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Health & Well-being Starting Well Campaign Dear Partners 'Starting Well Campaign' All parents want the best for their babies and children. That means making sure they get the best possible start in life. A strong, loving relationship between a parent and a child supports the child’s healthy growth and development. A child's early years from before birth to age six are very important for healthy development as this is a time when a child’s brain and body are developing at a rapid pace. Healthy babies and toddlers are more likely to stay healthy through their childhood, teen and adult years. Worcestershire health statistics around early years School readiness - Worcestershire had a lower percentage of children assessed as achieving a good level of development at the end of reception year (58.1%) compared with the England average (60.4%) in 2013/14. This rose to 66.4% in 14/15, similar to the England average. Breastfeeding – Breastfeeding initiation rates in Worcestershire are significantly lower than the national average. Worcestershire 70.1% compared to England average of 74.3%. (2014/15). Breastfeeding continuation rates (at 6-8 weeks) have increased to 45%. Smoking status at time of delivery - The percentage of women smoking at time of delivery in Worcestershire although reducing has remained significantly higher than the national average. Worcestershire 12.6% compared to England average of 11.4%. (2014/15) Excess weight 4-5 year olds - The % of children aged 4-5 classified as overweight or obese in Worcestershire remains higher than the national average. Worcestershire 22.7% compared to England average 21.9%. (2014/15) We are holding two 'Starting Well Events' in the county for 'parents to be' and 'parents/carers of young children. Wyre Forest Thursday 17th March 2016, 9.30am - 12.30pm - Kidderminster Town Hall. For further information contact Rachel Cockayne, 01562 732576 or email [email protected] Redditch Tuesday 22nd March 2016, 10am - 12.30pm, Redditch Town Hall. For more information please call Claire Mitchell on 01527 548220 This campaign will run throughout March and April. Please read this pack and distribute it amongst your colleagues and please feel free to photocopy the contents for a display. We hope you will find the pack useful to reinforce health messages around 'Starting Well'. Yours sincerely Dr Frances Howie - Head of Public Health, Directorate of Adult Services and Health, Worcestershire County Council, County Hall, Spetchley Road, Worcester, WR5 2NP Stats: http://www.worcestershire.gov.uk/downloads/file/6590/2015_briefing_on_early_help ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign 1. 2. 3. 4. 5. 6. Healthy eating during pregnancy Healthy start scheme Staying active when pregnant Stop smoking in pregnancy Drinking when pregnant Postnatal Depression 7. Benefits of breastfeeding 8. Helping a baby to sleep 9. Attachment 10. Introducing a baby to sold foods 11. Helping a child to speak 12. Parental wellbeing and resilience Contents and local contacts Locality Health Improvement Co-ordinator contact details Name Town/City Tel. number Email address Angela Waldron Bromsgrove 01527 881311 [email protected] Melanie Whistance Malvern 01684 862283 [email protected] Claire Mitchell Redditch [email protected] Remya Rajendren Worcester City 01527 548220 Ex: 2085 01905 721143 Clare Charlton Wychavon 01386 565182 [email protected] Rachel Cockayne Wyre Forest 01562 732576 [email protected] Health Chats are a free interactive 3 hour public health training session essential for any member of staff or volunteer who works with members of the public. Learn about the current health priorities and gain the skills to have an informed two minute Health Chat encouraging people to make healthier choices. The training covers health issues such as alcohol consumption, smoking, physical activity, diet, mental wellbeing and ageing well. By the end of the session you will be able to: Raise healthy lifestyle issues with people with confidence Assess peoples motivation and inspire them to make positive changes Signpost people to appropriate local support services. You will also receive a Health Chats certificate and supporting information to help you have conversations about living a healthy lifestyle. To book Call 01905 84 82 18 or email [email protected] To find out more go to www.worcestershire.gov.uk and search 'Health Chats' [email protected] Alzheimer’s Society’s Dementia Friends programme is the biggest ever initiative to change people’s perceptions of dementia. It aims to transform the way the nation thinks, acts and talks about the condition. You can attend a face-to-face information session or watch the online video. Dementia Friends is about learning more about dementia and the small ways you can help. To view the online video or find your nearest face-to-face information session visit:- ylyc.worcestershire.gov.uk www.dementiafriends.org.uk Health & Well-being Starting Well Campaign Have a healthy diet in pregnancy A healthy diet is an important part of a healthy lifestyle at any time, but is especially vital if you're pregnant or planning a pregnancy. Eating healthily during pregnancy will help a baby to develop and grow. There is no need to go on a special diet, but it's important to eat a variety of different foods every day to get the right balance of nutrients that mothers and babies need. It is normal to feel hungrier than usual, but there is no need to "eat for two" – even if expecting twins or triplets! Have a healthy breakfast every day, can help you to avoid snacking on foods that are high in fat and sugar. Eating healthily often means just changing the amounts of different foods you eat so that your diet is varied, rather than cutting out all your favourites. You can use the 'eatwell plate' to get the balance of your diet right. The 'eatwell plate' shows you how much to eat from each food group. Get your 5 a day - Eat plenty of fruit and vegetables because these provide vitamins and minerals, as well as fibre, which helps digestion and can help prevent constipation. Starchy foods (carbohydrates) - in pregnancy are an important source of energy, vitamins and fibre, and are satisfying without containing too many calories. They include bread, potatoes, breakfast cereals, rice, pasta, noodles, maize, millet, oats, sweet potatoes, yams and cornmeal. These foods should be ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign the main part of every meal. Choose wholemeal instead of processed (white) varieties, or potatoes with their skins on, when you can as they contain more fibre. Protein in pregnancy - Eat some protein foods every day. Sources of protein include: meat (but avoid liver) eggs (cooked not raw) nuts fish beans poultry pulses Make sure eggs, poultry, burgers, sausages and whole cuts of meat such as lamb, beef and pork are cooked all the way through. Check that there is no pink meat, and that juices have no pink or red in them. Fish - Try to eat two portions of fish a week, one of which should be oily fish such as salmon, sardines or mackerel. Find out about the health benefits of fish and shellfish. There are some types of fish you should avoid in pregnancy. For more information visit: http://www.nhs.uk/conditions/pregnancy-andbaby/pages/foods-to-avoid-pregnant.aspx Dairy in pregnancy - Dairy foods such as milk, cheese, fromage frais and yoghurt are important in pregnancy, because they contain calcium and other nutrients that baby needs. Choose low-fat varieties wherever possible, such as semi-skimmed or skimmed milk, low-fat lower-sugar yoghurt and reduced-fat hard cheese. Aim for two to three portions a day. There are some cheeses you should avoid in pregnancy. To find out which ones, visit http://www.nhs.uk/conditions/pregnancy-and-baby/pages/foodsto-avoid-pregnant.aspx Avoid foods high in fat, sugar or both - you should only eat a small amount of these foods. all spreading fats chocolate cake (such as butter) crisps puddings oils biscuits fizzy drinks salad dressings pastries cream ice cream Healthy snacks in pregnancy - Try not to eat snacks that are high in fat and/or sugar, such as sweets, biscuits, crisps or chocolate. Instead, choose something healthier, such as: sandwiches or pitta bread filled with grated cheese, lean ham, mashed tuna, salmon, or sardines, with salad salad vegetables, such as carrot, celery or cucumber low-fat lower-sugar yoghurt or fromage frais with fruit hummus with wholemeal pitta bread or vegetable sticks ready-to-eat apricots, figs or prunes vegetable and bean soups unsweetened breakfast cereals, or porridge, with milk milky drinks fresh fruit baked beans on toast or a baked potato For more ideas for healthy snacks visit: http://www.nhs.uk/change4life/Pages/healthy-snacks.aspx Information: NHS Choices and Change4Life ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Healthy Start Scheme Healthy Start helps give your family the very best start in life. If you are pregnant or have a child under four years old you could get Healthy Start vouchers to help buy some basic foods. This important means-tested scheme provides vouchers to spend with local retailers. Pregnant women and children over one and under four years old can get one £3.10 voucher per week. Children under one year old can get two £3.10 vouchers (£6.20) per week. The vouchers can be spent on: plain cow’s milk – whole, semi-skimmed or skimmed. It can be pasteurised, sterilised, long life or UHT plain fresh or frozen fruit and veg (fruit and vegetables with no added ingredients), whole or chopped, packaged or loose infant formula milk that says it can be used from birth and is based on cow’s milk Healthy Start vitamins - Women and children getting Healthy Start food vouchers also get vitamin coupons to swap for free Healthy Start vitamins. Healthy Start vitamins are specifically designed for pregnant and breastfeeding women and growing children. A midwife or health visitor will be able to tell you where you can swap your coupon for vitamins in your area. Do I qualify for Healthy Start? - You qualify for Healthy Start if you’re at least 10 weeks pregnant or have a child under four years old and you or your family get: Income Support, or Income-based Jobseeker’s Allowance, or Income-related Employment and Support Allowance, or Child Tax Credit (but not Working Tax Credit unless your family is receiving Working Tax Credit run-on only*) and has an annual family income of £16,190 or less (2014/15). You also qualify if you are under 18 and pregnant, even if you don’t get any of the above benefits or tax credits. How to apply - Applying for Healthy Start is easy – this is how you do it: You can get an application leaflet by: asking your midwife or health visitor for one calling the Healthy Start helpline on 0345 607 6823 and asking them to send one to you by post fill in the form online and then printing it off to check and sign. To fill online go to https://www.healthystart.nhs.uk/healthy-start-vouchers/how-to-apply/ Information:www.healthystart.nhs.uk ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Staying active during pregnancy Did you know that 150 minutes of walking each week has loads of benefits for pregnant mums? And it doesn’t even have to be in one go! A healthier baby - Being active during pregnancy means pregnant mums are likely maintain a healthier weight and be able to cope better with the physical demands of pregnancy and labour. It also reduces the risk of miscarriage, stillbirth, birth defects and diabetes. It can also prevent gestational diabetes, which makes a baby grow too big in pregnancy, and can lead to delivery complications and low blood sugar. Being active can also prevent high blood pressure, which can result in a stillbirth. A healthier mum - 150 minutes of walking a week makes it easier to get back to a normal weight after baby is born. It can also: Give mum more energy, help her sleep better, and reduce feelings of stress, anxiety and depression. So even if they are feeling shattered, it’s a great reason to try to get some walking in. Make mums stronger, so they can carry the weight of their growing baby. Prepare their body for the physical challenge of labour. This can help to make labour quicker and reduces the risk of complications. Help to lessen the risk of depression after the baby is born. It’s easy, when you know how! Here are a few suggestions on how to get active: Walk to work, a friend’s house or the shops If you already have kids, walk them to school Get off the bus one stop early Park the car further away than you need Take the long way Use the stairs, not the lift If you work in an office, deliver messages in person rather than over the phone/ email Talk and walk with a friend Walk the dog – or someone else’s! Here are some ideas on other activities you can take part in when pregnant. Swimming Aqua natal classes Yoga Dance classes Change4Life have a 'Get Going' tool which sorts out the right activity for you and your family. To access the 'Get Going' tool visit https://getgoing.change4life.co.uk/Home/Index Walking in Worcestershire In Worcestershire we have excellent 'Health Walks' which open are to everyone. Listed below are some websites to help you find walks available and local walking groups. Health Walks - http://www.worcestershire.gov.uk/info/20239/walks_and_rides/1013/health_walks Walking for health - https://www.walkingforhealth.org.uk/ Walking routes in Worcestershire - http://www.worcestershire.gov.uk/info/20239/walks_and_rides Information: start4Life and ylyc.worcestershire.gov.uk ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Stop Smoking in Pregnacy Protecting baby from tobacco smoke is one of the best things parents to be can do to give their child a healthy start in life. It's never too late to stop smoking. Every cigarette contains over 4,000 chemicals, so smoking when pregnant harms an unborn baby. Cigarettes can restrict the essential oxygen supply to the baby, so their heart has to beat harder every time mum smokes. Benefits of stopping smoking in pregnancy Stopping smoking will benefit both mum and baby immediately. Harmful gases like carbon monoxide and other damaging chemicals will clear from the body. The benefits of stopping smoking are: fewer complications in pregnancy more likely to have a healthier pregnancy and a healthier baby reduce the risk of stillbirth cope better with the birth baby is less likely to be born too early and have to face the additional breathing, feeding and health problems that often go with being premature baby is less likely to be born underweight: babies of women who smoke are, on average, 200g (about 8oz) lighter than other babies, which can cause problems during and after labour, for example they are more likely to have a problem keeping warm and are more prone to infection reduce the risk of cot death, also called sudden infant death (find out about reducing the risk of cot death) Stopping smoking will also benefit baby later in life. Children whose parents smoke are more likely to suffer from asthma and other more serious illnesses that may need hospital treatment. Second-hand (passive) smoke harms baby If a partner or anyone else who lives within the household smokes, their smoke can affect baby both before and after birth. Second-hand smoke can also reduce birthweight and increase the risk of cot death. Babies whose parents smoke are more likely to be admitted to hospital for bronchitis and pneumonia during the first year of life. More than 17,000 children under the age of five are admitted to hospital every year because of the effects of second-hand smoke. Nicotine replacement therapy (NRT) During pregnancy NRT can be used to help mum to stop smoking. However it is not recommended that they take stop smoking tablets such as Champix or Zyban during pregnancy. NRT contains only nicotine and none of the damaging chemicals found in cigarettes, so it is a much better option than continuing to smoke. You can be prescribed NRT during pregnancy by your GP or your local pharmacy. New Legislation It is illegal to smoke in a vehicle carrying someone who is under 18. It is now also against the law for a driver not to stop someone smoking in these circumstances. The fine for both offences is £50. It is now also against the law for a driver not to stop someone smoking in these circumstances. The fine for both offences is £50. The change in the law is to protect children and young people from the damaging effects of secondhand smoke, which can put them at risk of serious conditions such as meningitis, cancer, bronchitis and pneumonia, and make asthma worse. The NHS Smoking Helpline on 0800 0224 332, it is open 9am8pm Monday to Friday, and 11am-5pm at weekends or alternatively you may want to visit the website: http://www.nhs.uk/smokefree. Information: NHS choices ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Drinking Alchohol when Pregnant Experts are still unsure exactly how much, if any, alcohol is completely safe for you to have while you're pregnant. The Chief Medical Officers for the UK recommend that if you’re pregnant, or planning to become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk. How does alcohol affect my unborn baby? - Alcohol passes from the mothers' blood through the placenta and to the baby. A baby's liver is one of the last organs to develop and doesn't mature until the latter stages of pregnancy. A baby cannot process alcohol as well as we can, and too much exposure to alcohol can seriously affect their development. In addition to the risk of miscarriage, more recent research found that drinking, particularly in the first three months of pregnancy, also increases the risk of premature birth and low birthweight. Continuing to drink alcohol after the first three months of pregnancy carries the risk of affecting the baby after they're born. The risks are greater the more alcohol is consumed. The effects include learning difficulties and behavioural problems. Drinking heavily throughout pregnancy can cause a baby to develop a serious condition called foetal alcohol syndrome (FAS). Children with FAS have: • poor growth • facial abnormalities • learning and behavioural problems Drinking less heavily, and even drinking heavily on single occasions, may be associated with lesser forms of FAS. How to avoid alcohol in pregnancy? - It may not be as difficult as you think to avoid alcohol completely for nine months, as many women go off the taste of alcohol early in pregnancy. Most women do give up alcohol once they know they are pregnant or when planning to become pregnant. Information: NHS choices ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Postnatal Depression Postnatal depression is a type of depression that many parents experience after having a baby. It's a common problem, affecting more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners, although this is less common. It's important to seek help as soon as possible, as your symptoms could last months or get worse and have a significant impact on baby and the rest of the family. With the right support, which can include self-help strategies and therapy, most women make a full recovery. Symptoms of postnatal depression - Many women feel a bit down, tearful or anxious in the first week after giving birth. This is often called the "baby blues" and is so common that it’s considered normal. The "baby blues" don’t last for more than two weeks after giving birth. If symptoms last longer or start later, this could be a sign of postnatal depression. Postnatal depression can start any time in the first year after giving birth. Signs that you or someone you know might be depressed include: a persistent feeling of sadness and low mood lack of enjoyment and loss of interest in the wider world lack of energy and feeling tired all the time trouble sleeping at night and feeling sleepy during the day difficulties bonding with baby withdrawing from contact with other people problems concentrating and making decisions frightening thoughts – for example, about hurting baby Many women don't realise they have postnatal depression, because it can develop gradually. Treatments for postnatal depression - Postnatal depression can be lonely, distressing and frightening, but support and effective treatments are available. These include: self-help –talking to your family and friends about your feelings and what they can do to help; making time for yourself to do things you enjoy; resting whenever you get the chance and getting as much sleep as you can at night; exercising regularly; eating a healthy diet psychological therapy – your GP may be able to recommend a self-help course, or may refer you for a course of therapy, such as cognitive behavioural therapy (CBT) antidepressants – these may be recommended if your depression is more severe or other treatments haven't helped; your doctor can prescribe a medicine that's safe to take while breastfeeding Getting help for postnatal depression - Speak to a GP or health visitor. Many health visitors have been trained to recognise postnatal depression and have techniques that can help. If they can't help, they'll know someone in your area who can. Information: NHS Choices ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Benefits of Breastfeeding In the UK, more than 73% of mothers start breastfeeding. These are some of the reasons why: mums breast milk is perfectly designed for baby breast milk protects baby from infections and diseases breastfeeding provides health benefits for mum breast milk is available for baby whenever baby needs it breastfeeding can build a strong emotional bond between mother and baby The health benefits of breastfeeding for baby - Breastfeeding has long-term benefits for a baby, lasting right into adulthood. Giving nothing but breast milk is recommended for about the first six months (26 weeks) of a baby's life. After that, giving a baby breast milk alongside family foods for the first two years, or for as long as you and your baby want, will help them grow and develop healthily. Breast milk adapts as your baby grows to meet your baby's changing needs. Any amount of breast milk has a positive effect, however the longer a mum can breastfeed, the longer the protection lasts and the greater the benefits. Formula milk doesn't provide the same protection from illness and doesn't give you any health benefits. Breastfeeding reduces the risk of: infections, with fewer visits to hospital as a result diarrhoea and vomiting, with fewer visits to hospital as a result sudden infant death syndrome (SIDS) childhood leukaemia type 2 diabetes obesity cardiovascular disease in adulthood Health benefits of breastfeeding for mum - Breastfeeding and making breast milk also has health benefits for mum, the more they breastfeed the greater the benefits. Breastfeeding lowers your risk of: breast cancer cardiovascular disease ovarian cancer obesity osteoporosis (weak bones) Worcestershire Welcomes Breastfeeding Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large. Worcestershire Health and Care Trust aim to provide a high standard of care so that pregnant women and mothers get the support and information needed to enable them to breastfeed successfully for as long as they wish. Worcestershire Health and Care Trust in collaboration with Worcestershire Children’s Centres are working towards Unicef Baby Friendly accreditation. Don't be afraid to ask for support or advice to make breastfeeding work for you and your baby. Speak to your health visitor or contact the breastfeeding supporters. Remember, breastfeeding is a very special, unique and enjoyable experience. With practice and support during the first few days and weeks you will succeed. To find out more or to find a local breastfeeding support group visit http://www.hacw.nhs.uk/ourservices/worcestershire-welcomes-breastfeeding Information: NHS Choice and Worcestershire Health and Care Trust ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Helping a baby to sleep Some babies sleep much more than others. Some sleep for long periods, others in short bursts. Some soon sleep through the night, while some don't for a long time. A baby will have their own pattern of waking and sleeping, and it's unlikely to be the same as other babies. It's also unlikely to fit in with the parents need for sleep. Parents are advised to sleep when baby sleeps. If mum is breastfeeding, in the early weeks then baby is likely to doze off for short periods during a feed. Mums are advised to carry on feeding until you think the baby has finished or until they're fully asleep. This is a good opportunity to try to get a bit of rest. New parents are advised to sleep when baby sleeps, but if they aren't they should not worry about are keeping the house silent while they sleep. It's good to get a baby used to sleeping through a certain amount of noise. How can I get my baby used to night and day being different? - It's a good idea to teach a baby that night-time is different from daytime from the start. During the day, open curtains, play games and don't worry too much about everyday noises when they sleep. At night, however here are some suggestions that might be helpful: • keep the lights down low • keep talking down to a minimum and keep your voice quiet • put baby down as soon as they've been fed and changed • don't change baby unless they need it • don't play with baby Soon, your baby will learn that night-time is for sleeping. Where should a baby sleep? - For the first six months a baby should be in the same room as their parents, both day and night. Particularly in the early weeks, you may find a baby only falls asleep in mum or dad's arms, or when they are standing by the cot. Is it important to have a routine for your baby from day one? - Newborn babies will sleep on and off throughout the day and night. It can be helpful to have a pattern, but parents can always change the routine to suit their needs. Establishing a baby bedtime routine – Introduce a bedtime routine when baby is around three months old. Getting them into a simple, soothing bedtime routine can be helpful for everyone and help prevent sleeping problems later on. The routine could consist of: • having a bath • changing into night clothes and a fresh nappy • brushing their teeth (if they have any!) • putting them to bed • reading a bedtime story • dimming the lights in the room to create a calm atmosphere • giving a goodnight kiss and cuddle • singing a lullaby or having a wind-up musical mobile you can turn on when you've put your baby to bed As a child gets older, it can be helpful to keep to a similar bedtime routine. Too much excitement and stimulation just before bedtime can wake a child up again. Spend some time winding down and doing some calmer activities, like reading. ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Avoid bedtime feasts for your baby – Leave a little time between baby's feed and bedtime. If you feed a baby to sleep, feeding and going to sleep will become linked in a baby's mind. When they wake in the night, they'll want a feed to help them go back to sleep. How much sleep is enough for a baby? - Just as with adults, babies' and children's sleep patterns vary. From birth, some babies need more or less sleep than others. The list below shows the average amount of sleep babies and children need during a 24-hour period, including daytime naps. 0-3 months old - Most newborn babies are asleep more than they are awake. Their total daily sleep varies, but can be from 8 hours up to 16 to 18 hours. Babies will wake during the night because they need to be fed. Being too hot or too cold can also disturb their sleep. 3 – 6 Months old - As baby grows, they'll need fewer night feeds and will be able to sleep for longer. Some babies will sleep for eight hours or longer at night, but not all. By four months, they may be spending around twice as long sleeping at night than they do during the day. 6 to 12 months old - For babies aged six months to a year, night feeds may no longer be necessary and some babies will sleep for up to 12 hours at night. Teething discomfort or hunger may wake some babies during the night. 12 months - Babies will sleep for around 12 to 15 hours in total after their first birthday. 2 Year Olds - Most two-year-olds will sleep for 11 to 12 hours at night, with one or two naps in the daytime. 3 – 4 year olds - Most children aged three or four will need about 12 hours sleep, but this can range from 8 hours up to 14. Some young children will still need a nap during the day. How to reduce the risk of SIDS (Sudden Infant Death Syndrome) Place your baby on their back to sleep, in a cot in the same room as you for the first six months. Don't smoke during pregnancy or breastfeeding and don't let anyone smoke in the same room as your baby. Don't share a bed with your baby if you've been drinking alcohol, if you take drugs or you're a smoker. Never sleep with your baby on a sofa or armchair. Don't let your baby get too hot or cold. Keep your baby's head uncovered. Their blanket should be tucked in no higher than their shoulders. Place your baby in the "feet to foot" position (with their feet at the end of the cot or Moses basket). Information: NHS Choices ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Attachment What is attachment and why is it important for young children? Attachments are the emotional bonds that young children develop with parents and other carers. Children with strong early attachments cry less when separated. They engage in more pretend play and sustain attention for longer. They are less aggressive and are popular with other children and with adults. Their sense of who they are is strong. Children need to be safe in the relationship they have with parents or carers. They are vulnerable but will develop resilience when their physical and psychological well-being is protected by an adult. Being emotionally attached to such an adult helps the child feel secure that the person they depend on is there for them. When children feel safe they are more inclined to try things out and be more independent. They are confident to express their ideas and feelings and feel good about themselves. Attachment influences a child’s immediate all-round development and future relationships. Attachment Disorder What is attachment disorder? - The term attachment disorder can relate to specific disorders of mood or behaviour, and the inability to form social relationships due to a failure to form attachments at a young age. Typically, attachment disorder affects young children, but if left untreated it can apply to school-age children and even adults. At its worst, attachment issues can develop into reactive attachment disorder, a condition that is likely to require professional help. It is generally believed that attachment disorder and reactive attachment disorder is uncommon. The true number of children affected is unknown however; as many affected families don't seek help. What causes attachment disorder? - Attachment issues come about when a child fails to form an attachment to its parent or caregiver in its early years. The reasons behind this vary, but may include the following: no one responds or offers comfort when the baby cries the baby isn't tended to when it's hungry or needs changing the baby is abused or mistreated the baby is hospitalised or separated from its parents the baby is repeatedly moved from one caregiver to another the baby receives no attention, so feels alone the baby's parent/s are emotionally unavailable due to illness, mental health problems or substance abuse If the attachment disorder is left untreated, it can have a negative impact on the child's emotional, social and behavioural development. A child with attachment disorder may therefore be at higher risk for a number of emotional and mental health problems in later life. Information: www.earlyyearsmatters.co.uk and http://www.counselling-directory.org.uk/attachment-disorder.html ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Introducing a Baby to Solid Foods Introducing a baby to solid foods (sometimes called weaning or complementary feeding) should start when baby is around six months old. It's a really important step in their development, and it can be great fun to explore new flavours and textures together. To begin with, how much a baby takes is less important than getting them used to the idea of eating. They will still be getting most of their nutrition from breast milk or infant formula. Babies don't need three meals a day to start with, so offer foods at a time that suits both parent and child. Gradually, parents will be able to increase the amount and variety of food baby eats, until they can eventually eat the same as the rest of the family, in smaller portions. Why it pays to wait until they're ready - Research shows babies can get all the nutrients they need from breast milk or infant formula until they are around six months old. Waiting till then gives their digestive system time to develop fully so it can cope with solid foods. This includes solid foods made into purées and cereals added to milk. If breastfeeding; having breast milk alone up to the age of six months will protect baby against infections. Breast milk will carry on protecting them from infections for as long as mum carries on feeding. Whether baby has breast milk or infant formula, waiting until they are ready for food will save a lot of time. They'll quickly be able to feed themselves and with less mess, as they will be able to swallow properly. Three signs baby is ready for their first food - Every baby is an individual, but there are three clear signs that together, show the baby is ready for solid foods alongside breast milk or formula. It's very rare for these signs to appear together before a baby is six months old. 1. They can stay in a sitting position and hold their head steady. 2. They can co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth, all by themselves. 3. They can swallow food. Babies who are not ready will push their food back out with their tongue, so they get more round their face than they do in their mouths. Some signs that can be mistaken for a baby being ready for solid foods: • • • chewing fists waking in the night when they have previously slept through wanting extra milk feeds These are normal behaviours and not necessarily a sign of hunger or being ready to start solid food. Starting solid foods won't make them any more likely to sleep through the night. Extra feeds are usually enough until they're ready for other food. Getting started with solid foods - Always stay with your baby when they are eating in case they start to choke. • Let your baby enjoy touching and holding the food. • Allow your baby to feed themselves, using their fingers, as soon as they show an interest. • Don't force your baby to eat – wait until the next time if they're not interested this time. • If you're using a spoon, wait for your baby to open their mouth before you offer the food. Your baby may like to hold a spoon, too. • Start by offering just a few pieces or teaspoons of food, once a day. • Cool hot food and test it before giving it to your baby. • Don't add salt, sugar or stock cubes to your baby's food or cooking water. See what other foods to avoid giving your baby. ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Babies and food allergies - While variety in a baby's diet is really important, there is a chance they may be allergic to certain foods. That's why it's important to introduce cows' milk, eggs, wheat, gluten, nuts, peanuts, peanut products, seeds, fish and shellfish one at a time and not before six months. There is no evidence that waiting until your child is older will prevent them developing a food allergy. Once a baby is ready for solids, give them these foods in very small amounts and watch carefully for any symptoms of an allergic reaction. If a baby already has a known allergy, such as a diagnosed food allergy or eczema, or there is a family history of food allergies, eczema, asthma or hay fever, be particularly careful when introducing peanuts and peanut products. Talk to your GP or health visitor first. Remember, peanuts, like all nuts, should be crushed or ground. Baby food from 6 months – A baby's first foods can include mashed or soft cooked fruit and vegetables like parsnip, potato, yam, sweet potato, carrot, apple or pear, all cooled before eating. Soft fruits like peach or melon, or baby rice or baby cereal mixed with your baby's usual milk, are good as well. Keep feeding baby breast milk or infant formula, too, but don't give them whole cows' milk as a drink until they are one year old. Finger foods - Finger food is food that is cut up into pieces big enough for a baby to hold in their first with a bit sticking out. Pieces about the size of a finger work well. A baby learns to chew this way. Try grabbable bits of soft, ripe banana or avocado. Next foods - Once a baby is used to the foods above, they can have soft cooked meat such as chicken, mashed fish (check very carefully for any bones), pasta, noodles, toast, pieces of chapatti, lentils, rice and mashed hard-boiled eggs. They can also have full-fat dairy products such as yoghurt, fromage frais or custard. Choose products with no added sugar or less sugar. Whole cows' milk can be used in cooking or mixed with food from six months. Cups - Introduce a cup from around six months and offer sips of water with meals. Using an open cup or a free-flow cup without a valve will help a baby learn to sip and is better for their teeth. Vitamins - It's recommended that all babies and children are given supplements in the form of vitamin drops containing vitamins A, C and D from the age of six months to five years. Babies who are fed infant formula don't need vitamin drops if they're having 500ml (about a pint) of formula or more a day. This is because formula is already fortified with the vitamins they need. If you're breastfeeding your baby and didn't take vitamin D supplements during your pregnancy, your health visitor may advise you to give your baby vitamin drops containing vitamin D from the age of one month. Feeding a baby from 8-9 months – A baby will gradually move towards eating three meals a day. It will be a mixture of soft finger foods, and mashed or chopped foods. A baby's diet should consist of a variety of the following: fruit and vegetables; bread, rice, pasta, potatoes and other starchy foods; meat, fish, eggs, beans and other non-dairy sources of protein; and milk and dairy products. A baby's food from 12 months – A baby will now be eating three meals a day, chopped if necessary, plus breast milk or whole cows' milk and healthier snacks like fruit, vegetable sticks, toast and rice cakes. They can now drink whole cows' milk. Choose full-fat dairy products as children under two need the extra fat and vitamins found in them. From two years old, if they are a good eater and growing well, they can have semi-skimmed milk. From five years old, 1% fat and skimmed milk is OK. You can give a baby: • three to four servings a day of starchy food such as potatoes, bread and rice • three to four servings a day of fruit and vegetables • two servings a day of meat, fish, eggs, dhal or other pulses (beans and lentils) Information: NHS Choices ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Helping a child to speak Being able to talk is vital for making friends, as well as learning and understanding the world around you. Talking to a child from the day they are born is very important. Babies have to understand words before they can start to talk – we can help a child learn by holding them close, making eye contact and talking to them as soon as they're born. They will look back at you and very soon begin to understand how conversations work. Even making 'baby noises' will teach baby useful lessons about listening, the importance of words and taking turns in a conversation. The following tips will encourage your baby to start talking: Talk to your child From the day a baby is born, make faces and noises and talk about what's going on. Start looking at books with baby from an early age. Point out things you see when you're out and about for example "there is a bus". As baby grows, have fun singing nursery rhymes and songs, especially those with actions. Help a child learn sounds and words Repeat the sounds the baby makes back to them, a baby will learn to copy. If your child is trying to make a word but gets it wrong, say the word properly. Use short, simple sentences. Increase a child's vocabulary by giving them choices, such as, 'do you want an apple or a banana?' Play games where you have to take turns, like peep-bo and round and round the garden. Make time for listening and talking Giving a child opportunities to talk (such as in the bath, in the car or just before bed) will help them learn to talk. Get their attention by saying their name at the start of a sentence. Background noise will make it harder for a child to listen to you, so switch off the television and radio. Limit how much a child watches TV – no more than half an hour a day if they are under two years old. Playing and listening to stories is more helpful when they're learning to talk. Restrict use of their dummy to when it's time to sleep. It's hard to learn to talk with a dummy in your mouth. Children's speech difficulties - Some children find it hard to learn what words mean or struggle to use words or put them together in sentences. Others may use long sentences but find it hard to make themselves understood. These are all signs that they may need some extra help. If you're worried about a language development, talk to your GP or health visitor. Bilingual children - Lots of children grow up in a family where more than one language is spoken. This can be an advantage to children in their learning. Knowing another language will help the development of their English. The important thing is to talk to your child in whatever language feels comfortable to you. This may mean that one parent uses one language while the other uses another. Children adapt to this very well. Information: NHS Choices ylyc.worcestershire.gov.uk Health & Well-being Starting Well Campaign Parental Wellbeing and Resilience Becoming a parent can be one of the most wonderful but challenging experiences in life. Many parents have lots of questions in the early days. Here, we give information on the topics new parents most commonly ask about. Relationships as a new parent - Becoming a parent often puts a strain on relationships, regardless of what they were like before. This can include relationships with your partner, friends or family. But there are ways you can work through tough times and stay close to your loved ones. Keeping fit and healthy as a new parent - Being a parent is exhausting and you may have no time or energy to cook, eat properly or exercise. But being active can help you relax. It can also help your body recover after childbirth, and make you feel better and more energetic. And eating well doesn't need to take lots of time or effort. To find out how to incorporate healthy eating and exercise into your daily routine, visit http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/keeping-fit-andhealthy.aspx Coping with stress after having a baby - Coping with the demands of a new baby and everything else that's going on around you can be stressful. Sometimes you can feel as though life is completely out of control. If you're the sort of person who likes to be in control and worries about getting things done, this can make you feel very tense and frustrated. Worry and unhappiness can also cause stress. Maybe you're worried about where you're living, money or relationships. Or perhaps you're worried about a lot of small things that nevertheless make a big difference to your life. You may not be able to do anything about some of these things, but there are ways you can deal with the stress. Some of the following suggestions may help: Unwind. Spend half an hour each evening doing something you enjoy. This helps you put other things out of your mind and relax. Have a bath, read a magazine, watch TV or do whatever else helps you unwind. Borrow a book, CD or DVD about relaxation from the library. Ignore any housework – it can wait. Make some time for yourself. Seeing other people can help relieve stress. A health visitor or other parents may be able to recommend local mother and baby or mother and toddler groups. Visit the 'Netmums' website www.netmums.com for details of baby and toddler groups in your area. Make time for your partner. Relationships can suffer when you're tense, tired and don't spend much time together. Make time to be with your partner, even if all you manage to do is fall asleep together in front of the TV. Express yourself. Talking about how you're feeling can help, at least for a while. You and your partner need to understand how each other are feeling and work out how you can support each other. Sometimes it's better to talk to someone outside the family. Accept help. Make the most of all the help you can get. You can't do everything yourself, so there's no point in trying. Relax – there are no prizes for being a 'supermum' or 'superdad'. It can be difficult if you're a perfectionist, but being a parent is the one thing that nobody is perfect at. Information: NHS Choices ylyc.worcestershire.gov.uk