Rotherham Infant Feeding

Forum

11am -2pm

21st April 2010

Carlton Park Hotel

Forum Agenda• 11.15 Welcome & Introduction - Anna Jones, Public Health, NHS

Rotherham

• 11.20 Healthy Start - Anna Jones, Public Health, NHS Rotherham

• 11.25 Start4Life - Anna Jones, Public Health, NHS Rotherham

• 11.30 Going Baby Friendly

Jeannine Curtis, Unicef Baby Friendly Accreditation Coordinator, NHS Rotherham

• 11.40 Breastfeeding Friendly Rotherham

Vicky Wilkinson, Infant Feeding Coordinator (community), NHS Rotherham

• 11.45 Rotherham „Be A Star‟ Campaign

Vicky Wilkinson, Infant Feeding Coordinator (community), NHS Rotherham

• 12.10 Infant Formula Milk Update

Jane Shaw, Lead Dietician for Paediatric Services, RFT

• 12.40 Breastfeeding Targets and Performance update -Anna Jones, Public Health, NHS Rotherham

• 12.50 Q & A

• 1-2pm Lunch & Networking

Healthy Start

• Statutory Scheme

• Improve nutrition among pregnant women and children under 4 yrs in low income and disadvantaged families across the UK

• Those who qualify are at least 10 weeks pregnant or have a child under four years old AND they (or their family) get income support, income-based job seekers allowance, income-related employment and support allowance or child tax credit (not working tax credit) and an annual family income of £16.190 or less in 2010/11

• All under 18’s who are pregnant qualify (even if they don’t get any of the above)

Healthy Start Vouchers• Pregnant women get £3.10 per week, for each

baby under 1 get £12.40 per week and for every child over one and under four get £3.10 per week

• Vouchers for redeeming fresh fruit and vegetables, infant formula milk and liquid cow’s milk

• Approximately 3,600 signed up to the scheme (at any given time)

• Range of retailers signed up to the scheme in Rotherham (approximately 90).

Healthy Start Children’s Drops

• Children’s 6 months - 4 years daily dose of 5 drops contains: Vitamin A (233microg), C (20mg) and D (7.5microg)

• Recommendations:

– Breastfed infants from 6 months

– Formula fed infants who are over 6 months – if less than 500ml infant formula per day

– Children under 5 years

Women’s Vitamin Tablets

• Available for women from 10 weeks in pregnancy – their child is 1 year

• Daily Dose contains Vitamins C (70mg), D (10microg) and Folic acid (400microg)

• Recommendations:– Encouraging uptake of both folic acid and Vitamin

D

Healthy Start Vitamins• 3,925 children entitled to children’s vitamin drops

(Oct-Dec 2009)

• 1,322 women entitled to maternal vitamins (Oct-Dec 2009)– 341 pregnant women and 981 women with children

under 1 year.

• Historically distribution of vitamins has been challenging

• Currently Maternal vitamins distributed via 27 local pharmacies

Promoting Healthy Start

• Every opportunity promote the scheme & uptake of vitamin drops and women’s vitamins

• Signing Applications – Part B: health professional statement

• Equal benefits for breastfeeding and bottle feeding mothers

• Support for young pregnant women

• Choice and flexibility

Start4Life

• To support a better start in life for infants from birth

• Leads up to Change4Life focussing from conception

• Fully supports the Healthy Child Programme

• Provides health professionals with accessible, concise information

• Recommendations translated with key messages to engage new parents/families

Start4Life

• Source for the most up-to-date advice on

breastfeeding, introducing solid foods

(weaning) and active play

• Start4Life communicates 6 key behaviours

designed to build healthy habits from day

one, these include:

– Mum’s milk, every day counts, no rush to

mush, taste for life, sweet as they are and

baby moves.

Banana Challenge

• Removed from S4L due to worries of a chocking risk

• revising and reprinting the 'Introducing solid foods' and 'Building blocks for a better start in life' booklets

• Available from the DH Orderline (aka Prolog) by the end of March.

• Advance orders for stock via the DH Orderline– 'Introducing Solid Foods‘ Product Code: C4L175

– 'Building blocks for a better start in life' Product Code: C4L176

• DH prefer that you do not use existing stocks of 'Introducing Solid Foods' and 'Building blocks for a better start in life' and ask that you recycle

Rotherham Start4Life Roadshow3rd March 2010

• Rotherham Central

Children’s Centre

• 10-3pm

• Aimed at pregnant

women and new mum’s

• Activity sessions and

stalls including

breastfeeding peer

support, tot’s sports,

dietetics team, oral

health, cook and eat and

weight management

services.

• 42 parents/members of the

public attended the event

• This excluded families

attending day care/school

pick up

• 39 professionals/workers

attended the event

(including media and Bliss

Lancaster Staff)

• Good media interest

• Evaluations were undertaken

• Post codes of all families attending were identified

• Most families felt the advice and information they received on the day was excellent

“I think the banana challenge is great – why can’t all advice be

put this simply”

“If only everyday you could get all this advice under one roof”

What is the UNICEF Baby Friendly Initiative

and what does it entail for Rotherham?

Jeannine Curtis, UNICEF Baby Friendly

Accreditation Coordinator

Not the UNICEF

Baby Friendly

Initiative again!

The UNICEF Baby-Friendly Hospital Initiative ( BFHI ),was

launched in 1992, by the World Health Organization and UNICEF .

The Initiative was launched to protect breastfeeding in an increasing bottle

feeding culture.

The UNICEF UK Baby Friendly Initiative was launched in the UK in 1994.

It started with the Ten Steps to Successful Breastfeeding which maternity units

have to implement to become Baby Friendly.

In 1998 its principles were extended to cover the work of community health-care

services. The Seven Point Plan for the Promotion, Protection and Support of

Breastfeeding in Community was launched.

In areas where Maternity Services and PCT‟s have been designated UNICEF Baby-

Friendly Status; they have seen significant increases in breastfeeding initiation

and breastfeeding longevity rates. Some areas have seen a 20% rise in rates

following implementation of the Initiative.

Why are we trying to get UNICEF BFI?

•Firstly, Improving Breastfeeding rates is one of the 10 priority health

targets for Rotherham. The Initiative is being used to address this

priority health need.

Currently breastfeeding rates in Rotherham are well below the national

average. Rotherham‟s “Better Health, Better Lives” has set metric 6-8

week targets as below;

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

28% 30% 32% 33% 34%

• Secondly, we do not have a choice. NICE and the Government have

recommended as a minimum standard the implementation of the

UNICEF UK Baby Friendly Initiative. It has estimated a £500,000 saving

from treatment costs for every 1% rate increase in breastfeeding infants

beyond 13 weeks.

Implementing the UNICEF Baby Friendly initiative means following

and applying the set criteria laid down in their staged program.

• Rotherham Foundation Trust, NHS Rotherham

(RCHS) and Children‟s Centres are jointly going for

UNICEF UK Baby Friendly Initiative.

•We were awarded Stage 1 in February 2010.

•We now have 21 months to get Stage 2 (January

2012).

•Then another year to get Stage 3. We should be

awarded Baby Friendly Status in January 2013.

The UNICEF Baby Friendly Initiative:

•The aim is for a women to be given the same consistent, quality

breastfeeding care and advice, Antenatally and Postnatally from all health

care services and voluntary services.

•This will be done by ensuring all staff with primary responsibility for

pregnant women and new mothers receive breastfeeding training to the high

standards set by UNICEF BF assessors.

Staff who do not have primary responsibility will have breastfeeding

awareness training. Peer Supporters will also receive training.

G.P‟s will get training delivered at the September PLT event. Those who do

not attend will receive work books to complete.

•Staff‟s breastfeeding knowledge and practical skills are being audited and

reviewed to ensure the BFI standards are met.

We have to ensure 80% of staff are trained to the set standards and achieve

a pass rate of 80% in a lot of audits to get Stage 2.

The Breastfeeding Policy:

•A New updated Policy will be coming out soon. Orientation to

the Policy must take place within 7 days of starting

employment. This applies to CC staff as well.

•The Parents guide to the Rotherham Breastfeeding Policy

has to be displayed in all health care premises. (Up in all NHS

Rotherham owned premises with public access, G.P

practices, Children Centres and around all Maternity facilities

at RFT).

Mechanisms for recording antenatal breastfeeding information

and postnatal advice and support:

•To get UNICEF BFI, we have to ensure all our paperwork documents the

advice and info given to pregnant women, breastfeeding mothers and

bottle feeding mothers. We have to audit the paperwork to ensure it is

being filled in and advice is being given.

•Maternity service staff should be use to filling in the Antenatal info BF

checklists and Postnatal checklists for bottle feeding women and

breastfeeding women. Is paper work filled in correctly and all advice

given? Current audit results suggest not!

•New System 1 templates are being designed for Health Visiting Staff.

New Checklists will have to be completed at Antenatal Visits and at the

Primary Visit, Postnatally. I will be attending locality meetings in the

near future to explain the new documentation.

To get Stage 2 we have to complete Audits: Audits

•We have 6 audits to complete at RFT and 5 audits to complete across

Rotherham Community Health Services.

•Some audits are done 3 monthly, others 6 monthly or yearly.

•The audits monitor: Antenatal advice and info given to pregnant women,

Skin to Skin prevalence and support, Postnatal advice and support given

to breastfeeding mothers and bottle feeding mothers.

•Staff are also audited to assess their breastfeeding knowledge to find out

what update training is required to reach the 80% pass rate.

•Every member of staff who has primary responsibility, has to have a 1-1

Practical Skills Review with the Infant Feeding Coordinators or a trained

assessors. 80% of staff have to pass this to get Stage 2. These have

started at RFT and across RCHS.

AUDITS

• Give a wave if you are a Practical Skills Assessor or an auditor.

• Peer supporters may have some evaluations done in the future. Those

who are appointed as the new Officers will probably be assessed.

• Thank you for your cooperation with the audits, I know you are all very

busy people who do not really have time to be assessed and

breastfeeding is only a small part of your roles.

•. We have to undertake these audits to get Stage 2. 21 months is not a

long time to improve knowledge and skills to the required standards.

Thank you,

Any questions see me over lunch.

Performance Update

DH Feedback• Bottled water use in infant feeding• Bottled water is not a healthier choice than tap water and is not usually sterile. In

fact, some natural mineral waters are not suitable for babies because of the amount of minerals they can contain. If you need to use bottled water, remember that any bottled water that is labelled ‘natural mineral water’ might contain too much sodium for babies. Check the label to make sure the figure for sodium isn’t higher than 200 milligrams (or ‘mg’) a litre. You might need to look for ‘Na’ on the label, which also means sodium. Like tap water, it is always necessary to boil the water before using it to make up a feed and allow it to cool for no more than half an hour, following the guidelines on making up infant formula.

• Referenced on DH website and in Birth to Five

Breastfeeding Friendly Rotherham

Vicky Wilkinson

Community Infant Feeding Coordinator

Rotherham ‘Be A Star’

Vicky Wilkinson

Community Infant Feeding Coordinator

INFANT FORMULA

infant formula

infant formula

infant formula

infant formula

Jane Shaw BSc Med (Hons) RD

Sarah Milnes BSc (Hons) RD

Whats in cow’s milk

Protein composition

WheyAlpha -lactablumin Beta –lactaglobulinMost likely to produce IgE antibodies heat sensitive. Therefore may be able to tolerate evaporated, boiled or sterilised milk, UTH and milk powder

Caseinheat stable

SugarLactose

Additions to formulaLCP (long chain Polyunsaturates)

Omega-3DHAOmega-6AABrain development, nervous system, eyesight

Prebiotic Also known as Oligosaccharides or polysaccharidesNon-digestible carbohydrates Nutrients for gut flora such as Bifidobacteria lactobacilliExamples as FOS( fructo-oligosaccharides), GOS (galacto-oligosaccarides), inulin, transgalacto-oligosaccharides and lactulose

Nucleotides Support Immune system Improve growthImprove gut bacteria

Alpha- Lactalbumin Whey proteinReduced beta proteins therefore more like breast milk

Cow & Gate Milupa Aptamil SMA

Breastmilk fortifer Nutriprem Breast milk fortifier

Breast milk Fortifier

Preterm – under 2000g

Nutriprem 1 Aptamil Preterm SMA Gold Prem 1

Preterm -above 2000g

Nutriprem 2 SMA Gold Prem 2

Ex-prems discharged from RFT SCBU that have not had catch up growth are discharged on Nutriprem 2. It should only be used until 26 weeks actual age. Infants that are not growing

well on Nutriprem 2 need to be referred to Dietetics and Nutrition services for the provision of more suitable formula as soon as problem arise.

Cow & Gate Milupa Aptamil SMA HIPP

First milk(whey

dominant)

First Infant Milk Aptamil First Milk

SMA First Infant milk

Hipp OrganicFirst milk

First milks/Stage 1 used all first year no need for stage 2, stage 3 ……

Second Milks

“Hungry Baby”(Casein

Dominant)

Infant milk for the hungrier

babies

Hungry milk SMA Extra Hungry Infant

milk

Hipp OrganicHungry Infant

Cow & Gate Milupa Aptamil

SMA HIPP

Follow onFrom 6 months

onwards

Follow on milk Aptamil Follow on Milk

SMA Follow on Milk

Hipp organic follow on Milk

One year plus

When all you need is cow’s

milk

Growing up milk for toddlers

Aptamil Growing Up

milk

SMA Toddler Milk

Hipp Organic Growing up

Cow & Gate Milupa Aptamil HIPP

Good night milk Hipp Good night milk

Contains rice & buckwheat

High calorie

100% whey milks Cow & Gate Comfort Aptamil Comfort

Milupa Aptamil Mead Johnson SMA

Lactose free Enfamil O -Lac SMA LF

Pre-Thicken formula

Enfamil AR SMA Stay Down

Extensively hydrolysed formula

Aptamil Pepti Nutramigen 1 & 2

Cow & Gate Mead Johnson SMA Nutricia

ExtensivelyHydrolysed

Formula with MCT

Cow & GatePepti Junior

Pregestimil

Amino Acid Formula

NutramigenAmino Acid

Neocate LCP

High Energy SMA HighEnergy

Infatrini

Other milks – all not recommend

Soya infant formula only for over 6 month of age but

ideally not before 12 months therefore no need for soya

formula

Goats milkNEVER as banned in EU and

UK

Rice Milk

Not to be used in under 5’s due to high level of arsenic

Kcal in 1/4 Kcal in ½ Kcal in an apple

Apple 15 kcal 30kcal 60kcal

Kcal in 2 teaspoon Kcal in 3 tblespoons Kcal in 6 tblespoons

Baby rice 15kcal 56kcal 112kcal

Kcal in 30ml Kcal in 90ml kcal in 120ml

Formula 20 kcal 60kcal 80kcal

Formula Feeding ProblemsConstipation Check it is constipation

Return to whey dominant formulaCheck feed concentrationAdvise extra cooled boiled waterRefer to GP

Sugar should not be added to drinks or feedTake care not to compromise growth by giving too much cooled water

Colic Check bowelsCheck feeding positionCheck feed concentrationCheck winding methodCheck over feeding

Check teat size observe a feed (HV or Midwife)Offer support/self help groupsFeeding diarySome parents find colic preparations helpful

Excessive possetting

Check for over feedingSupport and reassureObserve feedReview weight gain

Examine feeding positionFeeding DiaryRefer to GP if possetting is excessive and weight gain is inadequate

Poor weight gain

Check formula preparationCheck amount and frequency of feeds

Observe feedsRefer to GP/CMO if appropriate

Weaning update

Exclusive breastfeeding from birth until weaning is the optimal way to feed young infants

Continuing breastfeeding throughout weaning may reduce the risk of coeliac disease and allergy

Term infants should not begin weaning before 4 months (17 weeks) but should begin weaning by 6 months

Infants should all be considered individually as they develop at different rates

Potentially high allergen foods such as egg, fish, milk used in foods and cooking, cheese, yoghurt, wheat and other gluten containing cereals do not need to be delayed until a certain age

Preterm infants need special consideration and around 6 months after their actual birth date is likely to be the best time to begin weaning

2 years

6 months 1 year

wea

nin

g

Birth

Breast milk

Cow’s milk as a drink, 500 -600ml/dayFirst milk

Family food1

7 w

eeks

th

e ea

rlie

st f

or

wea

nin

g

Fe r

ich

fo

od

s 7

/12

‘So

ur

‘ veg

bef

ore

9

/12

Vit D supplements for all– Abidec, Healthy start Vitamins, OTC till 5

3 meals & 3 snack

Fin

ger

foo

ds

Progress on to lumpier food faster

when solids introduced nearer

6/12

95% of infants should be 100% happy on the above

Preterm Formula till 26 wks actual age or stopped earlier if growth between 25-50th C

First milk can be used till 1 yr corrected

Cow’s milk as a drink, 500 -600ml/day

Performance Update• Three main targets/measures

– Breastfeeding initiation target to improve the breastfeeding initiation rate by 2% year on year. To achieve 60% by March 2010 – Actual 59.24%

– Healthcare Commission target - report the infant feeding method of 90% of infants at the 6-8 week check by March 2010 – Actual 96%

– Numbers breastfeeding at 6-8 weeks to improve the breastfeeding prevalence by 2% year on year– target 28% by March 2010 - Actual 29.75%

• Local Area Agreement target for breastfeeding prevalence

• Breastfeeding at 6-8 weeks is a WCC High Level Outcome

• The aim for NHS Rotherham is to work towards a target of 30% of women continuing to breastfeed at 6-8 weeks by 2011/12.

DH Feedback• Bottled water use in infant feeding• Bottled water is not a healthier choice than tap water and is

not usually sterile. In fact, some natural mineral waters are not suitable for babies because of the amount of minerals they can contain. If you need to use bottled water, remember that any bottled water that is labelled ‘natural mineral water’ might contain too much sodium for babies. Check the label to make sure the figure for sodium isn’t higher than 200 milligrams (or ‘mg’) a litre. You might need to look for ‘Na’ on the label, which also means sodium. Like tap water, it is always necessary to boil the water before using it to make up a feed and allow it to cool for no more than half an hour, following the guidelines on making up infant formula.

• Referenced on DH website and in Birth to Five