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Good practice guide to improving nutrition in Scotland's under-fives

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Dr Cathy Higginson, PhD, SRD, RPHNutr.

Research Specialist - Diet, Nutrition and Dental/Oral Health, Health Education Board for Scotland, Edinburgh


Healthy eating habits start with breast-feeding. And health professionals are central to ensuring women are aware of the health benefits, according to the Health Education Board for Scotland's new publication, Evidence into Action: Nutrition in the under-fives.

The publication covers breast-feeding, weaning and nutrition in pre-school children. Each section summarises current practice, reviews what affects each health behaviour cited, and summarises the evidence on what works in improving health outcomes. The crucial information, for those working at the cutting edge of clinical practice, comes last. The final section sums up the implications of the evidence set out in the paper for practice and training, as well as for policy makers and research.

The target audience is wide, from those working at the coalface to policy makers. The type of evidence cited is equally broad: the publication draws heavily on systematic reviews, and includes data from official reports and quality-checked papers.

The evidence on promoting breast-feeding is clear. The best methods of increasing both initiation rates and breast-feeding duration are through one-to-one and informal small groupwork ante- and postnatally, undertaken by trained health professionals with women and their partners/key support people.

The content of the sessions is crucial: they should stress the benefits of breast-feeding and provide detailed advice on the positioning and attachment of the baby at the breast, avoidance of supplementary formula feeds, how to know the baby is getting enough and how to express and store breast milk.

This review confirms that providing written information alone is of little value. As a result, it recommends that written information is backed up with support from a professional. It emphasises the importance of rooming-in post-delivery also.

The paper acknowledges the central role of health professionals and proposes a review of pre- and post-registration training for midwives, health visitors and other professionals (such as obstetricians, paediatricians and GPs), to assess its adequacy in relation to supporting breast-feeding.

There is less evidence on effective interactions to promote good weaning practice. However, research shows that the most effective interventions involve regular, intensive support for parents and families from appropriately trained health professionals, who can provide detailed, personalised, 'how-to' advice over an extended period.

None of the effective interventions identified used weaning leaflets alone, indicating that, as for breast-feeding, written materials are insufficient on their own. It recommends a review of existing weaning training and support materials for professionals likely to be approached for weaning advice.

Nutrition in pre-school children (one to five years)
A dearth of high-quality evidence identifying effective practice in promoting good nutrition in pre-school children means it is difficult to provide guidance for practice. The document identifies a number of interventions that improved pre-school children's nutritional knowledge, but the effect of these on actual food choice is hard to gauge.

The document acknowledges the key role of health professionals working with pre-school children in promoting good nutrition. Their role is vital not only because they provide information directly to parents and children, but also as trainers and sources of positive influence for other staff such as pre-school carers and community development workers.

The document recommends an assessment of the information and training needs of professionals working in this area to inform the development of education and training resources.

- For a copy of Evidence into Action: Nutrition in the under-fives contact the Health Education Board for Scotland: email:, fax: 0131-536 5502 or download from the website at:

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