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News Infant milk news BFLG-UK news Forthcoming Our next newsletter will be published after Easter.

Happy Easter!

News

New: Policy asks for ‘Healthy Early Years Diets’
First Steps worked with members of the Obesity Health Alliance to create this 2 page policy brief outlining the next steps the government can take, to create healthier food environments and help ensure the UK’s youngest children and babies grow up healthily. We propose a series of achievable, evidence-informed, and cost-effective steps that will measurably improve the quality of diets in the early years looking at:
  • Enabling families to feed their babies and young children healthy diets
  • Supporting early years settings to provide nutritious food and drink
  • Investing in the foundations for health in the early years
With evidence showing good diets in the early years create the foundation for life-time good health, our key recommendations include:
  • Protect babies and young children from misleading marketing
  • Implement standards to improve commercial baby and toddler food and drinks
  • Ensure early years settings are supported with healthy food and eating guidance – and legislate it so all can benefit
  • Invest in local community health staff and programmes to support healthy eating in the early years
  • Invest in the Healthy Start scheme
We hope you will support our asks and encourage you to share widely. The briefing can be found here.
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New: Academy of Medical Sciences report “Prioritising early childhood to promote the nation’s health, wellbeing and prosperity”
 
The Academy of Medical Sciences have published a report on Prioritising early childhood to promote the nation’s health, wellbeing and prosperity. It highlights the crucial role of early childhood, defined as preconception to age 5, in transforming health and prosperity.

The report outlines how the health of the UK population, including children, is declining and inequalities between the most and least deprived widening. It highlights that over a fifth of children of reception age are overweight or obese (those in deprived areas are twice as likely to be obese as those in the least deprived areas), nearly a quarter of all 5-year-olds were affected by tooth decay in 2019, and infant mortality in the UK ranks 30th out of 49 OECD countries.
 
The report emphasises the economic benefits of childhood interventions, which are likely to be more successful in reducing the lifetime risk of developing a chronic illness than interventions carried out later in life. Analysis by the Royal Foundation and the London School of Economics in 2018/19 estimated that £16.3 billion a year could be saved through interventions in early childhood.
The Academy makes five recommendations to Government, the NHS and local authorities that they believe will have the greatest impact on improving children’s health in the early years. These include implementing proven interventions and policies to improve child health, (including, tackling obesity, supporting breastfeeding and promoting oral health) and addressing the decline in the child and family health workforce, in order to ensure services are appropriately resourced.
 
First Steps support these recommendations as outlined in our report on enabling children to be a healthy weight. We continue to call for the implementation of evidence-based interventions including breastfeeding support, and evidence-based family behaviour change parenting programmes such as HENRY, alongside the protection and expansion of universal health visiting services.
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Latest: England Infant Feeding Survey
On February 8th DHSC shared an update of progress implementing the 2023 Infant Feeding Survey in England. This survey will be the 9th in a series first initiated in 1975, following up to the one last undertaken in 2010. It will provide much needed updated information on current infant feeding practices to inform policy and practice.

Following a pilot last October among 2,500 mothers they planned to send letters to 22,000 mothers who gave birth in December in late February, inviting them to take part in the survey. This is the first round of data collection and is meant to cover the period when babies are between 9 and 12 weeks old. DHSC are asking for those in contact with mothers who gave birth in December to share with them information about the survey and encourage them to take part if invited. Further information on the IFS can be found on the GOV.UK IFS webpage and the IFS participant webpage, which also gives mothers the opportunity to opt out from taking part should they wish.
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New: House of Lords Inquiry in to Food, Diet and Obesity
The House of Lords Select Committee on Food, Diet and Obesity was appointed on 24 January 2024. It is chaired by Baroness Walmsley and will report by 30 November 2024. This inquiry is considering the role of foods, such as ‘ultra-processed foods’ (UPFs) and foods high in fat, sugar and salt (HFSS) in a healthy diet, including how they influence health outcomes. It is seeking to assess how shifts in behaviours and trends have impacted obesity, how government policies have influenced these shifts, and the role of industry and the wider public in the public health landscape.

Our Director, Vicky, is giving evidence in person at 10.15am today (Thursday 7th March) in the House of Lords alongside two other panel members who have been asked to speak about diets and obesity in infants, young children and adolescents. You can watch the session live on Parliament TV but if you miss it and would like to catch up we will share the link on social media and in our next newsletter.

As well as a series of witness interviews, written evidence is being solicited and can be submitted until 10am on Monday 8th April. See more here.
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Updated: BLISS guidance on weaning preterm babies
BLISS, a national independent parent support organisation that aims to support parents and families of premature or sick babies, have recently updated their preterm weaning guidance, which can be found here.
Since its original publication in 2017, the guide has shifted its focus to ‘well/healthy’ preterm babies, in recognition that weaning guidance cannot serve the needs of all preterm babies. Instead, it recommends individual advice for babies with long-term conditions such as cardiac, gastrointestinal, respiratory problems and neurodevelopmental delay (as the skills needed for weaning may be impacted further by these conditions). 

The updated recommendations place greater emphasis on baby-led weaning, including strengthened advice on cue-based feeding. Further updates to the guidance include:
  • Recommending a later window to start weaning, and guidance on timing of introduction of textured food
  • More information on positioning and the importance of the upright sitting position and head control
  • Removal of advice on how to increase dietary energy intake in babies as the shift in focus to ‘well/healthy’ preterm babies means it is no longer necessary. Instead, it is instead recommended that babies with significant growth concerns are referred to a dietitian for individualised support
The guide also includes links to useful information for health professionals and parents. These include; adapted baby-led weaning in babies with developmental delay and other feeding challenges (Your Baby Can Self-Feed), links to gagging and choking advice, meal ideas at each stage of weaning, food hygiene, food preparation and storage information (Start for Life) and our Eating Well guide on introducing solids and eating well up to a baby's first birthday which you can access for free on our website or purchase as a hard copy here.
All of our resources are free to download and some are available to purchase as hard copies via this link.
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FAQs: Are there any benefits of organic formula? What are the recommendations for vitamin D supplementation for babies? What milk can babies age 6-11 months old be given?
We have received quite a lot of queries about two subjects over the last months. These are on the benefits of organic and non-organic formula milk, and recommended schedule for vitamin D supplementation of babies, including through use of Healthy Start vitamins.
Are there any benefits of organic formula?
On the first, we published an FAQ on this in 2021 which can be found in the FAQs section of our infantmilkinfo website here: Types of infant milk and ingredients - (infantmilkinfo.org) (it is the last one on this list). Our conclusions are: Strict regulations governing the composition of infant formula mean that there are no clinically significant nutritional differences between organic and non-organic infant formulas, and correspondingly no added health or nutrition benefits. It seems unlikely that organic infant formula contains fewer agricultural contaminants than non-organic infant formula; in particular, it is important to note that pesticide residues are strictly limited by law in all infant formula. Given that milk protein is the key ingredient of infant formula made from cows’ milk and goats’ milk, it is relevant that organic milk production is likely more sustainable and better for the environment than non-organic milk production. However, any environmental benefits of organic versus non-organic infant formula need to be considered in the context of the overall damaging effect of the infant milk industry on the environment. 
What are the recommendations for vitamin D supplementation for babies including where Healthy Start vitamins are used?
The advice on vitamin D supplementation for babies and that on Healthy Start vitamin use in infancy can be confusing when read together, noting that the daily dose of 5 drops contains 233 micrograms of vitamin A, 20 milligrams of vitamin C, and 10 micrograms of vitamin D3.

The NHS advice on vitamin supplements for children, including vitamin D, is available here: Vitamins for children - NHS (www.nhs.uk) and here: Baby vitamins - Start for Life - NHS (www.nhs.uk)

The NHS advice on Healthy Start vitamins for children, is available here: Getting vitamins – Get help to buy food and milk (Healthy Start) and additional information for health care professionals is available here: Healthcare professionals – Get help to buy food and milk (Healthy Start)

Here is a summary of the above recommendations:
  • Breastfed infants <12 months of age should be given vitamin D (8.5-10mcg) from birth
  • Infants <12 months of age drinking <500ml of formula should also be given vitamin D (8.5-10mcg)
  • From 6 months to 5 years all infants and children should be given vitamins A, C and D (10mcg vitamin D, doses of A and C as per Healthy Start) unless they are drinking >500ml of formula (noting that formula use over 12 months of age is not recommended)
  • For infants and children up to age 4 who are eligible, Healthy Start (vitamins A, C and D) should be used from birth unless the infant/child is drinking >500ml of formula (noting that formula use over 12 months of age is not recommended).
ICYMI: What milk can babies age 6-11 months old be given?
With the publication of its updated guideline on complementary feeding in 2023, the WHO has recently reiterated its pre-existing advice that for infants 6–11 months of age who are fed milks other than breast milk, either “milk formula” or animal milk can be fed. In last month's newsletter we wrote about this guidance and its applicability to the UK and you can now access this info in a new FAQ here (it’s the 6th one down).
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Infant milk news

Infant milk costs: More infant milk price reductions announced in the wake of the Competition and Markets Authority investigation
As some families continue to struggle to afford infant formula despite the slowing down of inflationary pressures on food prices, Iceland have announced that it will be marketing another brand of infant formula at a lower price than other retailers. They have been working with Nestlé to make a reduced retail price of £7.95 for an 800g can of SMA Little Steps infant formula possible. The formula priced at £7.95, which is about £2 less per 800g than at other retailers, is available on-line and at The Food Warehouse and is expected to be rolled out to Iceland stores.

Since the press release where Iceland claimed it stocked the cheapest infant formula on the market, Aldi have responded by lowering the cost of its own brand Mamia infant formula from £8.99 for 900g to £8.89 per 900g, a move which makes 800g of Mamia 5p cheaper than the 800g pack of SMA Little Steps infant formula. As Mamia is sold per 900g pack, this comparison is not one that will be clear to parents at the point of sale.  

Comparing the price per pack or per 100g can blur comparative costs when powdered formula milk is reconstituted - different brands require more or less powder per volume of water to prepare. We have compared the price of SMA Little Steps at Iceland to other infant formula milks per 100ml as reconstituted. The Iceland price for Little Steps infant formula is equivalent to 13p/100ml which is comparable with the new lower price of Aldi’s own brand Mamia infant formula and with the larger 1200g packs of Cow & Gate infant formula powder.

This confirms messages in our infographic shared last month, which is based upon the cost per 100ml of reconstituted infant formula. Current pricing strategies mean that the least expensive way to buy infant formula is in powdered format and that larger 1200g packs of powder and supermarket own brand infant formula offer the best value for money. The shifting pricing landscape makes it even more worthwhile shopping around for their infant formula as currently a branded infant formula is being marketed by one retailer at the same price as a supermarket own brand.
The Iceland price for Little Steps infant formula means that it joins Cow & Gate 700g from Aldi as the second infant formula powder that is affordable for the weekly value of Healthy Start in England. Aldi market Cow & Gate 700g at £8.49 which is equivalent to 16p/100ml. Clearly the 700g pack of Cow & Gate does not offer the same value for money that the 1200g pack does and a 700g pack may not last a week for younger babies. Parents who use Cow & Gate and have some flexibility in their budget would be best advised to buy the larger 1200g packs of Cow & Gate.
It is perhaps also worth noting the extent of the media attention Iceland has attracted in relation to its formula milk pricing strategy. A Government initiative that addresses the pricing and marketing policies of all manufacturers and retailers equally may avoid the media focus and subsequent ‘formula marketing’ effect which is an inevitable and unwelcome result of actions by individual manufacturers/retailers. We continue to advocate for the following 4 actions from Government:

1. Establish pricing policies and practices to ensure infant formula is provided at lower prices on a long-term basis, e.g. through a price cap

2. Run a public health messaging campaign around the nutritional equivalence of all first infant formula, to better inform parents/carers so that they may feel more comfortable to switch to cheaper products where available

3. Better enforce existing legislation designed to prevent inappropriate marketing of formula milks which protects breastfeeding AND safe and appropriate formula feeding (AND in the medium term strengthen in line with the Code)

4. Improve Healthy Start, including through increasing the cash allowance in line with food inflation (to enable purchase of infant formula where needed, but also fruits, vegetables, milk and other healthy foods) and increasing coverage by switching to autoenrollment and extending to those with no recourse to public funds (see the full policy asks of the Healthy Start Working Group here).
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New products

Kendal Nutricare is the latest manufacturer to offer probiotic supplements for babies
 
Kendal Nutricare have launched Kendamil pro-comfort baby drops - a probiotic supplement for babies. The liquid formulation contains 375 million colony forming units of the probiotic cultures Bifidobacterium Lactis, Lactobacillus Reuteri and Lactobacillus Rhamnosus in each serving. The drops are marketed for use from birth to 3 years of age in healthy infants who receive breastmilk or formula milk.

Although Kendal Nutricare makes no claims related to improved functional outcomes, the name ‘pro comfort’ would suggest that it can make a difference to digestive discomfort, particularly as it is marketed on the website alongside Kendamil Comfort Milk.  Statements on the website relate to supporting a balanced microbiome:

“Our unique blend of friendly bacteria is designed to support the development and balance of your little one's gut microbiome.”

“Our drops have been carefully crafted to support the development of the microbiome, without overwhelming the gut.” 

No evidence is cited to support these statements and it is important to note that for healthy term infants there are no independently agreed benefits for the addition of probiotics to breastmilk which already contains probiotics. EFSA (2014) have said that there is no benefit of the addition of probiotics to infant or follow-on formula.
Aside from our concerns about the lack of evidence to support the use of probiotic supplements added to breastmilk or infant formula, the manufacturer’s instructions for use are unclear and there may be implications for maintaining the sterility of the product itself and the milk to which it is added. The drops are marketed at £14.99 per bottle and each bottle contains enough drops for 30 days at the manufacturers recommended dose.

We hope that health workers will dissuade families from choosing a product that is expensive and not necessary for healthy infants.
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Where to find more information on infant milks

For those of you who are new to our newsletter, we have a sister website dedicated to infant milks marketed for infants aged from 0-12 months. Infantmilkinfo.org is where you can find information about the regulatory framework around infant milks, how much they cost and their composition. You can also find answers to a wide range of FAQs related to health and feeding issues, the ingredients use and infant milk safety as well as more general questions on infant milk feeding.

We host information about milks and milk drinks marketed for young children (12 months+) here on the firststepsnutrition.org website where you can find dietary guidelines on milk consumption for young children, the types of milk available, suitable choices, the potential risks and benefits associated with their use and answers to some frequently asked questions.
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 

British Journal of Midwifery formula sponsored conference
The British Journal of Midwifery (BJM) Conference 2024 taking place on Wednesday 27 March 2024 continues to be sponsored by manufacturers of commercial milk formula, which is inappropriate as it presents a clear conflict of interest. The BFLG-UK has previously written to the BJM Conference organisers (in 2022) to express our concerns. In February this year, the British Medical Journal (BMJ) published a news piece highlighting some of the reasons why this type of sponsorship should not be happening: Midwifery conference is criticised over formula milk sponsors. This type of sponsorship of health professional meetings by manufacturers of commercial milk formula undermines the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions, as well as implementation of the Unicef Baby Friendly Initiative.

There has been no response from the British Journal of Midwifery to our correspondence. Health professionals should be aware that there are many other education opportunities for continuing professional development (such as study days) that are available and free from conflicts of interest. Examples are the Royal College of Paediatrics and Child Health RCPCH Conference 2024 and the Royal College of Midwives RCM Conference 2024.
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Ministerial view on loyalty/rewards schemes and infant formula purchase
On 29 January 2024, Alberto Costa (MP for South Leicestershire) tabled a parliamentary question asking the Secretary of State for Health and Social Care “if she will make an assessment of the potential merits of allowing the use of loyalty card points to buy baby formula”. Rt Hon Andrea Leadsom MP, the current Parliamentary Under-Secretary (Department of Health and Social Care) formally responded on 8 February 2024. Minister Leadsom’s response re-emphasized the purpose of UK regulations relating to infant formula and highlighted the available DHSC guidance on implementing the regulations relating to infant formula, follow-on formula and foods for special medical purposes. Minister Leadsom specifically explained that “Where loyalty or reward card schemes are being used to induce the sale of infant formula, this is prohibited under the regulations. Loyalty and reward card schemes vary between retailers, and it is for businesses to ensure that their activities are in compliance with the regulations.” For more information on this, please see our Briefing document to clarify misconceptions about the UK law on the marketing of infant formula.
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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Forthcoming 

Webinar: Supporting families with introducing solid foods, Thursday 21 March, 13.30-14.30pm
Vicky and Rachel will be delivering this afternoon webinar at the invitation of Better Breastfeeding and as part of a wider series of webinars aimed at those working in local authorities and Local Maternity and Neonatal Systems in order to support them as they develop their local breastfeeding and infant feeding strategies. We plan to cover evidence-based, practical suggestions for commissioners and service providers, to help them design the most effective services for supporting families with starting their babies on complementary foods. Find out more and sign up here.
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World Public Health Nutrition Congress Community Conversations
The World Public Health Nutrition Congress 2024 is taking place from 10-13 June 2024 at the University of Westminster, London. The congress theme is “Questioning the Solutions: has the Decade of Nutrition delivered?” and there are several themes and sub-themes relevant to optimal maternal, infant and young child feeding. One activity is the “Community Conversations” where organisers are inviting Community Voices to contribute to answering the question “How do we reduce hunger and move towards fulfilling the right to food, nutrition and health for all?”. One of the community voices encouraged to respond are mothers, carers or health workers involved in feeding infants.

Interested participants are encouraged to submit responses to the questions:
  • What are your experiences, practices and perceptions on infant and young child feeding, in the last three years?
  • What is working and what is not?
  • What changes do you think would promote more effective infant and young child feeding practices and perceptions?
Submissions can take a variety of formats
  • A brief video of under 3 minutes
  • A text document of up to 250 words
  • A photo essay or drawing
  • A poster
Submissions can be made here on the conference website by 30 April 2024. For further information, please contact wphnc2024@westminster.ac.uk or Dr Regina Murphy Keith (r.keith@westminster.ac.uk).
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