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Baby Jimmy was being breastfed within a baby carrier worn by his mother. After 5 minutes she found that he was collapsed and although immediate resuscitation was commenced he died 3 days later on 11 October 2023 in St George’s Hospital. Jimmy died because his airway was occluded as he was not held in a safe position while within the sling. There is insufficient information available from any source to inform parents of safe positioning of young babies within carriers and in particular in relation to breastfeeding.  It was accepted that the sling was being worn snugly, not tightly, and although she could see his face when she looked down, the TICKS acronym was not met by his position within the sling as Jimmy was too far down. The TICKS acronym was prepared by the (now disbanded) UK consortium of sling retailers and manufacturers tight in view at all times close enough to kiss keep chin off the chest supported back. There appeared to be no advice in the literature regarding the risk of baby slumping and the risk therefore of suffocation, particularly if baby is under the age of 4 months, and no advice that breastfeeding “hands free” a young baby is unsafe, due to the risk of suffocation and not being able to meet every aspect of TICKS. There appeared to be no helpful visual images of “safe” versus “unsafe” sling/carrier postures. Evidence was given by the witnesses assisting the inquest that public information, readily available, not too complex but consistent in message would be welcomed to advise and instruct. Matters of concern There is very little information available to inform parents of safety and positioning advice of young babies in carriers/slings and in particular nothing in relation to breastfeeding in carriers/slings This is notwithstanding a significant increase over recent years in the use of such equipment. The question of whether it is safe to breastfeed “hands free” is not addressed or referred to in the public domain or manufacturers literature. The NHS available literature provides no guidance or advice. The only current “tips” are provided on the National Childbirth Trust (NCT) website but these are in fact unhelpful Young babies are at risk of suffocation. Consideration should be given to industry standards to promote the safe use of slings/carriers, to warn users of the risks and whether any such standards should be voluntary or mandatory.

Healthcare professionals are reminded to inform patients about the common and serious side effects associated with glucagon-like peptide-1 receptor agonists (GLP-1RAs). Advice for healthcare professionals: Inform patients upon initial prescription and when increasing the dose about the common risk of gastrointestinal side effects which may affect more than 1 in 10 patients. These are usually non-serious, however can sometimes lead to more serious complications such as severe dehydration, resulting in hospitalisation. Be aware that hypoglycaemia can occur in non-diabetic patients using some GLP-1RAs for weight management; ensure patients are aware of the symptoms and signs of hypoglycaemia and know to urgently seek medical advice should they occur. Patients should also be warned of the risk of falsified GLP-1RA medicines for weight loss if not prescribed by a registered healthcare professional, and be aware that some falsified medicines have been found to contain insulin. Be aware there have been reports of potential misuse of GLP-1RAs for unauthorised indications such as aesthetic weight loss report suspected adverse drug reactions to the Yellow Card scheme.

Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalisations for jaundice/hyperbilirubinaemia, hypernatraemia/dehydration, and hypoglycaemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide.This article argues that modern misconception of exclusive breastfeeding as natural and thus safe causes common and preventable harm to neonates. This review shows that the evidence regarding common and preventable harm to neonates associated with breastfeeding insufficiencies is sufficient to warrant fundamental changes to early infant feeding policies and practices.

The number of children and young people admitted to children’s wards with an eating disorder has increased significantly since the start of the Covid-19 pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children’s nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children’s nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

Total parenteral nutrition (TPN, also known as PN) is a method of providing nutrition directly into the bloodstream to those unable to absorb nutrients from the food they eat. TPN is used in all age groups, but in babies its use is often as part of a temporary planned programme of nutrition to supplement milk feeds in those too immature to suckle or too sick to receive milk feeds as a result of intestinal conditions. TPN consists of both aqueous and lipid components, which are infused separately into the baby via specific administration sets and infusion pumps. The rate at which TPN is administered to a baby is crucial: if infused too fast there is a risk of fluid overload, potentially leading to coagulopathy, liver damage and impaired pulmonary function as a result of fat overload syndrome. In a recent three and a half year period 10 incidents were identified where infusion of the aqueous and/or lipid component of TPN at the incorrect rate resulted in severe harm to babies through pulmonary collapse, intraventricular haemorrhage or organ damage, and where intensive intervention and treatment were needed. Most of these incidents involved too rapid a rate of infusion.

A review of government policies tackling smoking, poor diet, physical inactivity and harmful alcohol use in England. Key points Smoking, poor diet, physical inactivity and harmful alcohol use are leading risk factors driving the UK’s high burden of preventable ill health and premature mortality. All are socioeconomically patterned and contribute significantly to widening health inequalities. This report summarises recent trends for each of these risk factors and reviews national-level policies for England introduced or proposed by the UK government in England between 2016 and 2021 to address them. Based on our review, it assesses the government’s recent policy position and point towards policy priorities for the future. Population-level interventions that impact everyone and rely on non-conscious processes are most likely to be both effective and equitable in tackling major risk factors for ill health. Yet recent government policies implemented in England have largely focused on providing information and services designed to change individual behaviour. As well as relying heavily on policies that promote individual behaviour change, the strength of the government’s approach has been uneven for the leading risk factors, and decision making across departments has been disjointed. Action to tackle harmful alcohol use in England has been particularly weak. To reduce exposure to risk factors and tackle inequalities, government will need to deploy multiple policy approaches that address the complex system of influences shaping people’s behaviour. Population-level interventions that are less reliant on individual agency and aim to alter the environments in which people live should form the backbone of strategies to address smoking, alcohol use, poor diet and physical inactivity. These interventions need to be implemented alongside individual-level policies supporting those most in need. The strong role played by corporations in shaping environments and influencing individual behaviour must also be recognised and addressed in a consistent way through government policy. The costs of government inaction on the leading risk factors driving ill health are clear. As the country recovers from the COVID-19 pandemic and seeks to build greater resilience against future shocks, now is the time to act.

Investigation of a complaint against the Belfast Health and Social Care Trust A Trust’s failure to perform an examination of a patient on admission to hospital meant he was not assessed by medical staff against this baseline during his time on the ward. The investigation found a significant number of failures in the care and treatment of the patient overall and in the following areas: Nutrition and Feeding the patient – contrary to guidance which highlights the importance of high quality nutritional care based on individual assessment of needs with appropriate planning and monitoring, this investigation found the following failings: The feeding of porridge contrary to Speech and Language Therapy advice on 3 and 4 December 2016 and offering other foods contrary to advice. The recording who fed the patient porridge. The identification that the recommended diet was not provided and the taking of appropriate action. The recording of foodstuffs in a consistent manner. The reporting and recording of adverse incidents in relation to the feeding of porridge on 3 and 4 December 2016. Communication & Reasonable Adjustments – safe, person centred care is underpinned by effective communication. When caring for a patient with a learning disability communication must be timely and sensitive to the needs of the person and involve the family when appropriate. This is particularly essential in relation to pain management and when a patient is non-verbal. This investigation found the following significant failures: Failure to use any kind of pain tool to assess and record the patient’s possible pain or distress. This issue is of particular importance as the patient was unable to verbalise his pain levels. Failure to ensure the care of the patient was consistently tailored for a person with dementia and learning disabilities in accordance with GAIN Guidelines. The investigation also established further failings in relation to: A failure to ensure there was a coordinated approach between the Palliative Care and Care of the Elderly teams. A lack of coordinated communication between the family, Palliative Care and Care of the Elderly teams. The over prescribing of paracetamol to the patient on Ward 3 South due to the inaccurate estimation of the patient’s weight. The investigation established maladministration in relation to: The failure of the Trust to show regard for the patient’s human rights by failing to appropriately support or record the assessment of the patient's possible pain or distress; and to ensure the care of the patient was not consistently tailored for a person with dementia and earning disabilities. The failure to report overprescribing of paracetamol in line with the Trust’s ‘Adverse Incident Reporting and Management Policy’, April 2014 and Guidelines for the administration of intravenous (IV) Paracetamol’, December 2014. The failure to inform the complainant and her family of the overprescribing of paracetamol in line with the Trust’s ‘Being Open Policy’, February 2015 and it’s ‘Guidelines for the administration of intravenous (IV) Paracetamol’, December 2014. The failure to inform the complainant and her family of the overprescribing of paracetamol in line with the Trust’s ‘Being Open Policy’, February 2015. The poor management of complaints has been highlighted in many of the reports and inquiries that have examined the care of people with a learning disability in hospitals. Opportunities were missed in this complaints handling process to provide the family with empathetic and timely responses which may have helped resolve their concerns locally and prevented them having to use time and energy in approaching the Public Services Ombudsman. The investigation established failings in the Trust’s handling of the complaint namely: The failure to meet with the family prior to completing any investigation. The failure to share minutes of the meeting, held on 21 September 2018, with the complainant for comment. The delay in issuing minutes of the meeting, held on 21 September 2018, to the complainant. The delay in providing a final response to the complainant. The failure to provide regular and informative updates to the complainant. The failure to ensure coordination between the complaints team and the service area. The failure to recognise the sensitivities around arranging a venue for the meeting with the complainant on 21 September 2018. The investigation did not establish failings in the patient’s care and treatment in relation to: The decision to carry out the procedure of oral suctioning on the patient on the night before he died. The vitamin drip being administered after the patient was deemed End of Life on 6 December 2016. The reducing pain relief without consen. The anaesthetics care of the patient on 10 November 2016. The investigation was unable to make a determination as to whether the vitamin drip was administered prior to the administration of paracetamol on 9 December 2016