June 2022

Once again there’s been plenty of rain this month, but alongside the odd sunny day we have also seen some glimmers of hope in the nutrition world. In ‘News’: DHSC’s plans to start data collection for an infant feeding survey in England in 2023 were confirmed mid-month; the Government released a very disappointing ‘Food Strategy’ for England, raising the stakes for their promised ‘Health Disparities’ White Paper; and as the cost of living continues to rise we share some food and nutrition related messages and advice for those working with young families looking to cut costs and those working in community food provision. We also share a new paper reporting on the results of a Delphi consensus study on the detection and management of milk allergy. In ‘Infant Milk news’ we share an update of the fatal consequences of the US Abbott formula factory health and safety failings, which serves as a reminder as to the importance of ensuring parents/carers are aware of and understand the importance of following NHS instructions on safer preparation of powdered infant formula. As secretariat of the Baby Feeding Law Group UK, we seek to stress the importance of protection as well as support for breastfeeding during this year’s annual National Breastfeeding Week in England 2022, and update you of our related work. Lastly, we welcome Jen Hutchinson to our team covering our administrator role for the next few months, having said thank you and farewell to Jenny Parker who has left us in advance of expecting the birth of her first baby.

News

DHSC confirms 2023 Infant Feeding Survey for England

The DHSC has finally confirmed that it plans to start data collection for an Infant Feeding Survey of England in spring 2023. This survey was formerly conducted every 5 years from 1975 until 2010, so we have been relying on increasingly outdated infant feeding data for some time. The main aim of the survey is to provide estimates on the incidence, prevalence, and duration of breastfeeding as well as other feeding practices adopted by mothers in the first eight to ten months after their baby is born. The sample will be designed to achieve a representative profile by age and region of mothers in England. The survey design will be similar to that of the IFS 2010. It will be a longitudinal study with three questionnaires sent out when infants are about 8 to 10 weeks, around 6 months and around 10 months. The survey will be conducted by Ipsos UK.

Government releases its ‘Food Strategy’ for England

DEFRA published its long awaited ‘Food Strategy’, six months later than promised, on June 13th. You can read the strategy here. This strategy was a response to the independent review for a national food strategy written by Henry Dimbleby, published last July. Reaction to it has been largely one of great disappointment (Sustain have been collating reactions here). It is viewed as light on detail, lacking ambition and inadequate to meet its objectives, which include halving obesity by 2030. Within, it is promised that DHSC will shortly publish a White Paper on Health Disparities to address certain health related aspects.
 

• Henry Dimbleby said: “It’s not a strategy… It doesn’t set out a clear vision as to why we have the problems we have now and it doesn’t set out what needs to be done.”

• Anna Taylor, CEO of the Food Foundation said: "Today’s Food Strategy shows that no one in leadership in government appears to have really grasped the scale and urgency of the challenges posed to our health and our planet by the food system…What’s more, these challenges are growing exponentially with the cost of living crisis. Despite its name, the whole document is lacking a strategy to transition the food system towards delivering good food which is accessible to everyone”.

• Marion Nestle, Paulette Goddard Professor, of Nutrition, Food Studies, and Public Health, Emerita, at New York University, said: “I have to confess finding the report unreadable.  It is extremely wordy and imprecise, talks a lot about objectives, but says almost nothing specific… This is a lost opportunity, and a big one.  Disappointing, indeed.”

 
In February we highlighted the ‘baby-shaped blind spot’ in Henry’s independent review (read more here), so it came as no surprise that the Food Strategy also ignores babies and includes little of relevance to young children. You can read our reaction here, and also see the recommendations we have shared with the DHSC as they prepare the Health Disparities White Paper. We remain hopeful that this latest White Paper may acknowledge and address the specific food and nutrition needs and vulnerabilities of infants and young children.

Supporting young families to eat well as the cost of living continues to rise

Since sharing our briefing note on what the Cost of Living Crisis means for the diets of infants and young children (and recommended our actions) with you in May, the economic challenges facing households across the UK have sadly worsened. Inflation and food prices have continued to rise and financial forecasts predict the situation to deteriorate further, which will result in more families struggling to meet the nutritional needs of their infants and young children.

Despite their unique vulnerabilities, their needs have been largely ignored at National level, as outlined above with respect to the long-awaited Government Food Strategy. In addition, the Healthy Start/Best Start Schemes which are meant to protect the nutritional status of the most vulnerable pregnant women, babies and young children, will arguably be increasingly insufficient in light of food price rises. For these reasons, it is imperative that action is taken now to protect households with infants and young children, ensuring that they receive safe, appropriate, and optimal nutrition for optimal growth, health and development.

We are continuing to act on all eight recommendations outlined in our Cost of Living Crisis briefing note to ensure that the importance of good nutrition for infants and young children remains on everyone’s agenda. These actions include:

• Advocating for an increase in the value of the Healthy Start / Best Start payment as its value fails to keep abreast of rising food prices;

• Working with the UNICEF UK Baby Friendly Initiative to update guidance for Local Authorities on creating and strengthening pathways of financial and practical support for families with babies facing food insecurity;

• Promoting key public health messages to protect parents and carers from being pressured into purchasing unnecessarily expensive or discretionary products.

In relation to the last point, we hope you will find these two infographics helpful and encourage you to share widely:

Best practice in community food provision for families with infants and young children

The Child Poverty Action Group estimates that there are currently 3.9 million children living in poverty in the UK, including 39,000 infants under the age of 12 months and 179,400 children aged 1-4 years. All of these babies and young children are growing and developing rapidly and require an appropriately nutrient-dense diet, ideally including being breastfed in the first year or more, to ensure they meet their full potential and are protected from both childhood disease and non-communicable diseases later in life.

The FSA recently reported that in 2020/21, nearly 40% of The Trussell Trust’s Food Bank Network’s three-day emergency food supplies and support to people in crisis went to children, many of whom will be under the age of 4 years. For anyone working or volunteering in, supporting or liaising with food banks or other community food providers, we recommend the following evidence-based guidance on community food provision for infants and children is used to ensure this vulnerable group are fed appropriate and safe food that meets their unique requirements: 

• The IFAN early years nutritional guidelines: Nutritional guidelines - Independent Food Aid Network UK. These guidelines are written by Registered Dietitians from Centrepoint as an evidence-based and practical resource for staff and volunteers involved in community food provision.

• The UNICEF BFI/ FSNT guidance on supporting families facing food insecurity: The Unicef UK Baby Friendly guide for local authorities.  UNICEF Baby Friendly Initiative and First Steps Nutrition Trust have written guidance for Local Authorities on creating and strengthening pathways of financial and practical support for families with babies facing food insecurity.

• The UNICEF BFI statement on the use of infant formula in food banks: The Unicef UK Baby Friendly Initiative statement on infant formula in food banks. The short- and long-term nutritional needs of babies are unique and need to be carefully considered when providing food. This statement explains why trained health care professionals are best placed to support those families with babies needing emergency food assistance, and why the burden of care shouldn't be left to food bank volunteers.

NEW PAPER: Detection and management of milk allergy: Delphi consensus study

Our director, Dr Vicky Sibson, participated in this Delphi consensus study which was published on the 26th May. Developed by experts without commercial ties to the formula industry, it yields guidance which aims to reduce milk allergy overdiagnosis and to support carers of children with suspected milk allergy, and in doing so to increase support for breastfeeding where that may be appropriate. It was conducted to address the significant overdiagnosis of milk allergy in young children in the UK and elsewhere, which leads to unnecessary use of specialised infant milks and can undermine breastfeeding.

Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, the study’s recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialised formula, with more prominent support for breastfeeding compared with current guidelines.

You can read the full paper here.

Infant Milk News

The VITAL importance of safer preparation of powdered infant formula

As we highlighted in our last newsletter, it was World Food Safety Day on June 7th. We took the opportunity to highlight the importance of following NHS instructions when using powdered infant formula, which, because it cannot be made to be sterile, may suffer from intrinsic contamination with harmful bacteria. An essential part of these instructions is to ensure that the water used to reconstitute the powder has been boiled and cooled to no less than 70 degrees Celsius, to kill any bacteria in the powder.

There appears to be widespread poor understanding among parents of the reason to use water at this temperature, and poor appreciation that, although the chances of a baby becoming sick as a consequence of consuming formula contaminated with bacteria are low, the ultimate outcome may be death. One reason is that companies are not mandated to share this information on their product labels.

The risk posed by intrinsic contamination of powdered infant formula and the potential severity of consequences has recently been highlighted in the US where health and safety failings at Abbott’s Michigan formula factory led to the contamination of several products sold within the US and globally, leading to recalls. These contaminated formulas are now known to have caused non-life threatening illness in 80 babies, hospitalisation of 25 babies with severe infections, and the death of 9 babies. Below is an extract from the FoodSafetyNews report which included this information.

We continue to advocate for stronger measures to better protect formula-fed babies in the UK from the intrinsic contamination of powdered infant formula, as outlined in the recommendations in this recently updated report of ours on the subject.

Looking for information about infant milks? Check out our website www.infantmilkinfo.org. Still got questions about infant milks? Contact susan@firststepsnutrition.org

Baby Feeding Law Group UK news

National Breastfeeding Week England 2022: The importance of protection as well as support

This week is England’s national breastfeeding week, and the Better Health - Start for Life campaign theme is, 'Everyone has a part to play in helping mums to breastfeed'. The key focus is on the difference that can be made if everyone supports breastfeeding, including the mother’s partner, the wider family, the community, health and education services and workplaces. We agree, but also want to highlight the importance of better legal protections for babies, their mothers and families, and the health care professionals who look after them, from inappropriate marketing by the breastmilk substitute industry. At the end of this month, on behalf of the Baby Feeding Law Group UK, we will be submitting a report to the four nation Nutrition Labelling Composition and Standards Common Framework Policy Group, making a case for UK laws governing the marketing, labelling and safety of breast-milk substitutes, feeding bottles, teats and foods for infants and young children to be strengthened to reflect the International Code of Marketing of Breastmilk Substitutes in full (i.e. including all subsequent World Health Assembly Resolutions). We will let you know how we get on in future newsletters.

You can follow the work of the Baby Feeding Law Group UK on twitter @BflgUK

Staffing update

This month we said a sad farewell to Jenny Parker who has left us to have her first baby, while welcoming Jen Hutchinson. Jen is a dietetics and nutrition student at London Metropolitan University who has a keen interest in good food and public health nutrition. She will be covering our administrator role until Siân returns from maternity leave later this year.