Background: To assess whether monthly home visits from trained volunteers could improve infant feeding practices at age 12 months, a randomised controlled trial was carried out in two disadvantaged inner city London boroughs. Methods: Women attending baby clinics with their infants (312) were randomised to receive monthly home visits from trained volunteers over a 9-month period (intervention group) or standard professional care only (control group). The primary outcome was vitamin C intakes from fruit. Secondary outcomes included selected macro and micro-nutrients, infant feeding habits, supine length and weight. Data were collected at baseline when infants were aged approximately 10 weeks, and subsequently when the child was 12 and 18 months old. Results: Two-hundred and twelve women (68%) completed the trial. At both follow-up points no significant differences were found between the groups for vitamin C intakes from fruit or other nutrients. At first follow-up, however, infants in the intervention group were significantly less likely to be given goats' or soya milks, and were more likely to have three solid meals per day. At the second follow-up, intervention group children were significantly less likely to be still using a bottle. At both follow-up points, intervention group children also consumed significantly more specific fruit and vegetables. Conclusions: Home visits from trained volunteers had no significant effect on nutrient intakes but did promote some other recommended infant feeding practices. Trial registration: Current Controlled Trials ISRCTN55500035Nutrition in early life is a key determinant of growth, development and health status, both in childhood and later adult life. Current UK recommendations advise all mothers to exclusively breastfeed for 6 months, and to delay introducing solids until at least 6 months. [3][4][5] Data from national surveys show that infant feeding practices in the UK are, however, highly variable.6 7 The 2005 Infant Feeding Survey indicated some encouraging trends with 76% of mothers across the UK initiating breastfeeding. However, rates fell steeply after a few weeks and less than 1% of mothers were exclusively breastfeeding at 6 months.6 Stark social inequalities were evident, with breastfeeding rates highest amongst older, middle-class and educated mothers. The 2005 survey also reported that 51% of mothers had introduced solids by 4 months and only 2% had delayed introducing solids until 6 months. Mothers giving solids when babies were 4-6 months were more likely to provide commercially prepared foods (85%) than home prepared (51%), and only 46% had given fruit. 6A substantial body of research has evaluated interventions aimed at increasing the initiation, and to lesser extent, the duration of breastfeeding.8 9 In contrast, very few well-designed studies have evaluated interventions focusing on the later stages of infant feeding beyond breastfeeding. 10Recent National Institute of Health and Clinical Excellence (NICE) guidance has highlighted the paucity o...

Good nutrition in the early years of life is essential, yet the diets of many pre-school children in the UK are known to be poor. Understanding the decisions parents make when feeding young children is very important in determining what type and nature of interventional support may be developed to promote good nutrition. The aim of this study was to explore using qualitative methods, parental perceptions of feeding their children in order to inform the development of a nutrition intervention. Focus groups (n = 33) and individual interviews (n = 6) were undertaken with parents, most of whom were attending children's centres in two deprived populations from one urban (Islington, north London) and one rural (Cornwall) location in England. Accounts of feeding pre-school children were primarily concerned with dealing with the practicalities of modern life, in particular the cost of food and the need to manage on a restricted household budget. Time pressures, a lack of perceived knowledge and confidence in preparing food and managing conflict over food choices between family members were also strong themes. Parents commonly reported differences between how they would like to feed their children and the reality of what they were able to do in their circumstances. These findings suggest that the poor eating habits of many pre-school children may be less a case of parental ignorance but rather the product of a range of coping strategies. Designing an intervention, which helps parents to build their confidence and self-efficacy, may enable them to make positive changes to their children's diets.

The feeding of patients in hospitals is a topical issue. This review considers the development of feeding practices in British hospitals and highlights disturbing aspects which may have a bearing on recovery. The issues highlighted may also exacerbate the problem of hospital-induced malnutrition. There is little evidence that the provision of food per se is a cause for concern. It is rather the many other factors which may contribute to the patients consuming an in adequate diet.

Objective: To describe the process of establishing and implementing a social support infant feeding intervention.Design: This paper outlines the initial stages of a randomised controlled trial which assessed the effectiveness of a social support intervention on a range of infant feeding outcomes. Details are presented of the processes involved in recruiting, training and supporting a group of volunteers who provided support to the study sample. Setting: Camden and Islington, London, UK. Results: Initial networking with local agencies and organisations provided invaluable information and contacts. Employing a dedicated volunteer co-ordinator is vitally important in the recruitment, training and support of volunteers. Providing child care and travel expenses is an essential incentive for volunteers with young children. Advertisements placed in local newspapers were the most successful means of recruiting volunteers. Appropriate training is needed to equip volunteers with the necessary knowledge and skills to provide effective support. Particular emphasis in the training focused upon developing the necessary interpersonal skills and selfconfidence. The evaluation of the training programme demonstrated that it improved volunteers' knowledge and reported confidence. The provision of ongoing support is also essential to maintain volunteers' interest and enthusiasm. The retention of volunteers is, however, a key challenge. Conclusions: The processes outlined in this paper have demonstrated the feasibility of successfully establishing, implementing and maintaining a community-based social support infant feeding programme. The experiences described provide useful insights into the practical issues that need to be addressed in setting up a social support intervention.

Good nutrition in the early years of life is vitally important for a child's development, growth and health. Children's diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years' nutrition intervention. Choosing Healthy Eating when Really Young (CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children's centres in one urban (Islington) and one rural (Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children's centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings.