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Child and Antenatal Nutrition Manual
General information
ACKNOWLEDGEMENTS
The Statewide Policy and Planning Directorate, Child and Community Health
Division, would like to thank the many people who gave generously of their time,
expertise and contribution to the 2014 edition.
FEEDBACK
The Child and Adolescent Community Health Policy Unit (Statewide) invites
feedback from users on any aspects of this publication. Comments and
suggestions may be directed to:
CAN Manual Editor
Child and Adolescent Community Health Policy Unit (Statewide)
Telephone: (08) 9224 1625
Email: childcommunity@health.wa.gov.au
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
1
Child and Antenatal Nutrition Manual
General information
TABLE OF CONTENTS
Section 1
General information
Section 2
Planning for pregnancy
Section 3
During pregnancy
Section 4
Breastfeeding
Section 5
Infant formula
Section 6
Growth
Section 7
Introduction to solids
Section 8
Toddlers: 1 – 3 years
Section 9
School-aged: 4 – 11 years
Section 10
Aboriginal nutrition
Section 11
Multicultural nutrition
Section 12
Overweight and obesity
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
2
Child and Antenatal Nutrition Manual
General information
The Child and Antenatal Nutrition (CAN) Manual is a guide for community and
child health professionals on various issues related to the general nutritional health
and wellbeing of mothers, infants and children. The information and
recommendations bring together current evidence as well as national and
international guidelines to encourage consistent messages and advice along with
practical support.
The first edition of the CAN Manual was published in 1987 and since then, the
CAN Manual has been regularly reviewed and updated. Child health professionals
including dietitians, community child health nurses and policy officers have been
involved in each review to ensure the information is current and practical; and the
format user-friendly.
Context
Following the release of the National Health and Medical Research Council‟s
(NHMRC) Australian Dietary Guidelines (2013)1 and Infant Feeding Guidelines
(2012),2 nutritional resources used by health professionals in community and
clinical practice needed updating to ensure evidence-based information and
appropriate support were provided to parents.
The main source of information for community health staff, including child health
nurses, is the CAN Manual, last updated in 2010/2011. The CAN Manual is not
only used as a reference by community health staff employed by the Western
Australian Department of Health, but also other government and non-government
agencies working with families.
The Child Health Services Birth to School Entry Universal Contact Schedule
emphasises the importance of providing nutrition information. Within this
schedule, community child health nurses are encouraged to contact parents as
early as possible after the birth of their baby for the purposes of supporting and
establishing breastfeeding and the development of a trusting relationship with the
family. Each of the scheduled contacts thereafter continues to emphasise nutrition
information appropriate to the child‟s developmental stage.
Consistent with the universal contact schedule, the Personal Health Record (2013)
includes a „topics to discuss‟ section. This section provides prompts for parents
about nutrition and other health, developmental and behavioural issues and
concerns which they may like to discuss with community health professionals.
Health promotion is a critical component of each contact between community
health staff and parents/carers of infants and children. To assist, the CAN Manual
links the nutrition practice guidelines with other relevant child and community
health policies in Western Australia.
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
3
Child and Antenatal Nutrition Manual
General information
Rationale
Maternal and child nutrition is an important priority in Australia. The maintenance
of sound health throughout the life cycle is reliant on good nutrition during
pregnancy and lactation, and ensuring optimal infant and child growth.1
The general health and dietary intake of pregnant and lactating women are vital to
the health of infants and children. Investigations of many adult chronic diseases
have identified poor maternal nutrition as a contributing factor. Children born to
women whose dietary intake and health is inadequate have been shown to be at
increased risk of developing abdominal obesity, diabetes, hypertension,
cardiovascular disease and renal disease.3
In addition, current research indicates birthweight and growth during childhood
influences subsequent disease patterns in the adult years. Ongoing efforts are
required to reduce the prevalence of low birthweight babies, avoid under nutrition
and the development of overweight and obesity during childhood in order to
improve long term health outcomes.1,2
Expert opinion and research worldwide concur that breastfeeding provides the
best nutritional start for infants. The World Health Organisation‟s 2001 World
Assembly endorsed the recommendation for exclusive breastfeeding of infants
until around six months of age, with the introduction of complementary feeds and
continued breastfeeding thereafter.4
The Australian Infant Feeding Guidelines (2012)2 encourage health professionals
to continue promoting breastfeeding as the norm, and to support mothers to
overcome feeding difficulties they may encounter. Evidence suggests that
supporting breastfeeding is also an important strategy for reducing overweight and
obesity in children. Community health staff play a vital role as mothers may need
support to establish and sustain lactation to around six months after birth.
An individual‟s body weight increases about twenty-fold from birth to 18 years of
age. Early childhood and adolescence show the most rapid changes in body
weight consistent with periods of rapid growth. It is during these periods that
children are most nutritionally vulnerable. At this time, their nutrient and energy
needs in relation to their body size are greater than those of adults. The ultimate
aim is for adequate nutrition and physical activity to achieve optimal growth and
wellbeing.4
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
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Child and Antenatal Nutrition Manual
General information
Objectives of this manual
To provide a practical, evidence-based guide for community and child health
professionals on various issues related to maternal, infant and child nutrition.
To link relevant nutrition practice guidelines with:

“All about Me” Personal Health Record.

Child health record used by community child health nurses.

Community health policies, procedures and guidelines manual.
To assist community and child health professionals in translating the science of
nutrition into consistent, practical, evidence-based information for families and
the general public.
Limitations of this manual
The Manual contains standardised nutrition guidelines to be used by health
professionals. The information focuses on the general health and wellbeing of
mothers, infants and children.
Specific diseases or therapeutic treatments are generally beyond the scope of the
Manual. However, some references to diet-related problems are included to
enable community health staff to support specialist dietary or medical treatment
and management and /or identify a need for specialist referral.
This Manual:
will not provide individualised dietary information
will not describe the special dietary needs of women, infants and children
requiring therapeutic diets.
Individualised diets require comprehensive interpretation of a complex set of
factors pertaining to the client and as such, are outside the scope of the general
information provided. Some factors considered when designing individual diets
include the client‟s socioeconomic, ethnic and religious background, eating habits,
medical, surgical, biochemical history and status, motivation and barriers to
change. For individual dietary information and/or therapeutic dietary management,
consult or refer to a dietitian or general practitioner (GP).
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
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Child and Antenatal Nutrition Manual
General information
How to use this manual
Who is this manual for?
This Manual is designed to meet the needs of a wide range of health professionals
in community and child health services, including community health staff (child
health, school health, remote area health and generalist nurses; rural practitioners;
migrant/ethnic health and Aboriginal health workers), midwives, practice nurses,
dietitians and GPs.
For community health professionals
The Community Child Health Contact Schedule section is included in this edition.
It contains a table showing the list of key nutrition topics for discussion at each
scheduled universal contact, as specified in relevant sections of the community
health policy, procedures and guidelines manual.
Format
This CAN Manual is available online only and can be access on the PMH internet http://www.pmh.health.wa.gov.au/health/CAN/index.htm
This Manual is divided into topic sections with a Key Points, Overview and
Recommendations for Practice section at the start of each topic. Where possible,
a list of useful professional references and education resources are provided at
the end of each topic for further reference.
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
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Child and Antenatal Nutrition Manual
General information
Community child health contact schedule
Universal contact schedule
The Birth to School Entry-Universal Contact Schedule is an evidence-based
practice approach to community health services for parents, infants and young
children. The universal contact schedule includes consultations at key
developmental stages, where the child health nurse can provide information and
support relevant to child development and family circumstances, as well as
appropriate early detection and screening. The emphasis is on innovative and
flexible service delivery to improve access for families.
Table 1 shows a list of key nutrition issues that may arise at each scheduled
universal contact and their corresponding sections in the CAN Manual, although
nurses must be prepared to respond to parents‟ questions at any time.
Targeted high-risk groups
Child health professionals have an important role in identifying risks that may
affect a child's wellbeing or development. Adverse physical and social factors may
place families in need of additional contact and support from appropriate health
and community services. These families need targeted interventions.
The capacity of parents to adapt to the changing needs of the child will be
determined by their personal and social context. Adverse personal factors may
constrain parenting adaptability, namely disability, drug misuse, parenting age,
and/or physical or mental health problems such as severe depression or anxiety.
A number of factors may also affect a parent's capacity to be perceptive,
responsive and flexible in their parenting approach, including poverty, food
insecurity, poor neighbourhoods, inadequate housing, social isolation, relationship
distress and/or domestic violence.5
Clinically, it is widely accepted that an individually focused intervention is less
likely to be successful if other major contextual sources of adversity in a person's
life are not also addressed.5 In addition, the issue of how the child contributes to
parenting effectiveness needs to be considered. Factors that increase a child's
needs include sensory impairment, disability, illness and/or behavioural and
emotional problems. Contextual factors such as a violent neighbourhood, lack of
appropriate play spaces, and a poor school environment can also make meeting a
child's needs more difficult for some parents. Problems arise when the demands
of caring for a child are so overwhelming that they exceed the parent‟s capacity.5
These families need to be targeted for additional contact and support from
appropriate health and community services. Prevention programs focusing on
support for parents and the provision of information on age appropriate child
development, injury prevention, immunisation and nutrition may be delivered either
in a group format or on an individual basis.
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
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Child and Antenatal Nutrition Manual
General information
Nutrition issues for targeted groups
Everyone needs nutritious food to stay healthy; however, some may find it difficult
to obtain enough food and the right food important to living active and healthy
lives. Some families and individuals may find themselves in situations where they
are unable to afford or access food, leaving them vulnerable to food insecurity
and, in turn, at risk of poor nutritional health.6
Food insecurity
Food security is defined as ‘the state in which all persons obtain nutritionally
adequate, culturally acceptable, safe food regularly through local non-emergency
sources’6.
The lack of reliable access to food may be constant, cyclical or temporary. There
are many causes of food insecurity. Income, education, cooking ability, age, frailty,
disability, ethnicity, remoteness and limited physical access to food, social
isolation and chronic illness, are key factors influencing and affecting food
choices. Causes can also be compounded, as is common for Aboriginal
Australians on low incomes and living in remote communities, sometimes cut off
from services, and for some individuals with disabilities. Income, education,
cooking ability, age, frailty, disability, ethnicity, remoteness and limited physical
access to food, social isolation and chronic illness, influence and affect food
choices. Causes can also be compounded as is the case for Aboriginal
Australians on low incomes and living in remote communities, sometimes cut off
from services, and for individuals with disabilities.6
The health inequality and poor health status experienced by disadvantaged
families is further compounded by food insecurity. The immediate effects are
anxiety, hunger and lack of energy. In the longer term, there is growing evidence
that people experiencing food insecurity are more likely to be overweight or obese,
particularly women.7 People on low incomes also report lower consumption of
fruits and vegetables, often due to difficulties in accessing, purchasing and
storing.6
Good nutrition may not come easily for vulnerable and disadvantaged families.
Therefore, child health professionals need to be aware that healthy eating is more
than eating nutritious foods. Cultural, social and environmental factors that also
determine the type and amount of food eaten need to also be recognised and
addressed respectfully and appropriately.
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
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Child and Antenatal Nutrition Manual
General information
Table 1: Key nutrition topics at each scheduled universal contact
Scheduled Contact
Key Nutrition Topics
Birth to 10 Days
(First Contact)
Infant Feeding – Breast

Exclusively/Predominantly/Complementary

Attachment

Feeding difficulties and solutions

Expressed breastmilk
Infant Feeding – Formula

Correct preparation technique

Appropriate volume and frequency
Maternal Health

Nutrition

Breastfeeding support and encouragement

Support agencies
Infant Feeding – Breast

Exclusively/Predominantly/Complementary

Frequency of feeds

Supply and demand

Expressed breastmilk
Infant Feeding – Formula

Correct preparation technique

Appropriate volume and frequency
Maternal Health

Nutrition

Breastfeeding support and encouragement

Support agencies
Infant Feeding – Breast

Exclusively/Predominantly/Complementary

Frequency of feeds

Changing feeding patterns
Infant Feeding – Formula

Correct preparation technique

Appropriate volume and frequency
Introduction of solids around 6 months

Indicators of readiness

Process of introduction

Fluid intake and requirements
Maternal Health

Breastfeeding support and encouragement
Introduction of solids

Progressive introduction of textured solids

Feeding difficulties and solutions

Fluid intake and requirements

Cup use

Establishing healthy nutritious and varied diet
Breastfeeding

Breastfeeding to 12 months and beyond
Infant Formula

Use infant formula to 12 months
Establishing positive family eating environments

Small appetite

Temporary food fads

Fussy eaters

Food grazing, routines and expectations

Food intake and requirements
Fluids

Water preferred

Cup use
Positive family eating environments
Healthy nutritious and varied diet
At 6 – 8 weeks
At 3 – 4 months
At 8 months
At 18 months
At 3 – 3.5 years
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
Relevant
CAN Manual Sections
Breastfeeding
Infant formula
Growth monitoring and action
Breastfeeding
Infant formula
Growth monitoring and action
Breastfeeding
Infant formula
Introduction of solids
Growth monitoring and action
Breastfeeding
Infant formula
Introduction of solids
Toddlers: 1-3 years
Toddlers: 1-3 years
General Information
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Child and Antenatal Nutrition Manual
General information
Fluids (water preferred)
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
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Child and Antenatal Nutrition Manual
General information
References
1. National Health and Medical Research Council. Australian Dietary Guidelines.
Canberra: NHMRC, 2013.
2. National Health and Medical Research Council. Infant Feeding Guidelines.
Canberra: National Health and Medical Research Council; 2012.
3. Scientific Advisory Committee on Nutrition. The influence of maternal, fetal and
child nutrition on the development of chronic disease in later life. London, 2011.
4. World Health Organisation. Global Strategy on infant and young child feeding
[online] 2003 [cited 2014 May 19]. Available from:
http://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf
5. Department of Family and Community Services. Parenting Information Project
Volume 1: Main report [online] 2004 [cited 2014 May 19]. Available from:
http://www.parentingrc.org.au/index.php/sharing-knowledge/project-archive/3content/programs-sharing-knowledge/213-parenting-information-project
6. National Public Health Partnership. Eat Well Australia: an agenda for action for
public health nutrition 2000 – 2010 [online] 2001 [cited 2014 Mar 19]. Available
from: http://www.health.gov.au/internet/main/publishing.nsf/content/healthpubhlth-strateg-food-nphp.htm
7. King T, Kavanagh AM, Jolley D, Turrell G, Crawford D. Weight and place: a
multilevel cross-sectional survey of area-level social disadvantage and
overweight/obesity in Australia. International Journal of Obesity 2006;
30(2):281-7.
Date Issued: 2007
Date Reviewed: June 2014
Next Review: June 2017
NSQHS Standards:
1.7
General Information
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