The best start in life

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You and your team can make a real difference by supporting parents and babies through the crucial first 1,000 days of life. Here's how you can best advise expectant and new parents 

This spring, the Health & Social Care committee launched a new inquiry into the First 1000 Days of Life, widely recognised as a critical development period in a child’s life. The first inquiry was set up in 2019 and is being revisited to see what progress has been made and what changes are needed to ensure every child gets the best start in life. 

Chair of the committee, Layla Moran MP, said: “If the best conditions for healthy development are missing from a child’s life in the first 1000 days, this can have significant impacts on their life chances, including their physical and mental health, their education, work and social and emotional wellbeing.” 

The committee called for evidence from health professionals asking a range of questions on how to improve children’s outcomes in the future. The NHS Confederation highlighted vaccination access as a key priority; more provision for mental health services for under fives and their parents; and a shift towards early intervention. 

First Steps Nutrition Trust emphasised the crucial role of diet in shaping development. “Sub-optimal diets pre-conception, during pregnancy, in infancy and the second year of life, can have significant impacts on a child’s health and development,” says Dr Vicky Sibson and Dr Katie Pereira-Kotze. 

At the Royal Pharmaceutical Society, Laura Wilson, director for Scotland, says: “Community pharmacists are embedded in the heart of communities. From supporting maternal wellbeing and promoting vaccination uptake, to providing advice on infant health and nutrition, pharmacy teams can help to reduce health inequalities.

"With better integration into early years services, shared access to care records and the right investment, community pharmacists could make an even greater impact.” 

Advice and care in pregnancy 

At Tommy’s, midwifery manager Amina Hatia says: “Pharmacists are often a trusted first point of contact for women in early pregnancy and even before conception. Early pregnancy can feel isolating, particularly during the first trimester. Pharmacists play an important role in offering reassurance, safe treatment options and signposting to trusted resources.” 

At Well Pharmacy, professional standards and governance manager Wendy Lee says: “Pharmacies are often located in the heart of communities, making them well placed to share key messages where other healthcare services may be less accessible. The most important advice includes starting folic acid early, registering promptly with midwifery services, using only medicine and supplements that are safe for pregnancy, keeping up to date with recommended vaccinations and seeking advice promptly for any concerns.

"The best approach is to listen carefully, provide clear and tailored advice, explain when GP or midwife follow-up is needed and offer practical solutions such as suitable over-the-counter products.” 

Vitamins and supplements 

Women trying to conceive and up until 12 weeks of pregnancy should take 400mcg folic acid daily. Women who run a higher risk of having a baby with a neural tube defect should take 5mg daily up to 12 weeks. 

All women should take 10mcg vitamin D daily between September and March. For women who cover their skin or have dark skin, it may be needed year-round. 

“Iron needs increase in pregnancy. Encourage iron-rich foods. Some women may require supplementation after assessment,” says nutritionist at the British Dietetic Association, Lucy Upton, author of ‘The ultimate guide to children’s nutrition’. 

“Omega-3 fatty acids are essential for a baby’s brain and eye development. Oily fish like salmon and sardines are great sources and should be encouraged once or twice a week. For vegetarian or vegan mothers, an algae oil DHA/EPA supplement can be recommended.” 

Iodine insufficiency is common in women of childbearing age. “Iodine is essential for foetal brain and nervous system development and can be found in dairy and white fish. For vegan women an iodine supplement can be recommended,” says Upton.  

Bridget Benelam, nutritionist and spokesperson at the British National Formulary (BNF), says: “With so much confusion and misinformation about healthy diets, pharmacists can reiterate the key principles of a balanced diet as set out by the UK Eatwell Guide. It’s also important to emphasise the foods and drinks that should be avoided in pregnancy, in particular limiting caffeine to 200mg/day and avoiding alcohol.” 

Pregnancy sickness 

Hatia says: “Pregnancy sickness affects seven to nine out of every 10 pregnancies. Symptoms can happen at any time of day, and the impact can be physically and emotionally distressing, so it’s important not to refer to it as ‘just morning sickness’.” She has this advice to pass onto women: 

• Reassure women that pregnancy sickness is common, while acknowledging it can be difficult to cope with 
• Suggest small, frequent meals, avoiding an empty stomach and identifying trigger foods or smells 
• Provide guidance on taking medication if prescribed, especially if struggling to keep down fluids or swallow tablets. 

“Refer women to a GP or Early Pregnancy Unit if: their vomiting is persistent or severe; they are unable to keep fluids down; they are losing weight, suffering from dehydration or their symptoms are not improving; or you suspect they have hyperemesis gravidarum,” she advises. 

Indigestion and heartburn 

Dyspepsia in pregnancy is common, affecting around 40 per cent in their third trimester. “Hormonal changes and physical pressure on the stomach make heartburn and indigestion common. It can be helpful to eat smaller meals and avoid spicy, fatty or acidic foods. You can also suggest pregnancy-safe antacids, depending on the stage of pregnancy and medication history. Always refer women to a GP or midwife if they have sudden or severe epigastric pain, especially if they also have a headache or visual changes, as these can be signs of pre-eclampsia,” advises Hatia. 

Stress incontinence 

“Pharmacists can raise awareness and promote pelvic floor health early on. You can encourage women to start pelvic floor exercises from early pregnancy. Advise women experiencing stress incontinence to speak to their midwife,” says Hatia. 

These exercises are the best way for women to help themselves and should be done at least three times daily:

Slow pelvic floor squeezes: tighten back passage and vaginal muscles and hold for three to five seconds. Relax pelvic floor for five seconds between each contraction. Repeat 10 times. Build up until they can hold squeeze for 10 seconds. 

Fast squeezes: Tighten and squeeze pelvic floor muscles. Hold for one second and relax for three seconds. Repeat 10-20 times. The NHS Squeezy app is a useful tool. 

Vaccinations in pregnancy 

The following are recommended in pregnancy and it’s important that pharmacists counsel women on their benefits: 

• Flu vaccine - This can be given at any stage of pregnancy and will protect both mother and baby 
• Whooping cough - This can be serious for babies, and this will protect them until they have their own vaccine at eight weeks old. It is usually given around 20 weeks 
• Respiratory Syncytial Virus (RSV) - This can be serious in babies, causing lung infections. It is usually given around
  28 weeks. 

Supporting breastfeeding women 

“Community pharmacists can share the public health recommendations on optimal infant feeding, which includes the recommendation of exclusive breastfeeding to six months, with timely, adequate and appropriate introduction of solid foods alongside breastfeeding from six months,” says Pereira-Kotze. “They can be supportive of mothers’ infant feeding choices and also advise about any local feeding support services available.” 

All breastfeeding mothers should be advised to take a vitamin D supplement (10mcg). 

It’s common for breastfeeding mothers to stop taking prescription medication or to discontinue breastfeeding due to worries about how their medication might affect the baby. You can help by giving advice to breastfeeding mums who are taking prescribed medication. The Breastfeeding Network has useful fact sheets on drugs in breast milk you can signpost women to (breastfeedingnetwork.org.uk) as well as a helpline service. 

Babies who are not breastfed should be given first infant formula as their sole source of nutrition up to around six months, and then alongside solid foods until 12 months.

Tips to pass on: 

• Follow manufacturer’s instructions when making up feeds 
• Don’t add extra powder as this can cause constipation 
• Don’t add extra water as this dilutes the feed 
• Never add sugar or cereals to formula 
• Don’t warm in a microwave as it heats milk unevenly 
• Make up feeds one at a time to cut risk of infection 
• Use freshly boiled water only 
• Don’t use bottled water to make up feeds as it is not sterile. 

Weaning advice 

“Weaning is a significant milestone for babies and parents. I often remind parents that this is a journey of how children learn to eat,” says Upton. She has these tips to pass onto parents:

• Wait for signs of readiness. Weaning is recommended to begin around six months, when babies can sit upright unsupported 
• Variety is key. Offer a wide range of flavours and textures 
• Focus on iron-rich foods early, as babies’ iron stores start to deplete around six months 
• Don’t panic about portion sizes – in the early days it’s about exploration, and appetite can vary 
• A mix of spoon feeding and self-feeding helps babies develop different skills 
• Be aware of choking hazards – eg avoid whole grapes or hard chunks of raw vegetables 
• Reassure parents that food refusal is a normal part of learning to eat 
• Model eating by sitting and eating with the child and showing what to do. 

Benelam says: “It can be hard to encourage children to try different foods, but pharmacists can reassure parents it’s normal for young children to be wary of food they are not familiar with. It’s worth persevering as research shows it may take 10-15 tries before they are accepted.” 

Recommend giving mainly home prepared foods, without added salt or sugar. “In June 2025, the Department of Health and Social Care updated its advice for parents on what to feed babies and young children to make explicit that commercial baby and toddler foods should be avoided or minimised, and that healthy home-prepared foods are a better choice,” says Pereira-Kotze.