National Institute for Health and Clinical Excellence (NICE)
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New NICE guidance on diet and nutrition will help give babies and toddlers the best start in life

The National Institute for Health and Clinical Excellence (NICE) has today (26 March 2008) issued guidance advising those who work with pregnant women and mothers on how to help them make decisions about their diet and lifestyle that will keep them healthy and give their babies the best start in life. The public health guidance calls for national consistency in the quality and quantity of support available to help address disparities in the nutrition of mothers and young children from low-income and other disadvantaged groups compared with the general population.

The guidance is based on evidence showing how all those who work with families can support mothers in changing their own and their child’s eating habits, thus increasing their chances of a healthy life. The guidance makes recommendations relevant from conception to five years of age which include:

• 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 support families in changing their diet by providing them with practical and tailored advice on how to eat healthily throughout pregnancy and provide an appropriately varied diet for their children.

• Midwives should offer every woman information and advice on the benefits of taking a vitamin D supplement (10 micrograms μg per day) during pregnancy and while breastfeeding. Health professionals should take particular care to
check that women at greatest risk of deficiency are following this advice. These include women who have limited skin exposure to sunlight, those who are of South Asian, African, Caribbean or Middle Eastern descent and those who are obese.

• Health professionals should use all appropriate opportunities to advise women who could become pregnant that they can most easily reduce the risk of having a baby with a neural tube defect (such as spina bifida) by taking folic acid supplements, 400 micrograms (μg) daily before pregnancy and throughout the first 12 weeks, even if they are already eating foods fortified with folic acid or rich in folate.

• Those responsible for providing maternity services should set up easily accessible breastfeeding peer support programmes so that women receive skilled and practical guidance in feeding their babies. Providers should ensure that breastfeeding peer supporters contact new mothers directly within 48 hours of their transfer home (or within 48 hours of a home birth) and offer mothers ongoing support according to their individual needs.

• Those working in pre-school day care settings should encourage children to handle and taste a wide range of foods that make up a healthy diet by ensuring a variety of healthier choices are offered at mealtimes.

Dr Gillian Leng, Deputy Chief Executive, NICE, and Executive Lead for this guidance said: “Ensuring children eat healthily in the early years is very important for proper growth and development, and can modify the risk of chronic illness later in life. Unfortunately not all women are getting the support they need at the moment. This guidance aims to redress the balance and ensure that support for all women is consistent across the country so that they can give their child the best start – this means sometimes targeting help at those who most need it.”

Dr Anthony Williams, Consultant neonatal paediatrician and Reader in Child Nutrition, Chair of the Guidance Development Group, said: “Those of us who work with families in our daily practice know that all parents want the best for their children - this includes making sure that mothers, babies and children eat well. The practical support and advice that parents currently receive can be patchy and inconsistent; families in low income groups particularly are less likely to receive good support and advice. The guidance highlights that those who provide services or who work with families – inside and outside the health service – should be trained to provide this.”

He continued:
“Whilst the advice focuses on helping mothers and children to eat more healthily, it also points out the important role that appropriate use of supplements such as vitamin D and folic acid can play in ensuring mothers’ and babies’ health. We are asking health professionals to recommend the wider use of these supplements, particularly vitamin D for women at greatest risk of deficiency. These can be provided free to those who are Healthy Start beneficiaries and are available at a low cost from local pharmacies to those who aren’t.”

Cindy Hutchinson, Midwife and Guidance Development Group member, said:
“Recent findings show that most women who stop breastfeeding would have liked to continue. The recommendations in this guidance address many of the barriers that women face in their efforts to breastfeed and aim to ensure that all women receive skilled support and accurate and timely advice to help them successfully initiate and continue breastfeeding for six months and beyond. The guidance also recommends that peer support programmes be made available to provide proactive support at home for those who are least likely to continue to breastfeed.

She continued:
“This guidance is also for anyone supporting families with pre-school children, such as home-based child carers and those working in day care settings such as nurseries, crèches and playgroups. It provides recommendations on how they can help encourage good eating habits from a young age. For example, we have recommended that carers should eat with children wherever possible and snacks offered between meals should be low in added

Notes to Editors

1. The guidance is available at

About NICE

2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:

public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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