Northern England Strategic Clinical Network Conference

15th May 20151001 Critical Days

The importance of the conception to age 2 period

1001 Critical DaysEveryone’s business

• The nature of the day to day relationship between the child and primary care giver is crucial

• The physical and mental wellbeing of the mother during pregnancy can have lifelong impacts on the child

• The 1001 Critical Days cross party manifesto highlights the importance of acting early to enhance the outcomes for children. With a forward by the Chief Medical Officer (CMO), the manifesto calls for interventions that are evidence based and economically sound, have an emphasis on training of staff, and focus on prevention and early intervention.

The Age of Opportunity

Overwhelming international evidence from all the relevant fields has brightly illuminated the path we should travel.It shows that primary prevention coupled with robust, effective support for mothers, fathers and/or carers during the first 1,001 days offer the best chance to break the cycle of inequality. Taken from Scottish coalition document 11/14

The 6 High Impact Areas (DOH 2014)

• Transition to Parenthood and the Early Weeks • Maternal Mental Health (Perinatal Depression)• Breastfeeding (Initiation and Duration)• Healthy Weight, Healthy Nutrition (to include Physical

Activity)• Managing Minor Illness and Reducing Accidents (Reducing

Hospital Attendance/Admissions)• Health, Wellbeing and Development of the Child Age 2 –

Two year old review (integrated review) and support to be ‘ready for school’

Early Years High Impact Area 2 Maternal Mental Health

• Taken together, perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK. This is equivalent to a cost of just under £10,000 for every single birth in the country.

• Nearly three-quarters (72%) of this cost relates to adverse impacts on the child rather than the mother.

• The children are at higher risk of poor outcomes, emotional, social and educational.

(Centre for Mental Health LSE 2014)

Breastfeeding and Attachment

Breastfeeding has long been linked to mother and child attachment.

Recent studies which appear to corroborate this include -

• Does breastfeeding impact upon parenting capability? (Gutman LM 2009).

• Does breastfeeding have an effect upon child behaviour? (Heikkila 2011).

• Breastfeeding may have an effect on child and adolescent mental health (Oddy et al

2009). • Breastfeeding and it’s effect on child

maltreatment (Strathearn L 2009).

Oxytocin and Cortisol

Oxytocin - fertiliser for the brain

Cortisol – prunes back brain growth

Facilitating attachment• During breastfeeding women become more peaceful and

develop deep bonds with their baby

• Breastfeeding makes the mother more interested in close relationships, The more spikes in oxytocin content in her blood, the more open to attachment and bonding she becomes

• Women who have symptoms of anxiety and OCD often have a reduction of symptoms during breastfeeding

• Breastfeeding induces social memory and calmness in the infant

Moberg 2003

• The breastfeeding state of mind facilitates the womans ability to calm her baby and she is potentially more able to calm his stress response and ensure his cortisol levels remain low leading to the formation of fewer cortisol receptors (Gerhardt 2004)

In Practice

• Meaningful antenatal discussions for all families

• Timely face to face support for women who are breastfeeding, particularly in areas of low prevalence

• Encouraging women who are formula feeding to hold their baby close during feeds, and to limit number of caregivers

• Dads produce oxytocin too

Strategic Clinical NetworkTask and Finish Groups

• Building Happy Babies• Infant Feeding• Perinatal mental

health

Everyone’s business

• GPs- every woman of a certain age is potentially pre conceptual

• Community midwives• Health Visitors• Obstetricians• Paediatricians• Educational establishments• Sure Start

THANK YOU