Infant Feeding and Child Nutrition Strategy​ 2024​

Who has worked to co-produce to this strategy?

 

• Public Health Dorset​
• Dorset and Bournemouth, Christchurch and Poole (BCP) local authorities Best start in life initiatives​
• BCP and Dorset Local Authorities Family Hubs​
• University Hospitals Dorset and Dorset County Hospital Maternity and Neonatal Services​
• Maternity and Neonatal Voices Partnership​
• NHS Dorset​
• UNICEF Baby Friendly Initiative (BFI) Accreditation ​
• Better Breastfeeding​
• Breastfeeding Network contracted peer support service in Dorset​
• Dorset HealthCare, Public Health Nursing Service (Health Visitors and School Nurses), Speech and Language Therapy, Perinatal Maternal and Mental Health Services and Dietetic Teams. ​
• 97 participants in Public Health Dorset  infant feeding survey 2023​
• 187 participants in Maternity Neonatal Voices Partnership survey 2023​

 

External Engagement was undertaken with the following groups: ​

 

• DorPiP​
• Fostering Team​​
• Home start​
• Headteachers​
• Children and Young People Safeguarding Team ​
• LGBTQ+ Community Groups ​
• Parent Carers Together ​
• Dorset Race Equality Council ​
• Help and Kindness ​
• Dorset Women CiC ​
• NHS Dorset #FYI SharePoint ​
• Breastfeeding Network ​
• REY practitioners​
• Dorset Council Early Years Support​
• Clinical Directors​
• ICB Engagement Lead  Network​
• Family Hubs​
• Cerne Abbas GP​
• Dorset Council Best Start in Life Commissioner ​

We will be inclusive and responsive to any changes in national and local policies and guidance. The infant feeding strategy reflects the national and local policy context, including:

• ICB Joint Forward Plan Pillar 2 (2023-2028)
• Local Maternity and Neonatal 5-Year Equity & Equality Plan (2022)
• Healthy Child Programme (2023)
• NHS Long Term plan (2019)
• Chapter 3 Better Births (National Maternity Review, 2016)Postnatal Care, (3.22)
• The Best Start for life, A vision for the 1,001 Critical Days 
• Family Hubs and Start for Life Programme Guide (2022) 
• Guide to UNICEF Baby Friendly standards (2012)

Infant feeding strategies that support optimal infant and child nutrition contribute positively to reducing:

• poor health outcomes​
• health inequalities​
• the need for poverty food plans​
• food security and emergency planning​
• carbon emissions, water reduction and environmental pollution.
   

Optimal child nutrition which includes breastfeeding has a positive impact on lowering:​

• childhood obesity and healthy weight​
• poor maternal and infant mental health​
• rate of childhood cancers (childhood leukaemia, breast and ovarian cancer)​
• type 2 diabetes (mother and child)​
• rates of poor cardiovascular health​
• preventable childhood illnesses (respiratory, gastrointestinal, SIDS, NEC and otitis media​
• allergies​
• incidences of poor oral health​

“To create a supportive culture in Dorset that enables parents to make the decision about infant feeding in an informed way that optimises nutrition of their baby and infants and helps develop close and loving parent-infant relationships, setting babies up to maximise their potential for lifelong emotional and physical wellbeing.”

Our Ambition ​

The key purpose of the Dorset Infant Feeding and Child Nutrition Strategy is to support the health and wellbeing of  infants and children ages 0 to 5 years and their families in Dorset and improve experience and outcomes of our service users in Dorset.  

• improve breastfeeding rates and overall duration of breastfeeding in Dorset, we will do this by taking a Pan-Dorset approach to achieving Baby Friendly Initiative Accreditation​

• take an integrated system approach to the delivery of key initiatives to achieve Pillar 2 of the ICB Joint Forward Plan: To prevent 55,000 children from becoming overweight by 2040​

• work with system leads to inform the delivery of transformational initiatives to improve our local service offers, ensuring they meet the needs of our population, are inclusive, and easily accessible for all  

• ensure our workforce has access to training across maternity, health, and community partners. Equip staff with the skills and knowledge to support women, birthing people, and families in leading healthy lifestyles before, during, and after pregnancy. Provide focused support on breastfeeding, infant feeding, introducing solid foods, and child nutrition

• tackle health inequalities and improve experiences and health outcomes, we will do this by working with our communities and providing service and information that is accessible to all​

• improve communication and collaboration between organisations and teams across health, social care & early years providing services for 0-5 years through pathways to ensure the client journey is optimised​

This strategy is written to cover the feeding journey for families from the birth of their child to age five, a critical factor in these crucial early years that impacts on a baby’s healthy growth and development is what and how they are fed. 

• in the first two years of life, breastfeeding saves lives, shields children from disease, boosts brain development and guarantees children a safe and nutritious food source. UNICEF and the World Health Organization (WHO) recommend that infants begin breastfeeding within one hour of birth, be exclusively breastfed for the first six months, and continue breastfeeding until 2 years of age or beyond​

• at the age of 6 months, children need to begin eating their first foods. Young children should be fed frequently and in adequate quantities throughout the day, and their meals must be nutrient-dense and comprised of a variety of food groups. Caregivers should prepare and feed meals with clean hands and dishes and interact with their child to respond to his or her hunger signals​

• children need the right foods at the right time to grow and develop to their full potential. The most critical time for good nutrition is during the 1,001-day period from pregnancy until a child’s second birthday​

• meeting children’s nutrient needs in early life can be challenging, and many parents face barriers to securing enough nutritious, safe, affordable and age-appropriate food for their children​

• young children’s diets are frequently comprised of grains with little fruit, vegetables, eggs, dairy, fish or meat. Many are increasingly being fed sugary drinks and packaged snacks high in salt, sugar and fat​

• poor diets in early childhood can lead to deficiencies in essential vitamins and nutrients such as vitamin A deficiency, which weakens children’s immunity​

 

Breastfeeding Initiation Rate in Dorset:

• Dorset County Hospital – 89% (January 2024) ​
• University Hospitals Dorset – 74.76% (January 2024) ​
• Breastfeeding rate at discharge from Dorset County Hospital: 76% (January 2024) ​
• Breastfeeding rate at discharge from University Hospitals Dorset:  54.37% (January 2024) ​
• Breastfeeding rate at 10 days DCH:  67% (January 2024) ​
• Breastfeeding rate at 10 days University Hospitals Dorset: 41.42% (January 2024) ​
• Dorset County Hospital number of unrecorded Feeding Status at discharge: 1.2% (January 2024) ​
• University Hospitals Dorset number of unrecorded Feeding Status at discharge: 3.24% (January 2024) ​
• Dorset County Hospital Transfer of care from midwives to Health Visitor in Dorset = 64%​

Breastfeeding in Dorset at 6 weeks: ​

• Dorset: 58% Q1 &  55% Q2 2023-2024​
• BCP :  56% Q1 & 61% Q2 2023-2024​

Tongue Tie: ​

• Dorset County Hospital – 264 Referrals of which 181 released (2023) Equates to 68.5%​

Data Source: BadgerNet​

 

"Baby Friendly accreditation is based on a set of interlinking evidence-based standards for maternity, health visiting, neonatal and children’s centre services”.  Here at Dorset County, we have fully embraced the standards which is a roadmap for us to improve care.   At Dorset County we have implemented positive changes to practice for example our ‘Every Drop Counts’ project where we supply a kit to higher risk women who are inpatients awaiting induction of labour or a caesarean to express colostrum which can then be used to feed baby should the baby not feed straight away for whatever reason.  These are also given out at the diabetic clinic as these babies will be on the hypoglycaemia pathway once born.​

We now have a weekly feeding clinic which supports those babies past 10 days of age struggling to gain weight or support parents on a complex feeding plans.​"

Emma Barrett​

Infant Feeding Lead Midwife​

Dorset County Hospital 

Public Health Dorset Infant Feeding Survey 2023 feedback​

• 95.1% of respondents did not have a breastfeeding/baby feeding peer supporter visit at home after birth. of those mothers who did receive a home visit from a peer supporter 92% found this extremely or very valuable.​

• 32.4% of mothers who saw a health visitor within 2 weeks of birth said they needed more help.​

• many mothers of babies with tongue tie did not feel supported at all (30.2%) and 63.4% received no support feeding their baby while waiting for the tongue tie to be resolved.​

• 69.3% of mothers felt at least a little supported with feeding in the first 48 hours post-birth. of those who used local online support, 75% (12) found it very or extremely valuable.​

• 64% bottle feeding mothers felt unsupported​

 

Three most common themes extracted from the free-text survey responses were:​

• mothers felt that they were offered limited/no support to breastfeed
• ​mothers felt that advice received from a range of healthcare professionals both in hospital and in the community was inconsistent/conflicting/out-of-date/incorrect. ​
• the negative impact on baby's and mother's health of late- or un-diagnosed tongue ties. ​

 

Themes captured from service user suggestions included: 

• feeding friendly venues and spaces
• more information about weaning, health, children's foods, and allergy advice
• easily accessible, practical support in a variety of formats
• information on and access to a feeding buddy
• social media support groups and forums
• night feeding and sleep support
• FAQs and myth busters

 

Maternity and Neonatal Voice Partnership Survey feedback​

• 70.8% said they received enough feeding support (up from 48.7% last year)​
• 61.8% for UHD, 81.6% for DCH​
• 62.5% said they received enough feeding support in neonatal​
• 61.9% for UHD, 57.1% for DCH​
• 55% said they did not receive enough information on infant feeding​
• 23.3% said they did not receive enough information and practical support to feed their baby in the way they wanted to​

 

Common feedback themes included: ​

• improve postnatal support and advice​
• improve continuity of care and provide consistent advice​
• earlier diagnosis and treatment of tongue tie​
• enhanced feeding neonatal support​
• suggestion for lactation consultant in hospital or breastfeeding peer supporter to provide consistent support and advice

Breastfeeding releases a hormone called oxytocin which is increased by touch and closeness and has a psychological effect on both mother and baby, producing feelings of calm. It promotes brain development in the infant and Oxytocin helps mothers fall in love with their babies and want to hold and protect them.

 

It also has health benefits including:​

Lowers Mum’s risk of:​

• breast cancer​

• ovarian cancer ​

• osteoporosis (weak bones) ​

• cardiovascular disease ​

• obesity​

​

Protects baby against:​

• infections, with fewer visits to hospital as a result ​

• diarrhoea and vomiting, with fewer visits to hospital as a result ​

• Sudden Infant Death Syndrome (SIDS) ​

• obesity ​

• cardiovascular disease in adulthood​

• breastfeeding can build a strong emotional bond between mother and baby ​

 

It also has wider Environmental and Social Economic Benefits Including: ​

If 45% of women exclusively breastfed for four months every year, there could be an estimated: ​​

• 3,285 fewer gastrointestinal infection related hospital admissions​​

• 10,637 fewer GP consultations​​

• £3.6 million saved in treatment costs​​

 

If 75% of babies in neonatal units were breastfed at discharge, every year there could be an estimated: ​​

• 5,916 fewer lower respiratory tract infection related hospital admissions​​

• 22,248 fewer GP consultations​​

• £6.7 million saved in treatment costs​

​

If half those mothers who currently do not breastfeed were to breastfeed for up to 18 months in their lifetime, for each annual cohort of around 313,000 first time mothers there could be 867 fewer breast cancer cases, with cost savings to the NHS of over £21 million (Renfrew et al. 2012). ​

• investing in services to support women who wish to breastfeed for longer would provide a rapid financial return, with higher breastfeeding rates leading to greater savings (Renfrew et al. 2012)​

• breast milk is a natural, renewable food that is environmentally safe. It is produced and delivered to the baby without pollution, unnecessary packaging or waste (Francis & Mulford, 2002). A kilogram of powdered milk generates a carbon footprint of 21.8kg of CO2 (Rollins et al. 2016)​

• breastmilk is optimal nutrition always available to the baby free of charge​

Our aim in Dorset is to adopt an inclusive and supportive feeding culture and ensure all staff provide consistent information to families to enable them to make an informed decision on how they feed their baby. ​

• we do recognise that some parents may decide that formula feeding is the right choice for them, whether that be as an alternative or combination feeding with formula and breast milk.  Parents who chose to bottle feed should be supported to do so safely and in an attuned manner. ​

• parents combination feeding should be supported to maximise breastmilk intake where appropriate and all parents should be encouraged to feed their baby responsively to form a close and loving relationship.​

• in both breastfeeding and attuned/responsive formula feeding skin-to- skin contact, eye contact, responding to baby feeding cues, main care givers feeding the baby, holding the baby close and loving touch can all be an important part of the bonding experience to form close and loving relationships.​

• education about the benefits of even a small amount of breast milk, how to maximise breastmilk feeding and support should be provided on options such as:​

• expressing, pumping and alternative feeding methods​

• combination feeding ​

• make parents aware of the International Code of Marketing of Breastmilk Substitutes Framework, which protects breastfeeding through the regulation of marketing of breastmilk substitutes, sets standards for the labelling and quality of products and ensures that parent feeding choices are informed and based on full and impartial information. ​

 

In every case, we will respect personal choice and non-judgemental support will be offered, including how and when to start introducing healthy, unprocessed and nutrient-rich solid foods. Promoting loving, responsive and attuned feeding whether breast or bottle feeding should always form the basis of information & support to all families.​

As we work to enhance our support offers the create an equitable environment for all, areas for consideration will include, but is not limited to: ​

• same sex couples​

• transgender ​

• adoptive, Foster parents or Kinship Care Arrangements​

• surrogate parents​

• refugees and supporting translation requirements ​

• parents with Learning Disabilities​

• feeding from the breast with a nursing supplementer using expressed breastmilk or formula​

• mothers taking prescription drugs or undergoing therapies that are incompatible with breastfeeding​

• maximising breastmilk intake when combination feeding​

• using donor breastmilk formal or informal arrangements​

• supporting infants with complex medical issues i.e. Downs Syndrome, Cleft lip & palette​

• pre-mature babies​
   

Dorset Fingertips OHID Data 2022/2023: ​

• 4–5-year-olds measured as obese including severely obese:​

• Dorset 8% ​

• Bournemouth, Christchurch and Poole 6.8%​

 

Oral health (tooth decay) in 5-year-olds ​

• Dorset 19.1% ​

• England 23.7% ​

​

DiiS – Dorset Deprivation Data April 2024: ​

• Top 20% most deprived for age 0-4 in Dorset is 3,050 ​

• Female 49% ​

• Male 51% ​

Ethnicity: ​

• White British 63% ​

• Community minorities 36% ​

• Unknown 1% ​

 

National Data: ​

• 46% of 1.5-3-year-olds in the UK drink low calorie soft drinks​

• 32% of children aged 12-18months are consuming adult ready meals​

• ​15% of children aged 10-11months are consuming sugar sweetened soft drinks​

 

The strategy is written to cover the continued optimal nutrition for children 0 to 5 years.  This would include consideration of all the following:​

• introduction of healthy solid food (Weaning) and that Ultra -Processed Foods should be avoided if possible (First Steps Nutrition report)

• awareness that plant milk beverages do not contain all the nutrients required for optimal growth and development in infants and children

• ensuring all 0 to 5's have access to the iron, calcium, vitamin C,D and A that they require in their diet including the promotion and accessibility of the Healthy Start scheme ​

• improving the oral health of infants and children up to age 5 to prevent tooth decay by education of families on how diet and feeding methods can promote good oral health​

• improve access to food from Foodbanks, social supermarkets, community fridges etc. Food banks giving information on how to use foods to produce healthy meals

• ensure services and local data are available and accessible to support service planning for families with infants and children with restricted/ fussy eating including Avoidant/Restrictive Food Intake Disorder (ARFID)​

• ensure support is available and accessible for families who have infants and children with constipation/diarrhoea - which are linked to babies and young child's diet

• Ensure ICS have data and services available to support families with faltering weight gain in their baby​

• Ensure local data is used to plan services to effectively support families with overweight or underweight children​

• Ensuring all relevant organisations that provide services to 0 to 5 year olds in Dorset are aware of the negative impacts of and do not take part in any Branding and Marketing of formula milk and children's foods in line with government guidance, law and international code for the marketing of breastmilk substitutes

• Ensure continuity of diagnosis and treatment of Cow's milk protein allergy (CMPA) across Dorset

“Breastfeeding is a natural 'safety net' against the worst effects of poverty ... Exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence ... It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.”

UNICEF BFI ​

​

Provide information and support to enable stable and loving parent-infant relationships, through the promotion and protection of breastfeeding and attuned responsive formula feeding​

Improve breastfeeding rates and overall duration of breastfeeding in Dorset to reduce inequalities and significantly improve the health and wellbeing of mothers and babies

Work with system leads to inform the delivery of transformational initiatives to improve our local service offers to ensure they meet the needs of our population and are inclusive and assessable for all​

Ensure our workforce has training opportunities in maternity, health visiting, and community partnerships. Equip staff with skills and knowledge to support women, birthing people, and families in leading healthy lifestyles before, during, and after pregnancy, focusing on breastfeeding, infant feeding, weaning, and child nutrition.

Adopt the CORE20PLUS5 approach to reduce health inequalities at the system level. Align with key priorities from the Integrated Care Board Joint Forward Plan, focusing on preventing 55,000 children from becoming overweight by 2040.

Empower families to feed their babies safely in community and work environments and lead the way as a system to adopt and implement the principles set out in the Breastfeeding Friendly Scheme and UNICEF recommendations

Councils have designated officer or health professional with overall responsibility for the Healthy Start Scheme and increase the uptake of Healthy Start Scheme for eligible families, to meet the national target

Adopt a system approach to progress through each stage of Baby Friendly Initiative Accreditation for trusts, health visiting and family hubs and achieve sustainability standards​

Develop a fully integrated rapid access Pan-Dorset Tongue Tie Services​

Peer Support – to allow flexibility of service delivery to include innovations such as partnership working with volunteers, co-delivery of support for mothers on postnatal wards and NICUs​

Establish a pan-Dorset specialist infant feeding service to support parents and families with more complex feeding issues​

Improve our antenatal education and weaning programme offers and develop comms to target those least likely to engage

Work in collaboration with system organisations to develop and streamline plans, pathways, policies and procedures to support the implementation of the strategy

Develop and co-deliver communication and digital plans throughout the life span of the strategy ​

• work with community midwifery teams to improve our antenatal education offer to ensure it is equitable and accessible to all ​

• ensure that the critical services of midwifery and health visiting, physical and mental health support, infant feeding advice and nutritional support are equitable, inclusive, and available to all ​

• improve the family journey and pathways of support between maternity services, health visiting, local authority and voluntary services to strengthen the community wrap-around offer so parents are better prepared and supported from pre-conception and throughout the first 1,001 days​

• support women, birthing people, and partners and their families to establish committed loving and stable relationships, through safe and effective feeding methods​

• work collaboratively with local businesses, venues and organisations to encourage them to sign up to the Breastfeeding Friendly Scheme to ensure we create and promote feeding friendly spaces across our communities and in public spaces to enable women and birthing people to feel safe and welcomed to feed their baby without judgement​

• work with system partners to ensure we adopt inclusive schemes, policies and guidance to support women who breastfeed that are returning to work​

•  support families to adopt healthy lifestyles including healthy eating and access the Healthy Start Scheme including free vitamins for the eligible population​

• ensure the workforce has access to training across maternity, health visiting, and community partners. This will equip them with the skills and knowledge to provide consistent support, advice, and appropriate signposting

• educate staff, dads, partners, grandparents, and families about the available feeding options, methods, and services. Tailor the information to individual circumstances and choices, maximizing opportunities to promote breastfeeding and attuned formula feeding. This ensures optimal growth, development, and attachment during the first 1,001 critical days, setting babies up for lifelong emotional and physical wellbeing

• improve our public communications to provide clear and consistent system information about service offers and guidance in a range of languages and formats  ​

• use language to celebrate and value diversity, creating an inclusive culture for all​

• improve the quality and visibility of system data so that we can track our progress, identify gaps and highlight areas that require improvement​

• work collaboratively with system partners to inform the delivery of transformational initiatives to improve our local service offers to ensure they meet the needs of our population and are inclusive and assessable for all​

​

We will know we are making a difference when we see: 

• an increase in breastfeeding initiation and continuation rates in Dorset​

• a reduction in inappropriate referrals to specialist services, including tongue-tie​

• improved satisfaction levels with the quality of care, support and information service users receive across the antenatal and postnatal period​

• improvement in service user feedback received in annual surveys ​

• families using formula will report they are using recommendations for safe preparation of appropriate formula suited to the infants needs and using responsive feeding methods​

• all healthcare and community staff will have accessed up-to-date training relevant to their role, equipping them with the knowledge and confidence to provide consistent advice, information and guidance to families. ​

• families will have access to information and tools that are available across organisation in a range of languages and formats ​

• more families introducing healthy and nutritious solid food at the recommended time. ​

• families that are experiencing infant feeding problems will have timely and effective support ​

• an increase in the number of businesses, venues and organisations in Dorset signing up to the Breastfeeding Friendly Scheme ​

• audit results from UNICEF Baby Friendly initiative accreditation will evidence quality, consistency and family's satisfaction with the information and support for feeding their baby that they are given​

• an increase in the uptake of Healthy Start Scheme for eligible families​

• in the longer term, we expect to see an increase in the proportion of children starting school at a healthy weight, which will be evidenced through National Child Measurement Programme​

• we will expect to see a decrease in poor oral health in under 5’s​

• more efficient and streamlined pathways for complex infant feeding and child nutrition cases that require specialist support ​

• enhance service offers for the commissioned breastfeeding support service to maximising on peer support opportunities in primary and secondary care, including antenatal, feeding and weaning classes​

We will continue to monitor our progress throughout the implementation of the strategy and the delivery of initiatives which reflect our key priorities. Regular progress and assurance updates will be provided through system governance routes: ​

• a Strategy Implementation Group will be established and will take place quarterly to develop plans to implement the strategy and outline timescales for delivery of each initiative and improvement ​

• progress and assurance updates will be provided and monitored through the Best Start in Life Meeting ​

• maternity and neonatal specific deliverables will be monitored through Local Maternity and Neonatal System Transformation Meeting​

• regular engagement with service users to inform our work and track our progress ​

​

We will continue to work together as a system to improve integration and services offers to meet the need of our population, reduce health inequalities, and improve service user experiences and health outcomes ​

​

NICE Guidance:​

NICE NG194. Postnatal Care ​

NICE PH11. Maternal & Child Nutrition ​

NICE QS197. Faltering Growth Quality Standard​

NICE NG75. Faltering Growth: recognition and management of faltering growth in children​

NICE IPG149. Division of ankyloglossia (tongue-tie) for breastfeeding​

​

Office for Health Improvement and Disparities (OHID) Guidance:​

Child Oral Health​

 ​

First Steps Nutrition Trust Guidance: ​

Enabling children to be a healthy weight ​

Ultra-Processed Foods (UPF) in the diets of infants and young children in the UK​

​

UNICEF Standards, Research and Resources: ​

UNICEF Baby Friendly Initiative Standards (2012)​

Infant Health Research: Overweight and Obesity ​

Breastfeeding Resources ​

Relationship Building Resources ​

Bottle Feeding Resources ​

Sleep and Night Time Resources ​

Antenatal Care Resources ​

Neonatal Care Resources ​

​

Resources: ​

• Public Health Dorset – Children and Families ​

• Maternity Matters ​

• The Breastfeeding Network​

• Association of Breastfeeding Mothers  ​

• La Leche League GB​

• National Childbirth Trust ​

• National Breastfeeding Helpline​

• Royal College of Midwives ​

• Royal College of Paediatrics and Child Health​

• The Trussell Trust  ​

• Healthy Start ​

• Dorset's Food Banks and Affordable Food Projects​

• Dorset HealthCare Online Breastfeeding Course​

• NHS Breastfeeding help and support  ​

• ICON – Babies cry, you can cope ​

• UK Association for milk banks ​

• DorPIP – Free education courses and support for new and expectant parents​