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Diet and nutrition

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A healthy diet and good nutrition during pregnancy and the first four years of life are vitally important for a child’s growth, development and long term health. Maternal and infant diet and nutrition are key to promoting healthy development and protecting against a range of long-term adverse health outcomes later in life.

In the womb: A baby’s development in the womb is affected by their mother’s physical health, diet and behaviours. Epidemiological research has found that the nutritional status of women during pre-conception and pregnancy affects the long-term health and well-being of her child, and even grandchildren. Good mental and physical health, healthy eating and exercise, as well as a lack of exposure to toxins such as tobacco, alcohol and drugs, promote healthy development and reduce the prospect of premature birth and low birth weight.

Alcohol, smoking and substance misuse are associated with complications during pregnancy, low birth weight and premature birth. Maternal obesity in pregnancy is a significant risk factor – both for the baby’s health and that of its mother. Pregnant mothers with a high Body Mass Index (BMI) are more likely to have a miscarriage or stillbirth and be affected by pre-eclampsia and gestational diabetes.

Infants: What babies eat, and when, is also important for healthy development. Breastfeeding is the optimal way to feed babies up to six months. Breastfeeding protects children and mothers against health problems, supports mother-child bonding, reduces the risk of sudden infant deaths, and is associated with higher IQ.

Babies are likely to show the signs of readiness for solid food alongside breastmilk at about 6 months (this is known as complementary feeding. A healthy diet in infancy gives babies the nutrients they need to grow, and establishes children’s future eating patterns. Family physical activity during this period is also important to prevent obesity, and influences later child activity levels.

Good oral health for babies and young children prevents dental decay, which can cause pain, and make talking and eating difficult. The impact of poor dental care can also affect children’s social and emotional development, both in terms of their confidence and appearance. Poor oral health is financially costly - 25% of five-year-olds in England have tooth decay with the number of hospital admissions for treatment steadily increasing.

View the diet and nutrition infographic

Scale of the issue

The health and development of children under five varies dramatically between different parts of England, with children living in more deprived areas far more likely to be affected by poor health than those in more affluent areas.

Breastfeeding rates in the UK are among the lowest in the world. Recent data from NHS England shows that 73.8% of women start breastfeeding after birth, but rates reduce in the first week and months after birth, falling to around 45.2% at 6-8 week, and to 34% at six months of age.

"The success or failure of breastfeeding should not be seen solely as the responsibility of the woman. Her ability to breastfeed is very much shaped by the support and the environment in which she lives. There is a broader responsibility of governments and society to support women through policies and programmes in the community.” Dr Nigel Rollins, World Health Organisation, Open letter on the current crisis in breastfeeding in the UK.

Childhood obesity is one of the most serious global public health challenges for the 21st century. In England, 1 in 5 children in Reception class are overweight or obese, with rates twice as high for children living in the 10% most deprived areas. These children are at an increased risk of asthma, emotional and behavioural problems, poor sleeping patterns, and musculoskeletal disorders, as well as cardiovascular disease and diabetes in later life. Only 10% of children meet the Chief Medical Officer’s guidelines for physical activity at age 2-4 years. About half of women of childbearing age (16 to 44 years) in England are either overweight or obese, and the prevalence of obesity in women of this age is increasing.

25% of 4-5 year olds are affected by tooth decay, with dental extractions and treatment being the most common reason for children aged 5 to 9 being admitted to hospital in England. Sugary drinks, including via bottle feeding, not cleaning teeth properly or often enough, and not being exposed to fluoride are all known to increase the risk of tooth decay.

What promotes healthy diet and nutrition in pregnancy and the early years?

Healthy eating and exercise in pregnancy: For optimal health, mothers should aim to eat a nutrient rich and balanced diet, take vitamin D and folic acid supplements, and exercise for at least 30 mins four times a week. Low-income families are able to receive Healthy Start vouchers to support them with the cost of milk, fruit and vegetables, as well as free vitamins. Maternal obesity is linked to a range of adverse outcomes including severe morbidity, miscarriage, cardiac disease, pre-eclampsia, gestational diabetes and low breastfeeding rates.

Breastfeeding: The World Health Organisation recommends that babies should be exclusively breastfed during the first six months of life. Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond (see below).

Healthy eating for young children: When breastmilk is no longer enough on its own (ideally not before 6 months old), healthy and nutritious food can also be added to a baby’s diet. This is known as complementary feeding. Babies learn to feed themselves by trying food with lots of different flavours and textures. Older babies and toddlers can eat simple family foods that are low in salt and sugar, with milk or water to drink. Commercial baby food should be limited as their content is often too sweet or soft.

Physical activity for young children: It is recommended that babies from birth should have opportunities for floor-based play and water-based activities, with pre-school children who are capable of walking unaided physically active daily for at least 3 hours spread throughout the day.

Oral health: Oral health can be improved through supervising tooth brush using fluoride toothpaste, regular visits to the dentists, reducing sugar consumption and restricting drinks to milk and water.

What increases the risk of poorer outcomes?

Alcohol, smoking and substance misuse are all factors associated with low birth weight. Women who are pregnant or are planning a pregnancy are advised that the safest approach is not to drink alcohol at all, to keep risks to their baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the risk rising as alcohol intake increases.

Examples of innovative practice in the A Better Start partnerships include:

Case study: HENRY (Bradford)

Case study: Community Action and Nutrition (LEAP)

Case study: Cook and Play (SSBC)

Key reading:

About diet and nutrition

First Steps Nutrition Trust. (2014) Eating well for a healthy pregnancy: A practical guide. London: First Steps Nutrition Trust.

First Steps Nutrition Trust. (2015) Eating well: the first year: a guide to introducing solids and eating well up to baby’s first birthday. London: First Steps Nutrition Trust.

Victora, C.G. et al. (2013) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 87(10017), 475-490.

Prado, E. & Dewey. K. (2012) Nutrition and brain development in early life. Technical Briefing, Issue 4. Washington: Alive and Thrive.

National Children’s Bureau. (2015) Poor Beginnings: health inequalities among young children across England. London: NCB

Click here for resources from A Better Start on Diet and Nutrition

Scale of the issue

The Lancet. (2016). Breastfeeding series

World Health Organisation. (2016) Childhood overweight and obesity

Faculty of Dental Surgery. (2015)  The state of children’s oral health in England. London: The Faculty of Dental Surgery.

Risk factors for poorer outcomes

First Steps Nutrition Trust

Chamberlain C. et al. (2013) Psychosocial interventions for supporting women to stop smoking in pregnancy. London: Cochrane

World Health Organisation. (2003) Global strategy for infant and young child feeding. Geneva: World Health Organisation.

Department of Health. (2011) Start active, stay active: A report on physical activity for health from the four home countries’ Chief Medical Officers. London: Department of Health.

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