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Image by Serhii_bobyk on Freepik
Welcome to this bumper October edition of our newsletter, updating you on relevant news from August and September. Please see the contents below.
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But first, a huge thank you to everyone who supported our longest serving Trustee, Marjon Willers (a specialist dietitian for schools and early years in Islington, London), to run the London ‘Big Half’ at the start of the month. Marjon raised a whopping £1,097 to support our ongoing work at First Steps. If you haven’t donated and would like to, you still can through this link. Thank you!
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Secondly, we are supporting Sustain’s Children’s Food Awards this year by partnering to support a new award category: “Early Years Nutrition Legend”. This is for organisations or individuals with no commercial interests who made a meaningful difference to the diets, nutrition or the food environment for pregnant or breastfeeding women and/or for babies and young children during 2023-24. It might be on the food environment, in home or in early years settings and at a local, regional or national level. Find our more here and send your nominations to admin@firststepsnutrition.org by Wednesday 6 November.
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News
Infant milk news
BFLG-UK news
Forthcoming
Happy reading!
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New report: Drinks marketed as growing up and toddler milks and drinks
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In September, we published our latest policy report Drinks for young children marketed as ‘growing up’ and ‘toddler’ milks and drinks. It builds on our 2021 report ‘Drinks marketed as growing-up and toddler milks’ and draws on our previous work on milk and milk drinks marketed for children 1-4 years in the UK.
The report highlights how excess consumption of energy and free sugars among young children - drivers of overweight/obesity and dental caries - are driven in part by the consumption of ‘growing up’ and ‘toddler’ milks, which are the top source of free sugars in the diets of 12-to-18-month-olds. These products also displace more nutritious, minimally processed, and unprocessed foods essential for optimal growth, health, and development, starting with breastmilk. Despite this, in the UK, there are no specific regulations governing the composition, marketing, or labelling of these products, which are widely available and extensively marketed for children over 12 months of age. This effective marketing means that more than one-third of 12-to 18-month-old children in the UK now consume these products.
Public health guidance states that from the age of 1, formulas are unnecessary as children can continue to breastfeed and should be given ordinary cow’s milk or water as their main drinks. Health workers can support families by promoting and supporting mums to continue breastfeeding after 1 year of age, reminding parents and carers that the main drinks for young children should be ordinary cows’ milk or water (which is cheaper and contains a lot less sugar!), and by being wary of product marketing, and encouraging families to be wary too. These recommendations are outlined in our infographic for health workers.
First Steps are advocating with Government to regulate the marketing of ‘growing up’ and ‘toddler’ milks and ensure that any available products are reformulated to reduce the sugar content. In the short term, it is our view that the forthcoming “Voluntary industry guidelines for commercial baby foods and drinks aimed at children aged up to 36 months” should address both the misleading marketing and high sugar levels of these products. More information on our recommendations for policy makers can be found in our report and infographic for policy makers.
The Daily Mail covered our report in this article.
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Updated: Good food choices and portion sizes
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We've updated this guidance to bring the language used in line with our other resources for 1 to under 5s and to ensure it aligns with latest public health recommendations (e.g. highlighting that semi-skimmed milk can be given from the age of 1, not just full-fat). It provides up to date costs where necessary (e.g. for plant-based milk alternatives).
An updated 2024 PDF version is available here (for free, or for a contribution should you wish). A hard copy of this resource is also available to purchase here.
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New article: UK government’s nutrition advisers are paid by world’s largest food companies
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Investigative journalist Sophie Borland led on this exposé of the Scientific Advisory Committee on Nutrition (SACN), revealing the large proportion of its expert members that have financial connections to the food industry, including the formula and baby food industry. These systemic conflicts of interest are a great concern because it is well documented that they create bias which favours industry over public health. (Click on the image for a 3 min video summary of the article).
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Our Director, Vicky, was interviewed and raised the question: “If you’re working for and supporting a commercial baby food company, and then you’re also sitting on a committee that’s making public health recommendations — how can you be expected to give an independent view around how babies should be fed?”. Her view, speaking on behalf of First Steps: “…we should not have anyone who works with the [baby food or] formula industry sitting on a subcommittee of SACN and making recommendations for how you feed babies”.
We greatly value and actively engage with the work of SACN, and regularly liaise with several of its experts who avoid conflicts of interest. We hope that efforts such as this to shine a spotlight on the issue will lead to actions to reduce industry interference in the public health policy setting, thereby protecting infant health.
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New report: Rethinking plant-based meat alternatives
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In August 2024, the Food Foundation published this new report presenting an in-depth analysis of 104 products, including 71 plant-based meat alternatives (PBMAs), split into three subcategories:
- Processed (new generation) foods, aiming to directly mimic equivalent meat products and marketed as such (e.g., Beyond Meat, Quorn, etc)
- Processed (traditional) products, such as tofu, tempeh and seitan which have a long culinary history in other parts of the world (e.g. in Southeast Asia)
- Less processed (beans and grains) including legumes and pulses (lentils, chickpeas, kidney beans) and grains (rice, oats, barley)
These three sub-categories of PBMAs were compared with meat products: beef, lamb, pork and chicken.
Key findings:
- Environment: Most PBMAs have much lower greenhouse gas emissions and water footprints compared to meat products.
- Nutritional profile of PBMAs varies depending on product and level of processing:
- The positives: All three categories of PBMAs had lower calories, lower saturated fat and higher fibre compared to meat products.
- The negatives: Only one-third of PBMAs were fortified with iron and Vitamin B12. PBMAs are on average lower in protein compared to meat but this is not necessarily a problem since most of the UK population [including young children] consume enough protein.
- Cost: Some of the processed (new generation and traditional) PBMAs are more expensive than meats they substitute, while beans and grains are the most affordable option out of all PMBAs and meat.
- The report explains that greater nuance is required when describing healthiness of PMBAs and it is not helpful to group all PBMAs into the same category.
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The report concludes that “There is a real opportunity in the UK to champion and better promote beans as an affordable, healthy and sustainable alternative to meat, and to understand how best to increase uptake. They offer a win-win-win for environmental, health and equity outcomes.”
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For all families, less processed PBMAs offer the greatest number of co-benefits for health, the environment and cost. There are many ways that legumes and pulses (including lentils, chickpeas, kidney beans and others) can be used more regularly by all families, including for infants and young children.
See our resource Eating well: vegan infants and under-5s which has plenty of recipes using legumes and pulses, and this blog Anything is pulse-able, even for babies and young children with tips on how pulses and legumes can be included in meals and snacks for babies and young children.
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More new baby food pouches marketed for infants from 6 months of age
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Kiddylicious have recently added baby-food pouches to their range of products for babies from 6 months of age. Despite being marketed as ‘an ideal way to start the weaning journey,’ they are often very smooth in texture and sweet in taste, which do not accustom babies to the unprocessed and minimally processed foods which should form the basis of a healthy diet during childhood.
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Pouches also have nozzles, allowing babies to suck the contents out without the need for spoons and bowls. This may encourage overconsumption as portion sizes are often too big, children cannot see what they are eating, and packaging does not allow those feeding them to know how much they are eating. It also poses a risk to dental health due to the sustained contact of purées, which are high in free sugars, with teeth. Pouched baby foods do not require chewing, and as such, over reliance may hinder the development of eating skills. Packaging may also be detrimental to the environment as many are made from plastic layers with an aluminium core, making them nonrecyclable.
In the UK, public health guidance is that babies should be introduced to a varied diet, alongside their usual breast milk or first infant formula from around 6 months of age. Families should be made aware that young children require an energy and nutrient dense diet, and that perceived health benefits of baby food pouches may not be relevant or health promoting for babies.
The addition of new products to the commercial baby food sector highlights the urgent need for the Government to publish their “Voluntary industry guidelines for commercial baby foods and drinks aimed at children aged up to 36 months.” This would be a positive step towards addressing both the misleading marketing and nutritional composition of these products.
You can find a broader discussion on issues related to the use of pouches in young children’s diets in our report: Fruit and vegetable based purées in pouches for infants and young children. The advantages of preparing purées at home are shown in the infographic below. |
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New paper: Household food insecurity and novel complementary feeding methods in New Zealand
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This paper by Katiforis et al is the first of its kind to report on the use of baby food pouches in families experiencing food insecurity. Data was taken from an observational study of over 600 infants aged 7- 10 months in New Zealand. Among those studied, 7.6% of infants were living in severely food insecure households and 17.4% were living in moderately food insecure households. The study provides useful learning for the UK where 18.7% of households with children under 18 years of age reported that children were directly experiencing food insecurity in June (Food Foundation, 2024).
Results showed that mothers experiencing severe food insecurity were nearly 6 times more likely than food secure mothers to frequently use commercial baby food pouches (5 or more times per week). The reasons that mothers experiencing food insecurity gave for their use included:
- Convenience (i.e. ‘easy to use’, takes less time, ‘generated less mess’ and were a ‘hands free’ method of complementary feeding)
- Enjoyment by the baby, which the authors noted may be associated with pouches being more likely to be accepted than homemade foods
- Provision of nutritious food (i.e. ‘easy way to get fruit and vegetables in,’ ‘easy to get meat in,’ ‘good for baby.’)
Only 14% of mothers experiencing severe food insecurity reported that they used pouches because they cost less. However, the authors cite a wealth of data, including from the UK, which shows that perception of cost effectiveness is an important factor in choosing what to feed babies in food insecure households. Despite pouches being more expensive than the equivalent fresh ingredients, parents perceived pouches to be more cost effective because they are more likely to be accepted by babies and less mess is likely to result from children exploring and playing with food.
Despite pouch use being perceived to be a practical solution to feeding infants in food insecure households, whether the regular use of pouches in infancy supports public health recommendations for infant and young child feeding is a critical question, as adequate nutrition in the first 1,000 days of life is essential to support life-long growth and development. The authors recommend the need for further research to determine whether frequent pouch use impacts on infant health, citing evidence that pouches contributed significantly to fibre, vitamin A and vitamin C intakes for infants in New Zealand who consumed them.
However, it is essential that, in addition to consideration of nutrient intakes at this age, wider public health guidance on feeding infants is considered, including that young children should be introduced to a varied diet from 6 months of age to accustom them to the tastes and textures of unprocessed and minimally processed foods which should form the basis of a healthy diet later in life. We summarise the issues with commercial fruit and veg purees in the article above.
Urgent measures are needed to alleviate poverty and food insecurity among households with infants and young children, and the 10 recommendations we made to the UK Government in May 2023 in this report, remain relevant: What the Cost of Living Crisis means for the diets of infants and young children and recommended actions.
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New paper: Response to: World Health Organization (WHO) guideline on the complementary feeding of infants and young children aged 6-23 months 2023
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The WHO published updated guidelines for complementary feeding in 2023; among the recommendations are that from 6-11 months of age non-breastfed infants can be given formula milk or animal milk (NB this is NOT currently advised in the UK, see our thoughts on this in our February newsletter). Several paediatric and gastroenterology associations objected to this and several other recommendations which relate to breastfeeding (and effectively minimise the use of formula milks). In this paper, members of the guideline committee respond to those objections. It’s a good read! Access it here.
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Draft recommendations on plant-based drinks from SACN/COT
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In July the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) released a report ‘assessing the health benefits and risks of consuming plant-based drinks’ for a public consultation which closed in September. The report focused on oat, soya and almond drinks only, and no other plant bases, as the volume sales of other products is much lower than these three main plant bases.
This detailed scientific analysis will inform updated public health recommendations on plant-based milk alternatives to cows’ milk for the whole population from the age of 1 year and up. These recommendations are very important because of the rising popularity of these products among families where an alternative to cows’ milk is required for medical, ethical or dietary reasons, and because if used in place of milk there are big implications for diet quality.
Current NHS advice for young children is “You can give your child unsweetened calcium-fortified milk alternatives, such as soya, almond and oat drinks [but not rice drinks], from the age of 1 as part of a healthy, balanced diet”.
In the report, the committee highlight that at present NO products currently available for sale are appropriately fortified which means where possible cows’ milk is the better option from a nutrition perspective: “…for young children aged 1 to 5 years, any potential benefits of consuming [currently available soya, almond and oat drinks] are outweighed by the potential risks… cows’ milk is therefore recommended for young children aged 1 to 5 years” (page 108).
Their draft recommendations for non-vegans aged 1 and up (on page 120 of the report) state that soya, almond and oat drinks can be used in place of cows’ milk, but they must be unsweetened, without free sugars, and have ‘enhanced’ fortification. The problem here is that no products currently meet the required levels. Our view is that while we wait for the recommendations to be finalised, health workers should:
- Support mothers who want to continue breastfeeding their toddler
- Stress that cows’ milk is preferred over plant-based drinks, from a nutrition perspective (i.e. plant-based drinks are not equivalent to cows’ milk)
- Remind parents/carers that other dairy foods can be given in place of cows’ milk
- Refer to current NHS guidelines (above) for those parents/carers that want to give their child a plant-based drink, and advise that if choosing oat drinks, it is best to go for ‘no sugar’ versions (because unsweetened oat drinks still contain free sugars, whereas unsweetened soya and almond do not). Nb. Organic plant drinks are not suitable, because they are not fortified. Products marketed as growing up drinks are not suitable, as they are all sugar sweetened.
The committee’s draft recommendations for vegan 1-5s (also on page 120 of the report) state that soya, almond and oat drinks can be used in place of cows’ milk, and that these plant-based drinks are preferable than substituting cows’ milk with water, but as above they must be unsweetened, without free sugars, and fortified at enhanced levels. They further state that between these three options, soya drink is recommended, but also that consuming a variety of alternatives to animal food and drinks, rather than just soya, is recommend.
Notwithstanding the inadequacy of the fortification of currently available plant-based drinks, the above draft recommendations are consistent with our existing guidance and also address the concerns we raised about the free sugars in oat drinks in 2021. However, we also suggest pea-drinks as an option (see our plant-based milks report here).
Read our consultation response here.
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SMA have updated the packaging of their SMA ADVANCED Baby & Toddler Milk Range but have assured their customers that the composition of each formula product has remained the same. The similarity of the new packaging across their infant, follow-on, and toddler milks still serves to cross promote the infant formula.
SMA Soya Infant Formula continues to be out of stock. Our June newsletter contains advice for health care professionals who are supporting families who have been using this product.
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Kendamil have been experiencing product shortages across their range. Families who are concerned about not being able to access a certain product can be reminded that all infant formula brands are interchangeable. For healthy, non-breastfed/ partially breastfed babies between birth and 12 months of age, any infant formula is suitable because the law requires that they all comply with the same nutrition composition standards.
More information on formula choice and preparation specifically for parents/carers, is available here and there are infographics which may also be helpful here.
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News coverage of our editorial: Specialised infant milks: over used, overpriced and obesogenic
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ICYMI this editorial written by Vicky and Susan was published on 23 July in the Journal of Clinical and Experimental Allergy. We propose that limitations in the current regulatory framework around infant formula and infant milks marketed as FSMP are failing to contain increasing, often unnecessary and usually unsupervised use of these products, to the detriment of infant health. 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.
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Five papers covered our editorial, with the main story in the Telegraph, and with coverage in the Mirror, Daily Mail, the Express and the Times.
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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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Latest news from the Competition and Markets Authority on the infant formula market survey
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During August 2024, the Competition and Markets Authority (CMA) provided an update to the Infant and follow-on formula market study. The update provided information about the process and timelines for the market study, as well as a Summary of concerns to date, which included that:
- Parents and carers are paying more than they need to for infant formula and do not have the information they need about infant formula to make well-informed purchasing decisions.
- Many decisions around infant formula are made during vulnerable circumstances, and with the ongoing cost-of-living pressures, it is concerning that consumers tend to not switch brands of infant formula even when a cheaper option is available.
- These outcomes are being driven by a combination of issues including:
- the operation of the regulatory framework, especially inadequate enforcement of existing regulations
- the behaviour of companies in the market in response to the regulatory framework
- the way in which parents and carers behave in this market, influenced by how brand loyalty is established and marketing
There was media coverage when the update was published, with some inaccurate reporting that only represented partial content, such as the Guardian’s piece Baby formula ad rules contribute to high costs for parents, UK regulator says (slightly improve following a complaint we submitted). The Telegraph presented a more balanced report Baby formula makers face profiteering claims.
The CMA has indicated their intention to publish an interim report setting out their concerns and provisional recommendations for action, in October this year. There will be the opportunity for public consultation, and we would urge you to engage with this. On behalf of the BFLG-UK, First Steps will be submitting a response and if you would like to see our response prior to the deadline please email: katie@firststepsnutrition.org.
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New resource: Countering Industry Arguments Against Code Implementation: Evidence and Rights-Based Responses
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In August, through the Global Breastfeeding Collective, UNICEF published this resource for policymakers and breastfeeding advocates. It presents the 36 most common arguments the baby food industry uses to oppose Code legislation, alongside responses and counter-arguments based in scientific evidence and international human rights law. We hope you might find it useful in your work.
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The proposed draft WHA resolution on Digital Marketing
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In September, Brazil put forward this draft resolution on the regulation of digital marketing of breastmilk substitutes to the Executive Board of the World Health Assembly (WHA) for this to be included in the Agenda for the 2025 WHA. The Executive Board will meet from 22-27 January 2025 ahead of the 78th WHA in May 2025. More about the WHA is available here.
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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 Breastfeeding Network (BfN) Conference and AGM: Saturday 5 October, Online
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The BfN virtual online conference will take place from 10:15am to 3:00pm on Saturday 5th October 2024, with an exciting programme of guest speakers joining to share their knowledge, insight and experiences. Open to volunteers, parents, families and health professionals with an interest in breastfeeding, infant feeding and related topics. Book here.
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Unicef UK Baby Friendly Initiative qualifications framework applications open until 3pm Monday 21 October
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The Qualifications Framework is an eight-month distance learning programme designed to increase knowledge and capacity related to infant feeding and very early child development. Find out more here. There is an informational drop-in session on 7th October from 2-3pm open to all who are interested in applying. Contact the Baby Friendly office at bfi@unicef.org.uk for the link to join.
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Publication of updated NICE guidelines on Maternal and Child Nutrition: 15 January 2025
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The public consultation on the draft updated guidelines closed in mid-September, and the committee met to discuss the feedback in late September. The finalised guidelines will be published on Wednesday 15 January. Follow the progress and access the documents here.
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Maternal, Parental, and Infant Nutrition and Nurture Unit (MAINN) Conference: April 2025
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ICYMI 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 - 30 April at 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 keynote 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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