Presentation on theme: "MILK & MORE Helping children eat for a healthy life"— Presentation transcript:
1MILK & MORE Helping children eat for a healthy life Rosemary Brown CPHVA conference June 2013
2What are we aiming for?Healthy, active child able to enjoy life – now & laterWhat are we aiming for? A healthy, active child able to enjoy life – now and later. Healthy in all aspects – physical, emotional, mental, spiritual
3What are we aiming for?Happy, secure child through good relationships
4What are we aiming for? Child who enjoys food… A child who enjoys food – different types of food, the experience of eating, the social and developmental aspects of eating together with others – without anxiety for child or parent, without meals becoming a battleground. A child can actually be a means of the whole family eating more healthily and family interaction increasing.… without feeding becoming a battleground
5What are we aiming for? Child who eats enough for their needs A child who eats enough for their needs – of all the different nutrients, for all growth, development and body functioning – but not too much, leading to obesity and the Michelin man syndrome of a baby who is so fat they are unable to be active, and with the foundations for ill-healthh in the future… or too little. Though this is less common in the UK, it is nonetheless possible – overall undernutrition, or deficiency of certain nutrients.…but not too much
6How can we achieve that?Encourage what will build positive relationships from the beginningHarness a child’s inbuilt ability to regulate his/her own intakeEnhance parents’ knowledge, skills and confidence in enabling development of healthy eating habitsTo achieve that, we need to be able to:Encourage what will build positive relationships from the beginningHarness a child’s inbuilt ability to regulate their own intake, rather than override itEnhance knowledge, skills and confidence of parents to know how to help their child eat for a healthy life, how to build healthy eating habits for a lifetimeThat’s why the DH has given the recommendations it has done….
7Government recommendations: Breastfeed exclusively for 6 months, thenContinue to breastfeed until at least 1 year, whilst offering solid foods from around 6 monthsThat’s why the Dept of Health recommendations are what they are from 2003, and were reiterated in June 2010:- breastfeed exclusively for the first 6 months, since breastmilk provides all the nutrients that a baby needs for healthy growth and development in the first six months of life as well as providing a significant level of protection against many health problems for both baby and mother, short- and long-termThen CONTINUE to breastfeed, whilst starting to offer solid foods from around 6 months.
8How does breastfeeding help? Custom-made food and drink for baby, adapting to meet changing needs of babyDifferent for a premmie than an older babyDifferent from day to nightDifferent from feed to feed
9Contains many ingredients not present or active in formula How does breastfeeding help?NucleotidesBREASTMILKWhite blood cellsViral fragmentsContains many ingredients not present or active in formulaAnti-inflammatoryBifidus factorsFORMULAOligosaccharidesAntibodiesEnzymesGrowth factorsTransfer factorsWhy is that? Is there really much difference between breastmilk and formula? What is formula? – cow’s milk – many parents do not really understand this – it has been marketed as something specially made for babies, but it is actually cow’s milk with things taken out and other things synthesised from various materials and added. So what do formula and breastmilk contain?water: breastmilk filtered through mother’s body; formula – depends on water used – vital it is certain temp, not too many minerals, fluoride levels?Protein: breastmilk mostly whey protein – very digestible; much higher protein in formula associated with obesityCHOsFats: mostly vegetable oils, but some fish oils. Long chain polyunsaturated fats in breastmilk - LCPs added to formula made from algae, but no evidence that they work the sameVitamins and minerals: all well absorbed due to transfer factors and extra iron mopped up to avoid feeding infections; have to have a lot more in formula as time on shelf will lead to deterioration – so much excreted or make constipation more likely. Formula has 10x the amount of iron that a baby can absorb.Transfer factors: enable all the ingredients to be absorbed and well-used. May be less of something in breastmilk, but much more efficiently used and usually having more of that ingredient has not be found to be helpfulGrowth factors: help maintain healthy gutEnzymes: help break down milk to be used; also act to kill bacteriaAntibodies: ready-made from the mother – continues as mother comes into contact with infection through breathing them in or ingesting them, antibodies made and sent to breasts to be given in breastmilk to baby. So really important for mother and baby to be together. This protection has been shown to affect DNA over generations.Oligosaccharides: special sugars that also ensure a good gut and lung environment to guard against infectionBifidus factors: ensure good gut environment. Prebiotics added to formula not shown to have same effect.Anti-inflammatory factors: dampen down inflammation as that can give entrance to bacteria, allergy-causing factorsViral fragments: stimulate baby’s immune system to get goingWhite blood cells: mop up bacteriaNucleotides: special proteins that help with repair of body tissues, esp in gut.Vitamins/mineralsVitamins/mineralsFatsFatsCarbohydratesCarbohydratesProteinProteinWaterWater
10How does breastfeeding help? Breastmilk contains many protective factors, lowering the risk of infection & other diseases for babies and mothers:reducing all common childhood infections1/3 risk of SIDSreduced risk of breast and ovarian cancer for mum15% fewer GP visits in first 6 months (McConnachie et al 2004)decreased hospital admissions (DH quarterly figures)
11How does breastfeeding help? The hormones of breastfeeding (prolactin & oxytocin) and physical closeness facilitate:connecting up helpful pathways in braingood bonding & protective instincts in mumstabilise baby’s heartrate,breathing, temperature,blood sugarcalm the baby & help themum relax & rest
12How does breastfeeding help? Facilitates baby regulating intake to meet needs:hunger cues enable responsive feedingmore control over flow and how much they takeleptin: hormone regulates appetite and energy metabolismlearn to recognise when they are full – need several weeks of breastfeeding before this begins(Brown & Lee 2012)lower protein and energy in breastmilk reduces fat deposition -> lower risk of obesity (McCrory et al 2012)Baby’s hunger cues allow responsive feeding. A recent review on the development of healthy eating habits early in life found the ‘responsive feeding was one fo the most important practices for encouraging healthy eating habits in early life and should be encouraged in parents to reduce the risk of obesity’ (Schwartz et al 2011 in Cameron et al 2012). So it is important that breast fed babies have more control over the flow of milk and how much they take.Also breastmilk contains leptin, not present in formula, which regulates appetite and energy metabolism. Encourages preference for carbohydrates over fats. Improves insulin sensitivity.breastfed babies learn to recognise when they are full, but it is only after at least 6 weeks of breastfeeding that this ability begins to emerge, showing that prolonged breastfeeding is what we need to aim for.
13Enabling breastfeeding Skin to skin contact at and after birthHelp to ensure effective attachment:C close to mum, chin indenting breastH head able to tip back – nipple protected, big mouthful more from underneath of breastI in line – head & body in line helps swallowingN nose to nipple – stimulates wide gapeS sustainable & comfortable for mumEnabling breastfeeding involves:- encouraging skin to skin contact and leaning-back breastfeeding at and after birthensuring effective attachment - CHINS
14Recognising effective feeding Use breastfeeding assessment ourselvesEmpower mum to look for signs of effective feedingdeep suckles AND swallowsbaby calm at breastbaby content after most feedsat least 6+ wet and 2+ dirty nappies a daypain-free for mumbaby alert, when awake, with good colour and toneKnowing how to tell if baby is feeding effectively
15How can we achieve that? Bottle feeding: intake depends on: teat stimulating baby to suck, whether hungry or notsize of teatexpectations of mum/tin/society as to quantity and frequencytends to be more mother-ledcan involve less interaction &closeness & more peopleThe difficulty with bottlefeeding is that it can override some of the ways in which the baby can regulate his/her intake. The teat actually stimulates the baby to suck, whether they are hungry or not. The presence of milk in the mouth will also trigger swallowing. The size of the teat affects the flow of milk. Also mums often look at the tin to see how much milk her baby should have and feels pressure to get that down the baby. So bottlefeeding can tend to be more mother-led, rather than responsive to baby’s cues.
16How can we achieve that?Bottle feeding : important to encourage responsive feedingwatch out for and follow hunger cueslet baby decide quantityallow baby to draw teat into mouthtake bottle out from time to timehold baby close with eye contact, smiles, talkinglimit caregiversuse first stage milkIt is important if bottlefeeding to give opportunity for the baby to regulate their own intake, by encouraging responsive feeding. This means:- watching out for and following the baby’s hunger cues, rather than timing feeds. Means the baby needs to be nearletting the baby decide on the quantity of milk they want – sometimes more, sometimes less. Need willingness to throw away some feed sometimes.Giving the baby opportunity to show how much they want: allow them to draw the teat into their mouth, rather than the mum/carer putting it in their mouth; take the bottle out from time to time to see whether they really want moreMimic the closeness of breastfeeding to enable those synapses to be laid down, the helpful pathways in the brain – hold the baby close, have eye contact, talk with the baby, don’t watch television all the time or talk on the phone or…..Limit the caregivers: research shows it is vital for a baby to build up a relationship with one or limited number of carers in the beginning. Each person has their own way of feeding a baby, and this could be quite scary for the baby, even like waterboarding.Use first stage milk throughout the first year until the baby can go onto cow’s milk: despite all the advertising, first stage formula is the most suited to the baby’s digestion and needs, there is no evidence for any benefit to any other milk – whether helping the baby sleep longer, reducing colic or reflux, adding vitamins and minerals – and they may only add to problems. It is a concern that in the recent national diet and nutrition survey that 32% of 4-6 month olds were being given follow-on milk, which is not suitable for young infants.
17How can we achieve that? Start offering solids when: they are developmentally ready to cope well & eagerly with solidsnutritional needs no longer met completely in breastmilk or formulausually around 6 months – not too early or too early or too lateAllows baby to continue tocontrol own intakeBaby develops skills & good eating lifestyleAnd what about introducing solids? Well, many health visitors, including myself, remember when we were recommending starting solids at 3-4 months, and thought nothing of it. So why has it changed? Well, much of the reason for that is because we know more about the benefits and nutritional adequacy of breastfeeding for the first 6 months, about babies’ abilities to deal with other than liquids early on, and about how important it is to give the baby opportunity to continue to control their own intake. Also that there is no rush to mush, as the leaflet says! It is not a sign of developmental cleverness to start solids early and research confirms that starting solids early will not make the baby sleep more.
18So why from around 6 months? Breastmilk, or formula,has all they need till then:- energy for growth(Nielsen et al 2011; Wells et al 2012)- for adequate iron stores(Jonsdottir et al 2013)Giving anything elsedisplaces breastmilk(Wells et al 2012)-Till 6 months, breastmilk or formula milk provide ALL the nutrients the baby needs. Giving anything else will mean the baby breastfeeds less. This will affect milk supply and will also decrease the difference breastfeeding makes in terms of the baby’s short and long-term health and the mother’s health. Basically the benefits are dose-dependent – longer and more exclusive (up to 6 months) breastfeeding gives greater the benefit. Also what is given as first foods does not contain the same amount of nutrients as milk. However, from around 6 months, the baby needs more than milk on its own can provide. Not that the quality of the breastmilk has decreased, but the baby’s needs have increased. Initially they will not take great quantities of solids, but by 9 months, they will be taking a significant amount.
19So why from around 6 months? Their body systemsare mature enoughNeeded enzymes are presentBreastfeeding whilst whilst starting solids seems to reduce risk of allergies (Akobeng et al 2006)Their body systems – digestive system, kidneys, etc – are mature enough by then to cope with digesting and excreting the foods efficiently. They will have the enzymes they need. Certainly before 4 months, the needed enzymes are not there in sufficient quantity, which makes digesting and making use of the food more difficult.
20So why from around 6 months? Can sit upwithsupportSaferMore able to reach out for food-At 6 months, they can sit up with support – this makes eating solid foods safer and enables them to reach out much better, so that they are involved in the eating. It means that they can be part of the family mealtimes, learning other skills – social interaction, speech, mimicking etc.
21So why from around 6 months? Interestedin food – nocoaxingneeded!Start bywatchingpeople eatfrom 4-5monthsEarlier on, babies are not particularly interested in solids. Therefore, it can be a matter of the mum/parent coaxing the baby to eat. This tends to encourage mother-led feeding, and can lead to greater anxiety when the baby does not show much interest or take much. From 4-5 months, they start being interested in watching people eat food, and by around 6 months start to reach out to grab their food! That’s when we can harness that interest. Babies will vary – some ready just before, others just after 6 months. Solids should never be given before 16 weeks of age.
22So why from around 6 months? They take objects to their mouth and chew on them. They are keen to eat.Then reach out and grab objects, take to mouth & chew on them
23So why from around 6 months? They are eager to try feeding themselves – all hands on deck!. There is some evidence that waiting till later in the first year to give any lumpy food may make the baby much less likely to take it (Northcote study) . Allowing them to feed themselves may be messy (though there will be a mess at whatever age the baby is allowed to start feeding themselves) but it again involves them in the process and may well reduce the anxiety parents may feel. Many parents are surprised how adept their baby is at feeding themselves.Eager to eat and feed themselvesEncourages baby-led feeding & may reduce parental anxiety
24So why from around 6 months? Good eye& handcoordination& motor skills(Wright et al 2011)Feedingthemselvesdevelops skillsThey have good eye-hand coordination and will go on building these skills as they feed themselves-Research from Millennium study shows that most babies will have skills to feed themselves at around 6 months, though need to watch for some with developmental delay (Wright et al 2011)
25So why from around 6 months? Tongue ableto movefoodaroundmouthMunchingactionAt this age, their mouth is changing. Instead of a forward/backward movement of the tongue which is necessary for breastfeeding (or taking other fluids) , the tongue starts to be able to move the food around the mouth, enabling chewing – don’t actually need teeth to deal with solid foods, as they gum on the food and deal with it that way, but do need to be able to move it around the mouth
26So why from around 6 months? Able to swallow solid foods – learn to gum and gnaw before learning to swallow (Naylor & Morrow 2001)Can cope with lumpierfoods from beginning, so no need for purees &less work for mumBreastfed babies accept new tastes more easilyThey are able to cope with lumpier foods from the beginning, so there is no need for purees. They can start with softly cooked or mashed foods and soft fruit and vegetables raw. They can also be given finger foods to try feeding themselves – softly cooked vegetables, fruit, bread, pasta, etc. Can be family food, as long as no added salt and not too spicy.Breastfeeding babies may be more ready to try new tastes, since they are used to the taste of breastmilk changing from feed to feed
27So why from around 6 months? Able to take foodoff spoon withoutconstantly pushing it out with tongueAble to eat almosteverything (e.g. fish, eggs, dairy foods)They are able to take food off a spoon- without pushing it out with their tongue. Baby-led weaning would suggest that the baby should always do all the feeding. Whilst babies will usually be more keen to feed themselves than to be fed, there is no evidence at present that some spoon-feeding is inadvisable. Indeed there may be times when it is important, such as when the baby is unwell, or if there is any evidence of developmental delay, so that the other skills are not present yet.Another advantage of waiting until 6 months is that they are then able to eat almost everything – before that there is much that is not recommended, such as fish, eggs, dairy foods
28So why from around 6 months? Reflex causing baby to gagmovesfurtherback,but stillis safetymechanismThe gag reflex moves around about this time to be further back in the mouth – this means that it is less likely that they will gag or push out the food. Baby less likely to gag when feeding themselves than when being spoon fed – spoon goes further back in mouth, so more likely to trigger reflex. We need to help parents understand the difference between gagging and choking. In one recent study, 30% parents reported one or more episodes of choking, but in each case the baby coped with this completely on their own by coughing and bringing the food back out of their mouth (Cameron & Taylor 2012) . It is quite possible that what parents were interpreting as choking was in fact gagging, so helping parents distinguish between the two and know how to cope if there is genuine choking, will decrease anxiety and increase confidence.
29So why from around 6 months? -Great sense of achievement!
30Look for 3 signs together: Can sit and hold head steadyPicks up food & puts it in mouthSwallows some – not pushing it all out again-
31How to startStart with 1 meal a day, after or between milk feeds – time when baby not too hungry or tiredBuild up to 3 meals & 2 healthy snacks by 1 yr – baby’s stomach smallGive baby finger foods to pick up in fists to eat – finger-shaped pieces (Baby-led weaning cookbook)Offer softly cooked or mashed foods on a spoon – can add a little breastmilk or formula to mix.Baby’s stomach small so cannot get enough nutrients if food too bulky or high in carbohydrates. Fats are non-bulky source of calories and fat-soluble vitamins, so diet for children under 5 should not be low fat or high fibre. Avocados, peanut/groundnut or sesame butter good sources of fat as well as milk.Babies’ stomachs small so need more frequent, smaller meals – will eat more than if given in three big meals.Babies keen to reach out and grab food – use this eagerness and skill by giving them finger foods – softly cooked vegetables, fruit, bread, pasta, cheese, etc etc. Help parents to realise that it might be messy at the beginning, but that the child will quickly learn skills to eat more elegantly! It will make life a lot easier also as they will not need to take special food out with them when away from home. Need to hold in fist and eat the bit that sticks out the top – pieces about the size of adult’s finger. Scoop up food with whole hand – pincer grasp not till around 8 months.Can also offer softly cooked or mashed foods on a spoon, alongside finger foods.
32How to startOffer wide variety of food from all the food groups from the beginningIncrease lumpiness of foods quicklyBe prepared to offer new food many times (up to 20) – babies show they recognise new food by spitting it out!Baby’s tummy about the size of baby’s fist – use this as guide to portion sizesBaby’s stomach small so cannot get enough nutrients if food too bulky or high in carbohydrates. Fats are non-bulky source of calories and fat-soluble vitamins, so diet for children under 5 should not be low fat or high fibre. Avocados, peanut/groundnut or sesame butter good sources of fat as well as milk.Babies’ stomachs small so need more frequent, smaller meals – will eat more than if given in three big meals.Babies keen to reach out and grab food – use this eagerness and skill by giving them finger foods – softly cooked vegetables, fruit, bread, pasta, cheese, etc etc. Help parents to realise that it might be messy at the beginning, but that the child will quickly learn skills to eat more elegantly! It will make life a lot easier also as they will not need to take special food out with them when away from home. Need to hold in fist and eat the bit that sticks out the top – pieces about the size of adult’s finger. Scoop up food with whole hand – pincer grasp not till around 8 months.Can also offer softly cooked or mashed foods on a spoon, alongside finger foods.
33Encourage good eating lifestyle Sit baby up to eat and stay with him/herLet baby participate infamily meals - andpreparation when olderAvoid distractions duringmealsBe prepared for messy eating – bib, food on clean highchair surface, plastic sheet on floorBaby will be safer and eat more if he is sitting up to eat and also you stay with him. Babies are naturally interested in what is going on around them, so they are easily distracted. However, if they are part of family meals from the beginning, they are likely to be more eager to eat and will learn from watching others – manners etc etc. So encouraging family meals is important.Helping parents be prepared for the mess, and realise that babies explore their environment by touching, mouthing etc, so that this is an important stage in their development and “playing with food” is part of that. Nonetheless, some preparations can really help – a good bib, some plastic or newspaper on the floor, putting the food directly on the clean surface of a highchair might be safer – but it is easier to contain the mess at this age.
34Follow baby’s pace & cues Wait for baby to open mouth for spoonFollow babies’ cuesshowing they have hadenough – turning headaway, pushing food awayBabies will often screw their faces up when trying new food – not that they don’t like it, but that they are recognising that it is something new. So need to keep giving it and then the child will eventually accept it. If there is a family history of allergies, may be good to give one new food at a time, so can see if any reaction. Babies also explore food by chewing, spitting out – often not much is swallowed at the beginning – not something to worry about.Allow baby to set the pace – babies, especially breastfed ones, have learned to listen to their body’s signals that they have had enough, so will take what they need. Healthy babies will not starve themselves! To avoid obesity and fussy eating, do not force-feed. If baby refuses to open mouth, or turns head away, sign that they have had enough.Fluids should be given by cup – open or free-flow, non-valved cup. The valved cups are difficult for children and are basically about sucking, so not helpful for them to develop skills of drinking. Water is the best fluid – just tap water from the mains tap. Bottled/mineral water may have too many minerals for them. If juice is given at all, it should be diluted 1 part to 10 parts water and only given with meals – juices can cause tooth decay.Messy eating is part of the child developing skills – encourage parents to accept this developmental stage as an essential part of development. The sooner messy eating is allowed, the quicker the baby will develop skills to eat more tidily! Cover the baby with bib and the floor with a plastic sheet or newspaper, so that nothing is spoiled – then grin and bear it!
35Learning to drink from a cup Use open cup (or one withfree flow spout) to givefluids – water, milkWean off any bottles &dummies by 1 yearBabies will often screw their faces up when trying new food – not that they don’t like it, but that they are recognising that it is something new. So need to keep giving it and then the child will eventually accept it. If there is a family history of allergies, may be good to give one new food at a time, so can see if any reaction. Babies also explore food by chewing, spitting out – often not much is swallowed at the beginning – not something to worry about.Allow baby to set the pace – babies, especially breastfed ones, have learned to listen to their body’s signals that they have had enough, so will take what they need. Healthy babies will not starve themselves! To avoid obesity and fussy eating, do not force-feed. If baby refuses to open mouth, or turns head away, sign that they have had enough.Fluids should be given by cup – open or free-flow, non-valved cup. The valved cups are difficult for children and are basically about sucking, so not helpful for them to develop skills of drinking. Water is the best fluid – just tap water from the mains tap. Bottled/mineral water may have too many minerals for them. If juice is given at all, it should be diluted 1 part to 10 parts water and only given with meals – juices can cause tooth decay.Messy eating is part of the child developing skills – encourage parents to accept this developmental stage as an essential part of development. The sooner messy eating is allowed, the quicker the baby will develop skills to eat more tidily! Cover the baby with bib and the floor with a plastic sheet or newspaper, so that nothing is spoiled – then grin and bear it!
36Encourage a relaxed approach Praise good eatingDon’t use food as rewardsLook at what baby eats over a week rather than a dayIf they are not interested, wait till next mealtimeDon’t use food as rewards, but praise good eating. If the baby doesn’t want to eat now, wait until next time. Don’t fill in with snacks. Remember we don’t always eat the same at every mealtime.
37So what do they need? Milk still major source of nutrients until 2 years - andprotection, if breastfeedingFood from all food groups:raw or softly cooked vegetables and fruits – starting once day, 4 times a day by 1 yearstarchy foods – potatoes, rice, pasta, plantainprotein foods – soft well-cooked meat and chicken, fish, eggs, meat, pulses and beans, dairy foods a day by 1 year* Still need breastmilk on demand or formula. Milk is still very important source of food, and they will continue to breastfeed even if they stop eating other foods if they are ill. Breastfeeding also provides analgesia for painful procedures. Breastmilk continues to give protection against illness. Breastfeeding should continue as long as the mother wants, but certainly until the baby is at least 1 year old. WHO recommends until 2 years or beyond cf malnutrition. If the baby is formula feeding, the recommendation is to stay on first stage formula until 1 year, when the baby can go onto cow’s milk. There is no evidence for any benefit from any other formula or follow-on or toddler formulas. By 1 year, the baby should not be having more than mls milk, otherwise they will not eat enough solids.
38Just a few guidelines:Use whole milk – wait till 2 yrs to use semi-skimmed & 5 yrs for skimmed milk – young children need the fat content for calories without bulk and to carry vitaminsCut up any small round or coin-shaped foodMake sure egg is well-cooked – yolk & white firmAvoid:salt & sugar or salty/sugary snacks, including juices and squash.honey, in 1st year – rare danger of botulismreduced calorie or low fat foodvery high fibre food – fills stomach too quicklytea/coffee – reduce absorption of vitaminswhole nuts till 5 years – danger of inhalingrice or soya “milk” or goat’s milk – not suitableIf babies start solid foods before 6 months, there are many things they need to avoid. Starting at 6 mths means that they are able to eat almost everything.However, to avoid:obesity and tooth decay and because their kidneys are immature, avoid added salt and sugar or salty/sugary snacks, which only provide empty nutrients. Juices and squash also cause tooth decay.botulism – no honey until after 1 yearlisteria, salmonella – make sure eggs properly cooked, not softlow calorie or low fat food, including semi-skimmed and skimmed milk – babies need the calories and fat for brain development, carrying fat-soluble vitamins etcvery high fibre food – cannot consume enough to get the needed nutrientstea/coffee – reduce absorption of vitaminswhole nuts – till 5 yrs – danger of chokingrice or soya milk or goat’s milk – not recommended levels of minerals etc. Soya milk can cause allergies and can also contain sex hormones, inappropriate when baby still developing gonads
39Vitamin supplements Vitamin drops A, C & D are recommended : From 6 months, if:- breastfed- taking less than 500mlformula per dayFor all children 1-5 yearsFrom 1 month if mother has not taken vitamin D in pregnancyHelp parents know where & how to obtain themMums to take Vit D and folate while pregnant and breastfeedingChildren also need vitamins A, C & D, especially any children who have darker skins or are covered up most of the time. Formula contains added vitamins, so if children are taking 500 mls/day or more, they do not need vitamin supplements until they are 1 year old. It is recommended that breastfed babies and all children 1-5 years take daily vitamin supplements. For those families eligible for Healthy Start, they can get them free.Especially formula fed babies may need extra water. It is best to give this in an open or free-flowing, non-valved cup, preferably with 2 handles
40Why is Vitamin D needed?Healthy diet is not enough: 90% of our vitamin D comes from sunlightSunlight not enough Oct-March1 in 4 people in UK have low vitamin DDarker skins take longer to absorb enough from sunlightHijabs etc -> less sunlight exposureSafe sun messages – only a short time of exposure neededIncreased indoor pursuitsObesity: affects production & useDeficiency -> rickets, seizures in babies, smaller pelvis, lower immunityChildren also need vitamins A, C & D, especially any children who have darker skins or are covered up most of the time. Formula contains added vitamins, so if children are taking 500 mls/day or more, they do not need vitamin supplements until they are 1 year old. It is recommended that breastfed babies and all children 1-5 years take daily vitamin supplements. For those families eligible for Healthy Start, they can get them free.Especially formula fed babies may need extra water. It is best to give this in an open or free-flowing, non-valved cup, preferably with 2 handles
42Resources Leaflets (Start4Life - DH): ‘Introducing Solid Foods’‘Building blocks for a better life’‘Off to the best start’ (breastfeeding)‘Guide to bottle feeding’Islington (PDF in English & 7 other languages):‘Milk & More: starting your baby on solid foods’‘ Drinks for children up to 5’‘ Snacking for children under 5’‘ Vitamins and minerals for children 1-5 years old’‘Milk and More’ training pack and recipe bookResources available include:leaflets, especially ‘Milk and More’. Will be available in 7 other languages – French, Spanish, Albanian, Bengali, Somali, Turkish, ArabicWeaning and Beyond teaching packEarly years childhood obesity pathwayStart4Life
43Resources Websites: www.firststepsnutrition.org ‘Infant Milks in the UK’: independent info re formula milksEating well in the first years of life’ – for parents and carers – coming in 2013Breastfeeding and starting on solids:– research & resourcesThe Baby-led weaning cookbook (Rapley & Murkett)Resources available include:leaflets, especially ‘Milk and More’. Will be available in 7 other languages – French, Spanish, Albanian, Bengali, Somali, Turkish, ArabicWeaning and Beyond teaching packEarly years childhood obesity pathwayStart4Life
44References:Akobeng A.K et al (2006) Effect of breastfeeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies, Archives of Disease in Childhood, 2006(91), 39-43Brown, A. & Lee, M. (2012) Breastfeeding during the first year promotes satiety responsiveness in children aged months. Pediatric Obesity.2012, 7,Cameron, S., Heath, A-LM.., & Taylor, R.W (2012) How feasible is baby-led weaning as an approach to infant feeding? A Review of the evidence, Nutrients 2012, 4,Cameron, S, Heath, A-L.M. & Taylor, R.W (2012) Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, Baby-led Weaning: a content analysis study, BMJ Open 2010:2:e001542DH quarterly figures, including comparison between breastfeeding prevalence and prevalence of hospital admissionsDH (2013) Diet and Nutrition Survey of Infants and Young Children, 2011 (available on DH website)Jonsdottir O.H. et al (2012) Timing of the introduction of complementary foods: a randomized trial, Pediatrics, 2012:130:McConnachie A. et al (2004) Modelling consultation rates in infancy: influence of maternal and infant characteristics, feeding type and consultation history, British Journal of General Practice, 2004, 54,McCrory C. & Layte, R.(2012) Breastfeeding and the risk of overweight and obesity at nine-years of age, Social Science and Mediecine 2012:Jul:75(2):323-30Naylor, A.J. & Morrow, A.J (2001) Devclopmental readiness of normal full term infants to progress from exclusive breastfeeding to the introduction of complementary foods, Wellstart International and the LINKAGES projectNielsen S.B. et al (2011) Adequacy of milk intake during exclusive breastfeeding: a longtitudinal study, Pediatrics 2011:128:e907Rapley G. & Murkett T. ( 2011) The Baby-led Weaning CookbookUNICEF (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding ratesWells, J.C.K et al (2012) Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe, American Journal of Clinical Nutrition, May 16, 2012WHO (1998) Complementary feeding of young children in developing countries: a review of current scientific knowledge, WHOWright, C.M. et al (2010) Is baby-led weaning feasible? When do babies first reach out for and eat finger foods? Maternal and Child Nutrition
45Contact For more information: Rosemary Brown Infant Feeding Coordinator, Islington