COVER STORY Early Years' nutrition

cover story

Early years' nutrition

by Nigel Denby Dietitian and Author

Delivering a clinical service to Hammersmith and Queen Charlotte's Hospital Women's Halth Clinic and acting as Nutrition Consultant for the Childbase Children's Nursery Group, Nigel also runs his own private practice specialising in Weight Management and PMS / IBS

and Kathy Klein Paediatric Dietitian

Kathy works as a community paediatric dietitian for Buckinghamshire PC and as a freelance dietitian. She works with infants and children with a range of nutritional needs ranging from allergies, obesity, early feeding problems, behavioural related feeding problems, neuro-disabilities and other special needs.

It is well documented that during a child’s early years, good nutrition is vital, not just for growth and development, but also to help children establish healthy eating habits as an investment for a lifetime of good health. So what are the best resources out there to help all parents get early years’ nutrition right?

Nutrient requirements are comparatively higher in the early years than at any other life stage and the general healthy eating principles targeted at adults and older children are not appropriate for the under 5s.

Nutrients of particular importance in the early years include: Iron, Calcium, Zinc and Vitamins C, D and A. Family menus, recipes, snacks and breakfast foods all need to be nutrient dense as well as providing sufficient energy for appropriate growth and development. This can be a daunting task for parents, especially for those on limited budgets, or with poor cooking skills, or who struggle with reading English recipes and nutrition education resources.

Looking at nutrition statistics for the under 5s makes grim reading and suggests we need to find more simple but effective ways of supporting parents at this critical time. There is a re-emergence of rickets in UK infants and children, especially amongst Asian populations (1) A recent population study demonstrated that 20-34% of Asian children were vitamin deficient with vitamin D levels <25nmol/l (2) One in eight children aged 18-28 months had a low haemoglobin (3) 25%-35% per cent of ethnic minority and white young children from impoverished inner city areas of the UK have Iron Deficiency Anaemia (4) 13% of toddlers aged 2-3 years are obese (defined as BMI at or above the 95th centile) (5)

A key element in achieving better nutrition in the early years is evidence-based nutrition education resources that can be used by health professionals to help new mums get nutrition right from the start. To be more effective at getting our messages across to the widest audience possible, it would seem logical, therefore, to share good nutrition education resources in order to avoid reinventing the wheel - especially in this increasingly timeand financially-pressured working environment.

In a recent pole of dietitians working in the early years sector who are members of the online community www.grub4life.org.uk, there was a consensus that resources in languages other than English, weaning recipes that reflect cultural diversity and visual toddler portion size guides were all educational tools frequently requested by health professionals to make communicating the fundamental issues around early years nutrition easier to parents.

The professionals at the frontline in this area of public health are of

course health visitors, practice nurses, school nurses and district nurses. As dietitians, it is our view that our colleagues in these posts are often expected to be experts in all fields and seem to have to mop up the work and provide the detailed expertise of other health professionals. The availability of Community paediatric dietitians around the country is somewhat of a lottery and where posts exist, their case load is often consumed with children with special clinical dietetic needs, so they are unable to offer early, preventative advice and support for parents. Additionally, some Children Centres have dietitians in post but many don’t and again, the dietitian’s remit in these Centres is usually to provide clinical support to children with special dietetic needs.

A recent survey has shown that, whilst most non dietetic Health Professionals feel confident in providing early year’s nutritional advice, the biggest stumbling block seems to be the lack of good cost-effective resources. These resources need to be both evidence based and userfriendly, with practical ideas and tips and made available in the language that suits the target audience.

Could something as simple as a pool of the best resources, made available to all health professionals, make a difference?

What resources are available?

Here is a summary of the various types of resources available: • The Infant and Toddler Forum (www.infantandtoddlerforum.org) offers various study days, and provides useful fact sheets ‘useful information for parents’ (suitable for photocopying for healthcare professionals to give to parents).

Registration and all information is free to download to all health professionals. Resources can also be purchased from the website. The

Infant and Toddler Forum has also devised the Little People’s Plates initiative to communicate directly with parents and help them make the best food choices for their children right from the start. The website www.littlepeoplesplates.co.uk has useful tools and tips available for parents. • www.grub4life.org.uk is an online community supporting dietitians, childcare professionals, health visitors, school nurses, community nurses, practice nurses, district nurses and anyone else, including parents, with an interest in early years' nutrition. Grub4life is a fiveweek rotational menu in three stages from first-stage weaning through to family foods for use in Children’s Centres, nurseries and by childminders. All menus and recipes comply with the Caroline Walker Trust nutritional guidelines for the Under 5s in child care and can be adapted from vegetarian, milk free, egg free and wheat free diets. HENRY is a new initiative that has been designed to tackle early childhood obesity by training community and health practitioners with the aim of working more effectively with parents and young families. Courses and training opportunities are available for organisations and individuals. Henry is hosted by the Royal College of Paediatrics and Child Health and is funded by the Department of Health and the Department for Children, Schools and Families. www.henry.org.uk The British Dietetic Association Paediatric Group has a variety of leaflets available which can be ordered from the BDA website, but do come at a cost. www.bda.uk.com The Dairy Council – leaflets – Tiny Tums, Tiny Teeth, Baby Nosh ( also available in other languages) www.milk.co.uk Change4life. In autumn 2009, Change4life launches the early years' arm of its campaign, Start4life which will include a breastfeeding and weaning toolkit and will be available in hard and electronic versions. www.nhs.uk/Change4Life Unicef Baby Friendly Initiative www.babyfriendly.org.uk has a variety of leaflets available – e.g. Breastfeeding your baby; Feeding your new baby; Off to the best start; Preparing a bottle feed using baby milk powder; Weaning-starting solid food. These leaflets have also been translated into a host of languages including Albanian, Arabic, Bengali, Chinese, Gujarati, Japanese, Russian, Somali and Tamil. Weaning your child on to healthy Asian foods – Huddersfield NHS Trust (2000) – Languages: English, Urdu, and Punjabi. www.cht.nhs.uk

References: 1 SACN. Update on vitamin D. Position statement by the Scientific Advisory Committee on Nutrition. London: The Stationary Office, 2007 2 Lawson M, Thomas M. Vitamin D concentration in Asian children aged 2 years living in England: population survey. British Medical Journal 1999; 318 (7175):28 3 Gregory JR et al. National Diet and Nutrition Survey: Children aged 1.5-4.5 years.

London:UK:HMSO:1995 4 Moy RJD. Prevalence, consequences and prevention of childhood nutritional iron deficiency: a child public health perspective. Clinical and

Laboratory Haematology 2006:28:291-8 5 The Information Centre. Statistics on Obesity, Physical Activity and Diet: England, January 2008.

Government Statistical Centre. 2008

Grub4life – supporting early years' nutrition www.grub4life.org.uk

The vision of Grub4life is to make good nutrition in the early years the norm rather than the exception. We see the community nursing professions as being critical in achieving this vision and are very keen to build stronger links in order to understand what we can do to support you and also to showcase the work you are already doing in the field. Together we believe we really can make a difference.

Through dialogue with the website’s health professional membership, it has become clear that there is an opportunity to collaborate and collate the ‘best’ early years nutrition education resources available in one place to be shared and disseminated by colleagues around the UK.

We know that there are terrific resources produced around the country by health professionals and these could easily be shared with other colleagues. If you have developed nutrition education resources in your area and would be willing to share them with colleagues please contact us at nigel@grub4life.org.uk. Any resources Grub4life recommend will be made available in pdf format or via a weblink and will be fully credited to the authors and agency they work for. Similarly, if there are resources we haven’t mentioned that you like using and are affective at getting the messages across to parents, please tell us about them - we will approach the original authors and ask permission to promote them on www.grub4life.org.uk based on your recommendations.