextual points: breastfeeding (2)
  • Just over half of births in Scotland in ‘Baby Friendly’ hospitals
  • Breastfeeding etc. (Scotland) Act 2005
  • Scottish Government has formally adopted WHO guidance recommending exclusive breastfeeding for first 6 months; advocates introduction of solids at around 6 months
Scottish contextual points:vitamin D
  • At UK (and particularly Scottish) latitudes, limited sunlight of appropriate wavelength, especially during winter – maternal skin exposure alone may not achieve optimal vitamin D status needed for pregnancy
Relevant Scottish policies, etc. (1)
  • National Performance Framework
  • Equally Well: Report of the Ministerial Task Force on Health Inequalities (Scottish Government, 2008)
  • Better Health Better Care: Action Plan (Scottish Government, 2007)
  • The Early Years Framework (Scottish Government, 2008)
Relevant Scottish policies, etc. (2)
  • Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011)(Scottish Government, 2008)
  • CEL 36 (2008) – ‘Nutrition of women of childbearing age, pregnant women and children under five in disadvantaged areas - funding allocation 2008 - 2011’ (Scottish Government, September 2008)
  • Nutritional Guidance for Early Years: food choices for children aged 1-5 years in early education and childcare settings (Scottish Executive, 2006)
Web address and contact
  • Scottish Perspectives on NICE public health guidance
  • For further information, or to give feedback, please contact Kate Woodman of NHS Health Scotland [email protected]