On behalf of First Steps, Vicky collaborated on this study, led by Swansea University, the findings of which were published here yesterday. It confirms our concerns (outlined in our report on the bacterial contamination of powdered infant formula) that, despite their marketing claims, these formula preparation devices often do not deliver water hot enough (i.e. at least 70˚C) to kill any bacteria that may be in the powdered infant formula.

The study, which explored the safety of infant formula preparation practices compared to NHS guidelines, used community science methods and involved parents of infants aged 12 months or under. Around half of the 143 parents (74 people) used infant formula preparation machines while the remaining 69 parents used kettles to boil the water for infant formula preparation. 

It revealed that 85% of the 74 infant formula preparation machines tested by parents in UK homes did not appear to produce water that would be hot enough to kill all harmful bacteria in infant formula and could pose a serious risk to infant health. This was compared to 69 parents in the study who used a kettle to heat the water used to prepare infant formula, where 22% reported water temperatures that were not hot enough to kill all harmful bacteria.

We call for infant formula labelling requirements to be updated to align with NHS and WHO guidance by displaying information that powdered infant formula is not sterile, the optimal water temperature and the risks of not using sufficiently hot water while also stating the importance of hand washing and routinely sterilising all feeding equipment.

We also recommend that these public health messages should be shared in the course of antenatal and postnatal infant feeding support, following UNICEF Baby Friendly Initiative guidance. Finally, we advise that bacterial gastrointestinal infections in infants, particularly those resulting in hospitalisation, should be mapped to batches of infant formula and associated preparation equipment to provide information that could inform measures to improve the safety of formula feeding practices for babies in the UK.

The FSA have advised parents/carers to check that the temperature of the water used to prepare infant formula is at least 70˚C “regardless of the method used”, and that if that is not the case for those using an infant formula preparation machine, that they should contact the manufacturer and their local Trading Standards Department or Citizens Advice.

The UK’s product safety regulator, the Office for Product Safety and Standards has purchased examples of the infant formula preparation machines to assess compliance and have said that, if necessary, UK consumers will be informed of any actions they might need to take.

This and other infographics developed by the study team can be found here.

We will keep you informed of any new advice from the FSA and OPSS on social media and through future newsletters.

New research: Perceived influence of commercial milk formula labelling on mothers’ feeding choices in Great Britain

Rana Conway and colleagues published this paper in August 2023 exploring the perceived influence of commercial milk formula labelling on mother’s feeding choices in Great Britain. A qualitative study was undertaken among 25 mothers using commercial milk formula, alongside product mapping and a thematic analysis. 

The research findings indicate that branding plays a pivotal role in influencing the selection of commercial milk formula. Mothers spoke of anxiety about choosing ‘the best’ commercial milk formula brand and stage, and were drawn to brands that they recognised and felt could be trusted, often from years of exposure to advertising. The visual design of commercial milk formula packaging was also of importance. Messages associated with science, research and nature appealed to the mothers, and mentions of breast milk and logos that appeared to symbolise a breastfeeding mother were considered signals of a product's likeness to breastmilk. 

These findings complement a wealth of evidence on the unethical and deceptive marketing tactics employed in the commercial milk formula industry, as outlined in this year’s Lancet Breastfeeding Series. An earlier paper by the same team also showed that labels on commercial milk formula products in the UK contravene DHSC guidelines for implementing CMF legislation (Conway et al, 2023). 

Conway’s research highlighted that mothers would like more guidance from health care professionals, citing gaps in their understanding of infant feeding. Mother’s felt that on-pack information did not explain how products differed by brand and stage, and there was confusion over the appropriate use of specialist products. Furthermore, the wide availability of growing up milks for older infants and children, and on-pack messaging that suggests babies progress from one product to the next, led many to believe these products were necessary. This is despite public health advice that growing up milks are unnecessary from 12 months of age, and cow’s milk (or a calcium-fortified dairy alternative) is a cheaper and better choice. 

The authors make recommendations that commercial milk formula legislation should be updated to restrict brand advertising. They also recommend that clear advice on commercial milk formula feeding aligned with that provided by the NHS, should be routinely communicated to parents to counteract powerful industry marketing. 

For those of you supporting families using formula to feed their babies, First Steps provides this two pager on responsive bottle feeding and formula choice and this infographic on formula choice and preparation designed to speak to the additional pressures the cost of living crisis may have on this issue. 

New report: Ham-pering our health: It's time to act on processed meat, especially in the diets of babies and young children

On the 20th of September, the Eating Better alliance launched their report Ham-pering our health: It's time to act on processed meat, aiming to raise awareness of the health impacts of processed meat and the need for public sector caterers and health organisations to focus efforts on reducing processed meat consumption in the UK. As an Alliance member, our nutritionist Rachel contributed this blog: Processed meat and health of young children to highlight the nutritional concerns of processed and ultra-processed meats in the diets of babies and young children.

First Steps Nutrition Trust offer a comprehensive suite of practical Eating Well Guides to show how the nutritional requirements of young children can be met largely using unprocessed and minimally processed foods, including example recipes. These include examples of how minimally processed meat, or cheaper sources of protein and iron from less processed foods such as beans, pulses, and eggs, may be prepared in an age-appropriate manner for young children.

New report: Shining a light on early years nutrition: The role of councils

Government data shows that 92% of three to four year olds are registered for early years provision in England, with the number set to rise in September 2025 when childcare reforms come into place. What and how these children are fed will influence their dietary habits, taste preferences, nutrition status, health and development later in life, and yet a recent report commissioned by the Local Government Association reveals that little is known about whether food served to children in early years settings meets their nutritional needs. This report, commissioned by the Local Government Association and prepared by Bremner & Co, gives an overview the views of some councils in England on the challenges, barriers and enablers to good nutrition in early years settings. 

Councils point out that barriers to promoting proper nutrition in early years settings include reduced council capacity to assist early years settings, inadequate funding as well as the absence of dedicated funding streams for early years settings, and other limited resources. This is in part due to councils prioritising statutory responsibilities like safeguarding, welfare, and early intervention. Lack of political interest in early years nutrition was also raised as a concern in some contexts.

The report highlights examples of good practice, where councils and early years settings are actively working to deliver nutritious foods to young children. In these cases, key enablers include adequate funding, committed teams, a robust political commitment to this agenda, and access to quality data. 

Bremner & Co have put forward several recommendations for the Government. These include reviewing the current nutrition voluntary guidance for early years settings to ensure that it’s fit for purpose, reversing cuts to the public health grant, adequately funding early years settings and ensuring councils are funded to support early years resourcing. 

First Steps Nutrition Trust’s Eating Well Guides include nutritious and cost-effective recipes suitable for Packed lunches for 1-4 year olds and Snacks for 1-4 year olds, which may be helpful to those preparing food for children in early years settings. 

New report: First Steps Nutrition Trust user evaluation

We have finished the write up of our user evaluation of our resources and communications and are pleased to have received lots of positive feedback as well as some good ideas for how to improve. A big thank you to those of you who took the time to respond to the surveys we sent out. 

What we have learnt:

• Most survey respondents were UK health care professionals, indicating we’re reaching our primary audience. 

• Our First Steps website is a widely used and familiar resource among HCPs: 75% rated the useability as 8 or more out of 10, and 91% of respondents were able to find the information they were looking for. 

• In the current formats offered, 75% rated the useability of our resources as 8 or more out of 10. 

• Feedback on our resources included:

“Think they are fabulous and very easy for parents to see portion sizes and give great ideas”

“It’s an amazing website and I love the transparency of the platform, so that parents and professional information can be accessed by both groups, it is easy to navigate and understand.”

• This newsletter has 2839 subscribers and the engagement rate (40% open rate and 20% clickthrough rate) is very good compared to sector averages (of 25% and 3% respectively).

• 58% of respondents to the survey we sent to newsletter subscribers do not follow FSNT on social media, meaning this newsletter is a key channel of communication for many of you.

• 91% of survey respondents find the newsletter useful or very useful and 78% of respondents report reading the newsletter every month.  

• Feedback on our social media presence included:

"I think your social media is positive and engaging"

Recommendations we’re going to be considering include:

• Making our resources available in a mobile friendly format.

• Producing more infographics or bite sized summary sheets of resources. 

• Offering webinars to provide guidance on using the Infant Milk Info website to maximise its utility.

• Relaunching the dormant Instagram.

• Including bitesize versions of the newsletter stories to social media throughout the month.

• Posting more practical nutrition advice and recipes on social media.

If you’d like to provide any feedback on our resources and communications and missed the opportunity to participate in the evaluation surveys, please feel free to contact Vicky at vicky@firststepsnutrition.org 

Infant Milk News

Update on infant milk costs

Susan has updated our report “Costs of infant formula, follow-on formula and milks marketed as foods for special medical purposes available over the counter in the UK” which can be accessed at infantmilkinfo.org/costs. 

A reminder for anyone new to this report, it is intended for health care professionals to help families asses price differences between comparable products and make choices between product types and brands. We compare the cost per 100ml of made-up formula as this can differ between brands that are the same price per 100g of powder. Our report shows that the cost of infant formula has shown little change since our last review in April 2023, although it is still an expensive product that has become increasingly unaffordable for those on low incomes.

Aldi Mamia remains the least expensive infant formula powder in a standard size format, but Cow & Gate infant milk powder in a 2 x 600g Big Pack format is generally the least expensive way to buy infant formula milk from high street retailers.

Iceland stores currently offer some main brand infant formula (as well as follow-on formula and growing up and toddler milks) at lower prices than other high street retailers (see more on Iceland’s formula milk reductions in the BFLG-UK news section below). This means that parents who can access an Iceland store can buy some main brand infant formula milks at prices between 6% and 25% (per 100ml of made-up formula) lower than most other high street retailers.

Other retailers including ASDA and Sainsburys have also reduced prices or run promotions on some formula milks, mostly on follow on formulas and growing up milks.

It is important to remind parents/carers that that growing-up and toddler milks marketed for use from 12 months of age offer no extra nutritional benefits compared to cows’ milk. And that follow-on formula marketed as suitable from 6-12 months of age, offers no extra nutritional benefits for young children and is not recommended by the NHS. 

In addition, it is important to note that the price reductions being observed on some follow-on formulas may make them less expensive per 100ml than the brand equivalent infant formula. Whilst follow-on formula is not the optimal formula choice for formula-fed infants aged 6 to 12 months of age, it can be used for feeding infants alongside the introduction of complementary foods. Where families are facing difficult feeding decisions and cannot access lower cost infant formula, using follow-on formula according to the manufacturer’s instructions may be a safer option than resorting to using unsafe feeding practices in order to continue using an infant formula. However, follow-on formula should never be given to babies under 6 months of age. 

We are continuing our advocacy to ensure those families who need it can access infant formula as per the asks in our cost of living briefing and will report on the results of the ongoing Competition and Markets Authority investigation in to ‘baby milks’  in a future newsletter once their findings are made public.

Anyone interested in reading more about the variable cost of formula milks between different retailers can do so by visiting the Food Foundation’s Kids Food Guarantee webpages. We will build some similar analysis in to our next infant milks cost report due in November.

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

Baby Feeding Law Group UK news

Statements issued 

During August 2023, two important statements were shared by the BFLG-UK:

•    Legal restrictions on the marketing of commercial milk formulas and the cost-of-living crisis which was prepared to highlight the necessity of legal restrictions on the marketing of commercial milk formulas, even in the context of the cost-of-living crisis in the UK.
•    BFLG statement on Iceland’s special sale on branded commercial milk formula which was prepared in response to the much publicised special sales on commercial milk formula in the UK by the retailer, Iceland (as touched on in ‘infant milk news’ above).

Consultation response

•    During September 2023, the BFLG-UK submitted a response to the WHO Online public consultation: draft guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes. It is available here.

Department of Health and Social Care (DHSC) open consultations

The Department of Health and Social Care (DHSC) currently has two open consultations:

•    The consultation on nutrition and health claims on food was published on 9 August 2023 and is seeking views on proposed changes in relation to nutrition labelling, composition and standards (NLCS) retained EU law. The closing date is 31 October 2023. 
•    The consultation on the disclosure of industry payments to the healthcare sector was published on 4 September 2023 and aims to seek views on the possible introduction of regulations mandating the disclosure of industry payments to the healthcare sector. The closing date is 16 October 2023. 

If anyone is interested to read our responses before submission please contact Katie katie@firststepsnutrition.org.

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 twitter account @BflgUk. You can also email katie@firststepsnutrition.org

Forthcoming

All-Party Parliamentary Group on Infant Feeding and Inequalities (APPG IFI) meeting

The next APPG IFI meeting is scheduled to take place on Tuesday 24 October 2023, and Katie will be presenting on “The importance of legal restrictions on the marketing of commercial milk formulas in the context of the cost-of-living crisis”. You can sign up for APPG IFI updates here. 

World Public Health Nutrition Association Conference 2024

The World Public Health Nutrition Association (WPHNA) Conference will be taking place from 10-13 June 2024 in London, at the University of Westminster. The closing date for submission of abstracts has been extended to 31 October 2023 and more information is available here.