Tags: NICE Guidance

Updated NICE guideline on maternal and child nutrition

On 15 January 2025, NICE published the much anticipated updated guidance “Nutrition and weight management in pregnancy, and nutrition in children up to 5 years” (NICE guidance 247).

NICE guidance 247 replaces guidance on “Maternal and child nutrition” (PH11), partially replaces “Weight management before, during and after pregnancy” (PH27), and has been developed to be read in conjunction with guidance on “Overweight and obesity management” (NG246).

Through a review of the evidence in PH11, this new guidance is intended to provide clear recommendations from pregnancy, through the postnatal period and into early childhood, using the current evidence base and recommendations from research and subject experts. The guidance covers the following key areas:

  • Vitamin supplementation, including the Healthy Start scheme and clarification on folic acid now that bread and flour are fortified.
  • Healthy eating, physical activity and weight management during pregnancy.
  • Breastfeeding and formula feeding beyond 8 weeks after birth, returning to work and the value of continuing until around 2 years or beyond.
  • Weighing babies and young children.
  • Healthy eating behaviours in babies and children from 6 months and up to 5 years.

The guidance has been written for all healthcare professionals working with those who are pregnant, babies and children under 5 years old; in particular, midwives, dietitians and health visitors. One of the overarching messages that is embedded throughout the guideline is the importance of personalised healthcare, through tailored, non-judgemental, culturally sensitive conversations, using evidence-based information to improve maternal and child nutrition.

Key points of interest for health visitors include:

  • The importance of appropriate support for breastfeeding before birth and during the first weeks after birth to enable continued breastfeeding for longer – alongside messaging on the importance of focus on face-to-face contacts, both individually and in groups, to achieve this (recommendations 1.3.1 to 1.3.10).
  • The importance of discussing vitamin supplements, including vitamin D at health visitor appointments (1.1.10).
  • Guidance on the introduction of solid foods (complementary feeding) for babies between 6 months and 1-year-old – including a comprehensive “topics to discuss” section (1.5.1- 1.5.7). The guidance makes specific reference that:
    • Commissioners and providers of services should support healthcare professionals who have knowledge and expertise in introducing solid foods to babies (for example, health visitors) to act as ‘champions’ to pass on information to other staff (1.5.2).
    • When the baby is between 4 and 5-months-old, health visiting teams or other community health services should arrange an opportunity for parents to find out more about introducing their baby to solid food from the age of 6 months. This could be a face-to-face or online appointment, phone consultation or group session (1.5.5).

To read the guidance in full, follow this link https://www.nice.org.uk/guidance/ng247

 

End of life care for infants, children and young people: planning and management – Draft for Consultation

iHV briefing for HVs on new NICE Guidance on Antenatal and Postnatal Mental Health

The Institute welcomes the 2014 update of the original NICE Guidance for managing antenatal and postnatal mental health and the contribution it will make to improved early recognition and management of perinatal mental illness.

The iHV is especially delighted that NICE has included the need to support the mother–baby relationship. This is something that health visitors are best placed to do but they will require more capacity to do so well.  Currently the iHV is rolling out Infant Mental Health training for all health visitors to strengthen their contribution to this important area for future wellbeing.

We are also very pleased that NICE has endorsed use of the EPDS as part of a fuller assessment of the mother’s emotional wellbeing and the need for holistic assessment.

The iHV is issuing this briefing to help our perinatal mental health (PMH) champions, and health visitors in general, interpret the Guidance in relation to health visiting (HV) interventions.  On first reading some aspects seem to suggest that the intervention services they have been trained to deliver are not being supported by NICE despite their method of case finding and holistic assessment being endorsed.

The iHV PMH Champions training was cascaded during the development of this Guidance, and the early indications are that the content of the ‘listening visit’ is consistent with the recommended evidence base and messages in the Guidance.  However, it is disappointing that there is little made of the scale of the role that health visitors specifically have in this respect in terms of recognising and managing risk, early intervention and on-going support for mothers.  Their contribution as part of primary care low intensity interventions is included in the Guidance, just not given much specific emphasis.

There is an evidence base demonstrating that health visitors, specifically, can both prevent and successfully manage mild to moderate postnatal depression.  It is essential that they continue to be commissioned to deliver this role to prevent any further deterioration in the mother’s mental wellbeing before any other treatment becomes available. NICE does not specifically consider the role of any professional group so may not have looked at the evidence from the London School of Economics, for example, on the economic benefits of health visitor intervention at one year in relation to the mother’s quality of life and ability to return to work (Health visiting and reducing postnatal depression (2011) Bauer A, Knapp M, McDaid, D).

Hence this new Guidance, as with all NICE guidance, should be considered in the context of its limitations as well as its very many benefits for improving care.  In relation to health visiting practice this NICE Guidance seems to have been inhibited by:

  • the availability of sufficient high-quality research evidence e.g. for the role of health visiting and specifically the use of listening visits which were considered to not be well defined or researched
  • the generalisability of the available research findings.

Read iHV briefing for health visitors

To read NICE Guidance (national Clinical Guideline Number 192)

NICE Guidance on Domestic violence and abuse

We are pleased to announce that NICE’s Public Health Programme Guidance on Domestic violence and abuse – how services can respond effectively (PH50) has been published today, 26th February 2014.

See our Resources section for details