Improving maternal and infant nutrition: a framework for action

1.1 Preparation programmes for the defined workforce should include current, consistent, evidence-based education on maternal & infant nutrition which includes nutrition prior to conception, during & after pregnancy, appropriate nutritional supplementation, breastfeeding, infant formula feeding, complementary feeding & transition to family diet

1, 2, 3

Higher & Further Education Institutions

Maternal & infant nutrition included in preparation programmes for key health professions & early years workers

By end 2014/15

1.2 National occupational standards on maternal & infant nutrition will be developed.

1, 2, 3

Scottish Government

Standards developed

By end 2012/13

1.3 The defined workforce must accept responsibility for its CPD needs on maternal & infant nutrition relevant to their scope of practice and to enable them to do this training opportunities will be developed building on existing provision. Individuals who have a nationally recognised standard of expertise and skill in maternal & infant nutrition will deliver such training, with appropriate governance arrangement in place to support them.

1, 2, 3

Individual practitioners

NHS Boards

Local Authorities

Training opportunities for relevant staff available in each NHS Board area (such training will be made available to staff in other local organisations, e.g. local authorities)

Appropriately qualified staff available in each NHS Board area

By end 2011/12

1.4 A national training resource on maternal & infant nutrition, to include behaviour change models, which can be adapted according to scope of practice, and used for local CPD will be developed.

1, 2, 3, 4

NHS Health Scotland

NHS Education for Scotland

Training resource developed

By end 2011/12

1.5 Healthcare, education & social care managers must promote positive attitudes and challenge negative attitudes towards maternal & infant nutrition. This can be done using a range of methods e.g. health behaviour change and skills & attitudes training.

1, 2, 3, 4

NHS Boards

Local Authorities

Health behaviour change & skills and attitudes training available in each local area

By end 2011/12

1.6 Training opportunities will be available to enable the defined workforce to engage more effectively with disadvantaged groups. The NES health inequalities learning resource 'Bridging the Gap' should be used for such CPD training and be integrated into under & post graduate education programmes.

1, 2, 3, 4

NHS Boards

NHS Education for Scotland

Higher & Further Education Institutions

Training opportunities on engaging with disadvantaged groups available in each local area

Principles of 'Bridging the Gap' integrated into relevant education programmes

By end 2012/13

By end 2014/15

1.7 Staff responsible for weighing and measuring infants & young children will be trained in the use and interpretation of the new WHO growth charts and be competent to engage with parents and support them to manage issues such as growth faltering and obesity.

2, 3, 4, 5

NHS Boards

All relevant staff trained to use & interpret new growth charts

By end 2010/11

1.8 Sexual health and reproductive education for sexual health staff and other health professionals should include the importance of nutrition on reproductive health

1

Higher Education Institutions

Nutrition included in sexual health & reproductive education

By end 2011/12

1.9 Maternal history taking, as outlined NHS QIS Best Practice Statement on maternal history taking (2008) and Scottish Woman-Held Maternity Record ( SWHMR, 2008) will include a basic diet history including nutritional supplementation, BMI and, where appropriate, onward referral to specialist services (e.g. obstetrics, dietetics etc)

1, 4, 5, 6

NHS QIS

NHS QIS Best Practice Statement updated

By end 2011/12

1.10 Nutrition prior to pregnancy, during pregnancy and infant feeding will be included in Curriculum for Excellence and resources identified/developed for teachers

7-11

Learning & Teaching Scotland

NHS Health Scotland

Maternal & infant nutrition included in Curriculum for Excellence health & wellbeing experiences & outcomes

Maternal & infant nutrition included in the assessment criteria for the health & wellbeing experience & outcomes

Development of a resource to support delivery of the relevant experiences & outcomes

By end 2011/12

By end 2011/2012

By end 2012/13

2.1 All maternity units will achieve and maintain UNICEF Baby Friendly accreditation as a minimum standard

2, 8

NHS Boards

80% maternity units with BFI accreditation

100% maternity units with BFI accreditation

By end 2013/14

By end 2015/16

2.2 All Community Health Partnerships will achieve and maintain UNICEF Baby Friendly accreditation as a minimum standard. Measures which will lead to an increased uptake of Baby Friendly accreditation by GP practices will be explored.

2, 8

NHS Boards

50% CHPs with BFI accreditation

80% CHPs with BFI accreditation

By end 2013/14

By end 2015/16

2.3 All universities providing midwifery and public health nursing programmes should raise awareness of UNICEF Baby Friendly accreditation for their courses.

2, 8

Higher Education Institutions

50% midwifery & public health nursing programmes with BFI accreditation

By end 2015/16

3.1 All policymakers will ensure that new/refreshed national/local policies take account of the activities in the Maternal & Infant Nutrition Action Plan where relevant.

6

Scottish Government

NHS Boards

Local Authorities

Maternal & infant nutrition included in relevant policies

Ongoing

3.2 Increase the awareness of the WHO International Code on Marketing of Breast milk Substitutes and adopt the principles of the Code in all public sector organisations. Continue to influence decisions on legislation relating to manufactured baby & toddler foods to ensure it is fully implemented and enforced.

2, 3, 8, 9, 10

Scottish Government

NHS Boards

Food Standards Agency Scotland

Principles of WHO Code adopted by all public sector organisations

By end 2011/12

3.3 Work with NHS Boards to strengthen existing methods to meet with infant formula and baby food manufacturers to review and assess the suitability of their proposed product information for use in Scotland, in line with the principles of the WHO Code

2, 3

Scottish Government

NHS Boards

By end 2010/11

3.4 Work with food retailers in Scotland to provide and promote affordable healthy food choices for children., pregnant and breastfeeding women

12

Scottish Government

Food Standards Agency Scotland

To be determined as part of Obesity Route Map and Food & Drink Policy

3.5 Work with private sector companies to encourage them to include healthy eating considerations for children in all aspects of their work, for example in the products they produce, in the sponsorship they provide, in their product marketing etc.

9, 10

Scottish Government

Food Standards Agency Scotland

To be determined as part of Obesity Route Map and Food & Drink Policy

4.1 A positive media strategy with consistent lines and messages designed to combat myths and misinformation about maternal and infant nutrition will be developed. Appropriate mechanisms and communication channels will be developed to support and enable health professionals to interpret and respond to reports on maternal & infant nutrition appropriately.

7-11

Scottish Government

Media strategy & communication channels developed

By end 2011/12

4.2 Agree and distribute maternal and infant nutrition publications and resources which should be given out universally as per NHS Health Scotland Early Years Information Pathway. These publications and resources should be assessed and updated to ensure accessibility.

7-11

NHS Health Scotland

NHS Boards

Publications assessed and updated

By end 2011/12

5.1 Antenatal education will be made available to all women and their significant others (such as their partner, mother/mother-in-law) proportionate to need and include accessible, relevant, non-judgemental practical support and information on maternal and infant nutrition. This may include parent education classes, infant feeding workshops, nutrition resources in a variety of formats and signposting to locally provided practical food skills sessions.

In order to reach all women, services will need to be designed so that they are inclusive and responsive to those with additional needs who do not normally access services e.g. young parents, parents with learning difficulties, parents from minority ethnic groups and those living in areas of social deprivation.

7-11

NHS Boards

NHS Health Scotland

NHS Education Scotland

NHS QIS

Maternal & infant nutrition included in all aspects of antenatal education. Antenatal education in each Board reviewed and redesigned, where necessary, to reach those with additional needs

By end 2011/12

5.2 Structured support proportionate to need will be provided for breastfeeding mothers postnatally, including:

• Support from health professionals and relevant organisations e.g. Breastfeeding Network, National Childbirth Trust, La Leche League, Association of Breastfeeding Mothers
• Access to breastfeeding support groups and relevant organisations
• Access to the National Breastfeeding Helpline
• Access to peer /mother-to-mother breastfeeding support programmes

As with antenatal support, postnatal support services will need to be designed so that they are responsive and inclusive to those with additional needs who are least likely to breastfeed or only breastfeed for a short time, such as young mothers, mothers with poorer educational attainment and those living in areas of social deprivation where breastfeeding rates are low.

8, 10

NHS Boards

Voluntary sector

Information on local support given to all breastfeeding mothers on hospital discharge, to include local voluntary organisations, Helpline number, peer support programmes

Postnatal support for breastfeeding mothers in each area reviewed and redesigned, where necessary, to reach those with additional needs

By end 2010/11

By end 2011/12

5.3 Accredited breastfeeding peer support programmes will be provided in all NHS Board areas. These should be modelled on a nationally agreed framework and be supervised by an appropriately trained and experienced practitioner. Peer support will be offered to women before and after birth alongside other ante and postnatal support, and will be considered as core part of activity to support breastfeeding.

8, 10

NHS Boards

Voluntary sector

National framework for breastfeeding peer support programmes developed

Peer support programme available in each Board area, targeted to areas with low breastfeeding rates

By end 2011/12

By end 2012/13

5.4 Postnatal information and support will be provided to parents who have made a fully informed decision to formula feed, to minimise the risks associated with formula feeding. Information and practical support will include how to make up a feed correctly, how to use prepared feeds safely, how to sterilise equipment, appropriate positioning of the baby while feeding and the different types of infant formula.

9, 10

NHS Boards

NHS Health Scotland 'Bottle feeding' resource published

Practical support provided to all parents who decide to formula feed before hospital discharge

By end 2010

With immediate effect

5.5 In partnership with the community and voluntary sector explore opportunities to extend existing services aimed at parents e.g. parenting education include key age-appropriate healthy eating and oral health messages, and practical budgeting, shopping, cooking etc skills and support.

9, 10

NHS Boards

Local Authorities

Community and voluntary sector

Practical information and/or support for healthy eating included in existing parenting groups where possible

By end 2011/12

5.6 Encourage and enable community food workers/healthy living networks/centres to continue to deliver practical weaning sessions/healthy eating for families, including healthy eating and oral health messages, and practical budgeting, shopping etc skills and support. Map and signpost local community food initiatives e.g. food co-ops, weaning sessions, so that this information can be shared widely with various target groups.

4, 9, 10, 12

NHS Boards

Local Authorities

Community and voluntary sector

Local community food initiatives are supported to continue to deliver existing programmes

Local directory of community food initiatives developed in every area (where one does not already exist)

Ongoing

By end 2010/11

5.7 Widely promote the Healthy Start Scheme including how to use the vouchers, what can be bought with them, encouraging uptake of vitamin supplements and local community initiatives providing practical food skills support that beneficiaries can access.

7- 10, 12

Scottish Government

NHS Boards

Local Authorities

Community and voluntary sector

Local action plans for increasing uptake of Healthy Start in place (as part of implementation of CEL 36 (2008)

By end 2011/12

6.1 Encourage local development of Breastfeeding Welcome schemes to include private and public sector organisations.

10

Local Government

NHS Boards

By end 2011/12

6.2 Work with employers to support parents with young children in relation to nutrition e.g. providing information on the introduction of complementary feeding, healthy eating for toddlers, providing facilities for breastfeeding mothers when returning to work.

7-11

NHS Health Scotland (Healthy Working Lives)

Relevant criteria included in the refreshed Healthy Working Lives Award

By end 2012/13

6.3 All childcare providers (including childminders) who provide food, must provide appropriate healthy food and drinks for babies beyond the age of six months and young children. There is a range of guidance that can be used: 'Adventures in Foodland' (2004), 'Nutritional Guidance for Early Years' (2006) and 'Fun First Foods' (2010).

9, 10, 12

Scottish Government

Agree responsibilities of the new Social care & Social Work Improvement Scotland

By end 2011/12

7.1 Review the routinely collected data on breastfeeding on the ISD Scotland SMR02 Maternity Inpatient and Day Case Record and compare with the data on the CHSP-Pre-school system. Assess and review potential duplication in recording of breastfeeding information at birth and on discharge from hospital and provide further advice following this review.

13, 22, 23

ISD Scotland

Investigate completeness and accuracy of infant feeding data sources and recommend which data is most appropriate for monitoring purposes

By end 2011/12

7.2 Consider the feasibility of introducing a weight check as part of the 12 -13 month immunisation visit. This measurement should be plotted on the child's WHO Growth Chart and recorded in the Personal Child Health Record (Red Book) and entered on the Child Health Surveillance Programme - Pre-school system for statistical monitoring purposes. Where there are concerns about a child's growth and/or weight, or where the weight centile is above the 99.6 ^th, length should also be measured and appropriate advice should be given or a referral for further investigation made.

NHS Boards

To be agreed following Hall 4 consultation events

7.3 As part of the proposed reintroduction of a 24-30 month review into the universal child health surveillance programme, ⁸⁰ the issue of healthy growth patterns and weight should be discussed/raised with parents and/or carers. If there is concern about the child's pattern of growth or weight (either under or overweight), arrangements should be made for the child to be weighed and measured by the Public Health Nurse and their BMI calculated (using UK- WHO centile look up). This measurement should be plotted on the child's WHO Growth Chart and recorded in the Personal Child Health Record (Red Book). Height and weight should also be recorded on the Child Health Surveillance Programme - Pre-school system for statistical monitoring purposes. Where there are concerns about a child's growth and/or weight, appropriate healthy eating advice should be given or a referral for further investigation made.

21, 22, 23

To be agreed as part of Hall 4 consultation events

7.4 Explore the feasibility and potential effectiveness of a health check and intervention for postnatal mothers e.g. between 6-12 months, to provide an opportunity to improve maternal nutritional status. This feasibility study should take into consideration:

• The effectiveness (including cost effectiveness) of such an intervention aiming to improve maternal nutrition and prevent later ill health such as obesity, diabetes, osteoporosis
• The timing of a postnatal health check and intervention, taking into account current practice, provision and resources
• An intervention to improve iron, vitamin D and calcium status
• The recommendations from the forthcoming NICE public health guidance on weight management in pregnancy and after childbirth.

24, 25, 26

Scottish Government

Working group established to determine feasibility of health check and intervention for postnatal mothers

By end 2010/11