Maternal and child nutrition

Professional bodies should ensure health professionals have the appropriate knowledge and skills to give advice on the following:

As part of their continuing professional development, train midwives, health visitors and support workers in breastfeeding management, using BFI training as a minimum standard.

As part of their continuing professional development, train health professionals, including doctors, dietitians and pharmacists, to promote and support breastfeeding, using BFI training as a minimum standard.

Primary care trusts (PCTs) and NHS trusts.

Directors of public health, planners and organisers of public health campaigns.

Pharmacists, GPs, hospital doctors and nurses, particularly those working in gynaecology, sexual health, contraceptive and family planning services, fertility clinics and school health services.

Public health nutritionists and dietitians.

Manufacturers of goods for women of childbearing age.

Health professionals should:

PCTs should ensure local education initiatives aimed at health professionals include information on the importance of folic acid supplements. They should provide the maternal Healthy Start vitamin supplements (folic acid, vitamins C and D) for eligible women. They should also ensure women who are not eligible for Healthy Start can obtain the supplements from their local pharmacy.

GPs should prescribe 5 milligrams of folic acid a day for women who are planning a pregnancy, or are in the early stages of pregnancy, if they:

Manufacturers should include information with their products on the importance of folic acid supplements before and during pregnancy. Relevant products may include pregnancy tests, sanitary products, contraceptives and ovulation predictor kits.

PCT commissioners and managers.

GPs, midwives, health visitors, obstetricians, paediatricians, and community pharmacists.

PCTs should promote the Healthy Start scheme.

PCTs should ensure an adequate supply of both types of Healthy Start vitamin supplements (for women and for children from 6 months to 4 years) is available for distribution by health professionals when they see pregnant women and parents of children under 4 years.

PCTs should ensure an adequate supply of Healthy Start application forms is available and that the uptake of Healthy Start benefits is regularly audited.

Health professionals should advise pregnant women and parents of children under 4 years about the Healthy Start scheme. They should ensure all women who may be eligible receive an application form as early as possible in pregnancy.

Health professionals should use every opportunity they have to offer those parents who are eligible for the Healthy Start scheme practical, tailored information, support and advice on:

Health professionals should offer the maternal Healthy Start vitamin supplement (folic acid, vitamins C and D) to pregnant women who are (or who may be) eligible.

GPs and health visitors should offer children's Healthy Start vitamin supplements (vitamins A, C and D) to all children aged from 6 months to 4 years in families receiving the Healthy Start benefit.

Commissioners should consider distributing the maternal Healthy Start vitamin supplement (folic acid, vitamins C and D) to all women who receive Healthy Start benefit for children aged 1 to 4 years, particularly those who may become pregnant.

Community pharmacists should ensure the Healthy Start maternal vitamin supplements are available for purchase by women who are not eligible to receive them free of charge.

Early in pregnancy, discuss the woman's diet and eating habits and find out and address any concerns she may have about her diet.

Provide information on the benefits of a healthy diet and practical advice on how to eat healthily throughout pregnancy. This should be tailored to the woman's circumstances. The advice should include: eat 5 portions of fruit and vegetables a day and 1 portion of oily fish (for example, mackerel, sardines, pilchards, herring, trout or salmon) a week.

Inform women who have a BMI over 30 about the increased risks this poses to themselves and their babies and encourage them to lose weight before becoming pregnant or after pregnancy. Provide a structured programme that:

Health professionals should refer pregnant women with a BMI over 30 to a dietitian for assessment and advice on healthy eating and exercise. Do not recommend weight‑loss during pregnancy.

Advise breastfeeding women that losing weight by eating healthily and taking regular exercise will not affect the quantity or quality of their milk.

Adopt a multifaceted approach or a coordinated programme of interventions across different settings to increase breastfeeding rates. It should include:

Implement a structured programme that encourages breastfeeding, using the UNICEF Baby Friendly Initiative as a minimum standard. The programme should be subject to external evaluation.

Ensure there is a written, audited and well‑publicised breastfeeding policy that includes training for staff and support for those staff who may be breastfeeding. Identify a health professional responsible for implementing this policy.

Commissioners and managers of maternity and children's services.

PCTs.

Ensure health professionals who provide information and advice to breastfeeding mothers have the required knowledge and skills.

Ensure support workers receive training in breastfeeding management from someone with the relevant skills and experience before they start working with breastfeeding mothers.

Ensure all those who work in maternity and children's services, including receptionists, volunteers and ancillary staff, are made fully aware of the importance of breastfeeding and help to promote a supportive environment.

Midwives and health visitors should ensure pregnant women and their partners are offered breastfeeding information, education and support on an individual or group basis. This should be provided by someone trained in breastfeeding management and should be delivered in a setting and style that best meets the woman's needs.

During individual antenatal consultations GPs, obstetricians and midwives should encourage breastfeeding. They should pay particular attention to the needs of women who are least likely to breastfeed (for example, young women, those who have low educational achievement and those from disadvantaged groups).

A midwife or health visitor trained in breastfeeding management should provide an informal group session in the last trimester of pregnancy. This should focus on how to breastfeed effectively by covering feeding position and how to attach the baby correctly.

Ensure a mother can demonstrate how to position and attach the baby to the breast and can identify signs that the baby is feeding well. This should be achieved (and be documented) before she leaves hospital or the birth centre (or before the midwife leaves the mother after a home birth).

Provide continuing and proactive breastfeeding support at home, recording all advice in the mother's hand‑held records.

Provide contact details for local voluntary organisations that can offer ongoing support to complement NHS breastfeeding services.

Advise mothers that a healthy diet is important for everyone and that they do not need to modify their diet to breastfeed.

Do not provide written materials in isolation but use them to reinforce face‑to‑face advice about breastfeeding.

Provide local, easily accessible breastfeeding peer support programmes and ensure peer supporters are part of a multidisciplinary team.

Ensure peer supporters:

Consider training peer supporters and link workers to help mothers, parents and carers follow professional advice on feeding infants aged 6 months and over. The advice should promote an increasingly varied diet using food of different textures in appropriate amounts (in addition to milk), in response to the baby's needs.

Show all breastfeeding mothers how to hand‑express breast milk.

Advise mothers that expressed milk can be stored for:

Advise mothers who wish to store expressed breast milk for less than 5 days that the fridge preserves its properties more effectively than freezing.

Advise mothers who freeze their expressed breast milk to defrost it in the fridge and not to re‑freeze it once thawed. Advise them never to use a microwave oven to warm or defrost breast milk.

NHS trusts should train link workers who speak the mother's first language to provide information and support on breastfeeding, use of infant formula, weaning and healthy eating.

Where link workers are not available, ensure women whose first language is not English have access to interpreting services and information in a format and language they can understand.

NHS trusts should encourage women from minority ethnic communities whose first language is not English to train as breastfeeding peer supporters.

Commissioners and managers responsible for maternity, children's and primary care services.

GPs, midwives, health visitors and pharmacists.

Commissioners and managers should ensure mothers have access to independent advice from a qualified health professional on the use of infant formula. This should include information on the potential risks associated with formula‑feeding and how to obtain ongoing advice at home.

Midwives should ensure mothers who choose to use infant formula are shown how to make up a feed before leaving hospital or the birth centre (or before the mother is left after a home birth). This advice should follow the most recent guidance from the DH ('Guide to bottle feeding' 2011). (This recommendation has been amended to include more recent Department of Health guidance on bottle feeding. The original wording referred to the 2006 guide.)

Avoid promoting or advertising infant or follow‑on formula. Do not display, distribute or use product samples, leaflets, posters, charts, educational or other materials and equipment produced or donated by infant formula, bottle and teat manufacturers.

Ensure health professionals and pharmacists who prescribe or dispense drugs to a breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation Database [LactMed] or seek guidance from the Specialist Pharmacy Service.

Health professionals should discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most cases, it should be possible to identify a suitable medication which is safe to take during breastfeeding by analysing pharmokinetic and study data. Appendix 5 of the 'British national formulary' should only be used as a guide as it does not contain quantitative data on which to base individual decisions.

Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse.

NHS trust and PCT commissioners and managers.

Health visitors, community nursery nurses, the child health promotion programme (CHPP) team and children's centre teams.

Commissioners and managers should work with local partners to ensure mothers can feed their babies in public areas without fear of interruption or criticism.

Health visitors should assess the needs of all mothers, parents and carers with young children. They should provide relevant, early and ongoing support at home for those with the greatest needs, including any that may be the result of a physical or learning disability or communication difficulties.

Health visitors and the CHPP team should:

NHS trust and PCT commissioners and managers.

GPs, paediatricians, midwives, health visitors and community nursery nurses.

As a minimum, ensure babies are weighed at birth and in the first week, as part of an overall assessment of feeding. Thereafter, healthy babies should usually be weighed at 8, 12 and 16 weeks and at 1 year, at the time of routine immunisations. If there is concern, weigh more often, but no more than once a month up to 6 months of age, once every 2 months from 6 to 12 months of age and once every 3 months over the age of 1 year [new 2011]. (This recommendation has been amended to be consistent with the UK World Health Organization child growth charts published in 2009. The original wording was as follows: As a minimum, ensure babies are weighed (naked) at birth and at 5 and 10 days, as part of an overall assessment of feeding. Thereafter, healthy babies should be weighed (naked) no more than fortnightly and then at 2, 3, 4 and 8 to 10 months in their first year.)

Ensure infants are weighed using digital scales which are maintained and calibrated annually, in line with medical devices standards (spring scales are inaccurate and should not be used).

Commissioners and managers should ensure health professionals receive training on weighing and measuring infants. This should include: how to use equipment, how to document and interpret the data, and how to help parents and carers understand the results and implications.

Ensure support staff are trained to weigh infants and young children and to record the data accurately in the child health record held by the parents.

Advise mothers to feed the baby only on breast milk and to continue breastfeeding while introducing solid foods, when the infant is 6 months. For current dietary advice visit NHS Live Well.

Advise mothers who choose not to breastfeed that there is insufficient evidence to suggest that infant formula based on partially or extensively hydrolysed cow's milk protein helps to prevent allergies.

Encourage parents and carers to:

Discourage parents and carers from:

Support breastfeeding mothers by:

Implement DH guidance ('Guide to bottle feeding' 2011) on the preparation and use of powdered infant formula to reduce the risk of infection to infants in care settings.

Implement a food policy which takes a 'whole settings' approach to healthy eating, so that foods and drinks made available during the day reinforce teaching about healthy eating.

Take every opportunity to encourage children to handle and taste a wide range of foods that make up a healthy diet by:

Commissioning agencies, local authorities, local strategic partnerships, voluntary agencies and local businesses that fund or provide community projects.

Public health nutritionists and dietitians.

Public health nutritionists and dietitians should offer parents in receipt of Healthy Start benefit practical support and advice on how to use the Healthy Start vouchers to increase their intake of fruit and vegetables.

Provide support (both practical and financial) to develop and maintain community‑based initiatives which aim to make a balanced diet more accessible to people on a low income. Examples include: food cooperatives, 'cook and eat' clubs, 'weaning parties' and 'baby cafes'.

Work with local retailers to improve the way fresh fruit and vegetables are displayed and promoted.