Best start in life: cost-effective commissioning

A tool to help local commissioners provide cost-effective interventions for children aged up to 5 and pregnant women | Public Health England

This return on investment tool pulls together evidence on the effectiveness and associated costs for a number of interventions aimed at providing children with the best start in life.

The interactive resource allows results to be tailored to local situations based on the knowledge of the user. The tool is accompanied by a report providing further details on how the tool was constructed.

Local authorities and clinical commissioning groups can use results from the tool to protect and improve the health of their local populations when making commissioning decisions.


Breastfeeding: five ways it can be encouraged responsibly

Our behaviour is driven by the environment in which we live: public attitudes, financial constraints, and support from others all affect our confidence and ability to act | The Conversation

Baby's Healthcare

Despite increasing breastfeeding rates being a strategic priority globally, the involvement of many governments often only goes so far as unhelpful messages extolling women to breastfeed. These don’t work because they don’t change the environment in which women are trying to breastfeed. They might tell women breastfeeding is important but they don’t offer practical support, change negative public attitudes, or help women delay going back to work. All of this pushes many women to stop breastfeeding before they are ready.

Rather than focusing on telling women to breastfeed, governments must recognise their wider public health responsibility, and work to create an environment that actually supports breastfeeding. It shouldn’t be left to charities and volunteers alone. Support should be part and parcel of society – and implementing a new strategy is not as difficult as you might think.

Read the full blog post here

Skin-to-skin contact improves breastfeeding of healthy babies

Early skin-to-skin contact improves breastfeeding of healthy full-term babies. | National Institute for Health Research

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Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth.

This review found that about a quarter more women who have this contact with their babies are still breastfeeding at one to four months after birth compared with those who don’t. The evidence that skin-to-skin contact may also help to stabilise the baby’s heart and breathing rates and blood sugar levels after birth was based on fewer trials and less strong.

These findings support UK good practice to promote immediate skin-to-skin contact after birth to improve breastfeeding rates. It remains one of the important steps recommended by NICE and UNICEF aimed at improving the low rates of breastfeeding in the UK. Other measures include providing a favourable environment, support and education.

Full reference: Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:CD003519.

New resource to reduce barriers to breastfeeding

Public Health England (PHE) and NHS England have conducted a survey which found that of the three-quarters of the new mums who start breastfeeding, only 40% were still breastfeeding two months later.

To help dispel some of the concerns women have about breastfeeding, PHE’s Start4 life programme has launched a new interactive Breastfeeding Friend (BFF) ChatBot. The BFF can be accessed through Facebook messenger and provides personal support for mothers at any time of the day or night. The ChatBot works as a live chat tool which is able to respond to questions about breastfeeding posed by the user.

Read more on this at Public Health England


Breastfeeding Education and Support

The Cochrane Database of Systematic Reviews has published two reports on breastfeeding.

‘Support for healthy breastfeeding mothers with healthy term babies’

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There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant’s diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.

The authors concluded that when breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group.

Support is also likely to be more effective in settings with high initiation rate and strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.

Read more here

Breastfeeding education and support for women with twins or higher order multiples

There are rising rates of multiple births worldwide with associated higher rates of complications and more hospital care, often due to prematurity. While there is strong evidence about the risks of not breastfeeding, rates of breastfeeding in women who have given birth to more than one infant are lower than with singleton births. Breastfeeding more than one infant can be more challenging because of difficulties associated with the birth or prematurity. The extra demands on the mother of frequent suckling, coordinating the needs of more than one infant or admission to the neonatal intensive care unit can lead to delayed initiation or early cessation. Support and education about breastfeeding has been found to improve the duration of any breastfeeding for healthy term infants and their mothers, however evidence is lacking about interventions that are effective to support women with twins or higher order multiples.

The authors found no evidence from randomised controlled trials about the effectiveness of breastfeeding education and support for women with twins or higher order multiples, or the most effective way to provide education and support . There was no evidence about the best way to deliver the intervention, the timing of care, or the best person to deliver the care. There is a need for well-designed, adequately powered studies of interventions designed for women with twins or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies.

Read more here

Association between breastfeeding duration and cognitive development, autistic traits and ADHD symptoms

Boucher, O. et al. Pediatric Research. Published online: 4 January 2017


Background: Several studies have related longer breastfeeding duration to better intellectual performance in children. By contrast, few studies have investigated the potential protective effects of breastfeeding against behavioral problems such as attention deficit hyperactivity disorder (ADHD) symptoms, and even fewer on autism spectrum disorders (ASD) traits.


Conclusion: This study provides further evidence of a positive association of breastfeeding with cognitive function apart from socio-environmental factors, and also suggests a protective role against autistic traits. Results are in agreement with recommendations for prolonged breastfeeding duration to promote child development.

Read the full abstract here