Infant health

Leads: Peter Blair, Peter FlemingJenny Ingram and Pauline Emmett with Karen Birmingham, Alan Emond, Jean Golding, Yasmin Iles-Caven, Debbie Johnson, Sarah Manns, Jan Powell, Anna Pease, Colin Steer, Caroline Taylor and Zia-ud Din.

Collaborators: Ken Ong (Cambridge), Dr Maggie Redshaw (Oxford), Professor David Pontin (South Wales), Kay Pullen (UHBristol Trust), Dr Claire Rose and Heather Burden (North Bristol Trust) Imogen Rogers (Brighton), Joe Hibbeln (USA), Dr Christopher Barnes (Derby), Barbara Gaal, (Ontario, Canada).

Our main interests in this area are

  • Breastfeeding
  • Tongue tie
  • Growth faltering
  • Early nutrition and child development

Current projects

Archiving of the European Study of Pregnancy and Childhood (ELSPAC)

Archiving of the European Study of Pregnancy and Childhood (ELSPAC) administrative, as opposed to scientific data, is under way.  This project, which is funded in the first instance by the University of Bristol Alumni, is run by Karen Birminghm [PI] and Yasmin Iles-Caven.  Similar projects ran in Avon (ALSPAC), the Isle of Man, Russia; Ukraine: Greece: the Czech and Slovak Republics.  Despite initial resistance from the scientific community, ALSPAC has established its international reputation as a unique epidemiological resource which the other cohorts have had limited success.  The scientific aspects of ALSPAC in particular are well documented but much can be learned from the political, financial and ethical aspect of these studies.  Oral Histories from staff, collaborators and decision makers will provide recollections, opinions and anecdotes not to be found  in the formal archival material.

Childhood cough

Pete Blair and Jenny Ingram have been working within an NIHR 5 year research programme investigating Childhood respiratory infection led by Prof Alastair Hay in the Centre for Primary Care (link to TARGET programme). Pete led the final feasibility trial which explored the use of an algorithm combined with parent home care advice.

This advice is now available on the Children’s Cough website. Funding is being sought to run a full randomised controlled trial using the intervention materials. 

Picky eating investigation

Caroline Taylor and Pauline Emmett are using data collected in the ALSPAC study to investigate the background to and outcomes of picky eating behaviour in young children. This is a problem which worries many parents and is not well understood.

We found that 15% of children were described as very choosy (picky eaters) by parents at 3 years of age with 40% described as quite choosy. When we investigated the diet consumed by the children we found that the majority of children were eating too little fibre and the picky children were eating even less than the non-picky children. The main dietary difference was in the amount of vegetables and fruit eaten (non-picky children ate about half the recommended amount while picky children ate less an a third). We also found that picky eaters were more likely to be constipated than non-picky eaters and that this was associated with eating less fibre. The best advice to parents is to use a combination of approaches when feeding their children, including repeated offering of vegetables and fruit to overcome the fear of new foods, parental example in eating vegetables and fruit, and regular family mealtimes with the same meal offered to but not forced on all participants. (Industry funded).

Taylor, C. M., et al., Picky eating in preschool children: Associations with dietary fibre intakes and stool hardness, Appetite (2016).

Recent projects

Mothers' Attitudes to the Infant Sleep Environment and SIDS Risk

Anna Pease recently completed a PhD within the Centre for Child and Adolescent Health, looking at decision-making for infant care relating to the main risks for Sudden Infant Death Syndrome. The work was funded by the Lullaby Trust (formerly FSID). The main research element of the PhD was the MAISE Project - Mothers' Attitudes to the Infant Sleep Environment. This was a mixed methods project using a survey and qualitative interviews with mothers from deprived areas of Bristol.

Mother-baby interactions and infant care practices

In the sleep laboratory Professor Fleming and team have carried out longitudinal studies of the physiological and behavioural interactions between mothers and infants during sleep, and the effects these have upon the development of respiratory and thermal physiology in the infant.  (Diamond cot death appeal).  They have carried out longitudinal studies in the home of the development of infant thermal physiology, and the effects of environmental temperature and wrapping, in the UK and in Mongolia.  The study has been completed and published in Archives of disease in Childhood.

Preparing for Home Study - update April 2016

The study has been completed, the report published in the NIHR HS&DR journal series and the main findings published in the BMJ open.  Two further papers have been submitted to journals.

The study materials have been updated and are now available for all neonatal untis to use on the SW Network website. There is also a self-directed training package to help staff to use the materials effectively.

Following the introduction of the Train-to-Home package the number of post-discharge visits to Emergency Departments (ED) fell, with a significant reduction in associated healthcare costs after discharge.

Parents were overwhelmingly positive about the Train-to-Home. They reported that the Train-to-Home improved understanding of their baby’s progress and their preparedness for discharge. Medical and nursing staff generally agreed that the intervention materials were helpful in explaining a baby’s progress to parents, but some nursing staff had concerns that the estimated discharge dates were too optimistic.

Jenny Ingram and Professor Fleming conducted the research in four Local Neonatal Units in the Southwest and the study was funded by the National Institute for Health Research, Health Services and Delivery Research Programme.

Tongue Tie Trial

Around 3% of babies are born with a tongue tie, which can result in failure of breastfeeding. Cutting the tongue-tie (called frenotomy) to free up tongue movement and improve breastfeeding is becoming widespread. NICE recommends frenotomy, but calls for better evidence on which to base the practice. It is unclear if all infants with tongue tie, or only those with the most severe form, should be offered frenotomy.

From July 2011 to December 2013 we ran an NIHR funded feasibility trial to assess whether it would be possible to conduct a multi-centre Randomised Control Trial comparing immediate frenotomy of babies with mild to moderate tongue tie, with those receiving usual care (breastfeeding support).

Breastfeeding studies

The UNICEF Baby Friendly Initiative (BFI) programme supporting breastfeeding has been rolled out across NHS Bristol. As part of this process the Primary Care Trust commissioned a peer support breastfeeding support service for mothers (in 12 lower socio-economic areas of Bristol) with one antenatal visit and contact at 48 hours after they have had their baby.

The service aims to meet UNICEF/WHO Baby Friendly Initiative (BFI) and NICE guidance on the provision of peer support contact antenatally and in the 48 hours after discharge from hospital. Jenny Ingram evaluated this service and some commissioned materials for teenage mothers, using on-line questionnaires and interviews with mothers and peer supporters.

Early Nutrition and Neurocognitive Development

Pauline Emmett, Jean Golding and Colin Steer are using data collected by the ALSPAC nutrition project to investigate the effects of early nutrition on subsequent development:

Cognitive and visual development in children up to 12 years old in relation to fish eating in pregnancy and childhood and the modifying effects of genetic variance with Cathy Williams. Investigation of omega-3 and omega-6 fatty acid intakes in the diet of 7 year olds and their relationship blood levels of fatty acids. (Nutrimenthe - FP7 European collaboration)

Fish eating in pregnancy and development (NOAA) with Joe Hibbeln

Lead in the environment (Fellowship work by Caroline Taylor)

Diet and growth

Other projects using dietary data collected in ALSPAC led by Pauline Emmett include:

Pauline Emmett and Linda Hollen with Alan Emond have followed up on the work of Zin-ud Din using ALSPAC data to look at the long term effects of poor growth in infancy. They have investigated the effects of diet in the slow growth and recovery phases shown to be present in the growth pattern of these children.

Childhood diet variety and fruit and vegetable eating in relation to timing and type of complementary foods introduced in the first year of life with Louise Jones. (

The feeding of high volumes of formula or cow’s milk at age 8 month in relation to fast growth in childhood with David Hopkins.

The investigation of sources of vitamins in the diets of pre-school children in particular Vitamins A & D with David Hopkins.

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