National and international research shows time and again that what happens to a child during pregnancy and the first three years of life will influence the child’s health and wellbeing for their lifetime. By providing high-quality care and information at an early stage, parents can be supported in their caring role, helping to ensure children attain lifelong improved health and wellbeing.¹

The protection, promotion and support of good feeding practices and adequate nutrition for infants is of prime importance in order to reduce the risk of ill health in the future. The Nutrition Reference Pack for Infants (0-12 months) was developed for healthcare professionals (primarily public health nurses, senior medical officers, GPs and practice nurses) who give information, support and guidance on infant feeding to parents/carers of infants.

It was originally developed in 2008 by the Community Nutrition and Dietetic Service in Community Health East to promote consistent and accurate nutrition messages among healthcare professionals based on best practice and evidence-based information. The pack was used in many community health areas and disseminated to other health professionals, primarily public health nurses, with training. It was subsequently updated annually between 2009 and 2013.

In 2014, a review of the use of the packs among community dietitians and public health nurses was reviewed and this guided the development of the sixth edition. The sixth edition of the Nutrition Reference Pack for Infants (0-12 months) was completed in Autumn 2016 by community dietitians in Community Health East in collaboration with many colleagues in the health service. The pack was fully revised and reprinted in its entirety. New additions to it include:

• An expanded section on ‘allergy in the first year of life’ in collaboration with the Irish Food Allergy Network (IFAN)

• A revised breastfeeding section by Siobhan Hourigan, national breastfeeding coordinator

• Updates to other sections with new evidence and clinical guidelines. 

The pack is divided into five sections:

• Section one – antenatal/postnatal visits: Information on healthy eating guidelines for mothers during preconception, in pregnancy and while breastfeeding

• Section two – feeding 0-6 months: Practical information on breastfeeding including frequently asked questions, preventing and assisting with breastfeeding challenges and information on the International Code of Marketing of Breast Milk Substitutes. This section also includes information on each of the categories of infant formula available on the market including key points and ‘indications for use’ where applicable

• Section three – feeding problems in infants (0-12 months) and toddlers: Current best practice on the management of feeding problems such as wind, posseting, colic, reflux, constipation, fussy eating and childhood obesity

• Section four – allergy in the first year of life: Definition of allergy versus food intolerance. An allergy-focused clinical history template for completion to support with the diagnosis of allergy information on eczema and allergy. Definition, diagnosis and management of cow’s milk protein allergy, egg allergy, peanut allergy and referral pathways for the management of allergy.  Also included is a list of national paediatric allergy services

• Section five – weaning: Includes information on weaning through each stage, baby-led weaning, problems associated with weaning, religious dietary information and vegetarian eating.

A full list of all references is included in the pack. The pack is printed in a ringbound folder and disseminated as part of a three-hour standardised training programme delivered by community dietitians in all Community Health areas nationally. 

All public health nurses working with infants will be offered this training between 2016 and 2017 with a HSE key performance indicator that 100% of PHNs are trained by the end of 2017. This training has Category 1 approval for credits (3 CEUs) from the Nursing and Midwifery Board of Ireland. To date, 800 public health nurses have taken part in the three-hour training programme across the country.

Where to from here? 

The Nurture Programme – Infant Health and Wellbeing was formally launched on May 23, 2016. This is a new programme of work being implemented in the Health Service Executive which is designed to improve the information and professional supports that we provide to parents during pregnancy and the first three years of their baby’s life. 

The Nutrition Reference Pack for Infants 0-12 months will be incorporated into the work of the Nurture programme, specifically the nutrition e-learning module for public health nurses, area medical officers and practice nurses. This will help to apply new evidence to practice and engage with new approaches and resources to support learning and development.

Acknowledgement

We would like to acknowledge the support of the HSE, Healthy Ireland and the Nurture Programme with the Nutrition Reference Pack for Infants 0-12 months

Reference

1. The Nurture Programme Infant Health and Well being 2016