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Image by onlyyouqj on Freepik
Welcome to the August edition of our newsletter. Please see the contents below. But first, news about a fundraising event…
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Our longest serving Trustee, Marjon Willers (a specialist dietitian for schools and early years in Islington, London), is running ‘The Big Half’ marathon in London on Sunday 1 September and is raising funds for First Steps. If you can, please consider donating to support our ongoing work; the link to donate is here. And please do share widely! Thank you.
Please note that due to summer holidays we will not be writing a newsletter in September. The next newsletter will be sent out in early October.
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News
Infant milk news
BFLG-UK news
Forthcoming
Happy reading!
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Updated: Eating Well: The first year
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We have made some updates to the last, 2022 version of this resource, to keep it as relevant as possible to the changing context and in line with changing public health recommendations. The significant changes include:
- Updating reference to UK public health guidance on infant feeding, which now recommends breastfeeding into the second year of life and beyond, and clarifies that formula milks are not needed after one year of age.
- Updates to the table ‘a simple guide to infant milk’ to reflect changes to NHS advice (also updated in our resource: Infant milks: A simple guide to infant formula, follow-on formula and other infant milks, see below).
- Adding the new NHS advice on formula preparation machines: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/how-to-make-up-a-feed/#using-a-baby-formula-prep-machine
- Urging caution on shop-bought baby foods, in line with advice from the UK Scientific Advisory Committee on Nutrition which has stated that commercial infant/toddler foods are not needed, and that home-prepared baby foods are preferable. We state:
- Be wary of marketing: Commercial baby and toddler foods are presented as healthy and suitable choices. However, many contain too much sugar and salt, are too sweet, too smooth and not age appropriate. Labels should be read with caution.
- Babies don’t need shop-bought baby foods! Home-prepared foods are preferable to introduce baby to appropriate tastes and textures. They are also typically more nutritious than commercial baby foods
- Babies don’t need snacks! Snack foods (including shop-bought baby finger foods) displace baby’s milk feeds and provide less nutrition.
- Revised ‘golden rules’ for feeding in the first year of life as follows:
- Offer mostly simple and minimally processed foods – Base meals and snacks around real foods. Make sure children can see and touch the foods they are offered, and can connect food tastes to how things look and feel, so they can learn to choose foods for themselves.
- Avoid or limit use of shop-bought foods aimed at babies and toddlers – The flavours and textures of commercial baby foods do not help babies learn to like real foods. Baby food pouches, jars and packets also often do not contain the right balance of nutrients babies need for healthy growth.
- Do not give baby ‘junk’ or treat foods like sweets, crisps, chocolate, ice cream and fizzy drinks.
- Making explicit that as well as avoiding sugary drinks, all fizzy drinks should be avoided in infancy (and early years) (i.e. including diet/sugar free) because these are acidic (which means they can damage teeth)
- Clarified advice on allergies, because we understand that this is a common concern of parents/carers; including adding a reminder that after potentially allergenic foods have been introduced at 6 months, they should then be given routinely alongside other foods. We also acknowledge that there is some evidence to suggest that introduction of hens’ egg and peanut before 6 months may prevent food allergy development. However, safe and acceptable interventions to do this do not yet exist and the public health recommendation remains unchanged: potentially allergenic foods should be introduced at around 6 months.
- Lastly, we have also included some new content to address parental concerns about the mess and waste associated with introducing solids.
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An updated 2024 PDF version is available here for free, or a contribution should you wish.
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Reminder: Eating Well: Packed lunches for 1 to under-5 year olds
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In case you have not seen, we produce a practical guide (updated earlier this year) specifically on creating cost-efficient, healthy packed lunches that meet the nutritional requirements of children between the ages of 1 and 4 years of age, based on unprocessed and minimally processed foods.
Research among school-aged children indicates that packed lunches are frequently less healthy than the hot meals provided. There is no similar research available for early years settings, but anecdotal evidence suggests the same may be the case. Parents/carers may also choose commercial products aimed at toddlers and pre-school aged children, considering them healthy and appropriate choices, when this may not be the case.
We wanted to highlight this eating well guide now, in advance of the new school year starting in late August/early September (depending on where you are), so you can promote this to parents/carers - including those working in early years settings - who need or choose to provide packed lunches to their children attending nursery, a child minders or reception.
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New paper: Prevalence and risk factors for milk allergy overdiagnosis in the BEEP trial cohort
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Allen and colleagues analysed data from a clinical trial population of 1394 children from atopic families born in England between 2014 and 2016. The children underwent formal (gold standard) cows’ milk allergy diagnosis at or before 2 years of age. They found that many parents and health professionals (typically GPs) incorrectly ‘diagnose’ their child as allergic to milk (the estimate was 11-16%), and this may result in unnecessary use of low-allergy formula milks (half of infants with parent-reported milk reactions received a prescription, for a median duration of 10 months). One risk factor for ‘overdiagnosis’ included being exclusively formula fed from birth. Gastrointestinal upset such as diarrhoea, vomiting and reflux were the most common presenting symptoms leading to diagnosis of milk allergy in the first weeks of life. Unnecessary use of low-allergy formula is a concern because lactose is replaced with alternative carbohydrate sources which are categorised as or (in the case of maltodextrins) behave like free sugars, potentially increasing the risk of excessive weight gain and dental decay. It also costs the NHS a lot of money and may undermine breastfeeding.
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The study implies that greater care needs to be taken in the diagnosis of milk allergy, although the key challenge here is that industry influence pervades relevant guidelines (including NICE guidelines). A key reference, developed independently of industry, is this Delphi consensus study.
Read the full paper here. Read our report ‘Specialised milks for infants with allergies in the UK’ here.
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The Grocer focus on infant and childcare
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The Grocer recently published its report on infant and childcare trends in 2024, highlighting a notable shift in the babyfood category. Between May 2023 and May 2024, baby food sales saw a 2.6% increase in volume, to 142.6 million packs, and a 9.7% rise in value to £192.2 million. In contrast, the broader infant care sector, encompassing nappies and toiletries, experienced a 2.1% decline in volume sales.
Despite the overall growth in baby food, not all subcategories performed equally. Baby finger food enjoyed an 8.6% increase in value, reaching £159.4 million by May 2024. However, baby milk, including infant formula, follow-on formula, and toddler milks, saw a 1.2% decline in value, dropping to £315.9 million. Baby drinks faced a significant drop, shrinking by 81%.
Brand performance varied significantly as well. Among the ten baby food brands evaluated, only four—Little Freddie, Nestlé, Piccolo, and Kiddylicious—reported growth in volume sales. Popular brands like Ella’s Kitchen Organic, Organix, and Cow & Gate saw declines of up to 50.8%. The Grocer attributes this trend partly to rising consumer concerns about infant and child health, driving demand for brands that position themselves as healthy or as viable alternatives to home-cooked meals. This shift is expected to lead to more health-related claims in product marketing as reflected in upcoming product launches, including Little Freddie’s omega-3 pouches, marketed as “supporting brain development,” and Organix Multigrain Quackers, marketed as wholegrain with no artificial colours or flavours.
When supporting families navigating feeding options for infants and young children, it is crucial to note the absence of specific nutrition composition, marketing, or labelling regulations for baby and toddler food products, labelled with ages <36 months. This means that, despite being marketed as such, many products poorly reflect public health recommendations for infant and young child feeding (Public Health England, 2019). Research indicates that many products are misleadingly marketed, with 41% of items labelled as healthy actually being unhealthy.
First Steps Nutrition Trust continues to push for government to implement mandatory standards to improve the nutrition composition and marketing of commercial baby and toddler foods and drinks. These should be aligned with the WHO Europe's Nutrient and Promotion Profile Model and UK public health recommendations, ensuring that any marketing, labelling, or packaging avoids health and nutrition claims that can mislead families.
Both the Scientific Advisory Committee on Nutrition and Public Health England recommend that home-prepared foods are generally recommended to help introduce appropriate flavours and textures. First Steps Nutrition Trust have a range of resources to support eating well in the early years which provide guidance for feeding infants, and ideas for simple, cost-effective nutritious meals, packed lunches and snacks for children over 12 months of age.
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FSA guidance reminder: Slush ice drinks
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The FSA issues a reminder of age limits on the sale of slush ice drinks: slush ice drinks containing glycerol should not be sold to children aged 4 or below. Glycerol can cause adverse effects like nausea and headaches in young children, and in severe cases, more serious health issues. Refill promotions to under 10s are discouraged, and retailers of ice slush drinks are recommended to display the warning: "Product contains glycerol. Not recommended for children 4 years of age and under." Read more here. |
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Aldi Mamia first infant formula price drop
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Since our latest cost report in April 2024, Aldi have dropped the price of their Mamia infant formula (900g) to £7.99. This means that it can now be bought within the weekly allowance of both Healthy Start and Best Start food schemes, and it remains the least expensive powdered infant formula on the market at 12p per 100ml.
Aldi have also introduced a slightly smaller 800g pack of Mamia infant formula which costs £7.09. Based on the assumption that the scoop size is the same across both packs the cost per 100ml of the reconstituted product is the same at 12p per 100ml. It is unclear whether the 800g pack is the same formulation as the 900g pack and the intention is to replace the 900g pack with the 800g pack or whether both products will continue to be marketed. We have sought clarification from Aldi on these points but have not yet had a response. We hope to provide an update in our next newsletter.
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Updated: Infant milks: A simple guide to infant formula, follow-on formula and other infant milks
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We have updated our report A simple guide to infant formula, follow-on formula and other infant milks. Since this report was last updated, there have been some changes to NHS guidance around suitable milks for young children and the updated report reflects these changes. We have also signposted to an additional First Steps resource on plant-based milk alternatives for young children which has also been introduced since the last update. Guidance around formula feeding has been updated to better reflect the concept of responsive bottle feeding and the feeding table has been updated accordingly. We have also made some small changes to other sources of support and information available to parents to reflect updated web addresses and contact details.
The report is available here: Infant milks for parents & carers — First Steps Nutrition Trust
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New editorial: Specialised infant milks: overused, overpriced and obesogenic
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This timely editorial written by Vicky and Susan was published on 23 July in the Journal of Clinical and Experimental Allergy. It was informed by, and builds upon the findings of our December 2022 report ‘Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health’.
Despite public health recommendations, most infants in the UK and other countries including China and the USA are predominantly fed a commercial milk formula. For the small number of non-breastfed babies who have special dietary needs that cannot be met by a standard infant formula, a ‘specialised’ infant formula is needed. This editorial identifies the problems in the UK arising from current legislation around the marketing and promotion of these products and explains their causes and consequences.
The editorial suggests that limitations in the current regulatory framework around infant formula and infant milks marketed as FSMP is failing to contain increasing, often unnecessary and usually unsupervised use of these products. This occurs because of industry-led misclassification of products and ineffective controls on their sale to the public, including cross-promotion and inadequate health warnings. The situation is compounded by weak legal restrictions on marketing of commercial milk formulas to healthcare professionals, who are misled about the nature and effectiveness of products, using information that is not scientific or factual. Ultimately, this is leading to widespread exposure of the world's infants to unhealthy, unnecessary and expensive nutrition products.
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The recent ESPGHAN position statement on infant formulas for the treatment of functional gastrointestinal disorders (FGIDs) including regurgitation, colic and constipation corroborates many of the issues raised by the editorial which urges the new Government to take a two-step approach to closer enforcement and improved regulation of the marketing practices of formula manufacturers to better protect infants, however they are fed. The full editorial is available here.
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For infant milk information please visit our website www.infantmilkinfo.org. If you can’t find what you’re looking for, please email rachel@firststepsnutrition.org
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Baby Feeding Law Group UK News
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Update on the Competition and Markets Authority infant formula market survey
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The Competition and Markets Authority are continuing their infant formula market survey, launched in February this year ‘to investigate supply and if and why the market may not be functioing well for consumers’. We continue to feed in, e.g. sharing our recent analysis of the costs of FSMP, reported on above. The results and recommendations were meant to be published in September. However, the workplan and time have recently been updated as described here. The explanation given is as follows: “Given the timing of the general election and the central role of government policy and regulation in this market, the CMA plans to publish in the autumn an interim report on the market study, and invite views on this. This will help to ensure that the CMA can effectively engage with the UK, Northern Ireland, Scottish and Welsh governments and provides parties the opportunity to submit views on the CMA’s emerging thinking”. On behalf of the BFLG, First Steps will be looking at this consultation and if you would like to see our response prior to the deadline please email katie@firststepsnutrition.org.
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For more information about the Baby Feeding Law Group UK please visit our website Baby Feeding Law Group UK (bflg-uk.org) and sign up to our X (formerly Twitter) account @BflgUk. You can also email katie@firststepsnutrition.org
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World Breastfeeding Week 2024: 1 – 7 August. ‘Strength in numbers’ webinar, Tuesday 6 August
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World Breastfeeding Week starts today on 1 August. This year’s theme is ‘Breastfeeding Support for All’. Find out more here.
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Among several events during World Breastfeeding Week, on Tuesday 6 August, WHO, UNICEF, and Global Breastfeeding Collective will be hosting the webinar: Strength in Numbers – How monitoring breastfeeding policies and programmes creates accountability and empowers change. Behind every breastfeeding statistic is a mother trying to reach her breastfeeding goals. The webinar will discuss how monitoring policies and programmes is essential to creating an environment that enables breastfeeding. Sign up here.
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NICE consultation on updated guidelines on Maternal and Child Nutrition
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The consultation on the draft guideline opened on 30/07/24 and will run for 6 weeks, closing on 11/09/24. As our Director, Vicky was on the committee for this update, First Steps will not be submitting a response. However, we would encourage health workers for whom this is relevant to take time to review the draft guideline and submit a response so that the final guidelines are as robust and useful as possible. See more here. |
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SACN consultation on draft SACN and COT report ‘Assessing the health benefits and risks of consuming plant-based drinks’
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The invitation to provide comments on the scientific content of this draft report from the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) is open until 17/09/24. For further information about this peer review and links to the documents, see the Announcements section of the SACN webpage. First Steps will be looking at this consultation and if you would like to see our response prior to the deadline please email vicky@firststepsnutrition.org.
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SACN consultation on the draft report ‘Nutrition and maternal weight outcomes’
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The invitation to provide comments on the scientific content of this draft report from the Scientific Advisory Committee on Nutrition (SACN) is also open until 17/09/24. For further information about this peer review and links to the documents, see the Announcements section of the SACN webpage. First Steps will be looking at this consultation and if you would like to see our response prior to the deadline please email vicky@firststepsnutrition.org.
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Maternal, parental, and infant nutrition and nurture unit (MAINN) conference: April 2025
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This interdisciplinary conference is being organised by the Maternal, Parental and Infant Nutrition and Nurture (MAINN) Unit, University of Central Lancashire. The conference convenors are Professor Gill Thomson, Professor of Perinatal Health and Dr Victoria Hall Moran, Reader in Maternal and Child Nutrition. It will take place from 28 to 30 April in Grange-over-Sands, Cumbria. The conference aims are to:
- Illuminate the socio-cultural, political and economic influences upon infant and child feeding practices.
- Explore the nature of relationships within families in connection with various types of nutritive and nurturing behaviour in infancy and childhood.
- Increase the understanding of breastfeeding as a bio-psychosocial activity.
- Enhance understanding of the complex interactions between socio-cultural, psychological and biological factors in infant and child feeding, eating and nutrition.
- Focus on key initiatives that may impact upon practices related to infant and child feeding, eating and nutrition.
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Find out more about the key note speakers and abstract submission here. We hope to be able to go, and hope we will see many of you there too.
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We’re extremely sad to share the news that, after 13 years at First Steps - its whole lifetime to date – our Senior Nutritionist Susan Westland has decided to hand her notice in to take a break from the world of early years nutrition. Susan’s deep expert knowledge has been foundational to First Steps success to date. Whilst not usually engaged in much outwardly facing work, behind the scenes Susan has contributed to the majority of our reports, papers, resources and consultation responses. In particular, it is her knowledge, hard work and dedication that has yielded our infant milk info website.
Susan leaves behind a huge legacy which we’re proud has helped many health workers support families with feeding their babies, as well as supporting families directly. We’re going to miss her, and she leaves huge shoes to fill but we will do our best to continue her work which we know many of you rely on. We hope you will join us in thanking Susan for all that she has done during her time at First Steps.
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