Early childhood development: A Better Start Southend

The first days and months of life are precious. Parents and families are welcoming and celebrating a whole new person, with all their potential for wonder and discovery. It’s also the time to lay strong foundations for happier and healthier lives. The human brain grows and changes most in its first 1,000 days. This is a time when good nutrition, support, and stimulation can have lifelong effects.

A Better Start Southend (ABSS) is part of A Better Start, a ten-year, £215 million National Lottery-funded programme for babies and young children. At each of five A Better Start locations, partnerships are developing ways to improve diet and nutrition, social and emotional development, and speech, language and communication – working right across the child’s life. It develops and tests new approaches, improving the way services are commissioned and delivered, and involves parents as equal partners.

In this case study, you’ll learn how its work has helped to increase the 6-8 week breastfeeding rates from 39% to 56% in just three years — with rates now exceeding the national average. And we hear how it's improving young children’s speech and language, with positive spin-off effects on their school life.

While the programme works across the whole system, here we focus on the steps it takes to break down barriers and improve participation, so that all parents get the support they’d like for their children, right from the start.

We know that breastfeeding protects babies from infections and diseases, with benefits lasting right into adulthood. But the window of opportunity is short. Milk will dry up if it isn’t used, so the early days are very important – and getting off to a good start makes it much more likely that breastfeeding will go smoothly in the longer term.

That means families need to be aware about breastfeeding early on, during pregnancy. But many haven’t heard about the benefits, while some may face stigma. “Especially young mums,” suggests Brooke Littlejohn, project manager at A Better Start. “If their mum bottlefed them, then it’s hard to change that. You do look up to your mum, follow their ways.”

“Families who live in areas where breastfeeding rates are low (often areas of multiple deprivation) may never have seen a baby being breastfed before having their own,” adds Eleanor King, who manages a breastfeeding group support project. Young mothers reported that those around them expected them to use formula milk, “putting further pressure on a more vulnerable group to use infant formula in preference to breastfeeding.”

So ABSS starts early. It works with NHS partners to get the word out about the support they can offer. The one to one breastfeeding service is recommended at the NHS booking appointment, when the mother is 8 to 12 weeks pregnant. The doctor or midwife will share advice and information for a healthy pregnancy, including antenatal care and education. “They start sowing the seeds [of the breastfeeding offer] at that moment,” explains Julie Lannon, programme manager at ABSS.

Recognising the need for a wider cultural shift, the team works with the local council and businesses to make it easier to breastfeed in public. An awareness campaign encourages local venues to display Southend Supports Breastfeeding window stickers. Shops, cafes, leisure centres, museums, bus companies and restaurants are now helping more mothers to feel confident about breastfeeding out in the community.

…the 1-2-1 help that A Better Start Southend gave me was priceless, it gave me confidence and knowledge at a time when motherhood could be quite daunting for a first time parent.

Participant, 1-2-1 breastfeeding support

Family nurse partnerships (FNPs) are another point of contact. So far, 87 young parents have been paired with a specially trained family nurse, offering intensive support from the early stages of pregnancy. The FNP nurses can recommend ABSS services, including support for breastfeeding and speech and language.

They’re on hand to provide practical and emotional support, initially once a week, and then fortnightly until the baby turns two.

The FNP programme is based on years of research across the US and Europe. ABSS tests and refines new features, including improved access, so successful changes can be adopted on a wider scale. In most FNP programmes, women are enrolled up to the 28th week of pregnancy. ABSS changed the eligibility criteria, increasing access for some of the most vulnerable parents. Mothers who have concealed their pregnancy can be enrolled at any point in pregnancy or immediately post-birth. Those who present late for booking can enrol up to 32 weeks (plus six days) gestation.

Similarly, it’s important to support child communication as early as possible. Early language development is linked to long-term impacts on wellbeing. The greatest amount of brain development happens up to the age of two, so babies and toddlers need stimulation – and the best way to do that is to talk to them.

Let’s Talk, the speech and language programme, offers a range of support, tailored to specific ages and developmental stages. “We offer a suite of group sessions from Baby to Chatting Children for general language development,” explains speech and language therapist Isobel Wratislaw, “plus some more specialised groups for listening/attention, and we are about to start one for speech sounds.”

Early information is vital. Families may not realise the importance of speech and language development, or the impact it can have on the rest of the child’s education. So the programme works to rectify this, “weaving these messages into antenatal contacts that the parents have,” Isobel says. They help parents understand “what they can do to improve social communication, starting from being pregnant,” agrees Julie. Like the breastfeeding service, Let’s Talk has strong links with Family Nurse Partnerships and the local Health visiting team.

The programme screens children at 23 months for potential speech and language needs, but recognises that this isn’t early enough. It's about to add screening as part of children’s “under one” statutory visit from health visitors, using the WellComm tool for assessment.

“The earlier a potential SLCN [speech, language and communication needs] problem can be identified, the quicker we can start supporting the parents to effect change,” Isobel says. And working through health visitors will extend the reach. Take up for the 23-month screening is from 35 to 50%, but “the expectation is that the Under 1s screen will be nearer 95 to 100%.”

While statutory services are an essential way to make early contact, the programme works to get the message out in other ways. Both breastfeeding and speech and language groups work with The Storehouse, a large food bank in Southend. This ongoing presence at an important community resource offers “a good opportunity to build relationships and trust with local families who may be reluctant to come to a group,” Eleanor says. That creates opportunities to explain how much breastfeeding and communication matter, and to signpost people to services.

Empowering parents is important, too. People take part through self-referral, and parent champions help to spread the word. The parent champions “are really good at speaking to other people – finding out from parents what they want, what are the barriers,” explains Julie. Word of mouth helps to expand ABSS’s online presence, with parents engaging on Facebook or Instagram. They also have physical posters and flyers for those who don’t use social media.

I feel so confident about breastfeeding now and if I have a problem, I know all the resources I can use to overcome it. Also, I feel a strong urge to help other breastfeeding mums.

Group breastfeeding participant

The multiple routes matter. People may miss the first suggestion, or pay more attention if it comes from a particular source. Let’s Talk found that people were more likely to attend appointments if the text invite came from the NHS text service, rather than an ordinary work mobile.

This has led to fewer missed appointments too, with more children getting early support to address any difficulties with speech or language. The Let's Talk team aim to meet families at a location that is most convenient to them, which might be at home, in their nursery or childminders’, or at their local children’s centre.

They’re working to fill gaps in engagement. Across the programme, support officer Amy Wood notes that there had been less response from fathers, and from people from Black and minoritised communities. “This has led to new marketing strategies… such as providing leaflets in other languages and dropping leaflets to targeted places such as community and faith groups.”

They now plan to work with more diverse organisations to increase their reach, while some of the partners deliver their programmes in other languages. Talking Heads, a new project led by specialist early years teachers, aims to share key early years communication and language messages through video clips in different languages. This project has already received great interest from a range of services and providers across Southend, who want to be collaboratively involved.

It’s really important that parents/carers don’t feel ‘judged’. We avoid ‘finger wagging’ at all costs.

Isobel Wratislaw, Speech and Language Therapist

Throughout, “We wanted a really strengths-based approach,” Julie says, “so that people accessing a service aren’t perceived as having a problem. They might have a challenge.” In feedback, participants praise the non-judgmental approach, feeling that what they share won’t change how they are treated. And because it’s self-referral, Julie adds, there are no criteria to meet: “anyone is welcome at anything.”

They work to create a nurturing atmosphere. People are more likely to attend if the setting feels relaxed and welcoming. Some parents find the informal setting of a community venue more accessible than a children’s centre.

“We welcome people, give them a chance to tell their story first without interruptions,” explains Eleanor. “We offer them a hot drink and snack, and put out toys for their toddlers to play with.” Across different sessions, “We try our best to remember people’s names and what they have told us last time so that we can ask them how things are going.”

Everything is unhurried and patient. Where appropriate, “we ask whether they would like us to do a breastfeeding observation and watch the baby feed,” Eleanor says. “We have a ‘hands off’ approach when offering breastfeeding support and do not touch the mother or the baby, in order to empower them to do it themselves.”

Comfort and confidence produce better results. “We know that social and emotional development is inextricably linked to communication and language,” explain specialist early years teachers Lynsey Weston and Sîan Ansell. That is why they focus on “children’s social and emotional wellbeing as much as their language skills. We know that if children are feeling safe, happy and secure, their confidence to communicate increases.”

All the way through, the breastfeeding team “try to help people make links so they can build their own support network,” Eleanor says. “We work with other local community organisations, signposting people to those they may find helpful.”

It’s about sharing success, as well as problem solving. Let’s Talk found that some of the children attending sessions had no communication difficulties – but their parents were still learning, and building their confidence levels. “They understand that what they’ve done has been good,” Julie explains, “and then they share that with friends. It either increases intake, as friends want to go along, or at least friends have received the learning from a peer.”

Breastfeeding support lasts “as long as the family wants it to,” Eleanor says. In some cases, a phone call or text message conversation might be all the reassurance someone needs. Others “continue to attend groups regularly for a year or two or more, helping and supporting new families as they arrive, which is a real asset to our project.”

ABSS takes this a step further with its breastfeeding peer support training course, based on UNICEF materials. After completing the course, some parents register as volunteers with Southend YMCA, with access to further training. Others become “breastfeeding companions”, or simply members of the peer support group.

“If people don’t want to do either of those roles this is fine, as everyone’s circumstances are different,” Eleanor adds. Instead, they can “use their knowledge from the training course to help friends or family.”

In the long term, the programme is creating a supportive community for families: spreading knowledge, building networks, and normalising good communication, breastfeeding, and other ways to help babies and young children thrive.

Julie Lannon, YourFamily Programme Manager, A Better Start Southend, Early Years Alliance

Brooke Littlejohn, Project Manager, A Better Start Southend, Early Years Alliance

Isobel Wratislaw, Highly Specialist Speech and Language Therapist, A Better Start Southend

Siân Ansell, Specialist Early Years Teacher/Communication and Language Adviser for A Better Start Southend, Early Years Alliance

Eleanor King, Bump to Breast Manager, Southend YMCA

Nicky Ficken, Project Manager, A Better Start Southend, Early Years Alliance

Lynsey Weston, Specialist Early Years Teacher/Communication and Language Advisor for A Better Start Southend, Early Years Alliance

Find out more about the work of A Better Start Southend, or follow them on Facebook, Twitter, LinkedIn or Youtube.

For more information on the difference our funding makes, please read our other impact features.

Our feature on Home-Start Wandsworth, part of the Voices from the Pandemic interview series, highlights how the charity offered practical and emotional support for parents and young children during COVID-19.