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Welcome to a bumper June edition of our newsletter, featuring:
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News
Infant milk news
BFLG-UK news
Forthcoming
Happy reading!
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General Election 2024: Our policy asks for Healthy Early Years Diets
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Ahead of the general election, our policy asks of the incoming government are outlined in this two-pager which we led on writing with the support of peers and the Obesity Health Alliance.
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News: Giving babies smooth peanut butter could provide lifelong allergy defense
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The results of this new paper published by academics at Kings College London and collaborators made the news in late May, with the headline that “Giving babies smooth peanut butter could provide lifelong allergy defense”. The paper reported on peanut allergy among 12-year-old children in the UK who participated in a randomised controlled trial starting 15 years ago. As infants they had all been diagnosed with severe eczema and/or egg allergy, so were judged to be high risk of developing peanut allergy. Infants were enrolled at 4-10 months of age and randomly assigned to intervention or control groups; the intervention group were introduced to peanut and given 6g peanut protein a week until 60 months of age, and the control group were instructed to avoid peanut. Children in the intervention group were significantly less likely to develop peanut allergy, than those who avoided peanuts. These latest results from the trial indicate that at age 12, the high-risk children who received the intervention were still less likely to have developed peanut allergy than those who were in the control group, even if they had not consumed peanuts after the age of 6 years.
The BBC news report quotes a Dr Jeanne Marrazzo: "Today's findings should reinforce parents' and caregivers' confidence that feeding their young children peanut products beginning in infancy according to established guidelines can provide lasting protection from peanut allergy."
The current relevant UK public health guidance is as follows:
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However, the BBC news report also states “The team suggest starting [peanut] at four months if possible as this is before food allergies tend to emerge”. This goes against the above UK public health recommendations, and it is likely that it would not be possible for most infants, who would not be developmentally ready (as has been shown in prior research- see our March 2023 newsletter). However, it should be noted that SACN do advise that ‘families of infants with a history of early-onset eczema or suspected food allergy may wish to seek medical advice before introducing these foods’. The only available clinical guidance, from BSACI, promotes introduction from four months for infants with severe eczema and high allergy risk, under clinical supervision.
The most recent UK data on infant feeding from 2010 reported that only 8% of UK infants had eaten any peanut or peanut products by 8-10 months. This suggests that more could be done to encourage parents/carers to include peanuts (crushed or ground) among the first foods given to infants when they start complementary feeding at around 6 months, as well as to keep offering them routinely through the early years.
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New: Nutrition guidance from Department for Education for Early Years Providers
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The Department for Education commissioned the London Early Years Foundation (LEYF) to contribute to this new nutrition guidance for early years settings. The webpages cover:
- Introduction of solids
- A healthy plate
- Allergies
- Menu planning
- Cost-effective healthy food
- Planning food activities for children
The guidance is consistent with the voluntary Eat Better Start Better Guidelines, the Public Health England example menus and guidance, and existing public health recommendations, but provides new, concise, simple, user friendly resources to help implementation, including example menu cards and videos.
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Where more detailed information or additional recipes may be useful, early years providers may like to refer to First Steps Eating Well resources
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All of our resources are free to download and some are available to purchase as hard copies via this link.
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New: UK Government Food Security Index
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In May, the Department for Environment, Food and Rural Affairs released this first report of a new annual UK Food Security Index. It is an assessment of the state of UK food security 2023 to 2024, designed to complement the three-yearly UK Food Security Report which is a comprehensive analysis of statistical data relating to UK food security. It declares that the UK’s food security is broadly stable.
There has been some criticism of this index and its scope. Our core concern is that the index fails to acknowledge that food security needs to consider the needs of all people, including babies. The UN Committee on Food Security states: Food security is understood to exist when everyone in a population has access to sufficient, safe and nutritious food for a healthy life.
Monitoring by the Food Foundation shows that families with young children have a much higher risk of food insecurity than those with older children or no children; in January 2024 24% of families with children under 4 years old were food insecure. This is extremely concerning given that poor diets in the early years have life-long negative implications for their health and development. New research published in May also reveals that food insecurity during pregnancy decreases gestational weight gain while increasing maternal obesity.
Babies in particular have unique nutritional needs and vulnerabilities. Ideal feeding – and food security – for babies is founded in exclusive breastfeeding from birth until six months of age, and ongoing breastfeeding until the age of 2 and beyond. However, while many UK mothers would like to breastfeed, for various reasons most do not manage to do so for as long as they had wanted, or as is ideal. Consequently, the current reality is that the UK has a formula-feeding culture. This means that most UK babies are dependent on a single substitutable manufactured food for their first 6 months of life: infant formula. This is problematic because the UK relies on imports from a highly concentrated supply base and companies’ unjustifiably high prices are creating barriers to access for low-income families.
This briefing we led on writing a year ago, and its 7 recommendations, remain relevant. The bottom line is that breastfeeding and the infant formula supply chain need to be included in assessments of UK food security.
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New: Resilience Directorate Cabinet Office ‘Get prepared’ campaign
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The Cabinet Office has issued this new guidance for the public on how to prepare for and manage emergencies.
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The information on this site is meant to help the public prepare for emergencies, be more informed about hazards, and cope in the event of an emergency. There is specific advice for disabled persons and carers, however there is no detailed advice for parents/carers of infants and young children, with the exception of these two mentions:
- Bottled water – there is no standard figure for this as emergencies can vary in duration and people use different amounts. A minimum of 2.5-3 litres of drinking water per person per day is recommended by the World Health Organisation for survival. 10 litres per person per day will make you more comfortable by also providing for basic cooking and hygiene needs. Additional water might be needed to make up baby formula, for medical devices and for pets.
- Baby supplies such as nappies and baby formula – ready made or ‘ready-to-feed’ formula is best as you may not be able to boil water.
Comprehensive, practical guidance on emergency preparedness and infant and young child feeding and care (including breastfeeding, mixed feeding and formula feeding) has been produced in Australia, and this may be useful to fill the gaps in UK guidance. You can find it here: Emergency resources for babies and toddlers | Australian Breastfeeding Association
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New report: Prioritising early childhood for a happier, healthier society. How businesses can drive, and benefit from, transformative change in the UK
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In May, the Royal Foundation of The Prince and Princess of Wales Business Taskforce for Early Childhood released this new report, written by eight of the country’s leading businesses, and aimed at the wider business community. The report stresses that working to improve the experiences of every child in the UK is the right thing to do. “Each child is precious and deserves a healthy and happy childhood, as well as the opportunity to reach their full potential in adult life”. But the main purpose is to highlight how investing in early childhood and supporting those caring for babies and young children can be beneficial for businesses. It estimates that investing in early childhood in the UK could generate £45.5 billion in value added for the national economy each year. Businesses roles and reach are shown in figure i. The five areas of opportunity which are proposed could have a game-changing impact for babies/children, their families, the economy, and wider society are shown in figure ii.
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A few examples are given of ways in which Task Force businesses have been seeking to alleviate food insecurity among young families, and there is mention of the relevance to business of workplace regulations relating to breastfeeding. However, the roles of businesses in protecting, promoting and supporting optimal and appropriate infant and young child feeding is clearly out of scope of this current report. We are in touch with the Centre for Early Childhood and Development and hope to engage in their future work in this area.
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New: Start for Life children’s oral health campaign
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The Department of Health and Social Care (DHSC) intends to launch a new Start for Life children’s oral health campaign on June 17th, to raise awareness and provide instruction for good oral hygiene in children and pregnant women, with a particular focus on children aged 0-2.
The campaign will work to address the impact of poor dental health and will feature new content with tips and advice on the Start for Life website.
We’re guessing it highlight the updated wording on the NHS webpages arising from the Scientific Advisory Committee on Nutrition’s guidance on feeding children aged 1-5 years (see our May newsletter), such as:
Breastfeeding up to 12 months is associated with a lower risk of tooth decay.
- Squashes, flavoured milk, "fruit" or "juice" drinks and fizzy drinks are not suitable for young babies. They contain sugar and can cause tooth decay, even when diluted.
- Fizzy drinks are acidic and can damage tooth enamel so they should not be given to babies and young children.
If you’re not already subscribed to the Campaign Resource Centre, sign up to receive updates about this campaign and other Start for Life campaigns and programmes.
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In May, Sustain put out a renewed call for auto-enrolment, publishing new analysis estimating the value of unclaimed Healthy Start payments to be £58 million a year across England, Northern Ireland and Wales. Emma Lewell-Buck MP led a debate in parliament on the same.
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Millie Barrett and colleagues also published this paper reporting the results of a rapid qualitative analysis of the Healthy Start scheme in England commissioned by the Department of Health and Social Care. It aimed to capture the perceptions and experiences of key stakeholders including parents, non-government organisations, retailers and health and community professionals, and to identify their recommendations for how to improve the effectiveness and uptake of the scheme.
The research highlighted the value of the scheme in making it possible for families to purchase nutritious foods for their young children, enabling them to establish healthy dietary preferences. Stakeholders also noted that digitisation of the scheme has given families more freedom over where they can purchase food and has reduced stigma associated with the payment card. However, concerns were raised that the value of the allowance has not kept pace with rising food prices, with families finding it especially challenging to keep up with the rapidly rising cost of infant formula. The value of the card relative to current food prices was stated to fall outside the scope of the commissioned research, and the authors recommend further analysis.
A further two concerns of stakeholders were: the gap in nutritional support between a child’s fourth birthday and starting school; and the complexity and strictness of the eligibility criteria relative to the poverty line, meaning many food insecure families may be ineligible. These findings are concerning since the Healthy Start scheme is the only nutritional safety net for pregnant and breastfeeding women, infants and young children. These concerns were also stated to fall outside the scope of the commissioned research, and there are no plans to analyse them further beyond the current study. This highlights the need for further independent research on the effectiveness of the Healthy Start scheme in achieving nutritional outcomes.
Several barriers to uptake of the scheme were identified by the research. A lack of coordinated action at local and national levels makes it difficult for families and those supporting them to access timely support during the application process, and personal values, cultural beliefs, and family dynamics prevent some families from signing up for the scheme. These findings are of relevance for those working to improve uptake of the scheme, as they suggest that simply raising awareness is unlikely to automatically or universally increase uptake. This evidence supports calls for auto-enrolment, as above. This was another finding deemed out of scope of the commissioned research.
The authors make two recommendations for immediate consideration; ‘to continue to offer Healthy Start to families and assess how much the current value enables families to purchase’ and ‘to establish a solution-driven, cross departmental Healthy Start-specific working group’.
We support these suggestions, but our view is that without greater emphasis on the programme's objectives at local and national levels, it will be difficult to attain nutrition outcomes for pregnant and breastfeeding women, infants, and young children. If the scheme is to be made fit for purpose, it must be re-framed as a nutrition programme with clear objectives; to ensure that all pregnant and breastfeeding women, infants and young children can meet their nutrient needs for growth and development. As such, greater emphasis should be placed on the vitamin component of the scheme, as well as on raising the allowance amount to purchase comparable quantities of nutritious food as was possible when the scheme was set up in 2006. Additionally, the scheme must remain available for children until they start school.
More information on the history and objectives of the Healthy Start scheme are outlined in our 2018 report which can be found here. We also produce this Eating Well guide which provides a range of healthy family recipes using ingredients that can be bought through the Healthy Start or Scottish Best Start Foods schemes, and shows how these can feed the whole family.
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Product update: SMA Soya out of stock
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Users of SMA Soya may have noticed that this infant formula is currently out of stock. SMA have posted a notice on their website stating that they’re experiencing shortages of SMA Soya in the UK and Ireland and that the situation will not be resolved in the near term. They advise that for any new babies born in your care, or babies currently in your care using SMA® Soya Infant Formula, you should seek alternatives.
Nestlé have told us that the stock issues have arisen because of a delay in production as their strict quality standards were not met.
We know that families use SMA Soya Infant Formula for a variety of reasons – including wishing to use a plant based infant formula, or because of food allergies. It is important therefore that any families using SMA Soya for clinical purposes including food allergy, speak to their healthcare professional (GP, dietitian, health visitor) before switching to a different infant formula.
There are no other plant based infant formulas on the UK market and it is important that parents looking for alternatives are aware that infant formula manufactured from rice proteins is not recognised as a suitable breastmilk substitute for infants under UK law, and is therefore not marketed in the UK. This is potentially due to a lack of data to judge its safety and suitability for infant growth and development; however, it may also be due to concerns about the health implications of arsenic levels in rice-based products for infants and young children.
You can find further information about rice based infant formula and infant formula for infants following vegan or vegetarian diets under the FAQ section of our website www.infantmilkinfo.org under the header ‘Types of infant milks and ingredients’.
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Updated: Specialised infant milks marketed for infants with allergies in the UK
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We have updated our report Specialised milks marketed for infants with allergies in the UK. Since this report was last updated, there have been some significant changes in the availability of specialised infant milks for infants with cows’ milk allergy in the UK. The main change is a reduction in the number of products available. Product recalls due to contamination or quality issues have led to some suppliers discontinuing products in the UK whilst others which are still available may be in short supply. As all of the products covered in our report are available on prescription only (with the exception of SMA Soya), parents should be able to speak with their GP or prescribing clinician to find suitable alternatives if they are having trouble accessing the product they usually use.
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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 Susan@firststepsnutrition.org
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Baby Feeding Law Group UK News
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Marketing of breastmilk substitutes: National implementation of the International Code, status report 2024
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On 23 May 2024, the WHO and UNICEF, through the Global Breastfeeding Collective launched the 2024 status report of the national implementation of the International Code. The theme for the launch was “Are We There Yet? Measuring Global Progress on Protecting Breastfeeding”, and a recording of the webinar is available here.
While the UK is one of the 146 countries that have adopted legal measures to implement at least some of the provisions in the Code, it still scores a very low 40 out of 100 on the Code status scoring system. This indicates that current legal measures cover less than half of the provisions of the Code. It is particularly problematic that the score for ‘scope’ is 8 of out 20, since most of the UK provisions do not restrict the marketing of follow-on formula and growing-up or toddler milks, as recommended by the WHO. The UK also scores 0/10 on provisions relating to promotion in healthcare facilities and 0/10 on engagement with health workers and systems. This is reflected in continued examples of engagement of the commercial milk formula industry in various parts of the health system, as well as in research and academia in the UK.
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The BFLG-UK will continue to advocate to government and policy-makers to implement and enforce marketing laws that protect infant and young child feeding, and to strengthen these laws to be in line with the Code and subsequent World Health Assembly resolutions.
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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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The World Public Heath Nutrition Association Congress: London, 10 - 13 June
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We’ll be at the congress next week presenting across several themes. If you’re also attending and would like to come and say hello, we’ll be convening at the band stand in Regent’s Park on Wednesday 12 June at lunchtime, between 12.30 and 2pm.
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Consultation on updated NICE Maternal and Child Nutrition Guideline: *postponed*
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In our last newsletter we shared that this consultation on the updated Maternal and Child Nutrition guideline and supporting evidence would be open from 07/06/24 for 6 weeks. However, due to the general election, this consultation has now been postponed for at least one month. In the meantime, if you are not already registered as a stakeholder you can do so here. You can access the economic plan and review questions for this NICE guideline on the project documents web page. |
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Webinars: Infantmilkinfo.org
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We will be delivering a free webinar to introduce healthcare professionals with an interest in infant milk feeding to our website dedicated to infant milk. The webinar will show users how to navigate the website and provide some insight on how it may be useful in their work. It will take place online on Wednesday 26th June and will be repeated on Wednesday 17 July. You can register here.
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