Welcome to the fourteenth A Better Start Southend Research Bulletin, bringing you the latest on early years’ policy, practice and evidence around Diet and Nutrition, Social and Emotional Development, Communications and Language, Community Resilience and Systems Change.

Your regular update, produced by Rachel Wood, also shows how we are using these findings to influence our work in Southend as well as inviting you to help shape our work through your input!

If you would like to sign up to receive these updates, or have a question, please email abetterstart@pre-school.org.uk.


One Year Follow Up of the State of Child Health
Infant Feeding and Responsive Parenting (Diet and Nutrition)
Incredible Years Outcomes (Social and Emotional)
Language Development in the Early Years (Communications and Language)
Systems Thinking and Research Integrity (Systems Change)

One Year Follow Up of the State of Child Health

Title: RCPCH (2018), State of Child Health – England One Year On

Research source: https://www.rcpch.ac.uk/state-of-child-health/one-year-on

Publication date: January 2018

Our Summary: The original State of Child Health report 2017 showed the inequalities in the health and wellbeing of children in the UK.

Overall the report highlights that the picture remains largely unchanged and that “children deserve better”. It calls for vision and leadership at the highest level to reverse current trends and the rising tide of poverty.

One year on this report highlights the progress that has been made against 12 major policy recommendations and calls to action:

  • Develop and implement a cross-developmental child health strategy – Cabinet sub-committee (no change)
  • Reduce the number of child deaths – LA funding for health visiting and home safety schemes which educate parents and carers to keep their children safe (no change)
  • Develop integrated health and care statistics – Digital strategy launched (significant progress made), Maternity and Children’s Data sets – support for data submission and development (some progress made),
  • Develop research capacity to drive improvements in children’s health – increased investment in research, government development of incentives, higher education support, and National Institute for Health Research expansion of child health training (no change);
  • Reduce child poverty and inequality – Government adoption of ‘child health in all policies’ (no change), Government moratorium on cuts without full impact assessment (the situation has worsened), universal and targeted public health services (no change);
  • Maximise women’s health before, during and after pregnancy – Reinstatement of UK infant feeding survey (no change), Government cross-departmental initiative to support breastfeeding (some progress made), Protection for public health funding (no change), NHS England mandate for maintaining UNICEF UK Baby Friendly Initiative Accreditation January 2019 (no change)
  • Provide statutory comprehensive personal, social and health education, including sex and relationships education, in all schoolsSex and relationship education to be made mandatory for all England schools from September 2019, provision to be enshrined in Children and Social Work Act 2017, and delivery to be subject to Ofsted inspections (some progress made)
  • Strengthen tobacco and alcohol control DoH publication ‘Towards a smoke free generation: tobacco control plan for England July 2017 (fully achieved), extension of smoking ban, Public Health England to support second hand smoke measures, prohibition of e-cigarette marketing for non-medicinal use, and Government introduction of minimum unit price for alcohol (no change)
  • Tackle childhood obesity effectively commissioning of independent and on-going evaluation of the soft drinks levy and plans for regulatory framework (fully achieved), banning of advertising of foods high in saturated fat, sugar and salt before 9pm, Government audit of LA licencing and catering arrangements, and Government extension of mandatory school food standards (no change), Every contact count (some progress made), and extension of the National Child Measurement Programme (no change)
  • Maximise mental health and wellbeing throughout childhood Government National Mental Health survey (no change), DfE mental health support provision in primary and secondary education in England, NHS England commissioning of adolescent mental health services (some progress made), necessary tools to identify mental health issues, and CCGs to receive designated funding for expansion of Child and Adolescent Mental Health Services (no change)
  • Tailor the health system to meet the needs of children, young people, their parents and carers prioritisation given to Sustainability and Transformation Plans (STPs), better transitions from child to adult services, funded mandatory child health training for all GP trainees, named doctor or health professional for children with long term conditions, extended CQC patient survey, Support for parents and carers to navigate the planned digital health and care system, and NHS England information for Clinical Reference Groups, commissioning structures and assurance processes to maximise use of tools to support communications and ongoing management (no change)
  • Implementing guidance and standards clinical commissioning groups commissioning against evidence based standards (no change and some progress made), and Public Health England support of LAs to deliver evidence based quality public health services (significant progress).

How we’re applying this in Southend

  • We contribute actions to the recommendations in the report in terms of the health of children aged 0-4 years and their families. This includes the reduction of child poverty, childhood obesity and paternal mental health.

Help us help Southend

  • In what ways can we influence the action being taken on the calls for action in the report?

Let us know what you think by e-mailing abetterstart@pre-school.org.uk

Infant Feeding and Responsive Parenting (Diet and Nutrition)

Title: Perez-Escamilla, R. Segura-Perez, S. and Lott, M. (2017), Feeding Guidelines for Infants and Young Toddlers – A Responsive Parenting Approach, Nutrition Today, vol. 52 (5), pp223-231

Research source: https://journals.lww.com/nutritiontodayonline/Abstract/2017/09000/Feeding_Guidelines_for_Infants_and_Young_Toddlers_.5.aspx

Publication date: October 2017

Our summary: This American study examines how responsive parenting can have an impact on infant feeding. Its aim was to develop five stage evidence based guidelines produced by an interdisciplinary expert panel.

The dimensions of responsive parenting include feeding, sleeping, soothing and play/physical activity. All of which are highly interconnected. Responsive parenting groups and activities have been found to have a beneficial impact on child feeding behaviour and weight outcomes.

The report argues that the 5 stage key developmental milestones and guidelines (p225) for introducing complimentary foods are as follows:

1. Sits without support, and has good head and neck control;

2. Munches or chews and uses the tongue to move pureed foods to the back of the mouth for swallowing;

3. Does not have extrusion reflex any longer (does not automatically push solids out of the mouth with their tongue);

4. Brings hands and toys to the mouth for exploration; and

5. Indicates a desire for food.

It also outlines the evolution of hunger and fullness signals, as well as key feeding messages for infants and young toddlers in terms of what to feed, how to feed, sleep, physical activity, screen time, food safety and food allergies.

It argues in conclusion that it has outlined evidence based guidelines that are comprehensive and pragmatic for communicating to parents and carers, what and how best to feed infant and toddlers that takes into consideration developmental stages in the first two years of life. However, it states that further research will be required as to how they can be adapted (e.g. socio-economically and culturally) to other populations.

How we’re applying this in Southend

  • We are currently testing and learning services and projects that support infant feeding;
  • Follow the blog on our website to find out more about ante-natal feeding choices and cluster feeding among others.

Help us help Southend

  • Are there other ways that we can highlight key messages about breast and infant feeding?

Let us know what you think by e-mailing abetterstart@pre-school.org.uk

Incredible Years Outcomes (Social and Emotional)

Title: Letjen, P. Gardner, F. Harris, F. Landau, S. Mann, J. Hutchings, J. Beecham, J. Bonin, E-M. and Scott, S., Harnessing the Power of Individual Participant Data in a Meta-Analysis of the Benefits and Harms of the Incredible Years Parenting Program, vol. 59 (2), pp 99-109

Research source: https://www.ncbi.nlm.nih.gov/pubmed/28696032

Publication date: July 2017

Our summary: This analysis of randomised controlled trials (RCTs) aims to support positive children’s behaviour through family relationships. It also argued that in research that the precise protective and risk factors in terms of the family unit have been unsystematic and subject to publications and outcomes selection bias. The study reviews 14 of the 15 RCTS on the Incredible Years parenting that have taken place in Europe. This appeared to show that praise, discipline, behavioural issues and ADHD symptoms improved, whilst rewards, monitoring and laxness, emotional problems and parental mental health, self-efficacy and stress did not. There was however no evidence of harmful effects in terms of the programme. The analysis concluded that:

  • Broad constructs of parenting (e.g. ‘positive parenting’ are less systematic than more specific behaviours);
  • Incredible Years reduced children’s externalising behaviour (e.g. conduct problems);
  • Incredible Years did not change children’s internalising behaviour (e.g. emotional problems); and

It has a robust impact on the aspects of family well-being that it is primarily designed to.

How we’re applying this in Southend

  • Our Research Group will be reviewing all available outcomes measures in the early years;
  • We will be working with our Research Group to ensure that our evaluations are undertaken on specific behaviours.

Help us help Southend

  • What specific behaviours do you think that we should use to research and evaluate our test and learn services and projects?

Let us know what you think by e-mailing abetterstart@pre-school.org.uk

Language Development in the Early Years (Communications and Language)

Title: McGillion, M. Pine, J. Herbert, J. and Matthews, D. (2017), A Randomised Controlled Trial to test the effect of promoting caregiver, contingent talk on language development in infants from diverse SES backgrounds, Journal of Child Psychology and Psychiatry, vol. 58 (10), pp 1122-1131

Research source: https://www.ncbi.nlm.nih.gov/pubmed/28429816

Publication date: October 2017

Our Summary: This article argues on the basis of a Randomised Controlled Trial (RCT) that early language skills are critical for later academic success, and that children who came from lower Socio-Economic-Status (SES) are more at risk of having limited language skills. The authors therefore set out to investigate the idea that this is due in part to how often a caregiver talks about what an infant is focussing attention on (contingent talk).

The authors compared those attending a language intervention with a dental health programme. The families were asked to practice the techniques for 15 minutes a day for a month. Caregiver communications were assessed prior to and one month after the intervention. Infant communications were measured at baseline, 12, 15, 18 and 24 months.

The results were seen to be as follows:

  • All caregivers who were allocated to the language intervention group engaged in significantly more contingent talk;
  • Lower SES caregivers in the language intervention group reported that their children produced more words at 15 and 18 months;

The effect of the intervention did not persist at 24 months and so follow-ups at school entry would be needed.

How we’re applying this in Southend

  • All of our ‘Let’s Talk’ activities support the development of contingent talk;
  • We follow up, and are working closely with our local schools on communications and language.

Help us help Southend

  • In what ways can we ensure that the effect of our test and learn services and projects has an impact on language development last at 24 months and beyond?

Let us know what you think by e-mailing abetterstart@pre-school.org.uk

Systems Thinking and Research Integrity (Systems Change)

Title: Gorman, DM. Elkins, AD. and Lawley, M. (2017), A Systems Approach to Understanding and Improving Research Integrity, Science and Engineering

Research source: https://www.ncbi.nlm.nih.gov/pubmed/29071573

Publication date: October 2017

Our summary: This article argues that there is currently a concern about the integrity of empirical research, with many reporting positive research, or that cannot be replicated. Potential solutions (e.g. falsifying own findings) have been proposed but an evaluation of these findings would likely take many years. The authors therefore propose that systems dynamic modelling be used particularly in relation to countering flexible data analysis practices and distorted reporting. They can also be used as a way of capturing and providing insights into dynamic, causal relationships that will support research integrity. It is this that the authors ultimately argue that will “lead to the development of more effective public policy and practice”.

How we’re applying this in Southend

  • Our Research Group will support us in ensuring integrity in our evaluations and research;
  • Independent evaluations are a crucial process within our evaluations framework;

Help us help Southend

  • In what other ways can we ensure that our evaluations create impact and maintain integrity?

Let us know what you think by e-mailing abetterstart@pre-school.org.uk

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