Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceNICE guidanceNational policy will influence the nutrition of women of childbearing age and their children. Recentpublic health programme guidance from NICE on maternal and child nutrition endorses existingpolicy on nutritional recommendations for pregnant and pre-pregnant women and for infants. 278The guidance strongly reinforces and builds on the previous evidence-based guidance from NICEon the promotion of breastfeeding, 177 and recommends that all staff involved in the care ofpregnant or breastfeeding women have the appropriate knowledge and skills to support andadvise women about breastfeeding. Recent cross-government policy to tackle obesity alsohighlights the importance of breastfeeding and improved childhood nutrition in the preventionof obesity. 279Healthy Start schemesNational programmes introduced within the UK to address inequalities in the health of youngwomen and children may have an important impact on nutrition. The Healthy Start scheme wasintroduced in 2005, following a review of the Welfare Foods Scheme in 2000 by the Committeeon Medical Aspects of Food and Nutrition (COMA). The review recommended that pregnantwomen should be given vouchers for a wider range of foods, and identified the need for healthprofessionals to give general dietary advice during pregnancy, emphasising the importance ofbreastfeeding. The aim of Healthy Start is to reduce inequalities in nutrition for women andchildren. The scheme provides food support, professional advice and support to pregnant womenand mothers of young babies and children from disadvantaged backgrounds. Like the WelfareFoods Scheme before it, food support comes in the form of vouchers to buy milk and infantformula and provision of vitamin supplements. As recommended by COMA, however, there isgreater flexibility within the Healthy Start scheme allowing the vouchers to be used to buy fruitand vegetables. Early evaluation of the scheme in Devon and Cornwall suggested that womenwho were recipients of Healthy Start were buying more fruit and vegetables than they were beforethe scheme began. 280 Further follow-up will be needed to confirm whether these beneficial effectson fruit and vegetable uptake are observed on a wider scale and maintained in the longer term.The evaluation did not examine overall uptake of the scheme nor were any nutritional outcomesmeasured. A survey of health professionals was also carried out: interviews with a small sample ofhealth visitors and midwives suggested that most professionals interviewed were aware of thescheme and how to apply it. Knowledge about some elements of the scheme remained low,however, and the authors of the evaluation concluded that coverage of training to prepare forHealthy Start had been somewhat patchy. Evaluation at national level is needed to assess uptake ofthe scheme and to examine its impact on the nutrition of women and young children. Other publichealth programmes that are directed at families with young children including Sure Start Children’sCentres, also have the potential to bring about improvements in maternal nutrition and infantfeeding practices.Although national policy may influence maternal and child nutrition, the central importance of thefamily should also be recognised. A woman’s diet before and during pregnancy, and her views onbreastfeeding and weaning will be influenced by her partner, friends and family. Clear andconsistent guidance for families on the benefits of healthy eating is needed, particularly to explainthe long-term consequences for their children of early diet and nutrition. In the future it needs tobe ensured that all professionals who care for pregnant women and their families have appropriateknowledge and skills to provide this guidance.62Early life nutrition and lifelong health