Welcome to the Right Decision Service (RDS) newsletter for August 2024.
Contingency planning for RDS outages
Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.
We would like to invite you to a webinar on26th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.
I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.
2.National IV fluid prescribing calculator
This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.
Please do spread the word about this new calculator and get in touch with any questions.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.
Updated guidance on current and future Medical Device Regulations
We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.
Guide to six stages of RDS toolkit development
We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.
Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 pm
To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)
7 Evaluation projects
Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.
We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.
If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.
You can also find lots of useful information in Off to a Good Start:
Off to a Good Start
Click on image to open PDF
This leaflet is available in other languages - use this link to list them
Twins Trust: provide online Antenatal classes for parents expecting twins or multiples. This is funded via Scottish Government
Meeting your baby
Regardless of your feeding intention, skin-to-skin contact is the best start for every baby. If this is not possible immediately after birth, try to have some skin-to-skin time as soon as you and your baby are able to.
This first magical hour (which can be recreated later) is a natural process of nine stages your baby will go through and naturally make their way to the breast. For more information on this please see Off to a Good Start.
Off to a good start
Click on image to open PDF
This leaflet is available in other languages - use this link to list them
For those who wish to breastfeed, this will get breastfeeding off to a good start.
For all babies this time is invaluable. This is a calming, bonding time between mum and baby and it will help your baby to set up a healthy immune system, calm your baby and help you fall in love with your baby.
If you decide to formula feed it is best to give the first formula feed in skin-to-skin contact with mum to enjoy the same benefits.
Meeting your baby for the first time: UNICEF Baby Friendly Initiative
Building a Close and Loving Relationship with your Baby
Babies love to be close to their parents in skin-to-skin contact as this helps them feel more secure and loved. When this happens, both you and your baby produce a hormone called oxytocin which calms your baby down and helps with developing their growing brain.
Building a happy baby: UNICEF baby friendly initiative leaflet
Click on image to download PDF
The importance of relationship building: UNICEF Baby Friendly Initiative
For information about feeding baby during the night, please look at the safer sleeping section under Looking after your child.
Breastfeeding information
Breastfeeding has many benefits for babies and for mums. Your breastmilk is unique and is ideally suited to your baby. Breastmilk is especially beneficial for babies if they are born prematurely
Off to a good start
Click on image to open PDF
This leaflet is available in other languages - use this link to list them
Responsive feeding
This is about responding to your baby’s cues for feeds
It is also about listening to your own body and offering the breast anytime you feel full. Responsive feeding is a very valuable way of being able to soothe and comfort your baby if they are unsettled or upset, or if you just want to spend a bit of time with your baby. You are not going to overfeed or spoil your baby by doing this.
Off to a Good Start booklet has more information and the link is at the start of this section
The clip below from Best Beginnings shows how to achieve good attachment at the breast:
Positioning and attachment video
This clip from Best Beginnings shows how ineffective attachment happens and how it
can cause sore nipples
Suck/Swallow Pattern of a Breastfeed
The image below shows the sucking and swallowing pattern of a breastfeed. It can be helpful to understand what this looks like. For more information see page 45 of your Off to a Good Start booklet.
Throughout a breastfeed, baby receives a range of calories and nutrients:
Beginning of a feed - your baby will suck quickly and receive a high amount of liquid along with carbohydrate and fat
Middleof a feed – Rhythmic sucking, the volume of fat becomes more concentrated
End of a feed - ‘Flutter’ sucks, very high fat milk, low volume of liquid
All parts of the feed are important for your baby, and this is why we encourage baby to stay on the breast until your baby comes off naturally.
Wind your baby then offer the second breast at each feed. Baby may not always take it, but it's important to offer.
Hand Expressing
This video guides mothers on how to hand express and talks about the times when hand expression might be useful
Hand expression video - UNICEF Baby Friendly Initiative
Further information on how to hand express and store breastmilk can be found in your Off to a Good Start booklet
Exclusively Expressing
You may find yourself in the position where you are exclusively expressing breastmilk, either temporarily or long term.
If you have any concerns about breastfeeding, or have any concerns about your baby, please contact your Health Visitor who will be able to support you. If you are having more complicated feeding problems, they will also be able to assess if you need onward referral to our specialist Infant Feeding clinics.
This video features local GGC mums Alisha, Aimee and Linda talking about their breastfeeding challenges
Top Tips for Breastfeeding Out and About and Returning to Work, Training or Education
In Scotland the law says you can feed your baby wherever you are going when you are out and about. You can't be stopped or asked to move on.
You also have options to continue breastfeeding when returning to work, training or education. Please see the leaflet below for more information.
This video features local GGC mums Aimee and Linda talking about their experiences of breastfeeding out and about:
Breastfeeding Stories - Out and About
The Breastfeeding Friendly Scotland Scheme
This is a national scheme to support breastfeeding families. Businesses such as cafés and restaurants who have signed up to this will make an extra effort to welcome breastfeeding families and will display Breastfeeding Friendly Scotland stickers and/or posters.
To see which businesses have signed up across Scotland look at this interactive map.
Breastfeeding Support
The National Breastfeeding Helpline is open 24 hours a day every single day of the year, offering non-judgemental, evidence based, friendly breastfeeding support and information to anyone in the UK who needs it.
National Breastfeeding helpline – 0300 100 0212
The Breastfeeding Network and NCT Glasgow Breastfeeding Buddies offer breastfeeding support across Greater Glasgow and Clyde
This video features local GGC mums Aimee and Alisha talking about the support they received when breastfeeding and what that meant to them:
Breastfeeding Support for Families having Twins or Multiples
Twins trust – multiple birth information Registered charity UK, our mission at Twins Trust is to provide our families with the information and support they need to enable them to thrive
If you are formula feeding your baby, your Health Visitor or Family Nurse will discuss during visits how your baby's feeding is going. They will check that you know how to:
prepare formula feeds safely
clean and sterilise your feeding equipment.
Formula feeding: How to feed your baby safely - Public Health Scotland
Click on image to open PDF
This leaflet is available in other languages - use this link to list them
What type of infant milk should my baby have?
First infant formula (whey-based formula milk) is the most suitable formula for infants in the first year of life (unless your doctor or health visitor gives you different advice)
From around 6 months, babies are introduced to solid foods (see section on introducing solid foods). Continue to also give a first stage infant formula alongside introducing solids until 12 months of age. Cow’s milk can be used for cooking from around 6 months with the introduction of solid foods.
From 12 months of age, infants should be given full fat or semi-skimmed cow’s milk, a suitable plant-based alternative, or water as their main drink
There are a range of formula milks which would not be recommended, unless advised by your GP or health visitor. These include:
Soya milk formula
Goat’s milk formula
Comfort / Reflux formula
Hungry Baby formula
Follow on formula (not required at all and not suitable under 6 months old)
Toddler and Growing Up formula (not required at all and not suitable under 12 months)
If you have any issues or concerns about your baby’s feeding including worries about cow’s milk allergy, reflux, growth, or other concerns please speak to your Health Visitor/Family Nurse or GP for further assessment and advice.
What brands of infant formula milk are recommended?
As a new parent, it can be confusing when trying to decide which brand of infant formula is best to buy. In the UK, all brands of first infant formula milk all meet the same strict compositional standards, meaning they are all very similar. Any first stage infant formula milk is suitable from birth and there is no need to buy a more expensive brand for your baby.
Struggling with the cost of buying Infant Formula
First Steps Nutrition Trust have produced a range of very useful infographics that advise how you can safely save money while formula feeding your baby
You may be eligible for Best Start Foods as part of a Best Start Grant entitlement. This entitles the user to a pre-paid card towards healthy food and can be used towards first infant formula.
Your Health Visitor/Family Nurse will always be happy to discuss any financial issues or concerns you may be having and will be able to support and refer you on to a range of services that can help you.
Cleaning and sterilising your feeding equipment
It is very important that you know how to properly clean and sterilise your baby’s bottles, teats and feeding equipment to prevent them getting infections and stomach upsets. Please see pages 3 to 9 of Formula feeding booklet and the Parent Club website
This Parent Club video also has a useful demonstration on how to clean your feeding equipment
Safe preparation of formula
It is very important that you make up your baby’s formula feed safely. Infant formula powder is not sterile and can sometimes contain harmful bacteria. Although this is rare, these bacteria can cause infections and make your baby seriously ill. Please follow the instructions on pages 10-19 formula feeding booklet on how to do this safely
Parent Club also has a useful video showing a Health Visitor talking to a mum about how to make up a Formula feed
Babies should be fed when they are showing signs that they are hungry (often referred to as feeding cues) rather than feeding them according to a schedule
Keeping your baby close by will help you to pick up on your baby's cues for feeding and attention. In the first few weeks, it's great if you and your partner are feeding your baby; this helps them feel more secure and helps them continue to bond with you. Page 20 to 25 of your formula feeding booklet has more information about feeding your baby responsively
Babies should always be held for feeding, encouraging responsive, paced bottle feeding. Feeding pillows or props are not recommended for bottle feeding as they do not promote responsive feeding and are a choking hazard.
Neonatal Infant Feeding
Why breastmilk matters when your baby is born too soon or sick
Having your baby on the neonatal unit can be a really worrying time. Giving your baby your breastmilk is one of the best things you can do. It will protect your baby from infection and is uniquely made to meet their needs. Breastmilk is especially important if your baby is born very early or is sick after birth and needs to come to the neonatal unit.
Making milk for your baby
Expressing as soon after your baby is born will get your milk supply off to the best start. The staff on the neonatal unit can help you with this. Even if you never intended to breastfeed, giving your baby breastmilk in the early days is like a medicine only you can give.
If your baby was born very early, you may need to carry on expressing for many weeks. This can feel relentless at times. Double pumping (pumping both breasts at the same time) will save time and increase your milk supply. Expressing 8-10 times in 24 hours including once overnight will help you make enough milk for your baby in the coming days and weeks ahead.
Skin to skin contact
As soon as your baby is stable, both you and your baby will really benefit from spending time in skin
-to-skin contact. This can be a very special time for you both and it helps to steady your baby’s heart rate and breathing and keeps them snug and warm.
Skin-to-skin contact helps babies grow, reduces their stress levels and is the perfect way to soothe and calm them after a medical procedure. Skin-to-skin contact will also calm you, which can help if you have had a busy or stressful time getting to the hospital. Spending lots of time in skin-to-skin contact with your baby has been shown to shorten hospital stays and help your baby learn to feed more quickly.
Moving on to breastfeeding
All of the staff on the unit can support you with building your milk supply and transitioning to breastfeeding if that is what you want to do. We also have breastfeeding champions and peer supporters who have dedicated time to support you with feeding your baby. Ask your nurse if you want to speak to one of the infant feeding team.
If you know your baby is going to be on the neonatal unit and want to speak to one of the infant feeding team to find out a bit more about why breastmilk is important/how to express use the contact details on the leaflet below.
PRM Intensive care unit (NICU) - 0141 451 5221 or 0141 211 6356
PRM special care unit (SCBU) - 0141 451 5222
Royal Hospital for Children neonatal unit level 1 reception - 0141 201 2261 or 0141 211 6356
Royal Hospital for Children neonatal unit level 2 reception - 0141 232 4334 or 0141 232 4335
Milk Bank Scotland - Donor Breastmilk
Donor human milk (DHM) is breastmilk donated to a human milk bank by mothers who have extra to spare. The donors are screened to ensure their milk is suitable, and their milk is tested for bacteria before being heat treated. Just like with blood donations, the breastmilk is freely donated, and its use is tracked and recorded.
DHM is mainly offered on a temporary basis as a supplement to your own milk whilst you build your supply
It is mostly needed when babies have been born early or are very small
Your colostrum (first milk) and the milk produced after a few days are the most suitable first feeds for your baby, especially those that are tiny and sick. If there isn’t enough or your baby is not able to have your own milk, DHM is usually the preferred supplement in the early days and weeks when being cared for on a neonatal unit.
You can also donate breast milk that is stored and less than 90 days old. Once breastfeeding is established, usually around 6 weeks, you can express on a regular basis, usually once a day, to donate. You can donate up until your baby is two.
Can I donate my milk: on NHS Greater Glasgow and Clyde site has further information and screening forms
Milk Bank Scotland page on the NHS Greater Glasgow and Clyde site will give you more information
Introducing solid foods
In this section you will find information about introducing solid foods to your baby. Introducing or starting solids is also sometimes called weaning, or complementary feeding; they all mean the same thing.
The World Health Organisation recommends starting solids at around 6 months, when your baby is developmentally ready. The signs that your baby is ready are:
They can sit up unsupportedAND
They can reach out, grab objects and put them in their mouthsAND
They can swallow food
Once all 3 signs are in place, your baby is ready for solid foods - this usually happens at around 6 months.
Starting solids is an opportunity to introduce a wide variety of flavours and textures to your baby. Babies are naturally curious and will enjoy exploring food – let them see, touch, taste, smell, hold and squish lots of different foods. Starting solids can be an anxious time for parents, but with the right information and support it can be a fun (and messy!) time too. Babies are all different and, like with anything, some will take to eating solid foods quickly while others will take a bit longer to get used to it - and that’s okay.
Once your baby is around 6 months old, breastmilk and formula do not provide enough of certain nutrients, for example iron, for your baby, which is why it is important to start them on a wide variety of foods at this stage. Learning to eat and cope with different textures also helps with their speech development
Starting solids is a great opportunity to introduce healthy eating habits that continue through childhood and into adulthood.
Fun First Foods - Public Health Scotland
Click on image to view PDF
To see list of other languages available click on Link
Starting Solids Show – Getting Started (Part 1)
Starting Solids Show – Practical Tips (Part 2)
Starting Solids Show – All About Textures and Suitable Drinks for Your Baby (Part 3)
Starting Solids Show – More Healthy Meals & Snacks and a Note on Food Safety (Part 4)
Starting Solids Show - NHSGGC for more videos showing you how to easily prepare a range of tasty and healthy meals for your baby and the rest of the family.
First Steps Nutrition Trust is an independent public health nutrition charity that provides brilliant, free resources about eating well from pregnancy to five years
Parents with a baby born early can find it difficult to know when they should start their baby on solid foods, as babies born preterm may develop more slowly (e.g. sit at a later age) than babies who were born at full-term.
Parents may also feel unsure about how their baby will manage weaning after such an unplanned or unexpected start to life.
When your baby is developmentally ready, at around 6 months, introduce foods that are commonly associated with food allergies (foods known to cause allergic reactions, for example egg, peanuts/other nuts, dairy foods, fish/seafood and wheat)
Introduce each of these foods one at a time
Start with a small amount and increase gradually
Try to introduce these foods early in the day (to monitor baby’s reaction)
Once introduced into your baby’s diet, keep giving them regularly
For babies at higher risk of developing a food allergy
Risk factors:
Eczema (especially if eczema is very bad)
An existing food allergy
During weaning, the early introduction of foods associated with allergies has been shown to be protective against developing food allergies for all babies, even those with risk factors.
For further information, please contact your healthcare professional (GP or Health Visitor).
Gagging and Choking
Parents and carers are often worried about gagging and choking and it’s important to know the difference between the two. Gagging is a normal reflex that stops your baby from choking and is common as babies figure out how to eat. See the Parent Club website for more information:
The British Red Cross video below shows you what to do if your baby chokes
Feeding your child from 1-5 years
Healthy eating habits developed in the early years can set your child up for good health later in life. A healthy diet is about getting the right balance of foods and drinks in the right amounts. If you can, it’s great to get into the habit of sitting together to eat, making meals a fun and social occasion.
Toddlers and pre-school children grow and develop quickly, so it’s important tomake sure they are eating well to get all the energy and nutrients they need. This is a great time for children to learn about food and eating, so that, if possible, they can get into the habit of having a healthy, varied diet.
It’s important to offer a variety of foods from the four main food groups every day:
Fruits and vegetables
Starchy foods, e.g. bread, pasta, rice, potatoes
Dairy foods (or unsweetened plant-based alternatives) e.g. milk (if plant-based ensure it is unsweetened and has calcium added), cheese, yoghurt
Protein foods (e.g. meat, fish, beans/lentils, nut butters, eggs)
Children also need fats and oils such as rapeseed oil, olive oil and the oils you get in oily fish, avocados, nuts and seeds.
First Steps Nutrition Trust is an independent nutrition charity that provides brilliant, free resources about eating well from pregnancy to five years. Click the link for information on feeding 1 to 5-year-olds, including packed lunches, snacks, vegan kids, and information for South Asian families.
Remember that children are all different, some will eat anything, while others will be much pickier. Some parents find the Division of Responsibility helpful to remember:
The parent/carer decides what, when and wheretheir child eats
The child decides whether they eat and how much.
In other words, you provide, they decide!
Fussy eating is a normal developmental stage which can start from about 1 year old and can last until approximately age 5, sometimes longer.
Neurodiverse children in particular can struggle with food and often like to stick to a few safe foods that they are familiar with. If you are worried about your child’s diet, please speak to your GP or Health Visitor.
For more information on fussy eating, please see the links below.
We need vitamin D for bone and muscle health. The best source of vitamin D is from the sunlight in the summer, but in the winter months (October – March) our bodies cannot produce enough vitamin D from sunlight and food sources are limited.
There are groups of people who are more at risk of vitamin D deficiency and should take a daily vitamin D supplement throughout the year; this includes those who are pregnant and breastfeeding, and children under the age of 5. Not taking enough vitamin D can lead to problems with bone health.
For more information on the benefits of vitamin D, and on groups at higher risk of deficiency, visit:
The following groups are entitled to FREE vitamin D:
Those who are breastfeeding and mixed feeding.
All children under 3 years old. If your child is having more than 500ml of infant formula in 24 hours, then they do not require vitamin D supplement as infant formula has vitamin D added.
If you are breastfeeding at discharge from the maternity unit, you should receive vitamin D drops for your baby and tablets for yourself.
You can collect more vitamin D free from your local pharmacy.
Vitamin D for breastfeeding women and children under 3 – NHSGGC.
Click on image to open PDF
This leaflet is available in other languages - use this link to list them
Vitamin D This is the link to the NHSGGC pages on why Vitamin D is important and how to get hold of the free drops via pharmacies.
Vitamin D and You
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This leaflet is available in other languages - use this link to list them
Happy Healthy Tots
Attachment and bonding during pregnancy: Ready Steady Baby!
This leaflet is available in other languages - use this link to list them
about food and eating, so that, if possible, they can get into the habit of having a healthy, varied diet.
