Improving Maternal and Infant Nutrition: A Framework for Action

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more likely to feed their infants fruit and vegetables rather than sweets or othersnacks. 303.35 Data on infant weight and weight gain in Scotland is not routinely collected.While the opportunity to measure and record infant weight is possible during routineappointments within the NHS, there are currently no mandatory growthmeasurements recorded following the 6-8 week review until the infant starts schoolat around 5 years of age.3.36 After the initiation of weaning no recent large scale studies on nutritionalstatus or nutrient intakes of vitamin D, iron or calcium in infants in Scotland wereidentified. However the Avon Longitudinal Study of Parents and Children (ALSPAC)study provides more recent evidence from southern England and suggests that whilevitamin D levels were still below the RNI, iron intake was higher for this sample ofinfants at eight months and 12 months of age with only a small proportion of infantsfound to be anaemic. 68Conclusion3.37 There is neither sufficient nor sufficiently timely data on maternal and infantnutrition in Scotland. Some of the main sources have limited Scottish samples andare conducted very infrequently. Different sources report their results in differentways, thus comparison between sources, or over time, is difficult. The sourcesavailable do not enable a comprehensive description of maternal and infant nutritionin Scotland in 2010 to be given. The pace of improvement in maternal and infantnutrition appears, however, to be slow.What Next?3.38 There are many gaps and inadequacies in the available information butimprovements are being made. The new format of the UK National Diet andNutrition Survey of adults and children has an increased Scottish sample (resultsavailable in 2012). A new UK nutrition survey for infants (age 4 to 18 months) isbeing piloted. The scope for acquiring better nutrition information from existingScottish surveys, such as the Scottish Health Survey and Growing Up in Scotlandstudy, should be explored. There may also be potential for routine administrativeand clinical data sources to provide national information.3.39 Assessing the impact of the Maternal and Infant Nutrition Framework willrequire a monitoring framework that is consistent, scientifically well-founded andachievable without significant diversion of resources that might be used to implementthe Framework. The maximum use should thus be made of existing routineadministrative, clinical and survey data sources.
Chapter 4: Current Activity across Scotland4.1 Between 1996 and 2005 a National Breastfeeding Adviser was appointed towork with NHS Boards to stimulate the development of strategies to supportbreastfeeding. An audit of NHS Boards’ action on breastfeeding, carried out inMarch 2002, found that the majority of Boards had set up breastfeeding strategygroups and developed breastfeeding strategies that addressed the major factorsinfluencing breastfeeding success.4.2 Since then, a number of national and local initiatives have been implementedto improve both the incidence and duration of breastfeeding in Scotland. Althoughsome local activities have focused on improving complementary feeding practicesand the nutrition of pregnant women, there has been less attention on these areas atnational level. In 2008 a survey was carried out to provide a more up-to-dateunderstanding of activities designed to improve maternal and infant nutrition acrossScotland. 69Methodology4.3 Evidence was gathered through the use of a questionnaire. This was beendesigned using Questback survey design and administration software and wasissued electronically to individual e-mail addresses.4.4 Five separate questionnaires were designed to capture the range of activitiesoccurring across Scotland including breastfeeding, maternal nutrition, nutrition ofchildren under five, local authority activities and community and voluntary sectoractivities. In general, each of the surveys covered the following topics; jointplanning, training, education, information relating to specific initiatives, actions post-Chief Executive Letter 36 (2008) 70 and community and voluntary sector links. Aspreviously described, the scope of the Framework includes infants up until their thirdbirthday. However, given the amount of work in recent years to improve the nutritionof children in early years settings through implementation of the Nutritional Guidancefor Early Years 71 and Adventures in Foodland 72 , it was considered more practical toask Boards to report on activity targeted at children under five.4.5 The research sample consisted of respondents from NHS Boards, LocalAuthorities and the voluntary sector. Potential respondents were identified by theScottish Government Infant Nutrition Co-ordinator and questionnaires were sentelectronically to all those with an identifiable e-mail address. The main sampleincluded: NHS Boards Heads of Midwifery, NHS Boards Public Health Nutritionists,NHS Boards Breastfeeding/ Infant Feeding Leads, Community and Voluntary Sectorcontacts via Community Health Exchange, Community Food and Health (Scotland)and Local Authority contacts. Data was collected between November and December2008.4.6 A report of the results from the survey was produced and can be obtained viaemail from the Scottish Government Maternal and Infant Health Branch at:maternalandinfanthealth@scotland.gsi.gov.uk
Page 1 and 2: Improving Maternaland Infant Nutrit
Page 3 and 4: © Crown copyright 2011ISBN: 978-0-
Page 5 and 6: • Indicators for Outcomes 6.9•
Page 7 and 8: Executive SummaryImproving the nutr
Page 9 and 10: IntroductionIn order to change infa
Page 11 and 12: important for the scope to go beyon
Page 13 and 14: 1.6 In 2003, the Royal College of P
Page 15 and 16: 1.17 The Healthy Start Scheme was i
Page 17 and 18: Chapter 2: Why is Maternal and Infa
Page 19: Birth Weight and Health2.10 A mothe
Page 22 and 23: her wider community. The factors ar
Page 24 and 25: 2.31 Infant formula is manufactured
Page 27: Summary2.48 The diet and nutritiona
Page 31 and 32: Birth weight of infants born in Sco
Page 33 and 34: Breastfeeding at Birth3.23 Informat
Page 35 and 36: Figure 5: Breastfeeding at the 6-8
Page 37: 3. Water should be added to the bot
Page 41 and 42: AccreditedAyrshire Maternity Unit,
Page 43 and 44: Community Mothers Breastfeeding Sup
Page 45 and 46: 4.18 Just over half of Boards had a
Page 47 and 48: policies for each nursery, provisio
Page 49 and 50: 4.26 Eight Boards had an obesity st
Page 51 and 52: Promoting and Supporting Breastfeed
Page 53 and 54: Parents Cooking Group, Gowans Child
Page 55 and 56: Chapter 5: Process for Development
Page 57 and 58: FoodMediaKnowledgeSkillsIncomeCommu
Page 59 and 60: Government and WHO publications. It
Page 61 and 62: OUTCOMESShort Term (0-3 yr) Medium
Page 63 and 64: 5.24 The activities were compared t
Page 65 and 66: • Introduce new routinely collect
Page 67 and 68: Chapter 7: Action Plan7.1 It is rec
Page 69 and 70: training and be integrated into und
Page 71 and 72: 2. Baby Friendly InitiativeActivity
Page 73 and 74: 3.5 Work with private sector compan
Page 75: Breastfeeding Mothers• Access to
Page 83 and 84: 18. Kelly Y, Panico L, Bartley M, e
Page 85 and 86: 56. Gregory J, Collins D, Davies P
Page 87 and 88: Appendix 1: Membership of Maternal
Page 89 and 90:
Appendix 2: Membership of sub-group
Page 91 and 92:
Appendix 3: Healthy eating advice f
Page 93 and 94:
Appendix 4: NICE Public Health Guid
Page 95 and 96:
Appendix 5: Indicators for Short, M
Page 97 and 98:
6 All relevant national & localpoli
Page 99 and 100:
complementary feedingRelevant resou
Page 101 and 102:
15 Increased acceptability ofbreast
Page 103 and 104:
23 reduced inequalities in childnut
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