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An independent public health nutrition charity that provides information and resources to support eating well from pre-conception to five years

Previous newsletters

We provide an archive of our newsletters from the last year for your interest. Please be aware that links within older newsletters may not function and older resources may no longer be available. 

 
 

December 2024

Image by Vecstock on Freepik
Welcome to the December edition of our newsletter. We hope you have a good Christmas and 2025 gets off to a good start. Our next newsletter will be in early February.
News Infant milk news BFLG-UK news Forthcoming Happy reading!

News

New investigation: Campaigners call for end to food and drink industry’s infiltration of UK children’s education
Hot off the press today (Thursday 5 December), the BMJ have published this investigative report highlighting stealth marketing by the food and drink industry – including baby food brands - through education initiatives in nurseries and schools.

We signed a joint letter to the secretaries of state for education and health and social care calling for an end to this harmful marketing by companies marketing unhealthy foods which do not align with public health recommendations for children.

Our Director Vicky wrote this Op-Ed to accompany the report, highlighting the urgent need to address the composition and marketing of commercial baby and toddler foods.
 
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DHSC correspondence on folic acid supplementation
On 27 November, the chief medical officers, chief nursing officers and chief midwifery officers published this correspondence to all health professionals. It urges them to continue advising women to take 400 micrograms of folic acid daily if they could become pregnant, and in the first 12 weeks of pregnancy to prevent neural tube defects. The context is that the government has mandated fortification of non-wholemeal flour with folic acid, and a concern that this might lead some women in to thinking this mean they no longer have to take a supplement, which is not the case. 
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News: Little Freddie baby food pouches misleading customers over sugar levels
The Grocer reported on data from independent laboratory tests that indicate that the brand Little Freddie are presenting misleading sugar levels on packs of fruit pouches marketed for babies from 6 months of age. It found that some contained almost double the amount of sugar listed in the nutritional information on pack. The products tested contained on average, 40 percent higher sugar levels than declared, and 11 percent over the upper tolerance limit provided by food labelling regulations.

The pouches with the largest discrepancies were the Banana & Raspberry Coconut Yoghurt pouch, Peaches & Raspberries, Pink Lady Apple Yoghurt, and Coconut & Summer Berries yoghurt. These products’ labels suggest that their sugar levels are lower than equivalent products produced by other brands (between 5.3 – 6.9g sugar per 100g), when the laboratory tests found that they found between 9.7g – 10.4g sugar per 100g.
These findings are concerning for infants and young children as high sugar intake in the early years are linked to poor oral health and can lead to the development of sweet taste preferences and contribute to overweight in later childhood.

The investigation also highlights the urgent need for the Government to publish, and make mandatory, their “Voluntary industry guidelines for commercial baby foods and drinks aimed at children aged up to 36 months”. Regulations are essential to protect parents from misleading marketing and claims that portray commercial baby foods as healthy, despite contradicting public health recommendations. 

From 6 to 12 months, public health guidance recommends introducing babies to a variety of minimally processed or unprocessed foods with diverse tastes and textures. However, many baby food products, particularly pouches, are less nutrient-dense, sweeter, and have a different consistency compared to home-prepared alternatives.

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. 

Our Eating Well guides offer practical advice on meeting infants' (under 1 year) and young children’s (1 to under-5 years) nutrient needs in a cost-effective way while minimising the use of highly processed products. You can download or purchase hard copies here. Read the full article here.
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Spotlight: High free sugars in kids flavoured yoghurts
A study published in October this year (and included in our November newsletter) found that UPFs (Ultra-Processed Foods) account for 47 percent of toddlers' total energy intakes, and flavoured yoghurts were one the most commonly consumed groups of UPFs. These are generally perceived as healthy but often have high levels of free sugars despite carrying ‘no added sugar’ claims.

We compared the price and sugar contents of Tesco’s Greek style and natural yoghurts (which can be classified as minimally processed foods) with six flavoured yoghurts marketed to children from 6 months available at Tesco. We chose one product from each of the six leading brands.
 
Sugar content
We found that all flavoured yoghurts had more sugars than Tesco’s Greek style yoghurt. Yeo Valley’s flavoured Greek yoghurt pouches had the smallest difference, of 1.2g/100g more, it also had 0.5g less sugar than Tesco’s natural yoghurt. However, 4/6 products had around double or more sugars compared with Tesco’s Greek style yoghurt per 100g: Peppa pig by Yoplait (9.3g), Petit Filous (9.4g), Ella’s Kitchen (9.5g), and Kiddylicious (11g). The same four had at least 3.4g more sugar per 100g than Tesco’s natural yoghurt.

Price
All flavoured yoghurts were more expensive per serving than Tesco’s Greek and natural yoghurts, which were both 22p per 100g. The flavoured yoghurts sold in pots were around double the cost of Tesco’s Greek/natural yoghurts, at 49p per 85g pot (Petit Filous), and 60p for two 45g pots (Peppa Pig by Yoplait). Kiddylicious and Ella’s Kitchen flavoured yoghurt pouches cost £1.20 (100g, and 90g respectively), more than 5 times the cost of Tesco’s Greek/natural yoghurts.
 Pictured: Greek yoghurt with mixed berries, breakfast for a 7-9 month old, page 58, Eating Well the first year
In their 2023 guideline on feeding young children aged 1-5 years, SACN recommends unsweetened yoghurt. This can be served with stewed fruit as an alternative to buying flavoured children’s yoghurts, which as shown are often high in free sugars and far more expensive than less processed natural and Greek yoghurt alternatives. You can find recipes in our Eating Well guides, here.
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New editorial: Plant-Based and Dairy-Free Drinks: An Emerging Health Hazard for Young Children
We wrote this editorial on the health risks associated with plant-based and dairy-free drinks based on our report Drinks for young children marketed as ‘growing up’ and ‘toddler’ milks and drinks. The focus is on plant-based “growing-up” milks (GUM), reflecting their increased availability, shifting consumer preferences from cows’ milk to plant-based alternatives, and the widespread overdiagnosis of milk allergies in infants, leading to the use of specialised low-allergy formula products.
Although manufacturers promote GUM as vital sources of nutrients such as vitamin D, calcium, and iron for young children, there are clear health risks associated with many plant-based GUM due to their high free sugar content, which is linked to dental decay, overweight, and obesity.

Plant-based GUM are among those with the highest sugar content. According to the UK Department of Health and Social Care's recommended sugar limit of 5 percent of total energy intake, consuming just 140ml of plant-based GUM or 100ml of specialised low-allergy GUM can exceed the daily sugar limit for a 1- to 2-year-old. In comparison, it takes 260ml of dairy-based GUM to surpass the same limit.
The absence of labelling regulations allows GUM manufacturers to make misleading nutrition claims, giving the impression that these products are low in sugar. As a result, many parents and caregivers remain unaware of the high free sugar content in plant-based GUM. For instance, oat milks can be marketed as having "no added sugars," even though their free sugar content originates from oat processing, which can lead to higher sugar levels than standard cows’ milk-based GUM.

This underscores the urgent need for marketing regulations to better enable parents and caregivers to make informed decisions about their children’s diets in line with public health guidelines. Current NHS advice for young children states that unsweetened, calcium-fortified milk alternatives such as soya, almond, and oat drinks (excluding rice drinks) can be given from the age one as part of a healthy, balanced diet. If choosing oat drinks, our view is that families should choose a ‘no sugar’ option, as unsweetened oat drinks still contain free sugars, unlike unsweetened soya or almond options.

Additionally, health professionals should support mothers who wish to continue breastfeeding their toddlers.

For further details on plant-based milks, see our full report here. Earlier this year SACN (the Scientific Advisory Committee on Nutrition) and COT (the Committee on Toxicity) shared a report “Assessing the health benefits and risks of consuming plant-based drinks”. Our consultation response is here.

Lastly, for practical guidance on eating well for vegan families with children under 5, see here.
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New Paper: Exposure to sugar rationing in the first 1,000 days of life protected against chronic disease
Research published in October 2024 in Science by Tadeja Gracner and colleagues examined the impact of sugar rationing on type 2 diabetes and hypertension in the first 1,000 days of life. The study was a quasi-experimental design that analysed UK Biobank data from over 60,000 adults aged 51-66 conceived either during rationing (between October 1951 and June 1954) or after rationing (between July 1954 and March 1956). Adults born during rationing were exposed to sugar levels within dietary guidelines which recommend <40g sugar per day and no added sugar under the age of 2. Following rationing, sugar intakes almost doubled to around 80g per day.

The data shows that nearly 4,000 participants were diagnosed with diabetes, and almost 20,000 with hypertension. The risk of developing these diseases increased with age, and at a much faster rate for those who experienced minimal or no exposure to rationing; early-life rationing delayed the onset of diabetes by 4 years and hypertension by 2 years. It found that 92.2 percent of adults who were exposed to sugar rationing early in life were likely to be living without Type 2 Diabetes (a risk reduction of about 35 percent), and 65.4 percent without hypertension (a risk reduction of about 20 percent). Furthermore, participants exposed to rationing in utero and beyond the first year observed a 30 percent decrease in obesity. These findings reflect those of animal studies which found high-sugar diets during pregnancy can increase hypertension and type 2 diabetes risk factors.

Although other foods, such as butter were rationed at similar time points, the differences in intakes pre- and post-rationing were far smaller, and there were no differences between individuals’ outcomes before and after rationing ended.

This study highlights the role of sugar intakes during pregnancy and infancy in long-term outcomes of diseases.

NHS advice states that babies do not need sugar and SACN advises that the average free sugars intake for children aged 1 year and older should not exceed 5 percent of their total dietary energy intake, and that foods high in free sugars should be limited in children aged 1 to 5 years.

We offer a range of ‘eating well’ guides providing practical guidance on how to meet nutrient requirements and eat according to public health recommendations between pregnancy and the age of 5 years, including practical advice which minimises sugar intakes. You can find our guides here.
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Translated eating well guide: Eating Well 6 months to 2 years for South Asian children in Bengali
We are delighted to be able to share a version of this eating well guide in Bengali, translated by Lily Islam of the charity Women and Children First, with funding from the Access Foundation.
 
This resource was prepared in collaboration with the Nurture Early for Optimal Nutrition (NEON) programme. It summarises the importance of eating well between 6 and 24 months and shows how this can be achieved through providing nutritionally appropriate, affordable, culturally tailored South Asian age-appropriate recipes based on unprocessed and minimally processed foods.

There is currently no hard copy available of this resource but if you would like to have a printed copy of it, please express your interest by emailing admin@firststepsnutrition.org. If we receive enough requests, we may be able to do a print run. 
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Two new reports on food insecurity in the early years
“Reducing infant and maternal food insecurity in the UK”
The Independent Food Aid Network UK (IFAN UK) updated this briefing in mid- November, see here. They seek to shine a spotlight on families with young children, who are among the most vulnerable to food insecurity. This is incredibly concerning because of their specific nutrition needs to support growth and development and the lifelong implications of poor diets in the earliest years.
 
“It’s crucial to continue highlighting the scale and depth of infant food insecurity, but it’s more important than ever that parents and carers of infants can access adequate incomes and that this is the primary focus of policy makers. This cohort of people is presenting at food banks because they don't have enough money to afford essentials… In the here and now [there needs to be a] focus on developing and supporting emergency infant feeding pathways at local authority level. These need to prioritise income maximisation, autonomy, and dignity and choice regarding cash payments for the purchase of infant formula and to enable breastfeeding mothers to afford adequate nutrition”. 
IFAN makes 6 recommendations as follows:
  • Collaborate to ensure parents and carers struggling to feed infants are supported through a cash first approach 
  • Promote and invest in local advice services to help embed early cash first interventions  
  • Bring social security payments and wages in line with the cost of living and ensure everyone can access a Living Income
  • Ensure the availability of crisis support via cash payments    
  • Improve access to and adequacy of Healthy Start and Best Start schemes     
  • Take a cash first approach when providing immediate support   
We at First Steps Nutrition Trust endorse these recommendations, and the need to ensure that food security responses both protect and support breastfeeding and safe and appropriate formula feeding where needed.

“How can we reduce food poverty for under-fives?”
The Education Policy Institute published this report on 28 November, highlighting the issue of food poverty in the early years and making recommendations for action. It highlights the vulnerability of families with under 5s, the health harms of poor diets in this life stage and the root cause: poverty. It emphasises our inadequate benefits system, Healthy Start and food provision in early years settings.
 
The report recommends that the Government:
  • Ensure its forthcoming child poverty strategy includes a focus on food poverty experienced by young families. The Two Child Limit and the benefit cap should be abolished, and an ‘essentials guarantee’ instated to ensure that families on social security benefits have sufficient income to meet all basic needs.
  • Improve the Healthy Start scheme as per the recommendations of the Working Group
  • Work towards universal free meals in early years settings; improve the existing free early years meals programme, promoting awareness amongst parents and early years professionals, removing restrictive criteria and increasing the scope beyond maintained settings.
  • Fund and support local authorities to provide tailored solutions to food poverty based on local needs.
The report acknowledges the importance of breastfeeding for infant food security, and the recommendations made by other organisations to protect and support breastfeeding, including the Food Foundation in their report ‘Breaking Down the Barriers to Breastfeeding’ and Bremner and Co’s report, as shared below.
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New report: Breastfeeding in focus: Insights from the sector
On 4 November, Bremner & Co published its new report sharing insights and recommendations for UK breastfeeding policy and practice. This work was commissioned by Impact on Urban Health who acknowledge that infant feeding is often overlooked in food policy. The research consisted of 28 semi-structured interviews, desk research and a media review of the UK’s top newspapers and their portrayal of breastfeeding. Interviewees included representatives from n=14 charities/NGOs/campaigners, n=5 local government of members of parliament, n=5 health sector, n=3 academia, and n=1 industry. Six key themes were uncovered as barriers to breastfeeding: policy, infrastructure, culture/media, demographics, place of work or study and the Commercial Milk Formula industry.
 
The recommendations presented are from those who engaged in the research. They are extensive and intersect policy, communications, advocacy, information provision, and breastfeeding support interventions. They include a government feeding strategy, more funding for breastfeeding support, strengthened existing breastfeeding policies, improved statutory maternity pay and policies, the inclusion of breastfeeding in education curriculums, and funding and support to charities who advocate for stronger legislation on the marketing of commercial milk formulas. It also outlines some practical interventions for supporting women to breastfeed in the community, from creating breastfeeding spaces to implementing more support in areas with high need due to high infant mortality rates, malnutrition or food insecurity.
 
We look forward to drawing on the insights and recommendations in this report in our practical work and advocacy.
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New report: Nourishing Britain: a political manual for improving the nation’s health
This report by Dr Dolly van Tulleken and Henry Dimbleby is billed as a manual for politicians with guidance on ‘how-to’ fix the food system. It draws on interviews with three former prime ministers, one deputy prime minister, ten former health secretaries, and six other former and serving politicians. They say:
 
“We wanted to understand the messy, behind the-scenes compromises, the logistical frustrations and psychological and cultural barriers that get in the way of improving the food system. And perhaps even more importantly, we wanted to know what it takes to lift those barriers, and push through meaningful change”.
It’s a fascinating read, and this caught our attention in Chapter 5, under ‘Ingredients for success’: ‘Deploy a compelling argument’: Prioritise children: This makes sense nutritionally, since a good diet early on can have life-long health benefits. But it also makes sense politically, because the wellbeing of children is a priority for voters.
 
We will continue to highlight the vital importance of nutrition in the early years for public health and prevention.
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New editorial: Conflicts of interest: moving towards zero tolerance
On 19 November, Chris van Tulleken and colleagues published an opinion article in the British Medical Journal which calls for an end to conflicts of interest in scientific research. It draws upon the example of the tobacco industry – where public health messages were diluted despite research demonstrating that smoking, unequivocally, causes lung cancer. They explain how tobacco companies paid off doctors, academics, charities and policymakers resulting in delayed public health interventions and messages. A similar phenomenon is present with food, where those working to improve, research, or provide media coverage on, diet and health are funded by the food industry. Poor diet is a public health crisis, as it is now the leading cause of early death globally, ahead of smoking.
 
Conflicts of interest are often undisclosed, or an afterthought, in scientific journals. The authors calls for a complete reset stating that conflicts of interest lead to biases and impact healthcare practice, policies, and public health.
 
We support the recommendations to end conflict of interests by strengthening government action, zero tolerance for conflicting interests for healthcare professionals and their governing bodies/memberships, as well as stricter and clearer statements in scientific journals.
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Infant milk news

New and discontinued products

Last month, we announced the introduction of Lidl Lupilu infant formula and follow-on formula, and Kendamil Bonya infant formula and follow-on formula. We have updated our Infant Milks website with information on the composition and cost of these new products.

We are chasing Aldi for a definitive answer, but we think that the Mamia 900g infant formula has been discontinued. The 800g product is still listed online.
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New Infographics: Infant milk costs and trends

We publish a cost report summarising current costs of infant formula, follow-on formula and infant milks marketed as foods for special medical purposes marketed over the counter in the UK. We also publish a trends report which shows how the cost of powdered infant formula is changing over time, and how these costs impact on the cost of feeding a 10-week-old baby. Below are two new infographics to summarise the latest data, as of October and November 2024. The first offers information for health care professionals to share with families on the most affordable products, and the second outlines our recommendations for policy makers on how to ensure that infant formula is consistently affordable for all who need it.
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Update: Two-pager on responsive bottle feeding and which formula to choose

In case you missed it, we worked with Unicef Baby Friendly Initiative to update this two-pager on responsive feeding and which infant formula to choose.
For infant milk information please visit our website www.infantmilkinfo.org. If you can’t find what you’re looking for, please email vicky@firststepsnutrition.org
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Baby Feeding Law Group UK News 

Competition and Markets Authority: Interim report on the infant formula market study

On 8 November the CMA published their interim market study report with a three-week consultation period for response to a list of proposed policy solutions to high infant formula prices and concerns on how the market functions.

ICYMI this market study was undertaken after an initial investigation published last November, which used our infant milk cost data to confirm profiteering by the big brands. We have been concerned about the high cost of infant formula for some time, first publicising our concerns in this report prepared on behalf of the All Party Parliamentary Group on Infant Feeding and Inequalities in 2018, and raising them again in 2022 and 2023 as we observed rising prices during the cost of living crisis.

Read a summary of the CMA’s findings and potential solutions here, and the response we prepared on behalf of the BFLG with extensive member inputs, here.

The CMA will publish their final report in February, and the DHSC will have 90 days to respond. We will continue to support the CMA in their work and liaise with the nutrition legislation team and representatives of the devolved nations as we advocate for policies to protect and support breastfeeding, and enable safe and appropriate formula feeding when needed, in line with the Code.
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
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Forthcoming 

New Eating Well Guide for pregnant and breastfeeding women, babies and young children living in temporary accommodation
Image by Cleveland Health Clinic (clevelandcliniclondon.uk)
We are planning to publish a new Eating Well guide later this month aimed at healthcare practitioners, community groups, social services, volunteers, and hotel staff who support pregnant and breastfeeding women, babies, and young children living in temporary accommodation in the UK.

The guide will address challenges often encountered in these contexts, including limited access to practical resources such as kitchens, cooking utensils, storage equipment and the money to purchase food and resources, and to social and community support, which restrict families' food choices and eating habits.

It will provide practical advice on how to support pregnant and breastfeeding women, babies and young children to eat well in a range of resource-poor contexts, highlighting the importance of good nutrition during pregnancy and the early years.

The guide will be published alongside our other Eating Well resources here.  
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November 2024

Image by Wirestock on Freepik

 
Welcome to the November edition of our newsletter
News Infant milk news BFLG-UK news Forthcoming HR Update
Happy reading!

News

Latest childhood obesity data: release of NCMP 2023/2024 academic year

The National Childhood Measurement Programme Data for the school year 2023/24 was published on Tuesday 5 November. While there is a general trend of improvement for year 6 children, the opposite is the case for 4-5 year olds.

These are the overall stats for reception:
Key findings include:

The prevalence of obesity in Reception children increased from 9.2% in 2022/23 to 9.6% in 2023/24. This is lower than in 2019/20, but similar to 2018/19.
For children living in the most deprived areas, obesity prevalence was over twice as high compared with those living in the least deprived areas. For Reception children living in the most deprived areas the prevalence of obesity was 12.9%, compared with 6.0% of those living in the least deprived areas. There is a widening gap in obesity prevalence between least and most deprived areas.
We will continue our advocacy with Government to prioritise actions in the early years to enable all babies to eat well from the start of life.
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Autumn budget: reflections from an early years nutrition perspective
The budget was released on 30 October with some welcome commitments that will help address poverty and pressures on the NHS, but, not nearly enough to meet the Government’s pledges relating to ending reliance on food banks and ensuring the healthiest generation of children ever. And, despite the apparent rhetoric on ‘meaningful prevention’, there was a notable absence of any announcement on the public health grant. Our asks - which have not been addressed (with the exception of a commitment to look at extending the soft drinks levy to milk drinks and plant-based alternatives) - are here. The Food Foundation’s reactions are well worth a read, see here and here.
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New House of Lords inquiry report: Recipe for health: a plan to fix our broken food system
This report was published on 24 October to overwhelming positive reaction from public health and food system advocates. It is the outcome of an inquiry into the role of ultra-processed foods (UPF) and foods high in fat, salt and sugar (HFSS) in driving ill-health and obesity, in to which our Director Vicky gave oral and written evidence.
We strongly agree with the report’s findings and recommendations aimed at Government and the food industry, especially those seeking to better enable babies and young children to eat well from the start of life. Most align with those that we called for, and include:
  • Regulating commercial baby/toddler food composition and marketing, and discretionary formula milk marketing (including upgrading UK laws in line with the Code)
    • Necessary to stop parents/carers being misled in to buying inappropriate and unhealthy products marketed as good choices, which displace breastfeeding and less processed nutrient dense home-prepared foods
 
  • Reforming the national nutrition safety net, ‘Healthy Start’, increasing the allowance value and increasing coverage
    • Necessary to mitigate unacceptably high levels of food insecurity in the UK, which is especially acute among the most nutritionally vulnerable – pregnant women, breastfeeding women, and babies and young children on the lowest incomes
 
  • Reviewing and mandating food standards for early years settings, and supporting and monitoring their implementation
    • Necessary to ensure babies and young children are supported to eat well and develop healthy diets preferences and habits while at nurseries, pre-schools and childminders
 
  • Development of a ‘comprehensive and integrated maternal and infant nutrition strategy’
    • Necessary to bring in the health sector side of the equation, e.g. to address support for breastfeeding and complementary feeding, and the workforce and infrastructure to deliver this
It is only through intervening in the early years that reductions in the UK’s high levels of overweight and obesity will be achieved and sustained. Our challenge to Government: if they are serious about their pledge to create the healthiest and happiest generation of children ever, they need to prioritise acting on the inquiry’s recommendations urgently, especially those focused on babies and their families.
 
Read the report here and a summary here.
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New paper: Ultra-processed food intake in toddlerhood and mid-
childhood in the UK
This study by Rana Conway and colleagues at UCL explores UPF intakes in a cohort of UK twins at 21 months (n=2,591) and seven years of age (n=592), with data collected in 2009/10 and 2014/15 (i.e. at least 9 years ago). They found that UPFs account for 47% of toddlers' total energy intakes and 59% of 7-year-olds. Of the 570 individuals who completed diet studies at both time points, UPF consumption increased by an average of more than 15% between 21 months of age and 7 years, and higher UPF intake at the first time point predicted higher intakes in mid-childhood.
 
Average sugar and salt intakes exceeded recommendations for both age groups and were associated with higher UPF consumption. Toddlers who ate more UPFs had less saturated fat and protein in their diets, and children who consumed more had less fibre in their diets. High consumption of unnecessary commercial milk formulas (CMF) seem to drive this trend. Aside from CMF, toddlers' most consumed UPFs were yoghurts, wholegrain bread and high-fibre cereals. Children’s most consumed UPFs were puddings, sweet cereal products and white bread. Toddlers consumed commercial products from the baby food aisle that the researchers chose not to classify as UPF because they did not contain ingredient markers, but they do note that these snacks can be defined as ultra-processed by their form as they are extruded and puffed.
 
It should be noted that the data are old and reliance on UPF could well be higher currently, added to which the cohort are not representative of the general population and socially disadvantaged groups are also more likely have poorer diets.
 
This research further highlights the urgent need for action to reduce UPF consumption in the early years (which would also reduce HFSS food consumption) and to rebalance the diet towards the nutrient-dense, less processed/whole foods necessary to meet dietary requirements and lay the foundation for healthy dietary preferences and habits. Our recommendations are in our report 2023 report here.
Our ‘Eating Well’ guides provide pictorial, practical advice on how to meet nutrient requirements in pregnancy, while breastfeeding, for infants (under 1) and young children between the ages of 1 and 5, cost effectively and avoiding too many highly processed products. You can download or buy hard copies here.
Read the paper here.
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New editorial: Ending health care professional association conflict of interest with the nutrition industry
Last month, the World Health Organisation (WHO) published new resources to support Healthcare Professional Associations (HCPA) to avoid conflicts of interest in relation to nutrition companies marketing foods for infants and young children. The new WHO resources include a model policy, suggestions for alternative funding sources and case studies of good practice.
 
This editorial, co-authored by our Director Vicky, debunks arguments used to resist the WHO recommendation and outlines why doing so is important. It shines a spotlight on the allergy HCAPs many of which have a long way to go despite evidence that conflicts of interest can drive overdiagnosis and unnecessary use of specialised formula products which carry health and nutrition risks.
 
The aims of the baby formula/baby food industry are often directly opposed to public health aims, and the impact of nutrition industry sponsorship of HCPAs over many years can be seen in the debate about the updated 2023 WHO complementary feeding guidelines summarised in the figure.
Figure: Comparison of public health recommendations and nutrition industry funded HCPA recommendations for feeding infants and young children
The new WHO resources illustrate that culture change is possible, and that the missions of HCPAs can be successfully accomplished without nutrition industry sponsorship. Read the editorial here.
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New paper: Stakeholders’ views of the Baby Friendly Initiative implementation and impact
This paper by Frankie Fair and colleagues at Sheffield Hallam university was published earlier this year. It aimed to explore multinational stakeholders’ views of the Baby Friendly Initiative (BFI) programme in the UK, the barriers and facilitators to accreditation and its perceived impact. It used mixed methods including an online survey sent via professional networks in late 2020 and completed by 322 respondents in varied roles, and 17 interviews with ‘key stakeholders’ and maternity service users; most were from the UK. Data was analysed thematically.
 
In terms of findings, several respondents felt all the standards were equally important while some felt some were more important than others. There was no clear pattern or consensus. The authors assert that additional evidence for the effectiveness of each element and the importance of the whole package need to be established and communicated. However, it is important to note that respondents had limited experience of implementation of Baby Friendly, including in the UK. In addition, the researchers used the Ten Steps to Successful Breastfeeding and Seven Point Plan for Sustaining Breastfeeding in the Community as a basis for their enquiry. In the UK, these standards were superseded in 2012 with ones which include support for parents who are bottle-feeding and for close and loving relationships. In addition, the neonatal standards introduced in 2015 were not considered. 
 
Overall, the study showed the BFI to be viewed by most respondents as an intervention that could improve breastfeeding and health outcomes in the UK as part of a wider package of interventions: “The BFI is not a magic bullet intervention. To create a more supportive breastfeeding environment within society a holistic approach is required. This includes social and cultural changes, increased education ideally starting at school age, and advancing positive messaging around breastfeeding within the media, as well as fully banning breastmilk substitute advertising”.
 
We do not find this conclusion surprising and would concur that Unicef BFI is an important part of a package of interventions needed to enable breastfeeding and safe and appropriate formula feeding where needed.
 
Read the paper here.
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Updated nutritional standards and practical guidance for early years settings in Scotland: “Setting the Table”

In early October the Scottish Government published its updated nutritional standards and practical guidance for supporting eating well and creating a ‘whole setting’ approach to food in early years settings. Find them here: ‘Setting the Table’.
 
First Steps resources (including Eating Well: The first year; Eating Well: Vegan infants and under 5s and our infant milks for parents and carers webpage) are recommended within.
The resource was developed in partnership with a range of organisations across public health, education and childcare and food standards, and is clearly situated in the context of the full range of relevant policies. As well as setting standards and providing practical guidance, there is information within on expectations for implementation; settings will need to apply the guidance by August 2025 and the Care Inspectorate will assess this.
 
This is an accessible and technically sound guideline which has been created in a manner which will clearly really facilitate its application. Once again, the Scottish Government provides a best practice example on early years nutrition! Bravo!
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Update: Healthy Start for groups who have no recourse to public funds
In May 2021, the Department of Health and Social Care expanded Healthy Start eligibility to British children under 4 from families with no recourse to public funds (NRPF) or without immigration status through a non-statutory scheme, allowing them access to payments and vitamins. DHSC now aims to formalise this scheme into law and launched a consultation in July to explore the benefits, challenges, and potential impacts of extending eligibility for Healthy Start to NRPF families, especially regarding individuals with protected characteristics.
 
It is our view that access to adequate nutrition should not depend on immigration status. All pregnant and breastfeeding women, infants, and young children have specific nutritional needs that require a nutrient-dense diet to prevent ill health and support proper growth and development. Those unable to meet these needs should be entitled to a nutritional safety net, consistent with the UK Government’s commitment to the International Covenant on Economic, Social and Cultural Rights, which requires securing the right to sufficient food for everyone in the UK. Furthermore, expanding Healthy Start eligibility to British children under 4 from families with NRPF or without immigration status would ensure that the scheme achieves its aim of reducing health inequalities by ensuring that women and children “most in need” have access to essential vitamins and nutritious food.
 
Our full consultation response can be found here.
 
Food insecurity remains a critical issue for families with young children, with Trussell Trust data showing that 24% of households with children under four are experiencing hunger—the highest risk of any age group. First Steps is collaborating with the Healthy Start Working Group to push for essential improvements to the Healthy Start scheme, aiming to strengthen it as a vital nutrition safety net. However, we are concerned about the lack of progress on these issues at the Government level (including no commitment to improve this scheme in the Autumn Budget, see above).

Our practical guide to Healthy Start and Best Start Foods is designed to help families make the most of the Healthy Start scheme in England, Wales, and Northern Ireland, and the Best Start Foods scheme in Scotland. It includes a range of healthy family recipes using ingredients that can be bought through the Healthy Start or Best Start Foods schemes and shows how these can feed the whole family.
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Infant milk news

New and discontinued products

Similac Gold

Having been unable to find Similac® Gold First Infant Milk and follow-on milks for sale in high street retailers, we can confirm that these products are being discontinued.

New products

We recently found out that a number of new formula products have been introduced, although it’s unclear how widely available they are at this time.  We’re examining the product marketing and labelling and the extent of compliance with the UK law and the Code, and will respond to any contraventions in due course.

Lidl Lupilu infant formula

Lidl introduced their own-brand infant and follow-on formulas in September. Lulipu infant formula costs £7.09 for an 800g tin, making it the same price per unit as Aldi’s Mamia first infant milk. Lulipu follow-on formula also costs £7.09 for an 800g tin.

Kendamil Bonya infant formula and follow-on formula

Kendal Nutricare launched these two new products on the 1 November. The products come in 2 x 400g cartons and are priced at £8.45. The manufacturers describe the products as ‘low price’, but there are several more affordable products on the market, see below.

We are updating our Infant Milks website with information on the composition and cost of these new products.
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Infant milk cost report update and latest price trends

Costs of infant formula, follow-on formula and milks marketed as foods for special medical purposes available over the counter in the UK

Our latest review of the cost of infant milks reveals the following:

The cost difference between the most and least expensive cows’ milk-based first infant formula is £10.91 per 800g. Since all infant formulas in the UK are regulated, ensuring they are safe and suitable for babies from birth through the first year, parents can make substantial savings by switching brands.

The NHS states:

Current pricing strategies mean that the least expensive way to buy infant formula is in powdered format. Aldi Mamia and Lidl Lupilu are the least expensive infant formula powders in standard size formats. Since April 2024, Aldi have launched an 800g tin with a retail price of £7.09. This is 90p cheaper than their 900g tin (£7.99), but works out at 12p per 100ml of made-up formula. Lupilu is also £7.09 and 12p per 100ml of made-up formula.

Five lowest-cost first infant formula products (per unit)

Five lowest-cost first infant formula products (per 100ml)

The cheapest formats of Cow & Gate First Infant Milk, SMA Pro First Infant Milk and Aptamil First Infant milk per 100ml are their ‘big packs’ (2 x 600g packs), which are 4p cheaper per 100ml than standard size formats. However this requires families to pay a greater up-front cost, and these packs are not available in all retail contexts. 

There continue to be differences in the price of same brand infant formula and follow-on formula across different retailers, indicating that it is worthwhile shopping around for infant formula.

Follow-on formula, advertised for children aged 6-12 months, provides no additional nutritional benefits over infant formula and is not recommended by the NHS. While many believe that switching to follow-on formula after six months might save money—especially since UK regulations allow promotional offers on follow-on formula—our cost analysis reveals this may not be the case. In fact, powdered follow-on formula can be slightly more expensive than the same brand's infant formula when prepared.

Additionally, our review of promotions found that offers on follow-on formulas in April were no longer available by October 2024. This variability highlights that promotions are not a reliable foundation for families on a budget when making feeding decisions, leaving them exposed to price increases once promotions end.

Cost of powdered infant formulas in the UK: How have they changed since January 2021?

Our latest infant formula cost trend analysis reveals that since April 2024 the majority of infant formula prices have remained static, with the exception of Aldi’s Mamia 900g tin which has decreased in unit price by a further 6%, continuing the small downward trend observed between November 2023 and April 2024, when prices dropped by 1.8%. However, this decline is minimal compared to the 22% average price increase seen across products between March 2021 and April 2023 (and the 24% increase of the seven ‘standard’ powdered first infant formulas sold by market leaders Danone and Nestlé in the same time frame), which started from an already high baseline.

Unit cost of market leaders’ powdered first infant formula (all 800g), Aldi's Mamia (800g & 900g) and Lidl’s Lupilu (800g), compared to the weekly Healthy Start allowance

As explained in our report, we have taken prices from Boots the Chemist website, Tesco, Sainsbury's, Asda, Morrisons, Aldi, Lidl and Ocado online supermarkets and the manufacturers' online shop, prioritising our sources in that order. Where a product is not available at Boots we look for it on the Tesco website and so on until we find a current price. Prices for infant formula vary between retailers (for example, SMA Little Steps is available in some supermarkets for £7.95), but the prices shown in this graph represent typical prices in October 2024.

Price differentials between different brand’s ‘standard’ and ‘premium’ powdered first infant formula products (where these exist), show no clear trends. The popularity of more expensive branded products demonstrates the effectiveness of commercial milk formula marketing, which fosters trust among parents and carers, leading them to purchase higher-priced options, even though UK regulations ensure all infant formulas are safe and suitable for babies from birth through their first year.

Prices for "starter packs" have not remained stable. Between April 2023 and November 2023, Danone reduced prices for their Aptamil Advanced, Aptamil, and Cow & Gate starter packs of ready-to-feed infant formula, but these reductions have now been reversed, with the starter pack prices returning to their April 2023 levels. This highlights the importance of regulatory measures to protect parents from unexpected price increases.

Overall, infant formula remains an expensive and yet essential food item for many. Government action is needed to bring prices down more meaningfully across the board and in the long term, and to ensure accessibility for those families on low incomes that need it, while protecting and supporting breastfeeding. Both Aldi and Lidl serve as an example of the cost savings achievable through the availability of a supermarket's own-brand infant formulas.

For healthcare professionals advising parents/carers on economical formula and food choices for their babies and young children, our infographics may be of use:
We have also worked with Unicef Baby Friendly Initiative to update this two-pager on responsive bottle feeding and what infant formula to choose.  
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 

Latest news from the Competition and Markets Authority: Interim report on the infant formula market study due in “Autumn 2024”
We were hoping that the Competition and Markets Authority (CMA) interim report on the infant and follow-on formula market study would be published by the end of October 2024, as indicated on their webpage. The administrative timetable indicates that the interim report (with provisional recommendations) will be available by the end of Autumn 2024. Any updates will be shared on the CMA webpage on the Infant formula and follow-on formula market study.
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New paper: Outcomes of implementing the International Code of Marketing of Breast-milk Substitutes as national laws

On 27 September 2024, Chompoonut Topothai and colleagues from the National University of Singapore, Ministry of Public Health Thailand and London School of Hygiene and Tropical Medicine published a systematic review of outcomes of implementing the International Code as national laws in the International Breastfeeding Journal. The systematic review aimed to synthesise evidence on implementation outcomes in countries implementing the Code as national law. Articles published from 1982-2022 and in English were included in the review, resulting in 60 eligible articles (from 12,075 screened) from 28 countries (of 144 which had any Code legislation in 2022). Most articles (57) focused on legal compliance, while five considered acceptability and only 1 considered feasibility. Over half (55%) were quantitative, cross-sectional studies. Most studies (88%) were single country studies with 12% evaluating multiple countries. Studies were included from three different countries in Europe: one from Poland, one from Turkey and six from the UK.

The results from the review showed good compliance for media promotion of CMF for infants 0–12 months (i.e., infant formula), but lower compliance for promotions at points of sale, within health facilities, and among health workers across different countries. Similar industry tactics were used across countries, with an emphasis on digital marketing, cross-promotion (with products not covered by laws), and premiumisation. Compliance was assessed across 57 included studies and according to five main sources:

·        Mothers (n=25 articles): Maternal exposure to commercial milk formula (CMF) promotion was widespread, including mothers receiving free samples and coupons, and encountering CMF advertising in the media.

·        Health workers and healthcare settings (n=22): Compliance of health workers with national laws and exposure to CMF marketing varied across countries, with many health workers reporting contact with CMF companies despite legal prohibitions. Public facilities generally showed better adherence to national laws than private ones.

·        Media (n=22): While implementing the Code as national law effectively regulated the promotion of infant formula in public settings and the media, the promotion of unregulated products like growing-up or toddler milks was widely reported and often marketed through cross-promotion and digital platforms.

·        Point-of-sale (n=15): Compliance was inconsistent across countries, with many reporting non-compliant price-related promotions.

·        Product labels (n=13): Articles reported CMF labelling (n=7) but also the labelling of commercial complementary foods (n=6) and bottles and teats (n=1). Among studies evaluating CMF labels, most labels were non-compliant with at least one Code provision, most commonly relating to the use of text/images idealising product use and the absence of a statement on the superiority of breastfeeding.

The review concludes that implementing the Code as national law has improved regulation of CMF promotions. However, challenges persist in addressing promotions for unregulated products (especially through cross-promotion and digital marketing) and promotions at points of sale and in healthcare facilities.  To strengthen legal compliance, robust monitoring and reporting systems are necessary, including using technology-assisted solutions for monitoring compliance in countries with limited human resources.

While the UK still scores only 40 out of 100 on 2024 Code Status Report, implementation outcomes of national legislation will remain limited.

Read the full paper here and supplementary material here.
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 

Unicef Baby Friendly Initiative Conference (online), Wednesday 20 - Thursday 21 November
This year’s annual conference is virtual and will take place on 20 and 21 November. There’s an exciting and packed agenda, including our Director Vicky who will be presenting on “Formula prices: Greedflation, its impacts, and progress towards mitigation”.  Booking closes 5pm Wednesday 13 November so if you haven’t got your tickets yet, get them here now. See the full agenda and find out more here.
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HR Update
We’re both sad and excited to announce that our nutritionist Rachel will be going on maternity leave in the new year. But, joining the team as a nutrition officer to support our ongoing work, is Jasmine Brand-Williamson. Jasmine is a registered Nutritionist with an MSc in Human Nutrition from the University of Glasgow where she specialised in Public Health. She is passionate about communications and presenting scientific research in an accessible and engaging way. Since completing her undergraduate degree in Zoology from the University of St Andrews in 2017, she worked in marketing and communications and developed an interest in food security and its intersection with public health. For her MSc research project, she focused on commercial foods aimed at children under 36 months. This sparked an interest in maternal and infant nutrition and practices, and the policies which underpin them. As such, she is keen to contribute to the meaningful work of First Steps Nutrition Trust.
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October 2024

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. 
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!
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.
News Infant milk news BFLG-UK news Forthcoming
Happy reading!

News

New report: Drinks marketed as growing up and toddler milks and drinks
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
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
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).
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
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.
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.”
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
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.
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

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

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

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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Infant milk news

SMA news
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 news
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
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.
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.
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 

Latest news from the Competition and Markets Authority on the infant formula market survey

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

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
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

Forthcoming 

The Breastfeeding Network (BfN) Conference and AGM: Saturday 5 October, Online

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

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
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
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.
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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August 2024

Blueberries
Image by onlyyouqj on Freepik

Welcome to the August edition of our newsletter. Please see the contents below. But first, news about a fundraising event…
Our longest serving Trustee, Marjon Willers (a specialist dietitian for schools and early years in Islington, London), is running ‘The Big Half’ marathon in London on Sunday 1 September and is raising funds for First Steps. If you can, please consider donating to support our ongoing work; the link to donate is here. And please do share widely! Thank you.

Please note that due to summer holidays we will not be writing a newsletter in September. The next newsletter will be sent out in early October.
News Infant milk news BFLG-UK news Forthcoming
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News

Updated: Eating Well: The first year
We have made some updates to the last, 2022 version of this resource, to keep it as relevant as possible to the changing context and in line with changing public health recommendations. The significant changes include:
  1. Updating reference to UK public health guidance on infant feeding, which now recommends breastfeeding into the second year of life and beyond, and clarifies that formula milks are not needed after one year of age.
  2. Updates to the table ‘a simple guide to infant milk’ to reflect changes to NHS advice (also updated in our resource: Infant milks: A simple guide to infant formula, follow-on formula and other infant milks, see below).
  3. Adding the new NHS advice on formula preparation machines: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/how-to-make-up-a-feed/#using-a-baby-formula-prep-machine  
  4. Urging caution on shop-bought baby foods, in line with advice from the UK Scientific Advisory Committee on Nutrition which has stated that commercial infant/toddler foods are not needed, and that home-prepared baby foods are preferable. We state:
  • Be wary of marketing: Commercial baby and toddler foods are presented as healthy and suitable choices. However, many contain too much sugar and salt, are too sweet, too smooth and not age appropriate. Labels should be read with caution.
  • Babies don’t need shop-bought baby foods! Home-prepared foods are preferable to introduce baby to appropriate tastes and textures. They are also typically more nutritious than commercial baby foods
  • Babies don’t need snacks! Snack foods (including shop-bought baby finger foods) displace baby’s milk feeds and provide less nutrition.
  1. Revised ‘golden rules’ for feeding in the first year of life as follows:
  • Offer mostly simple and minimally processed foods – Base meals and snacks around real foods. Make sure children can see and touch the foods they are offered, and can connect food tastes to how things look and feel, so they can learn to choose foods for themselves.
  • Avoid or limit use of shop-bought foods aimed at babies and toddlers – The flavours and textures of commercial baby foods do not help babies learn to like real foods. Baby food pouches, jars and packets also often do not contain the right balance of nutrients babies need for healthy growth.
  • Do not give baby ‘junk’ or treat foods like sweets, crisps, chocolate, ice cream and fizzy drinks.
  1. Making explicit that as well as avoiding sugary drinks, all fizzy drinks should be avoided in infancy (and early years) (i.e. including diet/sugar free) because these are acidic (which means they can damage teeth)
  2. Clarified advice on allergies, because we understand that this is a common concern of parents/carers; including adding a reminder that after potentially allergenic foods have been introduced at 6 months, they should then be given routinely alongside other foods. We also acknowledge that there is some evidence to suggest that introduction of hens’ egg and peanut before 6 months may prevent food allergy development. However, safe and acceptable interventions to do this do not yet exist and the public health recommendation remains unchanged: potentially allergenic foods should be introduced at around 6 months.
  3. Lastly, we have also included some new content to address parental concerns about the mess and waste associated with introducing solids.
An updated 2024 PDF version is available here for free, or a contribution should you wish.
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Reminder: Eating Well: Packed lunches for 1 to under-5 year olds
In case you have not seen, we produce a practical guide (updated earlier this year) specifically on creating cost-efficient, healthy packed lunches that meet the nutritional requirements of children between the ages of 1 and 4 years of age, based on unprocessed and minimally processed foods.
 
Research among school-aged children indicates that packed lunches are frequently less healthy than the hot meals provided. There is no similar research available for early years settings, but anecdotal evidence suggests the same may be the case. Parents/carers may also choose commercial products aimed at toddlers and pre-school aged children, considering them healthy and appropriate choices, when this may not be the case.
 
We wanted to highlight this eating well guide now, in advance of the new school year starting in late August/early September (depending on where you are), so you can promote this to parents/carers - including those working in early years settings - who need or choose to provide packed lunches to their children attending nursery, a child minders or reception.
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New paper: Prevalence and risk factors for milk allergy overdiagnosis in the BEEP trial cohort
Allen and colleagues analysed data from a clinical trial population of 1394 children from atopic families born in England between 2014 and 2016. The children underwent formal (gold standard) cows’ milk allergy diagnosis at or before 2 years of age. They found that many parents and health professionals (typically GPs) incorrectly ‘diagnose’ their child as allergic to milk (the estimate was 11-16%), and this may result in unnecessary use of low-allergy formula milks (half of infants with parent-reported milk reactions received a prescription, for a median duration of 10 months). One risk factor for ‘overdiagnosis’ included being exclusively formula fed from birth. Gastrointestinal upset such as diarrhoea, vomiting and reflux were the most common presenting symptoms leading to diagnosis of milk allergy in the first weeks of life. Unnecessary use of low-allergy formula is a concern because lactose is replaced with alternative carbohydrate sources which are categorised as or (in the case of maltodextrins) behave like free sugars, potentially increasing the risk of excessive weight gain and dental decay.  It also costs the NHS a lot of money and may undermine breastfeeding.
The study implies that greater care needs to be taken in the diagnosis of milk allergy, although the key challenge here is that industry influence pervades relevant guidelines (including NICE guidelines). A key reference, developed independently of industry, is this Delphi consensus study.
 
Read the full paper here. Read our report ‘Specialised milks for infants with allergies in the UK’ here.
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The Grocer focus on infant and childcare
The Grocer recently published its report on infant and childcare trends in 2024, highlighting a notable shift in the babyfood category. Between May 2023 and May 2024, baby food sales saw a 2.6% increase in volume, to 142.6 million packs, and a 9.7% rise in value to £192.2 million. In contrast, the broader infant care sector, encompassing nappies and toiletries, experienced a 2.1% decline in volume sales.

Despite the overall growth in baby food, not all subcategories performed equally. Baby finger food enjoyed an 8.6% increase in value, reaching £159.4 million by May 2024. However, baby milk, including infant formula, follow-on formula, and toddler milks, saw a 1.2% decline in value, dropping to £315.9 million. Baby drinks faced a significant drop, shrinking by 81%.

Brand performance varied significantly as well. Among the ten baby food brands evaluated, only four—Little Freddie, Nestlé, Piccolo, and Kiddylicious—reported growth in volume sales. Popular brands like Ella’s Kitchen Organic, Organix, and Cow & Gate saw declines of up to 50.8%. The Grocer attributes this trend partly to rising consumer concerns about infant and child health, driving demand for brands that position themselves as healthy or as viable alternatives to home-cooked meals. This shift is expected to lead to more health-related claims in product marketing as reflected in upcoming product launches, including Little Freddie’s omega-3 pouches, marketed as “supporting brain development,” and Organix Multigrain Quackers, marketed as wholegrain with no artificial colours or flavours.

When supporting families navigating feeding options for infants and young children, it is crucial to note the absence of specific nutrition composition, marketing, or labelling regulations for baby and toddler food products, labelled with ages <36 months. This means that, despite being marketed as such, many products poorly reflect public health recommendations for infant and young child feeding (Public Health England, 2019). Research indicates that many products are misleadingly marketed, with 41% of items labelled as healthy actually being unhealthy.

First Steps Nutrition Trust continues to push for government to implement mandatory standards to improve the nutrition composition and marketing of commercial baby and toddler foods and drinks. These should be aligned with the WHO Europe's Nutrient and Promotion Profile Model and UK public health recommendations, ensuring that any marketing, labelling, or packaging avoids health and nutrition claims that can mislead families.

Both the Scientific Advisory Committee on Nutrition and Public Health England recommend that home-prepared foods are generally recommended to help introduce appropriate flavours and textures. First Steps Nutrition Trust have a range of resources to support eating well in the early years which provide guidance for feeding infants, and ideas for simple, cost-effective nutritious meals, packed lunches and snacks for children over 12 months of age.
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FSA guidance reminder: Slush ice drinks
The FSA issues a reminder of age limits on the sale of slush ice drinks: slush ice drinks containing glycerol should not be sold to children aged 4 or below. Glycerol can cause adverse effects like nausea and headaches in young children, and in severe cases, more serious health issues. Refill promotions to under 10s are discouraged, and retailers of ice slush drinks are recommended to display the warning: "Product contains glycerol. Not recommended for children 4 years of age and under." Read more here.
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Infant milk news

Aldi Mamia first infant formula price drop
Since our latest cost report in April 2024, Aldi have dropped the price of their Mamia infant formula (900g) to £7.99. This means that it can now be bought within the weekly allowance of both Healthy Start and Best Start food schemes, and it remains the least expensive powdered infant formula on the market at 12p per 100ml.
 
Aldi have also introduced a slightly smaller 800g pack of Mamia infant formula which costs £7.09. Based on the assumption that the scoop size is the same across both packs the cost per 100ml of the reconstituted product is the same at 12p per 100ml. It is unclear whether the 800g pack is the same formulation as the 900g pack and the intention is to replace the 900g pack with the 800g pack or whether both products will continue to be marketed. We have sought clarification from Aldi on these points but have not yet had a response. We hope to provide an update in our next newsletter. 
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Updated: Infant milks: A simple guide to infant formula, follow-on formula and other infant milks

We have updated our report A simple guide to infant formula, follow-on formula and other infant milks. Since this report was last updated, there have been some changes to NHS guidance around suitable milks for young children and the updated report reflects these changes. We have also signposted to an additional First Steps resource on plant-based milk alternatives for young children which has also been introduced since the last update. Guidance around formula feeding has been updated to better reflect the concept of responsive bottle feeding and the feeding table has been updated accordingly. We have also made some small changes to other sources of support and information available to parents to reflect updated web addresses and contact details. 
 
The report is available here: Infant milks for parents & carers — First Steps Nutrition Trust
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New editorial: Specialised infant milks: overused, overpriced and obesogenic
This timely editorial written by Vicky and Susan was published on 23 July in the Journal of Clinical and Experimental Allergy. It was informed by, and builds upon the findings of our December 2022 report ‘Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health’.  
 
Despite public health recommendations, most infants in the UK and other countries including China and the USA are predominantly fed a commercial milk formula. For the small number of non-breastfed babies who have special dietary needs that cannot be met by a standard infant formula, a ‘specialised’ infant formula is needed. This editorial identifies the problems in the UK arising from current legislation around the marketing and promotion of these products and explains their causes and consequences.
 
The editorial suggests that limitations in the current regulatory framework around infant formula and infant milks marketed as FSMP is failing to contain increasing, often unnecessary and usually unsupervised use of these products. 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. Ultimately, this is leading to widespread exposure of the world's infants to unhealthy, unnecessary and expensive nutrition products.
The recent ESPGHAN position statement on infant formulas for the treatment of functional gastrointestinal disorders (FGIDs) including regurgitation, colic and constipation corroborates many of the issues raised by the editorial which urges the new Government to take a two-step approach to closer enforcement and improved regulation of the marketing practices of formula manufacturers to better protect infants, however they are fed. The full editorial is available here.
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 

Update on the Competition and Markets Authority infant formula market survey
The Competition and Markets Authority are continuing their infant formula market survey, launched in February this year ‘to investigate supply and if and why the market may not be functioing well for consumers’. We continue to feed in, e.g. sharing our recent analysis of the costs of FSMP, reported on above. The results and recommendations were meant to be published in September. However, the workplan and time have recently been updated as described here. The explanation given is as follows: “Given the timing of the general election and the central role of government policy and regulation in this market, the CMA plans to publish in the autumn an interim report on the market study, and invite views on this. This will help to ensure that the CMA can effectively engage with the UK, Northern Ireland, Scottish and Welsh governments and provides parties the opportunity to submit views on the CMA’s emerging thinking”. On behalf of the BFLG, First Steps will be looking at this consultation and if you would like to see our response prior to the deadline please email 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 X (formerly Twitter) account @BflgUk. You can also email katie@firststepsnutrition.org
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Forthcoming 

World Breastfeeding Week 2024: 1 – 7 August. ‘Strength in numbers’ webinar, Tuesday 6 August
World Breastfeeding Week starts today on 1 August. This year’s theme is ‘Breastfeeding Support for All’. Find out more here.
Among several events during World Breastfeeding Week, on Tuesday 6 August, WHO, UNICEF, and Global Breastfeeding Collective will be hosting the webinar: Strength in Numbers – How monitoring breastfeeding policies and programmes creates accountability and empowers change. Behind every breastfeeding statistic is a mother trying to reach her breastfeeding goals. The webinar will discuss how monitoring policies and programmes is essential to creating an environment that enables breastfeeding. Sign up here.
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NICE consultation on updated guidelines on Maternal and Child Nutrition
The consultation on the draft guideline opened on 30/07/24 and will run for 6 weeks, closing on 11/09/24. As our Director, Vicky was on the committee for this update, First Steps will not be submitting a response. However, we would encourage health workers for whom this is relevant to take time to review the draft guideline and submit a response so that the final guidelines are as robust and useful as possible. See more here.
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SACN consultation on draft SACN and COT report ‘Assessing the health benefits and risks of consuming plant-based drinks’
The invitation to provide comments on the scientific content of this draft report from the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) is open until 17/09/24. For further information about this peer review and links to the documents, see the Announcements section of the SACN webpage. First Steps will be looking at this consultation and if you would like to see our response prior to the deadline please email vicky@firststepsnutrition.org.
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SACN consultation on the draft report ‘Nutrition and maternal weight outcomes’
The invitation to provide comments on the scientific content of this draft report from the Scientific Advisory Committee on Nutrition (SACN) is also open until 17/09/24. For further information about this peer review and links to the documents, see the Announcements section of the SACN webpage. First Steps will be looking at this consultation and if you would like to see our response prior to the deadline please email vicky@firststepsnutrition.org.
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Maternal, parental, and infant nutrition and nurture unit (MAINN) conference: April 2025
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 to 30 April in 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.
Find out more about the key note 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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HR Update

Goodbye to Susan!
We’re extremely sad to share the news that, after 13 years at First Steps - its whole lifetime to date – our Senior Nutritionist Susan Westland has decided to hand her notice in to take a break from the world of early years nutrition. Susan’s deep expert knowledge has been foundational to First Steps success to date. Whilst not usually engaged in much outwardly facing work, behind the scenes Susan has contributed to the majority of our reports, papers, resources and consultation responses. In particular, it is her knowledge, hard work and dedication that has yielded our infant milk info website.
 
Susan leaves behind a huge legacy which we’re proud has helped many health workers support families with feeding their babies, as well as supporting families directly. We’re going to miss her, and she leaves huge shoes to fill but we will do our best to continue her work which we know many of you rely on. We hope you will join us in thanking Susan for all that she has done during her time at First Steps.
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July 2024

Cherries
Image by Frimufilms on Freepik

Welcome to the July edition of our newsletter. Please see the contents below. But first, we wanted to explain what we’re doing with our resources, as you may have seen changes to our webpages.
Accessing First Steps resources
 
We are gradually changing the way users can access our resources, to gather info on how they are being used. When you download a PDF, you will be asked for some information about yourself, which will be anonymised and used solely to demonstrate our reach and relevance to our current and future donors. For our Eating Well resources, you will also be asked to consider contributing towards the costs of maintaining these resources, including keeping them up to date and in line with the latest UK public health recommendations*, and relevant to the changing context. Don’t panic - there is still the option to download for free!
 
Some resources are available for sale as hard copies. We don't make a profit from sales but we have had to slightly increase our prices to better account for the full costs of production, i.e. not just printing, postage, and packaging. These costs include technical staff time to update, designer costs to make amends, and administrator time to manage orders and mailouts. Current prices still don't fully cover these costs, so we will need to increase sales if we are to be able to continue offering hard copies.
 
If you have any suggestions or questions please don’t hesitate to get in touch with Vicky vicky@firststepsnutrition.org.
 
*We are in the process of updating our resources to take into account changes to NHS webpages made in April this year (see our May newsletter).
News Infant milk news BFLG-UK news Forthcoming Happy reading!

News

General Election 2024
It’s election day! Sadly, we saw very little mention of babies or early years nutrition in any of the party manifestos. We’re poised for the election result and will be working hard thereafter to influence incoming politicians to take on board our policy asks as outlined in this position statement: Healthy Early Years Diets: Achieving the Best Start in Life, which we led on writing with the support of peers and the Obesity Health Alliance.
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New survey: The Cost of Living and Maternity Leave
Maternity Action have published their third annual survey tracking the impact of the cost of living crisis on pregnant women and new mothers. The survey was promoted through social media outlets and includes information from 1,039 women.
 
Maternity leave has a significant financial impact on many women in the UK, who have some of the lowest rates of maternity pay among European countries. Most women are reliant on statutory maternity pay (£184.03 per week compared to £677 average weekly earnings), and others just Maternity Allowance. This is causing significant stress and worry not only during maternity leave, but throughout pregnancy and upon returning to work.
The survey also highlighted that women struggled to feed themselves and their children whilst pregnant or on maternity leave:
  • Half bought less healthy food and a quarter went without food themselves to prioritise feeding their children (38% of mothers were having smaller meals or skipping meals altogether).
  • 13% struggled to afford to buy formula milk and 27% cut down on buying food for themselves or their family because of the high cost of formula.
Furthermore, 59% returned to work earlier than they wanted to because of money worries (this is the highest proportion since the survey began in 2022, at which point 42% returned to work earlier than they wanted to because of money worries). This has implications for women being able to achieve their breastfeeding goals.
 
Maternity Action outline a series of recommendations for Government to tackle ‘pregnancy poverty’ and ensure pregnant women and new mothers can access their rights and entitlements. We support these recommendations, whilst noting that new models of maternity, paternity and parental leave should protect the maternity leave necessary to support the breastfeeding rights of women and their infants, who have unique needs and vulnerabilities.       
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New paper: What factors drive parents’ choice of baby food products?
This paper by Hollinrake et al, provides important new insights into what motivates UK mothers to use commercial baby foods, and for those that avoid them, why. The study was undertaken in the summer of 2021 and used an online survey among self-selected parents of babies under 1, yielding a sample of 271 questionnaires from predominantly highly educated, White/White British mothers. 173 used commercial baby foods while 98 did not.
 
Building on previous limited research, they find that the top reason for choosing commercial baby foods is convenience (95% agreed/strongly agreed), followed by time saving (88%), baby liking them (77%), being safe (75%), then being perceived as a good way to introduce new tastes and textures (51%). Worryingly, 40% were motivated by a healthcare professional recommendation. Answers also indicated some influence of marketing, through money off coupons, promotion on social media and in baby magazines.
 
45% of mothers said they gave their baby commercial baby foods daily, and vegetable puffs/sticks were the top-ranking type offered (25% gave every single day).
Among the rich findings, the top motivations for using purées were versatility, enjoyment and convenience. Mothers liked the fact that their babies could suck straight from the pouch (against manufacturer and public health advice), and that they enjoyed them and didn’t refuse or waste them (not surprisingly – as pointed out by the authors - given their high levels of sugar). For baby snacks, convenience and no mess were motivations, as were their utility for distracting babies and keeping them happy, and self-feeding (the authors unpack the downsides of avoiding mess and using food for comfort). These products were considered safe (from choking) and healthy (because of low salt and sugar levels). Inquiry into brand perceptions revealed a high level of trust among mothers, who also buy in to marketing messages around ‘natural’ and nutritious ingredients, of high quality.

The 98 mothers who did not use commercial baby foods reported not needing them, not trusting them, finding them expensive, and preferring home-made foods which they perceived were healthier.
 
The authors recommend stronger legislation on commercial baby food composition and marketing to enable parents to make informed choices. They also highlight how those supporting parents with complementary feeding need to be aware of the study’s findings.
 
We agree with these recommendations and would like to highlight this statement in the Scientific Advisory Committee on Nutrition’s 2023 guideline on feeding young children aged 1-5 years: ‘Home-prepared foods are generally recommended to help introduce infants and young children to a range of appropriate flavours and textures’.
 
An additional observation we would like to make is that despite this view from SACN, the NHS guidance does not currently explicitly advise parents to choose home-prepared foods over commercial baby foods or advise caution in relation to baby food marketing. Until this guidance is clarified, and especially while marketing remains unchecked, our view is that misconceptions will persist among parents. 
 
The full paper can be accessed here.
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Updated: Recommendations on giving water in infancy
We’ve already had one heatwave warning this year, and there may be more, so we have updated our guidance on giving water in infancy available here and the accompanying infographic as shown. Please note that, as with all our resources, this advice is aligned with NHS guidance.
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New report: Commercial determinants of non-communicable diseases in the WHO European Region
WHO Europe have published a report documenting the significant harm caused by the tobacco, ultra-processed food, fossil fuel and alcohol industries. The report outlines the tactics used by these commercial sectors, who have a disproportionate influence on health policy across the 53 member states of the European Region, driving inequalities, ill health and premature mortality. Globally, these industries contribute to 19 million deaths per year (34% of all deaths), of which 2.7 million deaths per year (7000 per day) occur in Europe.

The report documents the common goals of these commercial sectors, to generate profit, maximize product sales and drive consumption. This has enabled industries to consolidate into a small number of powerful transnational corporations with significant influence over the political and legal contexts in which they function. Case studies are presented which reveal common industry tactics, used to undermine public health and maximize profits. These include:
  • Obstructing public health regulations through political lobbying, harmful financial practices and shaping scientific evidence
  • Exploiting vulnerable groups (including children) through targeted marketing strategies, misleading consumers and making false claims about the health and nutritional benefits of their products
  • Shifting public discourse through spreading misinformation and disinformation in the media
These tactics are extensively documented in the Lancet Breastfeeding Series 2023, which gives an overview of the influence of the commercial milk formula industry on governments, science, and health-care systems. Further evidence of profiteering by formula brands, who protected or increased their substantial profit margins during the cost of living crisis, was provided by a report by the Competition and Markets Authority. Similar tactics are used by the commercial baby food industry to undermine public health recommendations on feeding young children from 6 months of age as outlined in our report on ultra-processed foods in the diets of infants and young children in the UK.  

The report notes that, to date, efforts by Governments and intergovernmental organisations to prevent or limit commercial actions that are harmful to public health have been inadequate. They call on the 53 member states of the European Region to recognize the impact that the tobacco, ultra-processed food, fossil fuel and alcohol industries have on public health, and to take action to identify conflicts of interest to protect public policy and political economic systems from industry interference.

This echoes our call to UK Government that health policy must be protected from commercial influence through the development of fair and ethical principles for interacting with the food industry underpinned by the latest evidence on the commercial determinants of health; see more in our joint position statement with the Obesity Health Alliance: Healthy Early Years Diets: Achieving the Best Start in Life.
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Infant milk news

New: ESPGHAN position on anti-reflux and comfort milks
The ESPGHAN Nutrition Committee has published a new position statement on infant formulas for the treatment of functional gastrointestinal disorders (FGIDs) including regurgitation, colic and constipation. This is therefore relevant to infant milks marketed in the UK as ‘anti-reflux’ and ‘comfort’ milks. Their review, which included 72 papers, was conducted with the aim of providing evidence-based guidelines for clinical practice.
The committee identified 2 issues with current specialised infant milks formulated to address these common feeding issues:
  • the evidence supporting their effectiveness is limited
  • some have altered nutritional compositions when compared to standard formulas and so these products should only be used under medical supervision and upon medical advice - marketing and over‐the‐counter sales do not ensure proper medical guidance and supervision. 
This corroborates some of the key points that we raised in our 2022 report  ‘Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health’  (summarised in our infographic, as shown)
In their review, the committee examined the safety and efficacy of different compositional modifications to infant formula marketed for the management of FGIDs. The key messages from their review included that in general, for breastfed babies with FGIDs, breastfeeding should not be stopped in favour of formula milk. Regardless of feeding method, non‐nutritional interventions should be used as the first line management of FGIDs, and parents should be reassured that FGIDs are normal, and most infants do not require treatment or a change of formula type. Where infants are experiencing one or a combination of mild FGIDs, breastfeeding should not be stopped - the use of specialised formula milks for combined FGIDs is generally not advised.

Review findings linked to functional constipation
The committee reported that formula milks with high β-palmitate and magnesium levels at the higher end of the regulatory threshold may be considered to soften stool, however there was insufficient evidence to support their routine use in the treatment of constipation. This recommendation is new as previous ESPGHAN and NASPGHAN evidence-based recommendations on infant constipation did not  consider formulas with high β-palmitate and an elevated magnesium content in their evaluation. The EFSA review on infant formula composition (EFSA, 2014) included infant milks with increased levels of β-palmitate but reported no benefits for their use in infants. The NHS currently suggest that constipation in formula fed infants can be treated with additional drinks of water and there is no advice to change formula.

Review findings relating to colic
There is no evidence for the efficacy of specialised infant milks for colic. This supports NICE clinical guidance that does not include any recommendations related to formula milk but includes a range of strategies including soothing techniques babies and offering reassurance and information on sources of support for parents (NICE CKS, 2022). The NHS also suggest practical and soothing strategies for colic as well as signposting to sources of support for parents.

Review findings relating to simple regurgitation
The evidence review concluded that some ‘anti‐reflux’/ ‘anti-reflux’ thickened formulas reduce the number of visible regurgitations but there is no evidence that protein hydrolyzation or fermentation offers a further benefit to thickening.  The subsequent recommendation is that in breastfed infants with regurgitation, breast milk can be expressed and supplemented with thickening agents and in formula fed infants, ‘anti-reflux’ formulas, or formulas with appropriately added thickeners can be considered in special cases under medical guidance. To avoid overfeeding it is generally preferred to use low‐energy thickeners such as locust bean or guar gum. This position differs from a previous 2002 ESPGHAN commentary on anti-regurgitation milk products for children in that it suggests that some thickened anti reflux milks may reduce visible regurgitation in some infants and may be considered in some cases for use under medical supervision. The 2002 commentary recognised that there is some evidence that anti-reflux milks can reduce regurgitation in some infants but their use in infants with simple reflux was not supported on the grounds that there is no conclusive information available on the potential effects of thickening agents on the bioavailability of nutrients and growth of children, or on mucosal, metabolic and endocrine responses.

This current ESPGHAN position supports NICE guidance and quality standards in the UK (NICE, 2015, NICE 2016), which states that regurgitation is a common and normal occurrence in infants and does not usually need any investigation or treatment, however a trial of thickener added to milk or a thickened infant milk is suggested only where (rarely) there are significant symptoms of frequent regurgitation with marked distress, and only after a review of feeding history, and a reduction in feed volumes where appropriate, or an increase in frequency of feeds, have been attempted.
Watch this space (and X/formerly Twitter) for a forthcoming editorial in which we share our latest thoughts on the marketing of infant FSMPs in the UK, building on our 2022 report.
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 

World Health Assembly Side Event on Digital Marketing of Breastmilk Substitutes
The 77th World Health Assembly (WHA) took place from 27 May – 1 June 2024. A Side Event was held on 28 May 2024 to discuss the Digital Marketing of Breastmilk Substitutes. The Side Event was organised by the International Baby Food Action Network (IBFAN), Save the Children, UNICEF, the International Lactation Consultant Association (ILCA), and the World Obesity Federation (WOF), and co-sponsored by Bangladesh, Brazil, Kenya, Lesotho, and Mexico. Presentations shared new evidence on the concerning increase in the digital marketing of breastmilk substitutes and the influence on pregnant women, parents and society. A summary of the Marketing of breast-milk substitutes: national implementation of the International Code, status report 2024 was shared together with an explanation of the 2023 WHO Guidance on regulatory measures aimed at restricting digital marketing of breastmilk substitutes. The Side Event concluded with a panel discussion between representatives from the five Member States about what can be done to strengthen the regulation of digital marketing of breastmilk substitutes. A recording of the Side Event is available on the Global Breastfeeding Collective YouTube channel here: https://youtu.be/DBGF7-UGNYc
 
During the 77th WHA discussion on Agenda item 15.2 on “maternal, infant and young child nutrition”, Brazil announced that 27 countries are advocating for a resolution on digital marketing of breastmilk substitutes to be tabled at the 78th World Health Assembly in 2025. This is an important commitment, and we look forward to seeing this progress.
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 

Infant milk info webinar: online, Wednesday 17 July
Following our first webinar in June, we will be delivering our second webinar on Wednesday 17 July from 10:30am until 11:30am, 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. You can register here.
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Breastfeeding Network conference: online, Saturday 5 October
Ticket sales are open for the BfN annual conference aimed their volunteers, parents, families and health professionals with an interest in breastfeeding and related topics. Speakers will be announced in due course. Find out more here.
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Nourishing Futures Network conference: Newcastle, Tuesday 22 October
The Nourishing Futures Network is an international collaboration seeking to exchange and generate new knowledge to solve food insecurity during preconception, pregnancy, and early life. Their first international conference is taking place in Newcastle upon Tyne, UK on Tuesday 22nd October 2024. They want to bring together early-career, mid-career, and senior experts in food security during the first 2001 days, whose interests span mechanistic, social, policy, and practice dimensions. We will be exhibiting, so come and say hello. Early bird ticket sales end on Monday 22 July. More here.
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Unicef Baby Friendly Initiative conference: online, 20 - 21 November
This year’s annual conference is online. They’ve opened applications for posters, with a deadline of Friday 9 August. We are among the speakers lined up and will be presenting our work on monitoring and advocating for regulation of infant formula prices, in the context of strengthening marketing restrictions. Early bird ticket sales end on Wednesday 31 July. Find our more here.
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June 2024

Image by ededchechine on Freepik

Welcome to a bumper June edition of our newsletter, featuring:
News Infant milk news
BFLG-UK news
Forthcoming
Happy reading!

News

General Election 2024: Our policy asks for Healthy Early Years Diets
 
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.

News: Giving babies smooth peanut butter could provide lifelong allergy defense
 
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:
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
 
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.
Where more detailed information or additional recipes may be useful, early years providers may like to refer to First Steps Eating Well resources
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
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
The Cabinet Office has issued this new guidance for the public on how to prepare for and manage emergencies.
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
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.
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
 
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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Update on Healthy Start
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.
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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Infant milk news

Product update: SMA Soya out of stock

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
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. 
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 

Marketing of breastmilk substitutes: National implementation of the International Code, status report 2024
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.
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.
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 

The World Public Heath Nutrition Association Congress: London, 10 - 13 June
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*
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

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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May 2024

Blossoms
Image by wirestock on Freepik

Welcome to the May edition of our newsletter, featuring:
News Infant milk news BFLG-UK news Forthcoming Happy reading!

News

Updated: UK public health recommendations on infant and young child feeding
In July 2023 the Scientific Advisory Committee on Nutrition (SACN) published new guidelines on feeding young children aged 1-5 years. These guidelines made a series of recommendations and two weeks ago we were informed that the UK Government has accepted these recommendations and made changes to certain NHS webpages accordingly.

SACN reiterate that “current UK dietary recommendations as depicted in the Eatwell Guide should apply from around age 2 years with…exceptions” which are explicit in the web pages which have been updated, along with additional recommendations relevant to 1-5s.

The NHS web pages that have changed are:
The SACN 2023 recommendations that we can see made explicit in these webpages are:

Drinks:
  • Milk or water, in addition to breast milk, should constitute the majority of drinks given to children aged 1 to 5 years.
nb The NHS now states:
  • The World Health Organization recommends that all babies are breastfed for up to 2 years or longer.
  • Breastfeeding up to 12 months is associated with a lower risk of tooth decay.
  • Children aged 1 to 5 years should not be given sugar-sweetened beverages.
  • Formula milks (including infant formula, follow-on formula, ‘growing-up’ or other ‘toddler’ milks) are not required by children aged 1 to 5 years. 
nb The following additional details on the NHS webpages are important to inform advice/practice:
  • 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.
  • Diet or reduced-sugar drinks are not recommended for babies and young children. Even low-calorie drinks and no-added-sugar drinks can encourage children to develop a sweet tooth.
  • Pasteurised whole and semi-skimmed cows’ milk can be given as a main drink from age 1 year as can goats’ and sheep’s milks.
  • Pasteurised skimmed and 1% cows’ milk should not be given as a main drink until 5 years of age. These lower fat milks can be used in cooking.
  • Children aged 1 to 5 years should not be given rice drinks as they may contain too much arsenic.
Foods:
  • Children aged 1 to 5 years should be presented with unfamiliar foods/vegetables on multiple occasions (as many as 8 to 10 times or more for each food/vegetable) to help develop and support their regular consumption (nb SACN focus their recommendation on vegetables, whereas the NHS webpages talk about foods more generally).
  • Dairy products (such as yoghurts and fromage frais) given to children aged 1 to 5 years should ideally be unsweetened.
  • Deliberate exclusion of peanut or hen’s egg (and foods containing these) beyond 12 months of age may increase the risk of allergy to the same foods. Importantly, once introduced, these foods should continue to be consumed as part of the child’s usual diet in order to minimise the risk of allergy to peanut or hen’s egg developing after initial exposure.
  • Children aged 1 to 5 years should continue to be offered a wide range of foods that are good sources of iron.
  • Salt should not be added to foods given to children aged 1 to 5 years.
Vitamin supplements:
  • Children aged 1 to 5 years should be given a daily supplement of 10μg (400 IU) vitamin D and 233μg vitamin A unless, contrary to recommendations, they are consuming more than 500ml of formula milk per day. (nb. SACN go on to state: “Vitamin C supplements are not necessary for the general population. However, there is no evidence that taking vitamin C supplements at the current recommended level of supplementation has any adverse effects”. This in part explains why NHS recommendations to give vitamins D, A and C are unchanged). 
This recommendation of SACN is addressed implicitly:
  • Between 1 to 2 years of age, children’s diets should continue to be gradually diversified in relation to foods, dietary flavours and textures. A flexible approach is recommended to the timing and extent of dietary diversification, taking into account the variability between young children in developmental attainment and the need to satisfy their individual nutritional requirements.
These recommendations of SACN have not been addressed explicitly, but it is important that they inform health worker advice/practice:
  • Specialised formula, including low-allergy formula, are also usually not required after the first year of life.
  • Foods (including snacks) that are energy dense and high in saturated fat, salt or free sugars should be limited in children aged 1 to 5 years in line with current UK dietary recommendations.
  • Commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements.
On the latter, it is worth noting this statement by SACN (2023) (page 37): “Home-prepared foods are generally recommended to help introduce infants and young children to a range of appropriate flavours and textures”. And also this recommendation by NICE in the Maternal and Child Nutrition Guidelines (2014): “Encourage and support parents and carers to make home prepared foods for infants and young children, without adding salt, sugar or honey”.

Our opinion at First Steps Nutrition Trust is that more explicit messaging both encouraging the use of home-prepared foods and discouraging the routine use of commercial baby and toddler foods would be helpful to parents/carers. This is because research tell us parents/carers implicitly trust the widespread misleading marketing messages on such products, which do generally do not align with public health recommendations for feeding these age groups (as outlined by PHE in their 2019 evidence review).

Lastly, SACN also make these recommendations which are important health workers know, but not relevant for the NHS webpages:
  • UK dietary recommendations on average intake of free sugars (that free sugars intake should not exceed 5% of total dietary energy intake) should apply from age 1 year.
  • Children aged 1 to 3 years should, on average, aim to have no more than 2g of salt per day; the figure for children aged 4 to 6 years is 3g per day.
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Updated: First Steps’ Eating Well Packed Lunches for 1-under 5 year olds

We have updated our packed lunches Eating well guide to reflect the updated guidance on Feeding young children aged 1-5, published by the Scientific Advisory Committee (SACN) on Nutrition last July. The guide provides practical guidance for anyone who is preparing packed lunches for children aged 1-4 years and may be particularly useful to early years settings who want to provide guidance to families and child carers about how to provide a nutritious, cost-effective and practical packed lunch for children of this age. Packed lunches that cater for vegan, vegetarian, gluten-free, egg-free and dairy-free diets are included.
All recipes also meet the energy and nutrient requirements for a main meal for children aged 1 to 4 years and the guide includes photos of portion sizes appropriate for different age groups. Evidence linking greater portion sizes of meals and snacks offered in preschool settings to higher short-term food and energy intakes (SACN, 2023) highlights the importance of preparing appropriate
portion sizes for children.

All of our resources are free to download from here and some are available to purchase as hard copies via this link.
 
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New paper: “Either something is wrong or I am a terrible parent”
This qualitative systematic review by Amy Dobson et al, aimed to explore parents' experiences of unsettled babies (defined as perception of excessive crying with additional feature such as vomiting, skin or stool problems) and medical labels.
 
Background: Normal unsettled baby behaviours are increasingly attributed to medical causes such as cows' milk allergy and gastrointestinal disorders such as reflux. The formula industry contributes to this issue, through funding and influencing healthcare professional training and clinical guidelines, as well as marketing to parents in ways which heighten health concerns around common baby behaviours such as crying and vomiting. This undermines breastfeeding and leads to unnecessary or ineffective medication use, with associated risk of side effects.
  • NHS spending for specialist milk formula increased by 700% from £8.1 million to £60 million between 2006 and 2016, without evidence of any increase in allergy prevalence.
  • Prescribing rates of medications for reflux increased between 2010 and 2016, introducing risks of side effects and a range of potential negative impacts on dietary and nutritional outcomes for the parent and baby in the short and long term.
 
Results: The review included 10 studies globally (2 of which were conducted in the UK), and found that parents expressed fearing judgement, feeling guilty and out of control as a result of babies' unsettled symptoms, and sought strategies to construct an ‘Identity as a “Good Parent”’. The ensuing cycle of ‘searching for an explanation’ (including external, medical causes) leads to considerable distress which is exacerbated by feelings of guilt and failure.
 
Parents' accounts almost universally linked unsettled baby behaviours to feeding and parents often were quick to blame breastmilk. Negative emotions emerged around infant feeding and repeated changes were made to parent/baby diet.
 
Parent quote: ‘We started our cycle of chiropractors, reflexologists, homeopaths, medication for reflux; we changed his formula a hundred times; we have a hundred bottles, a hundred teats; it was this desperate clinging to something’ (Cox & Roos, 2008)
 
Implications for practice: The authors suggest that the insight gained from this review could inform interventions to support parents, reducing inaccurate medicalisation. It is recommended that health visitors, nurses and midwives should be aware that parents seeking help for unsettled baby behaviours frequently feel dismissed or ignored. Care should therefore be taken to validate the parent's experience and listen to their concerns, maintaining an awareness of key medical red flags. Health visiting teams supporting parents with unsettled baby behaviour could focus on supporting a positive parenting identity by managing expectations, normalising the continuum of infant behaviours, reducing feelings of guilt or uncertainty, and helping parents regain a feeling of control.
 
Read the full paper here.
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New manifesto: Our Children, Our Future parents’ manifesto
The Children’s Food Campaign, hosted by Sustain, commissioned a national polling of parents with children under 18 to find out their opinions on the biggest challenges faced by parents in the current food system and their top priorities for change. Over 2,000 parents were surveyed in January of this year. Their views and perspectives were used to develop a parent’s manifesto, which also incorporates the opinions of 13 children’s food parent ambassadors.
 
National polling revealed that parents are concerned about the cost of food, their children’s dietary habits (7 out of 10 expressed worry about what their children are eating) and promoting healthy eating habits among their children (8 out of 10 parents perceive that it is getting harder to promote healthy eating). Parents are also becoming increasingly concerned about the quantity of ultra-processed foods available to children.
 
Parents were asked to indicate their support for possible future government policies that could help to improve children’s food. Of note for infants and young children was parental support for policies including state-funded nurseries to provide food that is nutritious and healthy (supported by 86% of parents surveyed), the expansion of funding for voucher schemes for low-income families (supported by 80% of parents) and standards to ensure that ingredients and marketing of baby foods support good nutrition (supported by 78% of parents). These results provide valuable evidence for ongoing advocacy for government action to improve the Healthy Start scheme (as outlined in the Healthy Start Working Group policy position) and to improve the commercial baby food offer (see our recent written response to the latter here).
 
The Future parents’ manifesto outlines five key pillars for government action, including;
  • to make free, healthy and sustainable school food a priority for all children, including those in nursery
  • to ensure honest and trustworthy information on food and drink packaging, including removing misleading health claims on children’s food
  • to make nutritious food affordable and accessible for all families, including reforming the existing Healthy Start scheme
First Steps Nutrition Trust support this call to action, and we will continue working alongside peer organisations to advocate with Government to take actions to support safe and appropriate infant and young children feeding to ensure that all children can achieve optimal growth, development and health.
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Updated training modules: NHS Health Education England’s e-learning for healthcare: Healthy Child Programme. Growth and Nutrition modules
Did you know that elearning for healthcare (elfh) is an online platform that offers more than 400 e-learning programmes for healthcare professionals? These programmes are developed in collaboration with organisations like the Royal Colleges, Department of Health and Social Care and others. One collection of 13 modules available is the Healthy Child Programme (HCP). These modules focus on the health and well-being of children in the early stages of life from pregnancy through to the first five years of life. Module 8 of the HCP is all about Growth and Nutrition.
 
We at First Steps Nutrition Trust have been updating some sessions in this module. The updated sessions are:
   
The HCP resource is designed to support the range of healthcare professionals involved in caring for pregnant women, infants and young children, including health visitors, nurses, midwives, general practitioners, paediatricians and obstetricians, dietitians, and speech and language therapists. Health and care professionals need to register to access the e-learning portal and access is free.
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New: Access to Nutrition Initiative reports on the global commercial baby food and breastmilk substitute industries
 
On 26 March 2024, the Access to Nutrition Initiative (ATNI) launched their most recent global Breast-milk Substitutes (BMS) and Complementary Foods (CF) Marketing Indexes 2024. A recording of the 2-hour launch event is available here. Companies are assessed on two main components which evaluate the extent to which company policies and practices align with the various provisions of the Code and subsequent World Health Assembly (WHA) resolutions:
 
  • The Country Studies measure companies’ marketing practices in selected countries and for this Index, five countries were selected representing companies’ primary baby food markets (China, Germany, Indonesia, Vietnam and the USA).
  • While the UK was not included as one of the countries for this index, the Corporate Profile assessment examines global corporate policies and procedures and level of disclosure and Nestle, Danone, and HiPP which market their products in the UK, are all included in this assessment.
 
The BMS Marketing Index assessed company policies and practices on the marketing of breast-milk substitutes, for use from 0 months up to the age of three years. The 18 companies assessed on ATNI’s BMS Marketing Index 2024 represent approximately 76% of the global BMS market. There is a 63-page full report and 5-page executive summary. No companies achieved full compliance with the Code. Like findings observed in the UK, nearly all product labels assessed (98%) were found to contain one or more incidences of non-compliance with the Code, (e.g. including claims and the absence of a statement on the importance of exclusive breastfeeding in the first six months of life and continued breastfeeding for up to two years or beyond).
 
The CF Marketing Index assessed the marketing of commercial complementary foods (including baby porridge and cereals, snack foods, baby teas and juices for infants and young children aged 6-36 months). The 10 companies (including Danone, Hipp and Nestle) assessed represent approximately 49% of the global CF market. There is a 53-page full report and 5-page executive summary. None of the 10 companies assessed fully align with the Code and guidance on appropriate promotion of foods for infants and young children in policies and practice. A concerning finding was that not one company committed to stop selling complementary foods marketed under 6 months of age
 
While the results produced by ATNI are useful and highlight low compliance by companies, there have been some criticisms (including in peer-reviewed literature and by civil society organisations such as IBFAN) of the assessment methodology used. ATNI tends to rely on information that is provided by companies themselves and not always available in the public domain. ATNI also evaluates corporate efforts to influence public policy in a limited way, through self-disclosure by companies. Companies have also used the ATNI results for their own marketing purposes despite continued non-compliance with global guidance and national legislation. We would therefore advise caution when using this data.
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Infant milk news

Updated: infant milk costs report and trends analysis

Costs of infant formula, follow-on formula and milks marketed as foods for special medical purposes available over the counter in the UK
Our latest review of the cost of infant milks reveals the following:

Within brand, big packs (2 x 600g) remain one of the least expensive options for buying infant formula. Cow & Gate and Aptamil are both available as big packs and Nestlé have recently introduced a big pack format to their SMA Pro infant formula brand. The 1200g packs (2 x 600g) of SMA Pro offer better value for money (18p/100ml) than the equivalent 800g packs (21p/100ml).

For parents who are willing to switch brands, there are greater potential savings available. The least expensive standard sized pack of powdered infant formula (PIF) is Aldi Mamia (900g) at £8.49 a can (12p/100ml). The next least expensive PIF is Cow & Gate in a big pack format which costs £12 for 2 x 600g packs (13p/100ml), however buying big pack formats requires families to pay a greater up-front cost, and these packs are not available in all retail contexts.
For parents who are willing to shop around, there are some significant differences in cost between the same brand of infant formula or follow-on formula when bought from different high street retailers. Table 7 in our cost report shows that across the retailers we have looked at:
  • Cow & Gate infant milk powder in a big pack format (2 x 600g) which is one of the least expensive ways to buy infant formula varies in price between £12.00 (13p/100ml) at Asda, Boots, Tesco and Sainsbury’s and £12.50 (14p/100ml) at Morrisons.
The price of SMA Little Steps varies between retailers and if bought at Morrisons costs £7.90 per 800g can (13p/100ml) or £7.95 (13p/100ml) at Asda, Tesco Sainsburys or online at Iceland which makes it comparable to Cow & Gate big packs. Buying SMA Little Steps at Boots where it costs £9.75 (16p/100ml) is more expensive.

Cost of powdered infant formulas in the UK: How have they changed since January 2021?
Our latest infant formula cost trend analysis reveals that since November 2023 (when the CMA published its first report including analysis of infant formula using First Steps data):
  • The majority of infant formula prices have remained static.
  • Small reductions in the unit prices of Aptamil, Aptamil Advanced and Aldi Mamia have resulted in a decrease of 1.8% in the average price of powdered infant formula (compared to an average price rise of 22% over the period March 2021 to April 2023, from an already high base).
  • With the recent fall in price, Aldi Mamia has become again affordable with the Healthy Start allowance of £8.50/week (and based on the cost per 100ml of made-up formula, it costs £33.00/month to feed a 10 week old baby Mamia infant formula compared to the monthly value of the Healthy Start allowance of £34.00/month). No other branded products cost <£8.50/unit.
  • Price differentials between different brand’s ‘standard’ and ‘premium’ products are decreasing; there is now no difference in price between Aptamil (800g) and SMA Pro (800g) and a difference of 2.8% between Aptamil Advanced (800g) SMA Advanced (800g).
Graph 1. Unit cost of all brands cows’ milk based powdered infant formula.
As brand loyalty is a common factor influencing choice of infant formula, the latest price reductions on Aptamil are good news for brand loyal Aptamil customers, although it is important to note that Aptamil remains one of the more expensive infant formula brands and despite the recent very small price reductions, parents willing to swap brands could make further savings.

The DHSC has recently updated its wording on its NHS Better Health Start for Life website to state:

“All infant formulas will meet your baby's nutritional needs, regardless of brand or price.”

and 

“By law, all infant formula sold in the UK must meet the same standards, which means they are all suitable for your baby's growth and development.”

To summarise, some infant formula prices are coming down a little, but overall it remains an expensive and yet essential food item for many. Government action is needed to bring prices down more meaningfully across the board and in the long term, and to ensure accessibility for those families on low incomes that need it, while protecting and supporting breastfeeding. As reported in the First Steps April newsletter, we submitted this evidence and recommendations  into the Competition and Market Authorities latest investigation, which will report in September.

For those of you advising parents/carers on economical formula and food choices for their babies and young children, our infographics may be of use:
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New formula preparation product which claims to reduce colic
Tommee Tippee have introduced a new formula preparation device to their infant feeding range which claims to reduce colic in babies fed formula milk. The claims made for the Colicsoothe include:
  • This vacuum technology removes air from baby’s milk. For even less gas, even less stress and even more sleep.
  • Parents saw a 40% reduction in average crying time after 2 days of use*.
  • After using Colicsoothe, parents notice that their baby cries less, is more comfortable and less gassy*.
  • And 9/10 parents said it helped their baby feel better*.
  • Proven relief for reassurance when feeding, and a calm, comfortable baby.
Claims marked with an asterisk are based on a small in-home consumer test including 26 UK and 24 US parents who had self-identified their baby as having colic. Parents were asked to confirm the average time that their baby cried prior to using the product, and every day for 6 days whilst using the product. Parents reported that the average time that baby cried reduced from 91 minutes to 55 minutes over two days from using Colicsoothe. The degree of manufacturer involvement with the study is not clear from the information provided.

Using the device appears to be quite awkward as the feeding bottle containing the made-up formula must be placed without a lid and teat into a column shaped flask. The rechargeable lid of the flask creates the vacuum that removes air from the formula milk. The user must then manoeuvre the open bottle out of the flask before screwing the lid and teat back on.
Image credit: newbornbaby.com.au
Aside from the lack of scientific evidence to support the claims made, the Colicsoothe introduces a further handling stage and another container to the preparation process which increases the risk of bacterial contamination. This could be mitigated by ensuring that the flask and its lid are clean and dry before use, however, the flask cannot be cleaned in a dishwasher or sterilised and the lid of the flask is wipe clean only.

Swallowing air is only one of a few factors thought to contribute to colic and so the Colicsoothe only has the potential to be effective for babies who are unsettled due to swallowing air with feeds, and comments from parents on the manufacturer’s website seem to reflect this. Shaking formula powder to mix or using a prep machine are obvious ways for air to get into a feed, however leaving bottles to cool from reconstitution temperature to feeding temperature should allow much of the air to be released. The extent to which the Colicsoothe can increase air removal is not clear and excess air is not always the cause of colic. The NHS recommend positioning your baby in an upright position during feeding and winding after feeds as methods of soothing a baby who has colic which may be related to swallowing air with feeds.

The impact that an unsettled, frequently crying baby can have on parents is well understood (see above our reporting on Dobson et al’s paper “Either something is wrong or I am a terrible parent”) and so this product is likely to have broad appeal, however, it is important that any parents considering buying this relatively expensive (£39.99) and, in our opinion, unproven product are aware of its limitations and the increased risk of contamination.
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 

WHA 77 Side event on Maternal, infant, and young child nutrition: Digital marketing of breastmilk substitutes
The 77th World Health Assembly (WHA) will be  held in Geneva, Switzerland, from 27 May – 1 June 2024 with the theme All for Health, Health for All. 2024 is a reporting year for Maternal, infant, and young child nutrition (MIYCN) and so this is on the Agenda, item 15.2. A Side Event taking place on Tuesday 28 May 2024, on MIYCN with a special focus on the digital marketing, is being co-organised by the International Baby Food Action Network (IBFAN), the International Lactation Consultants Association (ILCA), Save the Children and UNICEF. This event aims to share experiences and discuss solutions for Member States to meet the challenge of digital marketing of BMS. The event will also contribute to the increasing momentum for stronger regulation both at the international and at the national level to the benefit of public health interests.
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 

Consultation on updated NICE Maternal and Child Nutrition Guideline, Friday 7 June 2024
NICE will be sharing its draft, updated Maternal and Child Nutrition guideline and supporting evidence for consultation on 07/06/24. It will run for 6 weeks, closing on 19/07/24. You have to be a registered stakeholder to take part, and you can register here. To enable stakeholders to prepare for consultation you can access the economic plan and review questions for this NICE guideline on the project documents web page.
 
Our Director Vicky is on the committee for this guideline, and we’re excited that it will finally be published in November after more than two years of intense work. The guideline was last updated in 2014 (see the current PH11 guidelines here), so this update is significant. We encourage you to engage with the consultation to ensure that the guideline is a strong and informed as possible.
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iHV annual Evidence-based Practice Conference - in person in Manchester or virtual, Wednesday 3 July 2024
This year’s Evidence-based Practice Conference will focus on addressing health inequalities, addressing the questions: How can we ensure a healthier future, where all babies and children can thrive? How can we use the best available evidence and research to reduce health inequalities and strengthen health visiting practice?

Our Director, Vicky, will be presenting and attending in person, so please do come and say hello. Read more and make bookings here.
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Unicef UK annual Baby Friendly Initiative Conference – virtual, Wednesday 20 - Thursday 21 November 2024
Unicef UK have announced that the annual Baby Friendly Initiative (BFI) Conference will take place on 20-21 November 2024 and that the conference will be virtual this year. The discounted price of £65 per person is available for individual places booked before 5pm on 31 July 2024 or groups of 10 or more. The standard price is £75 per person. Booking and registration can take place here. We will share further details on the programme when this becomes available.
 

April 2024

Image by wirestock on Freepik

Welcome to the April edition of our newsletter, featuring:
News Infant milk news BFLG-UK news Forthcoming Happy reading!

News

New: Eating Well resource for South Asian families

In 2021 Dr Helen Crawley co-produced an Eating Well guide for South Asian children for the NEON (Nurture Early for Optimal Nutrition) study programme, which aimed to optimise infant feeding, care and dental hygiene practices for infants and young children up to the age of two years in East London.
 
The recipe book provides culturally tailored South Asian, age-appropriate, healthy recipes for babies from 6 months to 2 years based on unprocessed and minimally processed foods. It also provides information on why eating well matters, how to tell when your baby is ready for food other than milk and some tips to make sure your baby eats well.
 
Now that the first phase of this study is over, we can share this resource widely.
You can find it on our website here as well as on the NEON website.
 
There is currently no hard copy of this resource available for purchase, but if you would like one, please express your interest by contacting Priscilla at admin@firststepsnutrition.org; if we have enough interest we may be able to do a print run.
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New paper: What shapes parental feeding decisions over the first 18 months of parenting
This paper was published in February and reports on an investigation, conducted by the Centre for Food Policy at City University between 2020 and 2021, of feeding practices from starting solids through to 18 months of age, among parents of infants and young children across the income spectrum in England.

Researchers used a longitudinal, qualitative approach, undertaking three rounds of semi-structured interviews over a year-long period to elicit information on the social and environmental factors that influence infant feeding decisions at 4-6 months, 10-12 months and 16-18 months of age. Sixty-two parents were included in the study, 61 of which were mothers.

The research shows that, despite wanting to provide their children with home-prepared meals, parents regularly fed their children commercial baby/toddler foods. It is well established that the reasons underlying these decisions are complex, multi-faceted and influenced by social norms. However, a number of persistent issues that undermine the provision of home-prepared meals were identified, including:
  • Time limitations
  • Insufficient support from partners
  • Inconsistent and contradictory information on when and how to introduce solid foods
The provision of home-prepared meals was further hindered for families experiencing socioeconomic disadvantage due to barriers to accessing formal childcare, less flexible working conditions and fathers being less involved in infant feeding.

A recurrent theme of the research was the perceived convenience of branded commercial baby foods, which parents also trust to be healthy, nutritious and age-appropriate. This is despite evidence that commercial baby food and drink products available to UK parents are poorly aligned with public health recommendations for infant and young child feeding.

One arising recommendation made in the paper is for health and nutrition claims on commercial baby food and drink to be banned (as per Codex standards). The authors also call for policy makers and health care providers to change the eligibility for shared parental leave and improve access to formal childcare to facilitate a more enabling environment for optimal infant feeding practices across all socioeconomic groups. The rationale for these recommendations are provided and referenced. However we urge caution (as do the authors) with assuming that nutritious home-cooked foods are provided formal child care settings (see: Shining a light on early years nutrition: The role of councils; and Research into food and nutrition in Early Years settings).

It may be interesting to note that NICE will publish updated Maternal and Child Nutrition Guidelines in November 2024 (to replace guideline PH11). These will include recommendations for health care professionals and early years practitioners for improving uptake of Government guidance on starting solids/complementary feeding and feeding children aged 1-5 years. These recommendations will be based on new systematic reviews of available published evidence, including evidence on facilitators and barriers experienced by parents and carers. The guidelines will go out to consultation prior to publication. We will share more on this in future newsletters, so watch this space.
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Written response: OHID’s draft proposal for voluntary industry guidelines for commercial baby foods and drinks aimed at children up to 36 months
The Office for Health Improvement and Disparities launched a closed consultation during February/March, inviting selected stakeholders to provide written response on a draft proposal for voluntary industry guidelines for commercial baby foods and drinks aimed at children up to 36 months. The first version of these guidelines went out for public consultation in late 2020 (see our written response here), since when progress on their finalisation, publication and implementation faltered. OHID picked up this workstream off the back of the publication of the Major Conditions Strategy in August last year, sharing the current proposal with us after a series of informal consultations last Autumn. The guidelines focus on sugar and salt content, and address some elements of marketing, and are a step in the right direction to address some of the issues with the commercial baby/toddler food offer, as reported by Public Health England in 2019. However, our view is that the guidelines need to:

1. Better align with the stricter recommendations of WHO Europe in their Nutrient and Promotion Profile Model;

2. Be strengthened to address the wider range of issues highlighted in the PHE 2019 evidence review, and align with UK public health recommendations on feeding infants and young children;

3. Include formula milks which are not currently subject to any specific legislation on composition, marketing or labelling; i.e. those marketed for use from 12 months +

Additionally, our long-standing view is that while voluntary guidelines are better than no guidelines, the guidelines will need to be mandatory to elicit the changes needed to improve the commercial baby food and drink offer and protect infant and young child health.

Read our full response here.

Lastly, while the commercial baby/toddler food offer needs urgent improvement, it is important to consider that in their new guidance published in 2023, the Scientific Advisory Committee on Nutrition stated:
  • Home-prepared foods are generally recommended to help introduce infants and young children to a range of appropriate flavours and textures
  • Commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements
  • Formula milks (including infant formula, follow-on formula, ‘growing-up’ or other ‘toddler’ milks) are not required by children aged 1 to 5 years.
Our Eating Well resources provide practical guidance on how to feed babies and young children healthy and affordable diets based on unprocessed and minimally processed foods. See more here.
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Update: First Steps’ input in to the House of Lords Inquiry in to Food, Diet and Obesity
Last month we shared information on the House of Lords Food, Diet and Obesity inquiry, 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 the industry and the wider public in the public health landscape.
Our Director, Vicky, gave evidence in person at the fifth oral evidence session on Thursday 7th March, speaking to the early years diets. You can catch up on this session on Parliament TV and/or read the transcript of the session here. Subsequent sessions were also held on March 14th, 21st and 25th; catch up here.

As well as providing verbal testimony, we submitted a written response to the inquiry which you can read here. To summarise, ultra-processed foods (UPF) dominate the diets of babies and young children, with short and long term negative health implications, including on weight status. We make a case for urgent action by Government to re-balance early years’ diets towards unprocessed and minimally processed foods. Our stance is that while important, a focus on reducing the consumption of foods and drinks that are high in fat, sugar and/or salt foods (HFSS) alone, will be insufficient to tackle persistently high levels of overweight and obesity. We propose that policy actions to improve diets need to consider both nutrient composition and the extent of food processing.

For further information, read our policy report: Ultra-processed foods in the diets of infants and young children in the UK: What they are, how they harm health, and what should be done to reduce intakes.
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Infant milk news

Which? guide to formula preparation machines
Formula preparation machines have come to be seen by some parents and carers as an almost essential piece of equipment - no doubt encouraged by manufacturers reassurances that the machines they offer are convenient, safe and prepare feeds according to NHS guidance. Unfortunately, there has been little objective information available in the public domain that parents can use to make informed decisions about whether or not preparation machines are a safe and worthwhile investment. The consumers association Which? have helped to address this gap with this article discussing the practicalities of buying and using prep machines.

The safety concerns around using some types of preparation machine that we have previously identified and that have been confirmed by research from Swansea University have been fully addressed. You can see in the article that First Steps has contributed a statement on the safety aspects of using prep machines highlighting how important it is that parents/carers who bottle feed their babies understand the NHS guidance and the risks to their baby’s health it seeks to address. The article also links to our website pages on infant milks – information for parents and carers and so may be a useful article for healthcare professionals to signpost during any discussions they may be having with parents around infant formula preparation.
For more information on these devices and how they fall short of the NHS guidance please see the FAQ section of our infantmilkinfo.org website.
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Infant milk costs: Further price cuts announced as more brands and retailers seek to remain competitive
Since February, formula milk manufacturers and retailers have been announcing price cuts, no doubt feeling the pressure from the CMA investigation into the cost of infant milks, media coverage on the lack of affordability of infant formula products and price cuts announced by the retailer Iceland. In the latest wave of cuts, Tesco, Sainsburys and Aldi all announced that they were reducing the cost of some of their infant milks. Tesco has reduced the cost of SMA Little Steps infant formula (800g) from £9.75 to £7.97 and the cost of 1.2kg packs of Aptamil infant formula from £17 to £16. The cost of 1.2kg packs of Cow & Gate infant formula has been reduced from £12.50 to £12 and Cow & Gate 2 follow-on milk (800g) has been reduced from £10.50 to £9.65.

Nestlé has made further changes to improve the affordability of its SMA Pro infant formula brand with the addition of bigger 1200g (2 x 600g) pack. This retails in Boots at £16.99 and costs 18p per 100ml made up product which compares to 21p per 100ml for the standard 800g pack.
 
Aldi has cut the cost of its Mamia infant formula again- the 900g packs now cost £8.49 and Aldi has claimed that this makes it the “lowest priced formula milk available on the market."
 
As pack sizes differ and the cost per 100ml of made-up formula can differ between brands even where they cost the same per 100g of powder, we will be comparing the price of each product per 100ml as reconstituted for our April cost report which will more accurately reflect the comparative cost of products. We will share this in the May newsletter.

For those of you advising parents/carers on economical formula and food choices for their babies and young children, our infographics may be of use:
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FSA Consultation Response
We have responded to the Food Standards Agency (FSA) consultation on applications for authorisation of miscellaneous regulated products: four novel foods, three food additives, removal of twenty-two food flavouring authorisations, and a proposal to set a limit for ethylene oxide in food additives. Our response relates to our concerns over the authorisation of two novel foods, specifically, “Human Milk Identical Oligosaccharides” (HMiOs) for use in infant formula, follow-on formula and foods for special medical purposes intended for consumption by infants and young children. Briefly, we have outlined our concerns related to the appropriateness of safety assessments, the potential for use of optional ingredients as a vehicle for further inappropriate marketing of infant formula via cross promotion of follow-on formula and the potential for marketing to undermine breastfeeding. The full response is available here.
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Rickett Benckiser in the news again: landmark necrotizing enterocolitis law suit rules in favour of parents of a deceased baby
In March this year, following the tragic death of a premature baby in 2020, the lawyers acting for the family of the baby successfully argued that scientific research has shown that feeding products based on cows’ milk can cause necrotising enterocolitis in premature babies. A US court ruled that Rickett Benckiser (owner of the ‘Enfamil’ Mead Johnson brand used) was guilty of failing to include such warnings on their packaging and it was ruled that they had ‘aggressively marketed the products in hospitals to parents of premature babies’.
Although this case was based in the US, the risks of using cows’ milk based formula for preterm infants are the same in the UK and this case acts as a reminder of the significance of maintaining and strengthening existing UK laws that protect families from formula marketing. There are an estimated 400 further NEC lawsuits related to cows’ milk based infant milks pending against Rickett and Abbott laboratories. Rickett have said that there is no scientific evidence that Enfamil causes NEC and will be contesting the ruling.
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 

Submission to CMA invitation to comment: Infant and follow-on formula market study
On 20 February 2024, the Competition and Markets Authority (CMA) announced that they were undertaking a market study into infant and follow-on formula in the UK. This announcement included the publication of a Market Study Notice together with an invitation to comment to provide responses to the consultation questions. The invitation to comment document provided insights and a comprehensive explanation into the purpose of the market study, and 21 questions for stakeholders. On behalf of and with input from BFLG-UK members, First Steps Nutrition Trust provided a comprehensive response, available here. We will provide further updates on the market study as they become available from the CMA.
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 

iHV annual Evidence-based Practice Conference - in person in Manchester or virtual, Wednesday 3 July 2024
This year’s Evidence-based Practice Conference will focus on addressing health inequalities, addressing the questions: How can we ensure a healthier future, where all babies and children can thrive? How can we use the best available evidence and research to reduce health inequalities and strengthen health visiting practice?

Our Director, Vicky, will be presenting and attending in person, so please do come and say hello. Early bird ticket rates are available until 19 April and groups bookings of 5 or more will receive a 15 percent discount off the total order when booked at the same time. Read more and make bookings here.
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Unicef UK annual Baby Friendly Initiative Conference – virtual, Wednesday 20 - Thursday 21 November 2024
Unicef UK have announced that the annual Baby Friendly Initiative (BFI) Conference will take place on 20-21 November 2024 and that the conference will be virtual this year. The discounted price of £65 per person is available for individual places booked before 5pm on 31 July 2024 or groups of 10 or more. The standard price is £75 per person. Booking and registration can take place here. We will share further details on the programme when this becomes available.
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March 2024

Image by Devmaryna on Freepik

 
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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February 2024

Snowdrops

Image by pvproductions on Freepik

 
Welcome to the February edition of our newsletter. This month we have lots of varied news items to share with you. But in case you missed it in our last newsletter, we have one important question as follows:

Can you help support FSNT?

First Steps Nutrition Trust is a registered charity and has been fortunate to be funded by a small number of generous individuals and grants over the past 13 years. As we are all aware, the world around us is changing rapidly, and to continue our work beyond next year, we need to urgently seek new sources of funding. Our principles of only accepting funding from conflict-of-interest free sources won’t be changing, but can you introduce us to any organisations, trusts and foundations, grant-makers or individuals that may be able to support our work? Please contact our Director, Vicky Sibson (vicky@firststepsnutrition.org), if you are able to make any suggestions or introductions, or if you are interested and willing to support First Steps yourself. Thank you.

News
Infant milk news
BFLG-UK news
Forthcoming
Happy reading!

News

New report: “Breaking down the barriers to breastfeeding to support healthy weight in childhood”
The Food Foundation published this report and launched it in parliament on Tuesday. Our Director, Vicky, was one of the expert advisers to the report authors. The report builds on our 2021 report “Enabling children to be a healthy weight: what we need to do better in the first 1000 days”, reiterating how enabling breastfeeding is critical to tackling persistently high rates of overweight and obesity. This new report repeats our report’s recommendations to:
  • Increase the number of Baby Friendly Initiative accredited settings and services;
  • Invest in universal breastfeeding support;
  • Strengthen legislation to support breastfeeding mothers returning to work/study and to breastfeed in public;
  • Invest in health visiting;
  • Improve the Healthy Start scheme, so it better supports breastfeeding mothers
The Food Foundation make two additional recommendations: increasing statutory maternity pay and extending the Sure Start Maternity Grant, and a dedicated government team for breastfeeding.

It’s GREAT to see breastfeeding being put in the spotlight by the Food Foundation, whose vision is: “a sustainable food system which delivers health and wellbeing for all”. We’d like to say well done to all involved and fingers crossed for a positive policy response. 
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Updated: Simple guide to breastmilk and breastfeeding
 
We have updated our resource ‘Breastmilk and breastfeeding: A simple guide’. Although the guidance around breastfeeding has not changed, we have updated the language we use to better reflect the role of wider society in influencing how babies are fed and to acknowledge the costs associated with breastfeeding. We have also updated links and the list of sources of information and support. We hope you find it a useful resource in your practice.
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WHO recommendation on milk feeds for 6-11 month old infants who are fed milk other than breastmilk
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. This recommendation is stated to be “conditional, low certainty evidence”. Recommendations are classified as conditional when the Guideline Development Committee is less confident or certain about the balance between benefits and harms. Both its conditionality and the low certainty of the evidence mean the application of this recommendation should be approached with caution, as well as considering the context.

We have received many queries about this recommendation. One question it raises is whether food insecure/low-income families struggling to formula feed their 6-11 month old infants could simply switch to cows’ milk, which is far cheaper. Another is whether this recommendation might inadvertently undermine breastfeeding.

Below we extract the key points from the WHO report to explain the basis of their recommendation, we provide our thoughts on the two questions arising from queries coming our way, and outline suggested next steps.
 
UK public health guidance on milk feeding 6-11 months of age

The first key point is that UK public health guidance for milk feeding in the second half of infancy has not changed. To avoid confusion and potential harm, we would encourage all health workers to promote current NHS advice to:
-Breastfeed or use infant formula (follow on formula is not necessary)
-Use cows’ milk in cooking but not as a drink until 12 months of age, because it does not provide enough iron
Basis of the WHO recommendation

The WHO recommendation was based on the results of a systematic review (of 9 studies, 8 in high income countries) which found that cows’ milk compared to “milk formula” may increase the risk of anaemia and iron deficiency anaemia, and result in lower serum ferritin concentrations. The results were mixed for haemoglobin concentrations. There were no differences between milks for the anthropometric or developmental outcomes assessed, gastrointestinal blood loss or diarrhoea. The certainty of the evidence for all outcomes was graded as very low or low certainty.

The report stated that “The Guideline Development Committee (GDC) was of the opinion that there was uncertainty in the balance of benefits and harms of animal milk compared to milk formula for infants 6–11 months of age… as it would vary widely by context. However, there was some agreement that there were probably some benefits for infants 6–11 months of age consuming milk formula rather than animal milk”, though this was judged as uncertain. These benefits relate to indicators of iron and vitamin D status, though the report notes that iron status can be improved through other means including consumption of animal source foods.

The summary judgement below shows the GDC opinions on benefits, harms and balance, alongside opinions on the other ‘domains’ informing the recommendation: values and preferences, resources, cost-effectiveness, acceptability and feasibility. Values and preferences and acceptability were all judged to vary by context and the latter by household resources. Although there was uncertainty, the GDG was of the opinion that consideration of resource implications would favour consumption of animal milks.

Milks for children fed milks other than breastmilk, summary judgement
 
Questions on application of the WHO recommendation in the UK:

1.       Could food insecure/low-income families struggling to formula feed their 6-11 month old infants be advised to switch to cows’ milk, which is cheaper?

We advise not to do this while it contradicts current UK public health recommendations.

If UK public health guidance changed in line with WHO recommendations, then this could become a possibility. However, cows’ milk is a very poor source of iron and families struggling to afford infant formula may also not be able to afford the diverse diet needed to meet their baby’s iron needs. NHS recommendations are to give young children meat, fish, fortified breakfast cereals, green leafy vegetables, beans and lentils. Cows’ milk also contains a lot more protein, and average protein intakes for young children in the UK are far in excess of requirements, likely driving excess weight gain. This means that a switch from formula to cows’ milk may not be the simple solution it appears to meet the nutrient needs of a non-breastfed baby in a low-income household, especially where better interventions to address dietary inequalities are needed (e.g. improvements in Healthy Start). In addition, the values, preferences and acceptability of such a recommendation by these families would need to be considered. Lastly, given that we know some families give their babies follow-on formula before 6 months of age (which the NHS advise against), a change to recommend cows’ milk in infancy may risk some families giving cows’ milk before 6 months of age.

While UK public health guidance stands, our view is that it remains important to take actions which increase accessibility to infant formula while protecting and supporting breastfeeding (relevant resources include: UNICEF UK Baby Friendly Guide for Local Authorities and Health Boards; FSNT policy recommendations; FSNT infant milks cost report).

2.       Could recommending either formula or animal milk for 6–11-month-old infants receiving milks other than breastmilk undermine breastfeeding?

It has been suggested that this recommendation might inadvertently undermine continued breastfeeding IF reasons for continued breastfeeding are perceived inconvenience of formula feeding e.g. at night time or out of the home OR concern about formula safety (e.g. related to bacterial contamination, or the extent to which it is processed / contains additives). In short, mothers may choose to give their baby cows’ milk instead of continuing to breastfeed if they perceive it to be more convenient and/or safer than formula.

With this in mind it would seem important that any advice on giving formula or animal milk to babies is provided – where appropriate - in the context of messaging on the superiority of breastmilk and breastfeeding for infant/child and maternal health as per usual health promotion messaging on infant feeding. 

Next steps:

We have shared with the Scientific Advisory Committee on Nutrition that many practitioners have raised questions with us about the WHO recommendation, as well as concerns that it may lead to changes in infant feeding practices which may or may not be in the best interest of the baby. We understand that they will be considering if and how to explore its appropriateness in the UK context. In the meantime, we recommend reiterating and supporting application of the current UK public health guidance on milk feeding from 6-11 months of age, as outlined above, including sharing the health benefits of breastfeeding.
 
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Dietary Intake in Scotland’s Children (DISH) survey
This survey is live and if you work in Scotland, you are kindly asked to encourage questionnaire recipients to participate. Please see more information here and in the infographic below.
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New Report: The Grocer Baby and infant product report 2023
In December 2023, the Grocer Baby and infant report was published, providing valuable insights into the performance of the UK's commercial milk formula and baby food market. While there was a small increase in the value of both sectors there were notable declines in volume sales. The report also highlighted considerable differences in performance among brands within these categories.

During 2023, the leading commercial milk formula brands – Aptamil, Cow & Gate, and SMA – experienced declines in both volume sales and brand value. This trend may be attributed to falling birth rates and some increase in breastfeeding. However, the category as a whole showed a 2% increase in value, with Kendamil alone increasing by £19.2m in 2023 (a 118.2% increase). Research findings indicate that branding plays a pivotal role in influencing the selection of commercial milk formula. In the context of an ongoing cost of living crisis and with a very large range in the prices of different infant formulas (which remain on the whole too expensive), it’s important for parents and carers to be aware that 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 (see our latest infographic below which is relevant to this point).

The report also showed that leading commercial baby food brands, including Ella’s Kitchen, Organix, Kiddylicious, Heinz, and Hipp Organic, all experienced declines in volume sales. However, Organix and Heinz still saw some growth in brand value. Our reports on children's food explain why many commercial baby foods do not support public health recommendations. Practical information on how to eat well in the early years, including how to prepare and feed children diets based on unprocessed and minimally processed foods, can be found in our Eating Well resources.
All of our resources are free to download and some are available to purchase as hard copies via this link.
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Infant milk news

New guidance: Making up powdered formula
In light of the findings from the ‘Finding the Formula’ study in to home-based powdered infant formula preparation practices which was published in November (see our November newsletter), the NHS have updated their guidance on making up powdered infant formula as shown below (found here and also here). It is important that parents/carers using powdered formula are aware that it is not sterile, and to kill any bacteria that may be present in the powder, the (fresh tap) water used for reconstitution should be boiled and cooled to no less than 70 degrees C. Please see the full instructions on the NHS webpage for the other steps that are required to ensure that formula is made up as safely as possible, to minimise any risks to babies’ health.
For more information on making up milks safely see our main website here as well as FAQs which are on our infant milk website here.
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New statement: Nutramigen recall
At the end of 2023, Rickett Benckiser (owner of the Mead Johnson brand) took the precautionary step of recalling specific batches of the commercial milk formula powders Nutramigen LGG1 and Nutramigen LGG2 due to the possible presence of the bacteria Cronobacter sakazakii. Both products are foods for special medical purposes used for the dietary management of infants with diagnosed cows’ milk allergy who do not receive breastmilk or who are fed breastmilk and formula milk.

In response to the recall, on the 3rd of January this year, the FSA issued a food alert detailing which batches were affected and what parents who have bought these products should do. The symptoms caused by Cronobacter sakazakii usually include fever and diarrhoea, and in severe cases may lead to sepsis or meningitis which include symptoms in infants including poor feeding, irritability, temperature changes, jaundice (yellow skin and whites of the eyes) and abnormal breaths and movements (FSA, 2023).

We have issued a statement with more details about the recall and what parents using these products should do. It is intended to help health care professionals supporting affected parents/carers, and you can find it here.

This recall is a good reminder of why it is important to ensure parents/carers know, understand, and follow NHS advice on safer preparation of powdered infant formulas, which are not, and cannot be made to be, sterile.

You can find the NHS guidance on making up formula milk safely here.  If you want to know more about making up powdered infant formula safely or the bacterial contamination of powdered infant formula you can find this here on our website. We also have a set of FAQs  that address preparing infant formula safely on our infantmilkinfo.org website.
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News on infant formula prices
In case you missed it, the Competition and Markets Authority published a report in November which used First Steps data and analysis on formula prices to confirm company profiteering (see more in our December newsletter). We were disappointed not to see any recommendations from this report, and coordinated on writing this letter to Andrea Leadsom, MP to call for urgent action. This got picked up by the press (see here) and our Director Vicky will be meeting Minister Leadsom in March to discuss. We are also feeding in to a follow up investigation by the CMA which will be reported on in the summer. In the meantime we’re pleased to see that companies are starting to react, with Danone bringing down the wholesale price of its premium product Aptamil by 7% (see this news report). Several retailers are passing on this saving, and also starting to bring down the cost of other brands too. This includes Aldi bringing their Mamia down by 40p to £8.99 a tin (see the Food Foundation's latest report on infant formula prices here). We’ll keep you updated with future changes. 
New infographic: How can families safely save on formula milk?
Following on from our updated 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 we signposted in our December newsletter - we have created an infographic to support health workers in their conversations with families struggling to afford formula. It summarises the key points from the updated cost report and suggests how families using formula can safely reduce their formula milk costs. You can access it here or click on the image below.
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 

New briefing: Clarifying misconceptions about the UK law on the marketing of infant formula
On behalf of the BFLG UK we have produced this new briefing to clarify the intention of the current UK law on the marketing of infant formula, highlight and summarise relevant provisions, and to dispel recent misinterpretations of the law observed in the media. We hope it will be of use to journalists, policy makers, politicians and health care professionals.
 
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 

All-Party Parliamentary Group on Infant Feeding and Inequalities (APPG IFI) meeting
The next APPG IFI meeting is scheduled to take place towards the end of February 2023, with the date TBC. You can sign up for APPG IFI updates here.
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December 2024

Image by Wirestock

Welcome to the December edition of our newsletter. This month we have lots of varied news items to share with you. But before we get to the news we have one important question as follows:

Can you help support FSNT?

First Steps Nutrition Trust is a registered charity and has been fortunate to be funded by a small number of generous individuals and grants over the past 13 years. As we are all aware, the world around us is changing rapidly, and to continue our work beyond next year, we need to urgently seek new sources of funding. Our principles of only accepting funding from conflict-of-interest free sources won’t be changing, but can you introduce us to any organisations, trusts and foundations, grant-makers or individuals that may be able to support our work? Please contact our Director, Vicky Sibson (vicky@firststepsnutrition.org), if you are able to make any suggestions or introductions, or if you are interested and willing to support First Steps yourself. Thank you.

News On Healthy Start:
Infant milk news
BFLG-UK news We wish you a happy Christmas and New Year and will be in touch with our first newsletter of 2024 in early February. In the meantime, feel free to be in touch.

Happy reading!

News

New FAQs: Ultra-Processed Foods
We supported colleagues at the Soil Association to produce this briefing answering frequently asked questions related to UPFs, including:
  • What is the NOVA classification?
  • How do I identify UPFs?
  • Are all UPFs equally harmful?
  • What should we do to reduce our UPF consumption? Do we need to eliminate UPFs from our diets?
  • Why, given the evidence, is the UPF concept being questioned by certain quarters?
We hope you find it useful in your work.
 
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New paper: Snacking practices from infancy to adolescence
 
This paper was published in August and reports on two investigations of food practices amongst parents across the income spectrum in England, conducted by the Centre for Food Policy at City University between 2020 and 2022. Utilising a longitudinal approach, researchers conducted three rounds of in-depth interviews over one year, providing data on how snacking practices develop over time. The first study involved 60 parents interviewed when their infants reached 6, 12 and 18 months, while the second study engaged 62 parents with children aged 2 to 18 years.

The research shows the multiple ways ultra-processed snacks often high in fat, sugar, and salt (HFSS) become normalised in children’s diets from infancy onwards, and how low-income families lack the resources to mitigate this and foster healthier habits in children.

A recurring theme in the research was the role of ultra-processed snacks as rewards and treats for families across income brackets, including commercial infant and toddler snacks misleadingly marketed as healthy and trusted by parents.

The study’s authors call for policy intervention to reduce the appeal and ubiquity of ultra-processed and HFSS snacks, and the need for strategies which generate enjoyment and availability of healthy snacks such as fruit and vegetables. These include expanding access to the Healthy Start scheme, guaranteeing a living wage that covers the cost of a healthy diet, sensory fruit and vegetable education and greater regulation of misleading front-of-pack health and nutrition claims as well as the use of colours, imagery and brand characters which appeal to children.
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Healthy Start:
New resources for frontline staff
Move More, Eat Well was launched in 2020 to support and enable those that live and work across Cardiff and the Vale of Glamorgan to move more and to eat well. They have recently launched an accessible online resource outlining Food Benefits for frontline staff to raise awareness of the food related benefits available to families on a low income.

This includes a section on Healthy Start, which presents the importance of the scheme, outlines who is eligible and explains how individuals can apply.

The online resource can be accessed free of charge here. Please note that you will need to register on the website and will be sent a password to access the information.
Also, if you are not already aware we offer an Eating Well guide to help families to get the most out of the Healthy Start scheme in England, Wales and Northern Ireland, or the Best Start Foods scheme in Scotland. The guide provides a range of healthy family recipes using ingredients that can be bought through the Healthy Start or Best Start Foods schemes and shows how these can feed the whole family. The guide can be downloaded for free here.
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New paper: Evaluation of the Healthy Start voucher scheme
The National Institute for Health and Care research published an evaluation of the Healthy Start scheme earlier this month, looking at its effectiveness on infant, child and maternal outcomes and the lived experiences of low-income beneficiary women.

Routinely collected health datasets and a nested qualitative study of low-income women were used to compare women receiving the Healthy Start voucher, with two control groups: those eligible and not claiming the Healthy Start voucher and those nearly eligible (as shown in the diagram). At the time of data collection, which began in 2015, those eligible were receiving £3.10 per week to spend on liquid milk, formula milk, fruit, and vegetables (mothers with a child aged under 1 year received £6.20). In April 2021, the scheme increased in value to £4.25 per week (or £8.50 for families with infants under 1 year of age), although it is important to note that this is a decrease in real monetary terms due to food price inflation.
Quantitative results showed that there was no difference in vitamin use between those claiming Healthy Start vouchers and those not. The effect of Healthy Start vouchers on breastfeeding were inconclusive. The authors proposed that the value of the vouchers may be insufficient to impact on wider factors that determine whether women with low incomes can offer their children a healthy diet.

Key findings from qualitative data include that:
  • Participants were not made aware of Healthy Start until their baby was born, and so did not access the scheme during pregnancy.
  • Conversations with health professionals about nutrition were infrequent or unhelpfully timed.
  • The vitamin component of the scheme was used less than the vouchers; participants were confused about the need for vitamins and/or where vitamin vouchers could be redeemed.
  • Women wanted to provide a healthy diet for their families, but living on a low income poses a range of challenges in being able to achieve this. Women had limited knowledge of the use of financial services and benefit maximisation advice and support available to them.
  • The monetary value of the scheme was described by participants as being too low to make a difference in being able to achieve a healthy diet. However, the scheme was still valued.
  • Healthy Start vouchers were not mentioned in decision-making around breastfeeding. Women’s choice to breast or formula feed was based on a range of other factors, such as support to breastfeed and assumptions and expectations of health professionals. Although, results did indicate that use of the vouchers does not discourage breastfeeding in women with low incomes.
The authors conclude that there are inherent structural limitations of Healthy Start, including access and eligibility, which limit the possible effectiveness of the scheme. They propose that these could be addressed by increasing awareness of the scheme, increasing access to vitamins during pregnancy and consideration of the increased monetary value of the allowance. The need for further research to understand the barriers to providing a healthy diet is also highlighted, including the need to understand the optimal timing for provision for nutrition advice and support, modelling to understand if an increased value of the vouchers could have more of an impact on child and maternal health outcomes and research to determine what extra support could be offered alongside the Healthy start allowance.

First Steps Nutrition Trust are members of the Healthy Start Working Group and endorse the Healthy Start Working Group Policy Positions, which include asks for: expanded eligibility, an increase in the value of the allowance, improved accessibility and the provision of information, guidance and support to beneficiaries on breastfeeding and eating diets based on minimally processed foods.
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New survey: Food access among families with No Recourse to Public Funds
In 2021, the Department of Health and Social Care agreed to temporarily extend the Healthy Start scheme to British children who would otherwise be eligible for the scheme but whose families are excluded from claiming public funds. A consultation on whether to permanently extend the scheme to households with no recourse to public funds (NRPF) was promised in 2022 but has not yet taken place. Instead, a recent parliamentary question to the under Secretary of State for Health and Social care revealed that, since the extension of the scheme, 1300 application requests have been made, but have resulted in just 110 successful applications.

Sustain conducted a survey to understand the experience of families on low incomes with NRPF in accessing nutritious food during pregnancy and for their babies and young children. Nearly 200 individuals were surveyed, including front line health service workers and representatives from community organisations, between September and October.

The survey found that families with no recourse to public funds are facing destitution, worsened mental health and multiple challenges accessing food due to the rising cost of food. Meanwhile frontline support services are unable to meet level of need. The survey, which includes personal testimonies, can be found here.

Informed by the desperate findings of this survey, First Steps Nutrition Trust have signed an open letter, alongside 147 signatories NGOs, local government institutions, charities and medical bodies to Andrea Leadsom MP, the new Parliamentary Under-Secretary for Health and Social Care, calling for children from migrant and refugee households on low incomes with no recourse to public funds (NRPF) to be given permanent access to the Healthy Start Scheme.
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Updated Eating Well Guides
We have updated our Eating well: Snacks for 1- to under-5-year-olds and Eating well: Recipes book to reflect current grocery prices, after the significant price increases experienced since these resources were first published. These guides provide practical guidance on how to meet nutrient recommendations from pregnancy to age 5, by eating affordable diets based on unprocessed and minimally processed foods.
All of our resources are free to download from here and some are available to purchase as hard copies via this link.
You may also find this infographic helpful, which outlines ways in which families may be able to cut their food costs without negatively impacting the nutritional quality of their diets.
You may also find this infographic helpful, which outlines ways in which families may be able to cut their food costs without negatively impacting the nutritional quality of their diets.
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New guidance: ‘Feeding Baby at Nursery’
In September, the Early Start Group published this new guidance for Early Years Settings to ensure they are doing what is necessary to enable and support optimal, safe and appropriate infant feeding practices for babies in their care. It covers content from current infant feeding guidelines, how to make an infant feeding policy, breastfeeding welcome posters, safer formula milk preparation, and introduction to solids.

We hope this excellent practical resource will be of use to readers working nurseries and other early years settings. 
 
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Infant milk news

First Steps response to the Competition and Markets Authority report on price inflation and competition in the infant formula market
The CMA report presents the results of an investigation in to the pricing and marketing of 10 product categories in the context of high price inflation, one of which one is infant formula. Their analysis of the infant formula market relies on our data on the cost of formula and feeding babies, which we have been gathering and reporting on since 2018. It confirms two important issues we’ve been highlighting for some time, that need to be addressed, urgently:
  • Profiteering by formula brands. Infant formula prices have risen rapidly through the cost of living crisis, from an already high base, while companies have been protecting and even increasing their already substantial profit margins (which stand at between 15 and 30%)
  • The massive range in prices of what are nutritionally comparable products; in particular between the only own-brand infant formula available (Aldi’s Mamia) and branded infant formulas
The CMA did not make any formal recommendations for addressing these issues, and instead are about to undertake a more detailed investigation in to the infant formula market, which we will feed in to: “The CMA will now undertake further work to better understand consumer behaviour (including what influences choice) and barriers to entry and expansion for baby formula manufacturers and consider whether any changes to the regulatory framework could help the market work better”.

While we appreciate that this investigation may be useful to inform certain actions, our view is that the Government could and should be taking other actions NOW to ensure families can feed their babies. We are now actively promoting these 4 recommendations to Government to:

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 (NB our view on the suggestion by some that weakening current legal restrictions on formula marketing would make infant formula more accessible is that this is NOT appropriate; it does not address the cause of the high prices and does not acknowledge the vital nature of infant formula as a food stuff for vulnerable babies (see more in this statement of the BFLG).

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).

You can read some of the media reports about the CMA investigation here and here, and hear our Director talk about the issue on LBC radio here (from 12 mins in).
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Update on infant milk costs
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’ has been updated and can be accessed at infantmilkinfo.org/costs 

As ever, where babies are not breastfed or are partially breastfed, infant formula is suitable from birth and babies can drink it throughout their first year. Other types of formula milk including follow-on milks are not necessary.

In the UK, infant formula comes in different formats - powdered infant formula (PIF), powdered formula tablets and ready to feed (RTF) liquid format.  Infant formula is an expensive product that may be unaffordable for those on low incomes. The least expensive format is PIF which must be made up according to NHS guidelines as it is not sterile.
 
Since April 2023, the relentless escalation in the cost of infant formula appears to have stabilised – our latest data suggests that the average cost of (PIF) has risen by only 0.1% since April 2023 (see Graph 1 from our report “Cost of powdered infant formulas in the UK: How have they changed since January 2020?"). Although this is encouraging, infant formula remains a very expensive product and the Competition and Markets Authority investigation results (reported on above) indicate that recent price rises in branded products may be unwarranted and – in our opinion - should be reversed.
Graph 1. Unit cost of all brands cows’ milk based powdered infant formula
Key findings:

It may be surprising for some that Danone have reduced the cost of their Aptamil Advanced, Aptamil and Cow & Gate ‘starter packs’ of ready to feed infant formula by as much as 17%. Given how common brand loyalty is among parents/carers, it may be worthwhile sharing that  this reduction has not followed through to the brand equivalent PIF which, in the case of Aptamil Advanced, is the most expensive cows’ milk based PIF on the market.

The least expensive standard sized pack of PIF is Aldi Mamia at £9.39 a can (14p/100ml) but Cow & Gate infant milk powder in a 2 x 600g Big Pack format which costs £12 (13p/100ml) is generally the least expensive way to buy infant formula from high street retailers, however this requires families to pay a greater up-front cost, and these packs are not available in all retail contexts.

There can be some significant differences in cost between the same brand of infant formula or follow-on formula when bought from different high street retailers. To reflect this and to support healthcare professionals to help families struggling to afford infant formula to assess price differences between comparable products and make choices between product types and brands, we have included some new tables in our cost report. Table 7 compares the cost of the least expensive branded PIFs and Aldi's Mamia across high street and budget retailers and table 8 makes the same comparison for the least expensive branded follow-on formulas.

Across the retailers we have looked at:
  • Aldi Mamia remains the least expensive infant formula powder in a standard size format
  • Cow & Gate infant milk powder in a 2 x 600g Big Pack format is generally the least expensive way to buy infant formula
  • The price for Cow & Gate infant milk in a 2 x 600g Big Pack varies between retailers from £12.00 at Boots (13p/100ml) and £12.50 at Asda, Morrisons, Tesco and Sainsburys (14p/per 100ml)
Brand loyalty is common but unnecessary when it comes to feeding babies. It is important to re-iterate to parents that it’s OK to switch formula brands as all infant formula in the UK are safe and suitable for babies from birth and throughout the first year. It may take baby some time to adjust, and any new infant formula offered can be introduced all at once in a full feed or gradually across feeds – whichever works best for parents and their babies. 
UK legislation permits promotional offers on follow-on formula and promotions differ between retailers and are valid only for a short period of time. For these reasons, we generally report the prices for follow-on formula before any promotional offers have been applied. We have however included a new table that shows the promotional offers available in November at the time the data was collected. Table 9 shows that despite these savings, big packs of Cow & Gate follow-on milk remain the least expensive way to buy follow-on formula.

It is important to remind parents/carers 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
  • When made up, powdered follow-on formula may be marginally more expensive than same brand PIF when not bought at a promotional price (see table 6 in our updated report)
  • Transient promotional offers on follow-on formula are not a robust basis on which to base infant feeding decisions when budgets are limited
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 

New: WHO Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes
On 16 November 2023, the World Health Organization (WHO) published its Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes. The purpose of this guidance is to provide support to WHO Member States for developing and applying regulatory measures, by applying the Code to digital environments. The guidance provides 11 Recommendations that can be used by Member States as they work to develop and apply these regulatory measures. The BFLG-UK will make use of these recommendations in their advocacy with DHSC to strengthen regulations to protect infant feeding.
 
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Revised position statement in infant formula marketing legislation amidst the cost-of-living crisis
During November 2023, some revisions were made to the BFLG-UK position statement on Legal restrictions on the marketing of commercial milk formulas and the cost-of-living crisis. The edits were made to ensure that the statement reflected our updated understanding and interpretation of current matters, including the challenges regarding the accrual and redemption of loyalty points/rewards schemes for infant formula. This statement remains highly relevant given the reaction to the CMA report, which includes calls for weakening of legal restrictions on formula promotion.
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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 twitter account @BflgUk. You can also email katie@firststepsnutrition.org
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Photo by Aopsan

 

Welcome to the November edition of our newsletter.

This month we have the following news for you:

News

  • The Infant Feeding Survey for England is underway

  • The latest National Childhood Measurement Programme data in England show a mixed picture

  • New parliamentary briefing: Impact of ultra-processed food on children’s health

  • New paper: Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait

  • New paper: Non-sugar sweeteners: helpful or harmful? The challenge of developing intake recommendations with the available research

  • New research: Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data

  • New guidelines: WHO Guideline for complementary feeding of infants and young children 6-23 months of age


BFLG-UK news

  • Department of Health and Social Care (DHSC) Consultation submissions


Forthcoming

  • Deadline for abstracts for World Public Health Nutrition Association Conference 2024: extended to 20 November 2023 

  • Shared Learning Webinar: Developing the Breastfeeding Collective: 30 November 2023 

  • iHV Leadership Conference: 7 December 2023


Happy reading!

News

Infant Feeding Survey for England underway

 

The Infant Feeding Survey 2023 (IFS) for England is underway. Surveys are being sent out to 20,000 mothers randomly selected from those who gave birth this summer. The DHSC have commissioned Ipsos to run the survey.

What is the survey about?

The aim of the survey is to understand more about how mothers in England feed their babies and will provide information on infant feeding behaviours and related factors including:

  • Internationally comparable data on prevalence and duration of breastfeeding

  • The use of foods and drinks other than breastmilk in infancy

  • Infant feeding help and information received by mothers

  • Information about bottle and breast feeding in public places

  • Parental leave, return to work, working hours and facilities provided for expressing and storing breastmilk, or breastfeeding at work

It has been 13 years since the last survey and this new data will provide vital insights into the infant feeding decisions parents are making today. It will also give a much needed evidence base for policy and practice and will facilitate the monitoring of progress towards achieving improved breastfeeding prevalence and duration in England.

The DHSC wish to raise awareness among potential survey participants and also ensure that health professionals and volunteers working with new mothers are aware of the survey and have requested that stakeholders support them in this by sharing the OHID X/Twitter and DHSC Facebook posts with their networks.

 
 
 

Latest National Childhood Measurement Programme (NCMP) data from England show a mixed picture

Published on 19 October, this data shows:

  • An encouraging positive trend for prevalence of obesity in Reception children, with a decrease from 10.1% in 2021/22 to 9.2% in 2022/23, which is lower than in 2018/19 and 2019/20.

  • The prevalence of obesity in Year 6 children also decreased from 23.4% in 2021/22 to 22.7% in 2022/23, but this is still higher than in 2018/19 and 2019/20.

  • However, there are still huge inequalities in terms of deprivation and ethnicity. For Reception children living in the most deprived areas the prevalence of obesity was 12.4%, compared with 5.8% of those living in the least deprived areas. Black children have the highest rates of overweight and obesity whilst Asian children have the highest rates of underweight. 

  • Of huge concern, underweight prevalence in Year 6 children has increased from 1.5% in 2021/22 to 1.6% in 2022/23 and is the highest recorded rate in NCMP, since 2009/10.

 

This mixed picture highlights the importance of Government action both to prevent overweight and obesity from the start of life (see recommendations in our 2019 report “Enabling children to be a healthy weight: What we need to do better in the first 1,000 days”) AND to ensure reliable and equitable access to healthy diets based on unprocessed and minimally processed foods, particularly given the ongoing cost of living crisis (see recommendations in our 2023 briefing “What the Cost of Living Crisis means for the diets of infants and young children and recommended actions Updated: May 2023”).  

 

New parliamentary briefing: Impact of ultra-processed food on children’s health

Baroness Jenkin led a short debate in the House of Lords on 24th October, to ask the government what assessment it has made of the impact of ultra-processed foods on children’s health; read the full transcript here (the opening and closing sections of Baronness Jenkin’s speech are shown below). Preceding the debate, the House of Lords published a new parliamentary briefing. Both the debate and the briefing reference our report on Ultra-Processed Foods marketed for infants and young children in the UK.

In the UK, current Government policy to tackle diet-related ill-health focuses on specific nutrients, aiming to reduce salt, saturated fats and sugar consumption. This policy approach is supported by SACN, whose recent position statement on processed foods and health stated that evidence regarding ultra-processed foods should be treated with caution.

The parliamentary briefing and several participants in the debate questioned the appropriateness of the current nutrient-focused strategy, particularly with respect to children's health. However, and despite evidence that the association between diets rich in UPFs and ill-health persists when the nutrient profile is taken into account (as explained on page 42 of our report), the closing remarks of the debate by Lord Markham (Parliamentary Under Secretary of State for Health and Social Care) continue to suggest that re-formulation is the key to solving the health harms of UPF dominated diets: “Mostly importantly of all…the real prize of course is the reformulation of food”.

We welcomed this debate on the impact of ultra-processed foods on children’s health, recognising the critical role that Governments must play in improving the food environment for parents and carers with infants and young children. We will continue to advocate that dietary recommendations and policies put a special emphasis on making sure that all families can reliably access minimally and unprocessed foods that are known to support optimal nutrition and health. More information on our specific policy recommendations listed below can be found in our report here.

Our suite of (free to access) Eating Well resources provide practical guidance on how to meet nutrient recommendations from pregnancy to age 5, by eating diets based on unprocessed and minimally processed foods. 

New paper: Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait

On 9th October, a review on ultra-processed foods and cardiometabolic health was published in the BMJ, to answer the question ‘do we have enough evidence to take concrete action on ultra-processed foods from a government policy and public health standpoint?’ This is a particularly pertinent question for infants and young children in the UK, where there are currently no policies directly addressing ultra-processed foods, despite the fact that they make a significant contribution to the diet, as described in our recent report on ultra-processed foods in the diets of infants and young children.

The review outlines more than 70 epidemiological studies, published since 2015, that have consistently observed that consuming ultra-processed foods is linked with weight gain and increased risk of cardiometabolic conditions. Based on the available evidence, and studies that explain how ultra-processed foods could drive adverse health effects beyond their nutrient profile, the authors conclude that public health measures to reduce population level exposure to ultra-processed foods are justified. The review also includes nine studies in children or adolescents and six in pregnant women which show that a high intake of ultra-processed foods during childhood was linked to higher levels of cholesterol as well as adiposity, and that a high intake of ultra-processed foods during pregnancy is linked to a higher rate of gestational weight gain and blood sugar levels. We believe this evidence warrants specific policy actions to reduce exposure to ultra-processed foods during pregnancy and the early years, as per our recommendations above.

The authors identify practical challenges in regulating ultra-processed foods, including that the term UPF comprises a large and heterogeneous group of products, each of which may have a different impact on health and that national and international regulatory agencies currently authorise many UPF-markers, such as sweeteners and emulsifiers, as safe using toxicology studies. This highlights the importance of policy solutions that focus on reducing the contribution that UPFs make to the overall diet and studies to assess the cumulative intake of UPF-markers on health, and not focussing on individual foods.

The review concludes with policy recommendations to support a dietary shift away from ultra-processed foods throughout the population. Actions that encourage individuals to identify and limit their consumption of ultra-processed foods would have limited impact in the current UK food environment due to inappropriate and misleading marketing and the limitations in access to minimally and unprocessed foods for some groups, particularly in the current context. However, we support the authors recommendations to transform the current food system using fiscal measures, marketing and labelling regulations, developed without industry involvement or commercial conflicts of interest.

New paper: Non-sugar sweeteners: helpful or harmful? The challenge of developing intake recommendations with the available research

Non-sugar sweeteners (NSS) are consumed by many children from a young age. For example, as we highlighted in our 2019 report “Sweet enough already? Artificial sweeteners in the diets of young children in the UK”, 65% of 1.5-3 year olds in the UK drink low calorie soft drinks, and drink, on average, the equivalent of a whole can each day.

In May 2023 the WHO issued guidelines advising against the use of non-sugar sweeteners for the prevention of non-communicable disease, despite the evidence on the health effects of NSS being considered uncertain. Read more on this in our May newsletter.

In June, the UK Scientific Advisory Committee opted not to advise immediate action to reduce sweetener consumption, but proposed further scrutinising the WHO report. Read more on this in our July newsletter. This means that at present there remains a lack of clear public health guidance in the UK on NSS use among pregnant women and children in their early years.

This paper published in the BMJ earlier this month, sought to review current evidence on non-sugar sweeteners to determine whether they are helpful or harmful. The authors conclude that current evidence on non-sugar sweetener intake is inadequate, and further research is needed to determine their health effects especially in specific population subgroups, including children and those who are pregnant or breastfeeding. The study discusses how, despite epidemiological studies suggesting that early-life exposure to NSS is associated with elevated body fat and cardiometabolic risk factors, existing research on NSS intakes among children is insufficient. However, due to their increased relative exposure in terms of intake per kilogramme of body weight and their ongoing development, children are more vulnerable to the effects of NSS. The authors also highlight the need for further research on NSS use among pregnant women, as evidence shows that NSS are transferred through amniotic fluid and breast milk. This has potential consequences for development of infant taste preferences, lifelong dietary patterns, and metabolic risk factors.

Despite acknowledging the lack of evidence and the need for more research, importantly, the report reaches the same view we did in 2019, which WHO also adopt in their guidelines:

“…the precautionary principle should be applied, which emphasises caution in the absence of conclusive scientific evidence, particularly regarding use in specific populations, such as pregnant and lactating women, young children, and those with diabetes. This is particularly important because evidence of potential harm exists; and, as highlighted in the WHO guideline, non-sugar sweeteners are not essential dietary components”.

We have shared this paper with the SACN secretariat and look forward to the outcome of their scrutiny of the WHO report. 

You can find out more about artificial sweeteners in the diets of infants and young children in the UK here.

New research: Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data

This paper was published in October 2023 by Maria Quigley and colleagues. It compares breastfeeding rates in England during and after the pandemic using data from the National Maternity Surveys (NMS) from 2018 and 2020. The prevalence of breastfeeding initiation and ‘any’ breastfeeding and exclusive breastfeeding (EBF) at 6 weeks and 6 months were compared and the data was then interpreted in the context of underlying trends in prevalence from previous NMS from 2010 and 2014 and annual routine data for England from 2009/2010-2020/2021. 


How did breastfeeding rates compare pre-pandemic and during the pandemic?

According to the NMS and routine data, breastfeeding initiation and any breastfeeding remained relatively constant (initiation 85%; any breastfeeding 64% pre-pandemic and 64.6% during the pandemic), although rates were consistently higher in the NMS than the routine data.

Giving birth during the pandemic was associated with a small decrease in EBF at 6-8 weeks in the routine data which was consistent with year-on-year fluctuations, whereas EBF at 6 weeks declined by 3% in the NMS. In contrast, giving birth during the pandemic was associated with a 3% increase in any breastfeeding at 6 months in the NMS data – unfortunately there were no comparison data at 6 months from previous NMS or routine data to confirm or refute this finding.

 
 
 

Routine data collected in Wales, Scotland and Northern Ireland indicate a similar pattern of no marked changes in breastfeeding prevalence resulting from the pandemic.

The authors offer two possible explanations for the lack of substantial change to breastfeeding trends observed during the pandemic. Firstly, some of the negative aspects of the pandemic may have been offset by other aspects that facilitated breastfeeding, such as women having more uninterrupted time at home; partners may have been around more and for longer and working from home may have facilitated ongoing breastfeeding. The second explanation may be that although there was a reduction in in-person breastfeeding support, some women may have been more likely to receive ‘remote’ support which has the advantage of being easier to access and available ‘out of hours’.


Did inequalities in breastfeeding increase during the pandemic?

The small changes observed between pre-pandemic and pandemic NMS data were broadly similar across the sociodemographic factors examined, indicating that existing inequalities did not increase disproportionately during the pandemic. The strongest sociodemographic determinants of not initiating breastfeeding or shorter duration of breastfeeding were young age, having lower levels of education, living in a deprived area, White British ethnicity and being born in the UK. The authors recommend that services should continue to aim to reduce the stark and persistent inequalities in breastfeeding that have been documented since the 1970s. They also highlight that whilst the number of women who breastfed changed very little during the pandemic, the numbers do not necessarily reflect quality of care of breastfeeding experiences more generally .

New guidelines: WHO Guideline for complementary feeding of infants and young children 6-23 months of age

On 16 October 2023, the World Health Organization (WHO) shared its revised Guideline complementary feeding of infants and young children 6-23 months of age. This guideline provides global, normative evidence-based recommendations on complementary feeding of infants and young children 6–23 months of age living in low, middle- and high-income countries. It considers the needs of both breastfed and non-breastfed children. The guideline supersedes the earlier Guiding Principles for Complementary Feeding of the Breastfed Child and Guiding principles for feeding non-breastfed children 6-24 months of age. The guideline is intended for use by a wide audience, including policy-makers, and technical and programme staff at government institutions and organizations involved in the design, implementation and scaling of programmes for infant and young child feeding. They may also be used by caregivers, health-care professionals, clinicians, academic and research institutions, and training institutions.

Key points of note:

  • The age of introduction of complementary foods remains at 6 months.

  • Follow-up formulas are not recommended after 12 months (i.e., products marketed in the UK as growing-up or toddler milks).

  • The review of evidence recognised that children are consuming “increasing amounts of unhealthy foods and beverages, often referred to as highly processed or ultra-processed, that contain high amounts of free sugars, salt, and unhealthy fats such as saturated fats and trans fats” and that consumption of ultra-processed foods in children is associated with higher BMIs and higher fat mass.

 
 
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Baby Feeding Law Group UK news

Department of Health and Social Care (DHSC) Consultation submissions

The BFLG-UK submitted responses to the following two DHSC Consultations:

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

Deadline for abstracts for World Public Health Nutrition Association Conference 2024: Monday 20 November 2023

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 further extended to Monday 20 November 2023 and more information is available here.

 

Shared Learning Webinar: Developing the ‘Breastfeeding Collective’: Coproduction and partnership working, Thursday 30 November 2023 

Small Steps Big Changes (SSBC) will be hosting a shared learning event on Thursday 30 November 2023 from 10:00-11:30 which aims to share knowledge gained through the ‘Feed Your Way’ public health campaign. The aim of this campaign has been to transform Nottingham into a “breastfeeding-friendly city”. The campaign has already developed some wonderful resources that can be downloaded and used (by health care workers, breastfeeding families and community members) to support breastfeeding in communities.

The webinar will also be an effort to frame infant feeding as a civil issue, to share how you can further promote breastfeeding as well as what success looks like in the breastfeeding agenda. The organisers suggest this is also an opportunity to form the ‘Breastfeeding Collective’ by reflecting on the next steps required to create breast/chest-feeding friendly cities in other areas and discuss the role that various stakeholders can take in this. You can register here.

 

iHV Leadership Conference: Wednesday 6 December 2023

 

Institute of Health Visiting are hosting their annual leadership conference on 6th December in London. The conference’s theme ‘Leading in a complex world’, will explore current and future challenges that are impacting the life chances of babies, children and families in the UK.

We will be there and look forward to meeting you and hearing your feedback on our resources.

The meeting is hybrid and therefore in-person or online attendance is possible. Find out more and register here.

 
 
Autumn leaves by Viktor Hanacek

Photo by Viktor Hanacek

 

Welcome to the October edition of our newsletter. It’s been quite a while since our last newsletter, and we hope you enjoyed the summer. 

You may have noticed that we are sending this newsletter out a week later than usual, so just to explain, moving forward we will be issuing our monthly newsletters the first week of the month, covering news and events from the month preceding (and for this month, two months preceding). 

Before we start, we wanted to share two announcements as follows:

1.    We are recruiting for two new Trustees. One a practicing health care professional, and the second, someone with fundraising experience. Deadline for applications is Friday 13th October. Find out more here.

2.    We are reviewing which resources we make available for sale as hard copies. If you may be interested in purchasing either of our Eating Well in pregnancy guides or our Healthy Start Best Start Foods practical guide, please be in touch with Priscilla at admin@firststepsnutrition.org. There is no obligation to buy now, but we would welcome any indications of interest for our planning. 

This month we have the following news for you:

News

  • New research: The safety of at home powdered infant formula preparation: A community science project

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

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

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

  • New report: First Steps Nutrition Trust user evaluation


Infant milk news

  • Update on infant milk costs


BFLG-UK news

  • Statements issued 

  • Consultation response

  • Department of Health and Social Care (DHSC) open consultations


Forthcoming

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

  • World Public Health Nutrition Association Conference 2024


Happy reading!

News

New paper: The safety of at home powdered infant formula preparation:  A community science project 

 

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.

 
Formula preparation
 

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

 
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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.

 
 
 

Welcome to the July edition of our newsletter. We hope you are enjoying the summer months and the opportunities the warmer weather brings to spend more time outdoors. 

This month has been particularly busy and so we have lots to share with you, including news of three recent Scientific and Advisory Committee on Nutrition (SACN) publications: guidance on feeding young children aged 1 to 5 years, a statement on processed foods and health, and a response to the WHO guidance on non-sugar sweeteners. We also include a link to our guest appearance on a Food Active podcast to talk about ultra-processed foods, and a summary of the most recent programme guidance from WHO and Unicef on how to engage with the food and beverage industry and protect children from the negative effects of food marketing.

In the infant milk news, we report on an industry commitment by one manufacturer to freeze infant milk value pack prices.

As secretariat of the BFLG-UK, we update you on the publication of the Retained EU Law (REUL) Act.

We share details of World Breastfeeding Week and Breastival which start on 1st August, and the 'Breastfeeding not on the agenda' series of webinars, which continues through August.

Happy reading!

Please note as we’ll all be taking some time off in August, our next newsletter will be late September.

News

NEW SACN GUIDANCE: Feeding young children aged 1-5 years

 

Following the consultation last summer (in to which we fed this response), the Scientific Advisory Committee on Nutrition (SACN) published their long awaited guidance on Feeding young children aged 1-5 years earlier this month. It complements Feeding in the First Year of Life, published in 2018 and includes a much-needed evaluation of the available evidence on young children’s diets, albeit limited to systematic reviews. It provides a wide range of recommendations for research, policy and to a lesser extent, practice.

In our view, some of the recommendations in the report are not easily translated into clear practical advice (e.g., ’give this’, ‘avoid this’) and to provide this we will need to wait for clarification from SACN and/or the interpretation of the Department of Health and Social Care (DHSC) when they update public health guidance on the NHS webpages. These include the recommendations which state that formula milks are “not required” by children aged 1 to 5 years and that commercially manufactured foods and drinks marketed specifically for infants and young children are “not needed” to meet nutritional requirements. The key question for practice arising from these recommendations is whether these products should or should not be used in young children’s diets? 

In the meantime, below are some of the unequivocal recommendations which can inform your practice now [with our commentary in square brackets].

Between 1 to 2 years of age, children’s diets should continue to be gradually diversified in relation to foods, dietary flavours and textures. A flexible approach is recommended to the timing and extent of dietary diversification, taking into account the variability between young children in developmental attainment and the need to satisfy their individual nutritional requirements.

For children from around the age of 2 years, the dietary recommendations in the Eatwell Guide apply [noting that the images for the main food groups show mainly unprocessed and minimally processed foods], with the following exceptions: 

•    Milk or water, in addition to breast milk, should constitute the majority of drinks given to children aged 1 to 5 years [we read this to mean, avoid artificially sweetened drinks as well as sugar sweetened drinks, as listed below].

•    Pasteurised whole and semi-skimmed cows’ milk can be given as a main drink from age 1 year, as can goats’ and sheep’s milks [noting that the recommendation to use semi-skimmed milk is new, though practical guidance on when semi-skimmed would be preferable to whole milk would be useful].

•    Pasteurised skimmed and 1% cows’ milk should not be given as a main drink until 5 years of age. These lower-fat milks can be used in cooking.

•    Children aged 1 to 5 years should not be given rice drinks as they may contain too much arsenic.

•    Children aged 1 to 5 years should not be given sugar-sweetened beverages.

•    Dairy products (such as yoghurts and fromage frais) given to children aged 1 to 5 years should ideally be unsweetened. 

•    Foods (including snacks) that are energy dense and high in saturated fat, salt or free sugars should be limited in children aged 1 to 5 years in line with current UK dietary recommendations.

•    Salt should not be added to foods given to children aged 1 to 5 years. 

Children aged 1 to 5 years should be presented with unfamiliar vegetables on multiple occasions (as many as 8 to 10 times or more for each vegetable) to help develop and support their regular consumption.

Deliberate exclusion of peanut or hen’s egg (and foods containing these) beyond 12 months of age may increase the risk of allergy to the same foods. Importantly, once introduced, these foods should continue to be consumed as part of the child’s usual diet in order to minimise the risk of allergy to peanut or hen’s egg developing after initial exposure.

Children aged 1 to 5 years should continue to be offered a wide range of foods that are good sources of iron. They do not require iron supplements unless advised by a health professional.

Children aged 1 to 5 years should be given a daily supplement of 10μg (400 IU) vitamin D and 233μg vitamin A unless, contrary to recommendations, they are consuming more than 500ml of formula milk a day (Vitamin C supplements are not necessary for the general population. However, there is no evidence that taking vitamin C supplements at the current recommended level of supplementation has any adverse effects).

In addition, it is pertinent to note that the guidelines recommend that: government considers a range of strategies and actions to support and promote continuation of breastfeeding into the second year of life.

And among the recommendations for monitoring: intakes of low and non-caloric sweeteners among children aged 1 to 5 years.

Once we are clear on how to interpret all the recommendations in the report, we will be updating our Eating Well guides to ensure they align with the latest public health guidance. We will keep you informed in future newsletters. 

 

NEW SACN STATEMENT: processed foods and health 

In the Autumn of 2022, the UK government requested SACN to examine the most recent research findings regarding the relationship between food processing and health. This request was made in response to a growing body of evidence that indicates a higher intake of Ultra-Processed Foods (UPF) is associated with adverse health effects, as outlined in our recent report. 

SACN issued a position statement on food processing and health on 11th July 2023. This position applies to the general population and so excludes infants and young children who have unique nutritional needs. We think this is a missed opportunity as what children eat in their first years of life sets the trajectory for lifelong health. 

Unsurprisingly, SACN found that “most systematic reviews reported that increased consumption of processed food (specifically UPF) was associated with an increased risk of the adverse health outcomes considered.” In our view, this overwhelming evidence base, which points towards the potential harmful effects of high levels of ultra-processed foods in the diets of infants and young children warrants a public health response. However, this is not SACN’s view. They state that “the evidence needs to be treated with caution” because of perceived limitations in the NOVA classification system, the potential for confounding and the possibility that the observed adverse associations with ultra-processed foods are covered by existing UK dietary recommendations. 

In order to establish a higher degree of certainty in evidence, SACN recommend gathering further evidence before updating public health guidance, missing the opportunity to take a precautionary approach in order to safeguard child health.

We are concerned that industry affiliations prevalent among the members of SACN might have unduly influenced the conclusions of this position (you can see more on this in the Soil Association’s blog post) and we plan to provide feedback on the report to SACN, which we will share in due course.

In the meantime our Eating Well Resources already address food processing, and show how it is possible to eat well in pregnancy, infancy and the early years by consuming diets based on nutrient-dense unprocessed and minimally processed foods, avoiding commercial baby and toddler foods. This approach aligns well with the images used on the Better Health Start for Life webpages around feeding babies and toddlers and with those in the EatWell guide which is applicable to children from the age of 2 and up, with some exceptions (see above, on SACN’s new guidance for feeding children aged 1-5 years). It is also consistent with SACN’s new recommendation that “commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements.”

The images below show minimally processed meals and foods suitable for infants and toddlers from:

FSNT Eating Well resources:

Better Health Start for Life (NHS) webpages:

 

NEW SACN RESPONSE: to WHO guidance on non-sugar sweeteners

Following the release of WHO guidance on the use of non-sugar sweeteners (NSS), SACN undertook a horizon scanning meeting in June 2022 and have proposed actions based on their interpretation of the evidence that “swapping sugar for sweeteners, alongside other positive changes to diet, is likely to be beneficial overall.” This means that SACN do not endorse the WHO guidance that NSS should not be used as a means of achieving weight control or reducing the risk of non-communicable diseases) (see more in our May newsletter).

We believe the actions proposed by SACN are not sufficiently precautionary, and do not support the promotion of optimal feeding practices during pregnancy and in the early years the following reasons:

-    The WHO systematic review and meta-analysis on the health effects of the use of non-sugar sweeteners suggest possible unfavourable effects of NSS consumption on birthweight and adiposity in offspring later in life.
-    Acceptable Daily Intakes for NSS by infants and young children are based on old and limited population data not including the UK.
-    Public health messaging around NSS and diets in pregnancy and the early years is not sufficiently clear or consistent. 
-    Initiatives like the NHS Food Scanner App actively promote products containing NSS, without any safeguards for parents or carers purchasing foods for infants and young children.
-    NDNS (National Diet and Nutrition Survey) data reveals potentially high levels of NSS intake among young children. Data from 2008-15 (pre-dating the Soft Drinks Industry Levy) shows that 65% of children aged 18 months to three years old drank a low-calorie (artificially sweetened) soft drink during the four-day recall period (and mean consumption was 330g/day, which is equivalent to one whole can of soft drink).
-    The focus on reducing intakes of high fat, salt, sugar (HFSS) foods and drinks may be leading to increased intake of NSS as products are reformulated. SACN note that “Evidence indicates that the Soft Drinks Industry Levy has resulted in significant sugar reduction in the UK soft drinks market.  However, this appears to reflect replacement of sugar with NSS, rather than development of new, unsweetened, drinks.”

We welcome SACN’s recommendation to the Food Standards Agency (FSA) to monitor UK population exposure to non-sugar sweeteners (noting, as above, that a recommendation in the new guidance for feeding 1–5-year-olds includes monitoring of intakes among this age group) and view this as overdue and urgent. 

Aspartame

This month the International Agency for Research on Cancer (IARC) and the WHO and FAO Joint Expert Committee on Food Additives (JECFA) classified the sweetener aspartame as “possibly carcinogenic to humans”, but Acceptable Daily Intakes remain unchanged. The approach to foods and drinks containing aspartame with respect to the early years should be as for other sweeteners, as outlined below. 

In terms of implications for practice, infants up to 12 months of age should be given only breastmilk/infant formula, and from 6 months, water. For children aged 1-5 years, milk or water, in addition to breast milk, should constitute the majority of drinks given. As above, we read this to mean, avoid artificially sweetened drinks as well as sugar sweetened drinks. Commercial infant and toddler foods are not permitted to include artificial sweeteners. Public health advice on the use of foods containing artificial sweeteners for infants and young children is unclear (and we are seeking clarity). However, such foods would be ultra-processed, so in our view should not feature prominently in diets which are based on unprocessed and minimally processed foods.   

More information on sweeteners relevant to the early years can be found in our 2019 report on sweeteners in the diets of young children in the UK.

 

Lay Member role with the Scientific Advisory Committee on Nutrition

SACN is a UK-wide advisory committee set up to provide advice to the UK government on nutrition related matters. The committee is made up of specialists from a range of relevant disciplines and includes lay members, who are expected to contribute robust views representing the interests of the wider public. The role involves a time commitment of up to approximately 10 days per year, including three meetings per year.

SACN are currently looking for a lay member and are looking for applications from members of the public. Applications for the role can be found here: Working for DHSC - Department of Health and Social Care - GOV.UK . The closing date for applications is midday on 8 September 2023.

NEW PODCAST: Ultra-processed diets in the early years

At the end of June, our Director, Dr Vicky Sibson and Nutritionist, Rachel Childs, were interviewed for the Food Active podcast. You can listen to the (28 minute) recording through Spotify on Ultra processed diets in the early years – unpacking the concerns. Some of the key findings and recommendations from our recent report on Ultra-Processed Foods marketed for infants and young children in the UK were described and discussed. 

 

NEW WHO and UNICEF PROGRAMME guidance

During June, UNICEF published a Guidance Framework to Support Healthier Food Retail Environments for Children: A practical tool for nutrition and children’s rights in the food retail sector (15 June 2023). This document starts off by providing the “business case” for addressing unhealthy diets and obesity and a description of how nutrition is becoming a material issue for investors. Next, recommended actions that food retailers can take to support healthy diets among children and families are provided, including: corporate strategy, product development and labeling, product availability and placement and promotional activities. One of the examples illustrated in the guidance is the role of food retailers in upholding the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions. The guidance ends with current food retailer actions that are promoting healthy eating. 

Taking action to protect children from the harmful impact of food marketing: A child rights-based approach was published by WHO and UNICEF on 7 July 2023, and provides a practical guide for governments and partners with steps to introduce legal measures to restrict food marketing that are fit for purpose. It is intended to complement the WHO’s recent Guideline on Policies to protect children from the harmful impact of food marketing (see below) as well as UNICEF’s 2018 A child rights-based approach to food marketing: a guide for policy makers. This new document provides an evidence update, a framing of food marketing as a child rights concern and a 4-stage process for the policy cycle involved in restricting food marketing using a child rights-based approach. 

The WHO Nutrition Guidance Expert Advisory Group Subgroup on Policy Actions launched Policies to protect children from the harmful impact of food marketing on 3 July 2023. This builds on the 2010 WHO Set of recommendations on the marketing of foods and non-alcoholic beverages to children. This new guideline includes a comprehensive review of latest evidence on the extent of, practices used in and effects of food marketing to children. A WHO good practice statement is made that “Children of all ages should be protected from marketing of foods that are high in saturated fatty acids, trans-fatty acids, free sugars and/or salt” through the implementation of policies to restrict the marketing of unhealthy foods (classified using appropriate nutrient profiling models) to children. 

Infant Milk News

One manufacturer promises a price freeze on infant milk value packs for this year

As the rising cost of commercial milk formula gains attention, manufacturers are finding ways to tackle the issue while staying competitive in the market. Danone have responded to rising costs by increasing the prices of the majority of their products whilst also introducing value packs of their Aptamil and Cow & Gate brands. The value packs use the same formulation as the standard packs but in larger unit volumes, using different, and presumably less expensive bag in a box packaging. This helps them to maintain their market share by offering parents a more ‘wallet-friendly’ price point for some existing formulations. Cow & Gate value packs (1200g) of infant formula currently cost £12.00, equivalent to 13p/100ml made up formula whilst the standard packs (800g) cost £10.50, equivalent to 17p/100ml made up formula. Danone have also committed to freezing the price of their value packs until the end of the year. We regularly monitor the price of infant milks in the UK, you can read our latest April 2023 cost report here. We expect to publish an update in August. 

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. 

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

Retained EU Law (REUL) Act published 

 

Following months of deliberation and considerations from the Houses of Lords and Commons respectively, the Retained EU Law (Revocation and Reform) Bill (REUL Bill) has been given Royal Assent and was passed into an Act, the Retained EU Law (Revocation and Reform) Act 2023 on 29 June 2023. One purpose of this Act is to revoke certain retained EU law through the sunsetting of legislation. All legislation to be “sunsetted” (revoked) is listed in Schedule 1 of the Act, but of note, none of the relevant legislation relating to the composition, labelling, and marketing of foods for infants and young children is included in this list. This means that all legislation relating to foods for infants and young children will be retained. Government departments will now create secondary legislation where necessary to effect changes and these will be consulted on in due course. 

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

Webinar series: Breastfeeding not on the agenda 

The Breastfeeding webinar series has started, with 3 webinars having taken place already (recordings available here and also on a YouTube channel) and 6 webinars still to come (see here for the lineup). This forms part of the launch of a social media call to action, including the screening of a documentary, Breastfeeding: Not on the Agenda and a petition (which can be signed here) to Embed Breastfeeding in the curriculum, family-friendly rights and the Net Zero 2050 Target. 

Breastival

Breastival 2023 is taking place in person on Saturday 5th August and online from 1st-7th August 2023. Breastival is a unique, award-winning festival which aims to support, normalise and celebrate breastfeeding as part of everyday life in Northern Ireland and across Ireland. You can register for tickets here.

Reminder: World Breastfeeding Week: 1-7 August 2023

World Breastfeeding Week (WBW) takes place annually from 1-7 August and this year’s theme is “Enabling Breastfeeding: Making a difference for working parents”. The comprehensive (28-page) Action Folder is now available.

WABA
Breastfeeding collective

The Global Breastfeeding Collective is hosting a webinar, Let’s Make Breastfeeding Work on Thursday 3 August, from 13:00-14:30 UK time. The purpose of the webinar is to:

  • Hear from mothers about experiences combining work and breastfeeding

  • Get new ideas from countries who have used evidence-based policies to make breastfeeding work

  • Learn about updated maternity leave recommendations 

  • Find resources to support advocacy

You can register for the webinar here.

 
 
Sunflowers stock image
 

Welcome to our June newsletter. We hope you are enjoying the summer.

This month we have a large amount of varied news for you as follows:

  • We are excited to share our latest policy report on ultra-processed foods (UPF) in the diets of infants and young children in the UK, calling on the Government to take action to reduce UPF intakes in the early years given evidence that UPF-rich diets are associated with ill-health independently of their nutrient profile;

  • The Food Foundation have launched their annual Broken Plate report on the state of the UK’s food system outlining “what needs to change to support us all to eat healthily and sustainably”, which echoes growing concern about UPFs;

  • UNICEF have published new programme guidance on engaging with the food and beverage industry, which we think sets a great example of dos and don’ts to protect child health from conflicts of interest with breastmilk substitute and UPF companies.

We also provide an update on our advocacy to improve accessibility to infant formula for struggling families affected by the ongoing cost of living crisis; share a new documentary highlighting the need for actions to enable breastfeeding; and highlight new advice from the FSA asking businesses not to sell plastic containers or utensils containing bamboo.

In infant milk news there is one product line which will be discontinued.

As secretariat of the BFLG-UK, we report back from the WHO/UNICEF ‘Code Congress’ we attended in Geneva.

In forthcoming events, World Breastfeeding Week will take place during the first week of August.

Happy reading.

News

NEW FIRST STEPS REPORT: Ultra-Processed Foods in the diets of infants and young children in the UK

 

After two years of research and writing, we finally published our long awaited UPF report in early June. The main messages are that UPF-rich diets are now the norm in the UK, from birth and the first years of life. This is concerning as a wealth of evidence shows that such diets are associated with multiple negative health outcomes, including obesity. We outline what products marketed specifically for infants and young children (and commonly consumed) are likely to be ultra-processed, what mechanisms might be in play, what may be driving high intakes, and make seven recommendations to the UK Government which we believe could reduce reliance on UPFs in the early years. These are informed by what other countries are already doing to address the issue and build on current initiatives and opportunities.

The publication was covered by The Guardian and The BMJ and was featured in The Week. Report co-author and First Steps Director Dr Vicky Sibson was interviewed about the report in the second of a two-part Food Programme on BBC Radio 4 on ‘Learning to Eat’. Lastly, she and the lead author, First Steps Nutritionist Rachel Childs, talk about the report in this podcast for Food Active.

We’re pleased to see that our report has been received positively and shared widely both in the UK and internationally and endorsed by experts on the NOVA classification (of which UPF is one category), including Professor Carlos Monteiro who created the concept.

The launch of our report comes ahead of the release of a position on (ultra)processed foods by the Scientific Advisory Committee on Nutrition, and amid great interest, concern, and contention around the NOVA classification and UPF as a concept. This is illustrated by this Hansard record of the recent Westminster Hall debate on the subject. The multi-national conglomerates that supply much of our food stand to lose out enormously if the UK Government decide to take an active stance on UPFs, meaning much of the contention and doubt in the science is likely to be driven by food industry voices.

We are working hard to encourage constructive dialogue on the subject with our peer organisations and seek to identify actions that we can agree on to rebalance early years diets away from UPF (including by advising avoidance of commercial baby and toddler foods where possible) and in favour of nutritious unprocessed and minimally processed foods.

Lastly, in terms of what this means for your work if you are a health care professional supporting families to eat well and want to help them avoid UPFs, our Eating Well resources do this! They provide guidance on how to feed infants and young children up to 5 years of age, in line with public health recommendations on diets based on unprocessed and minimally processed foods. You can find all these resources here.

 

NEW FOOD FOUNDATION REPORT: The Broken Plate 2023

This report was launched on Tuesday 27 June and outlines how our dysfunctional food system continues to fuel diet-related preventable disease and damage to our environment. “This is not a result of individual failure – not a lack of will power nor a shortage of knowledge – but rather the consequence of a food system which traps us into eating in a way that is harmful to our health and harmful to our planet”. It highlights how food companies are also trapped in this system: the economic imperative drives them to sell foods that are cheap to produce and have the greatest profit margins but that also make us sick. The report shows impact on diet quality via two metrics (one is UPF consumption), and health impacts via five additional metrics. “Together these metrics paint a picture of where we are now and critical next steps for ensuring we can all eat well”. See the seven recommendations (‘what needs to happen’) below (including one on regulating commercial baby and toddler food composition and marketing).

NEW UNICEF PROGRAMME GUIDANCE: Engaging with the Food and Beverage Industry

This guidance outlines how UNICEF programmes’ engagement on and engagement with the food and beverage industry should be driven by the best interests of children, avoiding conflict of interest.

It acknowledges that the food and beverage industry play a central role in the production, distribution, marketing and retailing of foods that are consumed by children globally. As a result, the industry is a key driver and shaper of our food systems, impacting children’s nutrition, health, and development. “The food and beverage industry can and must be a force for good, for all children, everywhere, without exception”.

The backdrop is that the poor quality of children’s diets is the most important driver of the triple burden of child malnutrition: undernutrition, micronutrient deficiencies and obesity. In line with what the Food Foundation’s Broken Plate report states, this guidance outlines the triple burden is largely driven by a broken food system that is failing to provide children with the nutritious, safe, affordable, and sustainable diets they to grow and develop to their full potential.

Interestingly, this guidance specifically calls out the UPF industry: “The companies producing these unhealthy, nutrient-poor UPF–rich in sugar, salt, trans-fats and food additives and preservatives - are major drivers of today’s broken food system and the global epidemic of childhood overweight and obesity and diet-related non-communicable diseases..among children...It is now widely accepted that the practices and products of the UPF industry harm children’s lives and have become the main commercial determinant of childhood malnutrition and disease”. It goes on to state: “Evidence shows that direct partnering with the UPF industry (i.e., working with) and voluntary UPF industry initiatives do not translate into large-scale sustainable results in transforming food systems for children”, and highlights how direct funding poses reputational risk to organisations engaged in policy development and provision of normative guidance.

The guidance outlines 10 parameters for engagement, including strengthening public policy to transform food systems (whilst avoiding conflict of interest by excluding the food and beverage industry in all public policy making processes), avoiding all partnerships (financial and non-financial, and collaborations) with food and beverage industries that violate the International Code of Marketing of Breastmilk Substitutes and with UPF industries (including individual companies as well as associations, platforms, and front groups). Lastly, it states that UNICEF favours upstream advocacy and public policy work and prioritises engagement on over engagement with the food and beverage industry.

As summarised, there are some strong principles in here that we hope UK organisations will look to replicate to put child health first.

COST OF LIVING UPDATE: Supporting safe and appropriate feeding of formula-fed infants during the cost of living crisis

As the cost of living crisis continues, there is growing concern for families who are struggling to afford to purchase and prepare infant formula and may resort to unsafe practices, putting their baby’s health at risk. At the same time, formula companies appear to be safeguarding their profits (The Financial Times recently reported margins in excess of 20 percent!), as revealed by wide variations in prices of comparable infant formulas, differing rates of price increases between brands, and market growth despite slowing sales (read more about this in our Cost of Living briefing).

In light of this, we continue to call for intervention to control the price of infant formula to make it more affordable for families. We were delighted to see Ian Byrne MP put the ask for a price cap to the big supermarkets in parliament this week, although all disagreed that this was an appropriate response to the problem of high prices. We await the results of the inquiry of the Competition and Markets Authority into supermarket pricing which will be published in early July.

Directly related to this, we also support the Food Foundation’s Kids Food Guarantee which includes an ask of retailers to make own brand infant formula available and/or to control infant formula prices. You can track progress on this initiative here.

Lastly, the Healthy Start Allowance should be a vital safety net for families struggling to feed their infants. However, payments are no longer sufficient to cover the cost of any first infant formula, and uptake rates reveal that roughly 35 percent of eligible families are missing out on this support. To urge the Government to take action in improving the scheme, we signed an open letter coordinated by Emma Lewell-Buck MP, ahead of her Rule Bill, arguing the case for autoenrollment for Healthy Start.

For more information on our calls for affordable infant formula, check out this Food Foundation podcast where our Director, Dr Vicky Sibson explains the issue.

NEW DOCUMENTARY: Breastfeeding: Not on the Agenda

This week a new documentary was aired showcasing the benefit and impact of breastfeeding to health, work, economy, and the environment. Created by Dr Ernestine Gheyoh Ndzi, Associate Dean in Law and Police Studies at York St John University, it explores challenges faced by mothers, fathers, health professionals and breastfeeding organisations and what is needed to support breastfeeding mothers. The launch of the documentary is being used to mark the start of a social media call to action titled 'Breastfeeding: Urgent Agenda Item'. Please support the campaign! You can find out more here.

 

The FSA asks businesses not to sell plastic containers or utensils containing bamboo

The Food Standards Agency (FSA) has asked businesses not to sell plastic containers and utensils containing bamboo or other plant-based materials like rice husk, wheat straw and hemp. Bamboo and similar plant-based materials have not had their safety assessed in plastic. Nor have they been authorised under retained (EU) Regulation 10/2011 for use in plastic food contact materials (applicable in England, Wales, and Scotland), or Commission Regulation (EU) No 10/2011 (applicable in Northern Ireland). 

What is the problem?

The Committee on Toxicity (COT) has carried out a review of plastic composites containing bamboo. However, due to a lack of available data, they have been unable to carry out a comprehensive risk assessment. Their preliminary investigations suggest that in some cases, the presence of bamboo or other plant-based materials could result in migration of formaldehyde or melamine into foods, beyond the legal limit, particularly when used with hot or acidic foods or when the utensils are put in the microwave. The FSA have therefore called for evidence or any information to help inform an assessment of their long-term stability and overall risk.

What products might contain these composite materials?

Plastic composites that include bamboo or other plant materials are commonly found in reusable drinking cups, tableware and cutlery, lunchboxes, and chopping boards, plates, bowls, and cups including some specifically marketed as crockery sets to infants and children. Products made from bamboo alone are not of concern. Whilst it is very unlikely that the initial use of these composite products would result in an immediate health risk, the longer-term health impacts are unknown, mainly due to the current lack of evidence. The FSA have advised that as a precautionary measure, where there is any doubt about the materials used, these products should not be used until a full study into their safety has been completed.

You can read the full FSA notice here.

Infant Milk News

Aptamil Organic range of formula milks to be discontinued by the end of the year

Danone (Nutricia) have announced that they are to discontinue their Aptamil Organic range of infant and toddler milks. They have said that this is to ‘allow them to focus on other recipes.

Aptamil organic

The organic range will stop selling at slightly different times in different retailers throughout 2023, so you might be able to find products in some retailers longer than others as stocks deplete. The products will continue to be stocked by Amazon until the end of the year.

This is the second big brand to discontinue a short-lived organic range – Nestlé delisted their SMA Organic brand at the end of April 2022.

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

Feedback from Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes

 

From 20-22 June 2023, the first ever Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes organised by the WHO and UNICEF took place. Over 400 delegates from over 100 countries  representing government, civil society, academia, and UN agencies came together to share latest evidence, discuss common challenges and learn from successful experiences on how to improve implementation of the Code to protect infant and young child health.

Various updated and helpful resources were shared on the Global Breastfeeding Collective Breastfeeding Advocacy Toolkit website, including the following that we would like to bring to your attention:

The UK delegation included representatives from civil society and academia, but unfortunately no government officials. We look forward to using the resources shared, lessons learned, and connections made at the Congress to take forward our work with the Baby Feeding Law Group UK member organisations and continue efforts to advocate for alignment of the current UK laws relating to the marketing of commercial milk formula to be in line with (and extended to encompass all elements of) the international Code, as well as continuing to advocate for improved enforcement of existing legislation.

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

World Breastfeeding Week 2023

World Breastfeeding Week (WBW) takes place annually from 1-7 August and this year’s theme is “Enabling Breastfeeding: Making a difference for working parents”. Resources are available at the World Alliance for Breastfeeding Action (WABA) website and the World Breastfeeding Week website (WBW) including:

 
 

Tree in bloom image by Bearfoto

 

Welcome to our May newsletter. We hope you are enjoying the onset of summer.

This month we have lots of news for you as follows: headline news reports on infant formula price inflation (informed by our routine price monitoring); an updated cost of living briefing based on this new data; new guidelines from WHO on non-sugar sweeteners (which should be good news for infants and young children in the UK if taken on board); and news of even more ‘healthy’ discretionary snacks being marketed for pre-school children.

In infant milk news we share our updated infant milks cost report and remind you where you can find answers to your frequently asked questions.

As secretariat of the BFLG-UK, we update you on the latest on the Retained EU Laws (REUL) Bill and tell you about an upcoming ‘Code Congress’ we will be attending at the WHO in Geneva next month.

And for forthcoming events, there is a meeting of the APPG on Infant Feeding and Inequalities in June as well as the conference of the Association of Breastfeeding Mothers.

Happy reading.

News

Infant formula prices rises raised with PM!

Shockingly high infant formula prices, high rates of inflation and the coping mechanisms being used by desperate families made headline news mid-May. Sky news broadcast a feature on this subject, in to which we fed our updated infant formula cost data and price trends analysis (see more on both below).
Highlights here:

The main news story: https://youtu.be/QNBWnqWECQE

 

Intervention by Alison Thewliss, MP in parliament: https://twitter.com/alisonthewliss/status/1659153996047581184 

Our two main asks to protect infant health in this context are: 

1. For Defra to intervene to investigate and cap infant formula prices.
2. For DHSC to urgently increase the Healthy Start allowance to take in to account food inflation, along with other improvements to increase coverage and effectiveness of what is meant to be a nutritional safety net. These are among 10 recommendations in our ‘Cost of Living briefing’ – see below.

Healthy Start infographic

This news led to a Westminster Hall debate on Healthy Start, focusing on the need to increase the allowance amount. Unfortunately, and almost unbelievably, this still does not look likely (you can read the debate transcript here).  

Update Cost of Living Briefing

Based on our updated infant milk cost report (see below), we updated our report: “What the cost of living crisis means for the diets of infants and young children and recommended actions”. Read this report here.

Key points include:

  • Between March 2021 (before food prices started to rise) and April 2023, the most widely available and purchased powdered infant formulas increased in cost by an average of 24% (range 17-31%) and the only ‘own-brand’ infant formula increased 45% over the same two year period.

 

  • No first infant formulas are affordable with the Healthy Start allowance.

 

  • There is a huge range in the retail prices of comparable products – which must all conform to the same UK regulations - meaning the monthly cost of feeding a 10-week-old baby infant formula typically varies from £44 to £88.

  • Three factors call in to question the justifiability of the price rises: wide variations in prices of comparable infant formulas, differing rates of price increases between brands, and market growth despite slowing sales. It appears that companies are safeguarding their profits whilst families who cannot afford increasingly expensive infant formula may resort to unsafe practices, putting their baby’s health at risk.

The rising prices over time and how they compare to the Healthy Start allowance is shown in this graph:

Formula price increase graph

We make 10 recommendations which we believe would improve the food security of infants and young children in the short and long term, including:

  • The Government must address the fairness of infant formula pricing, and cap the price

 

  • The Government must urgently improve the Healthy Start Scheme in order that infant formula is accessible to all families who need it

 

  • Public health messaging should make clear that all infant formulas are nutritionally adequate and there is no need for families to buy more expensive infant formulas

 

  • More retailers should offer an own brand infant formula

 

  • Local Authorities and Health Boards should support families with infants under 12 months experiencing food insecurity

 

  • Research is urgently needed to assess the scale and scope of the impact of the cost of living crisis on the diets and health of babies and young children

 

  • The Government should take action ensure infant food security in the long term, such as including infant formula in the UK food security assessment and doing more to enable breastfeeding

WHO releases new guidance on the use of non-sugar sweeteners

The World Health Organization (WHO) has released a new guideline on the use of non-sugar sweeteners (NSS) (also called artificial sweeteners). The guidance specifically states ‘that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases’. It applies to all adults and children with the exception of those who have pre-existing diabetes.

The guidance is based on the findings of a systematic review of the available evidence including 283 studies in adults, children, pregnant women and mixed populations. Overall, the data shows that whilst there may be some benefits with NSS use in the short term, over the longer term, which is key to maintaining good health, the use of NSS is not beneficial as a means of weight control nor for reducing the risk of noncommunicable diseases (NCDs). Long-term use of NSS may even be harmful to health, potentially increasing the risk of type 2 diabetes, cardiovascular disease and mortality in adults.

Since the WHO and other authoritative health bodies issued recommendations that population intakes of free sugars be reduced as a means of protecting against NCDs, the food industry has used NSS to reduce the free sugars in its products whilst maintaining a sweet taste. The new guideline points out that because free sugars are often found in highly processed foods and beverages with undesirable nutritional profiles, replacing these with NSS has little impact on the overall quality of the diet.

Francesco Branco, WHO Director for Nutrition and Food Safety stated that "People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages”.  We couldn’t agree more: it is important not to cultivate a sweet palate and the sooner in life this begins, the greater the benefits for future health.

The authors highlight that the guidance is not based on toxicological assessment of individual sweeteners but rather NSS as a class of compounds and so it does not replace existing guidance on safe intakes of NSS. They also note that although no conclusive mechanistic links have been validated in human models, their existence reinforces the importance of the associations identified in prospective cohort studies and highlights the need for further research.

If you want to learn more about the latest findings and their implications for policy, don’t miss Anna Taylor - CEO of the Food Foundation in conversation with Francesco Branco on Wednesday 31 May at 9.00am. You can sign up to listen here.

You can find out more about artificial sweeteners (NSS) in the diets of young children in the UK in our 2019 report Sweet enough already?

More new commercial snacks marketed for pre-school children

The commercial baby food sector is expanding into preschool snacks in response to declining birth rates. According to the market research firm Mintel, ranges of food products for older children help businesses continue to maintain profits by growing their audiences and retaining users for longer.

In July 2021, Kiddylicious introduced a line of products for children over three, while in October of the same year, Piccolo introduced a line of cereals, yoghurts and snacks for this age. The most recent entrants to the market are Ella's Kitchen, who introduced a new line of snacks for children aged three and older earlier this year, added to which Organix plans to introduce snacks in June for children between the ages of three and six.

These snacks are often marketed as healthy for children, with companies taking advantage of the Ofcom HFSS rules (i.e. ensuring that these snacks cannot be classified as high in saturated fat, salt or sugar), despite these rules being based on recommended dietary intakes for the general population and not young children.

The growth of the pre-school snack market contradicts public health advice that snacks should be based on healthy family foods, including a wide variety across the food groups. In addition, commercial children’s snacks are likely to be ultra-processed, and so do not accustom young children to the real taste of the unprocessed and minimally processed foods which should form the basis of a healthy diet during childhood.

Infant Milk News

Updated infant milk cost report

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” has been updated and can be accessed at infantmilkinfo.org/costs. 

A reminder that the purpose of this report is for health care professionals to be able to advise parents on the comparable costs of the wide range of different brands and formats of formula, which (within categories: infant formulas and follow on formulas), are otherwise comparable in terms of their nutrition composition, as they must all meet the same legal requirements, should parents require cost information. We compare cost per 100ml, as infants cannot eat powder!

Aldi Mamia powdered infant formula is the cheapest infant formula on the market despite increasing in price to £9.39 for 900g. For families who cannot access the Aldi formula, the least expensive of the more widely available alternatives (on the basis of a week’s average consumption), now cost between £9.75 and £11.35 per can.

'Big packs' of formula (such as Cow & Gate 2*600g packs) are less expensive per 100ml than standard pack sizes. However, purchasing a larger pack will require families to pay a greater up-front cost, and these packs are not available in all retail contexts.

FAQs

Here at FSNT we love to receive your comments, feedback and queries. Some of the most frequently asked questions relate to the safety of making up infant formula using the different preparation devices available on the market and the suitability of soya milk for babies whose parents wish to raise them on a vegan diet. Here is just a quick reminder of some of the questions we answer in the FAQ section of our infant milk website www.infantmilkinfo.org 

Are formula preparation machines safe?

Are rapid cooling devices safe to use when preparing powdered infant formula?

Is filtered water safe to use when preparing powdered infant formula?

Are soya based infant formulas useful if there are allergies in the family?

Are there any infant formula suitable for vegans?

Please do have a quick look to see if we have a relevant answer before sending Susan your queries 😊 Susan@firststepsnutrition.org

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Baby Feeding Law Group UK news

Retained EU Laws (REUL) Bill update

The original Retained EU Law (Revocation and Reform) Bill (REUL Bill) contained a “sunset clause” which stated that retained EU laws (including many related to foods, such as those relating to foods for infants and young children) would automatically expire by the end of 2023, if they had not been reviewed by the government (explained here). Many felt that this provided insufficient time to review all EU laws (especially since an increasing number – over 2000 – of such laws were identified) and to ensure that measures were put in place to cover the regulation provided by those laws. Therefore, on 10 May 2023, government tabled an “amendment for Lords” Report, recommending that the sunset clause be replaced with the commitment to publish a list of (approximately 600) EU laws that government intends to revoke by the end of 2023. On 17 May 2023, this REUL Bill HL Bill 139 (as amended on Report) was published, including the list of laws that government plans to revoke in Schedule 1. Any laws that do not appear on that list will remain valid, for now, and this includes the UK laws governing infant and follow on formula and foods for special medical purposes, and baby foods. While there may still be challenges with implementing the bill, this change provides welcome extra time to review all retained EU law, and as necessary, facilitate revoke or reform of laws after proper assessment and consultation. On 22 May 2023, the Lords Amendments to the REUL Bill was tabled at the third reading of the REUL Bill in the House of Lords, and on 24 May 2023, these amendments will be considered in the House of Commons, indicating the final stages of the passage of this bill.

We will keep you informed of the implications for laws relevant to formula and baby foods.

Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes

From 20-22 June, the Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes will be taking place at the World Health Organization (WHO) in Geneva.

The objectives of the Congress include to develop national roadmaps/work plans to strengthen legislation, monitoring and enforcement of the International Code of Marketing of Breast-milk Substitutes. The Congress will be attended by country delegations including government representatives, parliamentarians, UN agencies and NGOs supporting Code issues, civil society organisations working on breastfeeding, consumer protection and human rights and academics researching the marketing of breast-milk substitutes. First Steps Nutrition Trust will be represented at the congress by Dr Vicky Sibson and the Baby Feeding Law Group UK by Dr Katie Pereira-Kotze.

Forthcoming

Houses of Parliament

All-Party Parliamentary Group on Infant Feeding and InequalitieS (APPG IFI) meeting: Tuesday 13 June

The next APPG IFI meeting, chaired by Alison Thewliss MP will take place on the Tuesday the 13th of June at 12pm in Parliament. The speakers will be Prof Nigel Rollins and Dr Robert Boyle presenting on the Lancet Breastfeeding Series 2023, and Patricia Wise presenting on the Infant Feeding Support Competencies Framework. We assume the questions and debates in Parliament arising from the Sky News on infant formula prices will also be included. Anyone is welcome to contact Alison Thewliss MP at Alison.thewliss.mp@parliament.uk to confirm interest in attending. These meetings are hybrid and therefore in-person or online attendance is possible.

Sign up here if you would like to receive the APPG IFI newsletters.

ABM logo

Association of Breastfeeding Mothers (ABM) Conference: Saturday 24 June

The ABM Conference 23 is taking place on Saturday the 24th of June, both online and at The Priory Rooms in Birmingham. The theme for the conference is “Shifting Perspectives – Navigating the Future of Breastfeeding”. A list of speakers are available and tickets can be booked here. Dr Katie Pereira-Kotze will be presenting on “Current challenges with infant milks marketed as foods for special medical purposes (iFSMPs) in the UK” which will include some of the key findings from the BFLG-UK report “Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health” published in December 2022.

 
 
 
 

Welcome to our April newsletter.

We hope you’re enjoying the recent sunshine and warmer weather.

This month it’s a short one for a change. We share with you two news items: the Food Foundation’s data on food insecurity in households with under 4s and related to that, an update on Healthy Start including revised working group recommendations; and results from a survey among members of the Independent Food Action Network looking at the extent to which families with babies are asking for help. In infant milk news we have a new growing up milk to tell you about. For forthcoming events, the Children’s Food Summit is on May 16th in Leeds and we hope to see some of you there to join in a lively discussion on the commercial determinants of early years diets. Lastly, we wanted to share that we are now very close to finalising our report “Ultra-Processed Foods in the diets of infants and young children in the UK”, and below give you the low-down of what this will cover ahead of publication in early June.

Happy reading!

News

Food insecurity in households with under 4s and latest asks of the Healthy Start scheme

In April, the Food Foundation released data from their January survey which showed that at 27%, the prevalence of household food insecurity is highest among families with children aged 0-4 year of age. Comparable figures are 23% for households with children aged 5-17 and 15% for households without children. The Food Foundation said in their press release: “The data illustrates that this age group is at particularly high risk of food insecurity and more needs to be done to support younger children specifically”. We agree and outline nine recommendations in our Cost of Living Briefing which you can find here.

One recommendation is that Defra intervene to control and cap infant formula prices. We also endorse the Food Foundation Kids Food Guarantee (see our March newsletter) which calls on retailers to provide own brand infant formulas and to “insulate prices from the worst of inflation”. A key recommendation is that the Healthy Start scheme is made fit for purpose. The latest data released by the government on the uptake of Healthy Start scheme show that coverage was only 64%, falling short of their target of 75% set for March 2023 (and far lower than the 88% achieved by Best Start Foods in Scotland). Sustain estimates this translates in to 207,000 households who are missing out on £68 million of funding.

It is also pertinent in light of the headline news about record high food price rises, that in April while the value of a host of benefits were rightly increased to take in to account inflation, the value of the Healthy Start allowance remains unchanged.    

With our input, the Healthy Start working group has updated its asks as follows:

1.   Increase the value of the Healthy Start allowance in line with food inflation, with regular review

2.   Expand eligibility of the Healthy Start scheme to include more low income families, and to support children in those families until 5 years of age

3.   Improve access to the Healthy Start scheme, including through switching to opt-out enrolment

4.   Support the scheme to meet its nutrition objectives, including the provision of information, guidance and support to beneficiaries on healthy eating

Read the Healthy Start Working Group policy paper here

IFAN UK survey results: Food bank support for parents and carers of infants

 

In our March newsletter we reported on the Scottish results of the Independent Food Aid Network (IFAN)’s UK survey, tracking demand and their capacity to cope with increasing need. Since then they have shared the results of the UK-wide data in this briefing note: Reducing food insecurity in UK households with infant children, April 2023.

They observe that rising food insecurity (particularly among young families, as reported above), high and rising formula prices, inadequacy of Healthy Start (which is meant to be the nutrition safety net), and in general, a lack of effective pathways to access infant formula, means many parents and carers are turning to food banks for support. However, the independent food banks in IFAN’s network have been struggling to cope with the massive increase in demand at the same time as food and financial donations have fallen. The following results come from 85 organisations operating 154 food banks in 81 different local authorities (collected in February 2023).

Among the findings:

  • 45% of surveyed organisations reported that more parents/carers had asked for their support to feed their babies from December 2022 to January 2023 compared to the same two-month period a year ago.

  • Food bank managers commented on seeing “a lot more parents with very young children” and having to work on policies to support them where “this was previously never needed.”

  • The number of organisations who had not supported any parents/carers with infant children from December 2022 to January 2023, was just 4%.

  • The most common route of referral was self-referral (56%), followed by referral through a health practitioner (47%).

  • 56% of contributing organisations were not yet aware of any local authority guidance on how to support food insecure families with babies (noting that guidance is available here): Supporting families with infants in food security - Baby Friendly Initiative (unicef.org.uk).

 
 
 

  • Food banks which have supported parents/carers to access infant formula reported providing it directly (51%), giving cash (4%) or vouchers (14%) or purchasing formula on their behalf (31%).

 

As illustrated in the neighbouring infographic (and in line with elements of the guidance above), IFAN UK recommend the following:

  • Embedding local cash-first pathways

  • Strengthening of pathways to income maximisation and a cash first response to help parents/carers with an urgent need to access formula safely / access adequate food to support breastfeeding.

  • Parents/carers who reach out for support should be provided with advice and support to maximise their income as well as access to cash/vouchers to purchase formula to meet immediate need.

  • Investment in advice and support services

  • Bring social security payments in line with the cost of living

  • Improve Healthy Start and Best Start schemes

 

Infant milk news

New products

 

Alpro have recently added an oat-based milk alternative “growing-up” drink for 1–3-year-olds to their range. This is now the third plant-based milk alternative growing-up drink available in the UK, the others being Alpro soya growing-up drink and Nestlé Little Steps Plantygrow. The main ingredients in Alpro growing up oat drink are water, oat, pea protein, vegetable oils and maltodextrin.

In the UK, public health guidance is that unsweetened, fortified milk alternatives, but not those that are rice based, can be included as the main milk drinks from the age of 1 year. It is important however, to note that there are some issues related to the macro and micronutrient content of plant-based milks and the bioavailability of the fortificants added. As there are no specific compositional, marketing or labelling regulations for either growing-up milks or plant-based milk alternatives, their composition is highly variable and they may have limited nutritional equivalence to animal milks. For example, Alpro growing up oat drink contains less protein and fat than its sister product Alpro soya growing up drink but more iron and iodine. Although the manufacturer recommends their product as suitable for young children, this evaluation is entirely their own.

Alpro growing up oat drink, like cow’s milk-based “growing-up” and “toddler” milks, is an ultra-processed food with added free sugars; in Alpro growing up oat drink the free sugar added is maltodextrin. This is of concern as the taste profile of sweetened, ultra-processed foods does not accustom young children to the real taste of the unprocessed and minimally processed foods which should form the basis of a healthy diet during childhood. The NHS and the European Food Safety Authority say that growing up and toddler milks are not a necessary part of a young child’s diet.

It’s important to remember that breastmilk is the optimum main milk drink in the second year of life, and where young children are no longer receiving breastmilk, the NHS currently recommends full-fat cows' milk for children from their first to second birthdays. Full fat cows’ milk makes an important contribution to the provision of energy, macronutrients and micronutrients in young children’s diets in the UK.

Families should be made aware that young children require an energy and nutrient dense diet, and that perceived health benefits of a plant-based diet may not be relevant or health promoting for young children.

You can find a broader discussion on issues related to the use of plant-based milks in young children’s diets in our briefing paper: Plant-based milk alternatives in the diets of 1–4 year-olds.

For infant milk information please visit our dedicated website: www.infantmilkinfo.org. If you can’t find what you’re looking for please email susan@firststepsnutrition.org

 

Forthcoming

Event: Children’s Food Summit: Tuesday May 16th, Leeds

 

Sustain’s Children’s Food Campaign are holding their first ever summit in Leeds on May 16th. The event will bring together leading voices from the world of children’s food and the opportunity to network with those campaigning to improve children’s food. Early Years is on the agenda (specifically a discussion about necessary actions to address the commercial determinants of early years diets) and we hope some of you will be able to attend and participate in what we hope will be productive discussions. Find out more and register here.

 
 

Report: “Ultra-processed Foods in the diets of infants and young children: What they are, how they harm health, and what should be done to reduce intakes”

We’ve been working hard on this report since summer 2021, and are excited to be very close to publication now (with this week’s activities including being a spot of UPF food photography, as shown: Spot the difference: which one is a commercial baby finger food and which an ordinary crisp?).

In our report we outline public health recommendations for infant and young child feeding and how prevailing practices fall short of optimal practices, including through the common use of commercial food and drink products marketed for them. We examine the extent to which these products are ultra-processed, and further, the extent to which infants and young children consume UPFs. We review and summarise the evidence on the negative health effects of diets rich in UPFs and how this relates to the early years, and touch upon their environmental effects too. We then unpack some of the core reasons we believe there is a high level of consumption of UPFs in infancy and early childhood, focusing on commercial products marketed for infants and young children. We outline what the UK are doing to address high levels of consumption of UPF compared to other countries, focusing on the diets of infants and young children. And finally, we end with recommended actions to reduce high levels of consumption of UPF in the UK during the foundational early years.

Read some media coverage of our forthcoming report in i-news this week here.

More soon!

 
 
 

Welcome to our March news update. We hope you are enjoying the lighter evenings since the clocks went forward.

Before we get on to news, once again we’d like to highlight that we have a surplus of our “Eating Well: Packed lunches for 1-4 year olds”. We would be happy to send a free bulk order to any early years settings or public health organisations that could put them to good use, we’d only ask for postage to be covered. Please email admin@firststepsnutrition.org if you are interested.

This month we share with you: reflections on two new studies on preventing food allergy through the early introduction of potentially allergenic foods; news on the tightening of EU (but not UK) laws on arsenic in baby foods and on the use of titanium dioxide as a food additive; and lastly information on a range of new work on food insecurity and recommendations to mitigate its effects on infants and young children.

As secretariat of the BFLG-UK, we share with you a new infographic of our report ‘Infant milks marketed as Foods for Special Medical Purposes: A case for regulatory reform to protect infant health’.

For forthcoming events, City University is holding its annual Food Policy symposium on April the 27th and Sustain’s Children’s Food Campaign are holding their first ever summit in Leeds on May 16th. We’ll be at both so please come and say hello. Also, please look out for the first in a series of short surveys we’ll be sending to you, our key audience, over the coming months, with the aim to evaluate our communications and resources and their usefulness to you

Lastly, we’ll be very sad to say goodbye to Siân next week, but are delighted to introduce you to Priscilla who will be stepping in to the administrator role.
 

Happy reading!

News

Preventing food allergy through early introduction of potentially allergenic foods

Two recent papers explore the allergy-prevention effects of introduction of certain potentially allergenic foods before 6 months of age, challenging current public health guidance. Allergenic foods include milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soya, but the most widely studied to date are egg and peanut. Here we critique both papers and implications for practice. It should be noted that there is a great deal of conflict of interest in this field of research with respect to the food industries that stand to gain from any change in current recommendations.

‘Defining the window of opportunity and target populations to prevent peanut allergy’ by Roberts et al, 2022

 

In December, Roberts et al published this modelling exercise using data from the Enquiring About Allergy (EAT) and Learning About Peanut Allergy (LEAP) clinical trials (this made the news in March, see here: BBC, Guardian newspaper and here BMJ, hence us covering it in this newsletter). The authors estimated reductions in peanut allergy of 82% if all infants were introduced to peanut at 4 months and 77% if peanut was introduced to the infants without eczema at 6 months and to those with eczema at 4 months (because eczema is a recognised risk factor for peanut allergy). The study also reported that the protective effect of peanut exposure reduced with every month of delay.

The modelling exercise is based on scenarios where peanut products are introduced to infants at 4 months or at 6 months. The researchers go on to recommend that the general population of infants should start to eat peanut products by 6 months of age. As this implies before 6 months (and could be interpreted to mean as early as 4 months, as per the news report headlines) it does not align well with existing public health guidance from the NHS, which still currently remains to introduce potentially allergenic foods including peanut ‘at around 6 months’.

 

The researcher’s recommendation that infants with eczema (especially severe eczema) are introduced to peanut from 4 months is more straightforward. However, it should be noted that the data presented in the scenarios does not provide evidence for benefit of reducing the age of introduction of peanut for infants with eczema from the existing public health recommendation of ‘around 6 months’ to ‘from 4 months’. Current relevant NHS advice is as follows ‘If your baby already has a diagnosed food allergy or eczema, or if you have a family history of food allergies, eczema, asthma or hay fever, you may need to be particularly careful when introducing foods, so talk to your GP or health visitor first’. In their 2018 report ‘Feeding in the First Year of Life’ SACN state ‘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. However, it should be noted that this has not been endorsed by any independent national bodies such as NICE.

In addition, it is important to remember that the study itself is a data modelling exercise and makes a number of assumptions, including that allergy prevalence will be the same at 3 years of age as at 5 years, that there is no allergy protection associated with breastfeeding and that intervention compliance would be good, a fact not reflected in the initial EAT study (plus see more on this critical point in the second study, below). There are also weaknesses associated with merging different datasets and it is unclear whether this data is based on introducing peanut products only where readiness for solids has been established. Also noteworthy is the potential conflict of interest present in the original clinical trials: the LEAP trial received some grant funding from the National Peanut Board and one of the authors has received grant support from Meridian foods who make peanut products, and in the EAT study, one of the authors received grant funding from the National Peanut Board.

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. In terms of practical actions on the basis of this study in the context of the current public health recommendations, 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.

The full paper can be access here.

‘Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy: A Systematic Review and Meta-analysis’ by Scarpone et al, 2023

On Monday this week, Scarpone et al published this updated systematic review and meta-analysis examining the timing of allergenic food introduction and risk of Ig-E mediated food allergy (i.e. allergy involving reaction within minutes of eating the food, including itchy rashes, swelling of lips/face/skin around eye) as well as anaphylaxis; read more here).

The stated background to this paper is that, at a public health level, ‘earlier’ egg and peanut introduction probably reduces the risk of egg and peanut allergy respectively, but it is uncertain whether food allergy as a whole can be prevented using ‘earlier’ allergenic food introduction (where ‘early’ is defined differently in different studies, but spans the period under 6 months of age). The authors highlight that this question is important because prevention of 1 or 2 specific food allergies only may have limited public health impact, and, for infants and their caregivers, prevention of any food allergy is likely to be the more important goal.

This study found that earlier introduction of multiple allergenic foods was associated with reduced IgE-mediated allergy to any food; that earlier egg and peanut introduction were associated with lower risk of egg and peanut allergy respectively; but also – importantly - that early introduction interventions can be hard to adhere to. Two large pragmatic multiple allergenic food introduction trials reported low adherence to interventions involving stepwise introduction of foods, due to reported feeding difficulties. Whilst three smaller studies used multiple allergenic food protein powders and had lower rates of withdrawal. The authors recommend that wider issues around the nutritional composition, texture, flavour and marketing of commercial foods for infants need to be considered before making recommendations to use commercial multiple allergenic food protein powders for food allergy prevention.

The authors also highlight that interventions involving the introduction of foods before 6 months of age contravene WHO [and UK public health] infant feeding recommendations on exclusive breastfeeding, and that effects on general child health and development are unclear and may be harmful in low and middle income countries.

The findings support the concept of using earlier allergenic food introduction to prevent food allergy, but highlight the need to develop allergenic food interventions that are safe and acceptable for infants and their families.

As above, the conflict of interest inherent in this study given its data sources means that its findings and recommendations need to be assessed with due caution.

The full paper can be accessed here.

EU regulatory changes limiting arsenic in baby foods and banning the use of titanium dioxide as a food additive, will not be reflected in UK food standards

Limiting organic arsenic in rice based foods, including baby foods

Inorganic arsenic, which is the form of arsenic that poses a risk to health, occurs naturally in the environment and is therefore present in the food we eat. Long term exposure to high levels of arsenic causes skin lesions and may be a precursor to skin cancer (WHO, 2018). Although it can’t be eliminated from food and we are all exposed to it to some degree, the concentration of arsenic in rice-based foods is regulated. Current UK regulations are based on the retained EU regulations introduced in January 2016 which define maximum concentrations permissible in rice and rice-based products.

 

Rice-based products make a relevant contribution to the inorganic arsenic in the diets of infants and young children. Whilst the UK regulations have remain unchanged, the EU has recently adopted new limits reducing the amount of inorganic arsenic in certain foods, including white rice and baby foods. The new rules are based on a 2021 scientific report from EFSA which assessed chronic dietary exposure to inorganic arsenic and took into account the most recent occurrence data for inorganic arsenic in food.

 

Banning the use of titanium dioxide as a food additive (E171)

Titanium dioxide (TiO2) is widely used in foods such as cakes, pastries, confectionery and food supplements to give them a white colour, some of which may be eaten by young children. It is not permitted in foods and drinks marketed for infants and young children under (EC) No 1333/2008 of the retained EU legislation. In 2022, as a result of research carried out by EFSA, its wider use as an additive in foods was banned in the EU on the basis of potential genotoxicity. In the UK, the EFSA evidence was reviewed by COT (the Committee on the Toxicity of Chemicals in Food, Consumer Products and the Environment) and COM (the Committee on the Mutagenicity of Chemicals in Food, Consumer Products and the Environment) who did not agree with the EU position banning its use as a food additive. The Food Standards Agency and Food Standards Scotland are in the process of undertaking their own risk assessment which is meant to report in the first quarter of 2023.

What does this mean for food standards in the UK?

These changes to the EU regulations are not influencing changes in UK regulations as they might have done prior to Brexit. The UK’s food regulations are based on the EU regulations as they were when the UK left the EU. Under the Northern Ireland Protocol, foods produced in Northern Ireland destined for the UK or Europe must comply with EU regulations. However, foods produced in Great Britain and imported into Northern Ireland may, under the conditions of the Windsor Framework, continue to be manufactured in adherence to UK safety standards. In theory this means that baby foods produced in Great Britain where regulations permit higher arsenic residues, and general foods produced in Great Britain where titanium dioxide remains a permissible food additive, will still be eligible for sale in Northern Ireland as well as in Great Britain.

In practice, however, the threat of the higher permissible limits on arsenic in baby foods in the UK is lessened by the fact that most baby food is imported from Europe (and in our November 2022 newsletter we provide guidance on how to safely approach rice and rice-based products in the diets of infants and young children). As no baby foods are allowed to contain titanium dioxide, the different regulations between the EU and UK on titanium dioxide as a food additive in food more generally is perhaps more of a concern, given the transition to family foods that starts in infancy. We await the recommendations of the FSA and FSS. The main purpose of reporting on these cases of regulatory change and discrepancy between the UK and the EU, is to highlight the concerning precedent they set with respect to food safety for our youngest citizens. This is a matter which we will be undertaking advocacy on in the year ahead.

Rising rates of food insecurity: the latest recommendations and initiatives

 
 

The Food Foundation continue through their monitoring, to draw attention to high and rising rates of food insecurity. Food prices continue to rise, and consumer price inflation for foods is higher than general inflation (see graph). This means that the cost of the food basket the Food Foundation is monitoring has risen by 20-25% since April 2022.

It is not surprising therefore, that the Food Foundation have also reported that the number of households where children are experiencing food insecurity has nearly doubled in the past year (from 21.6% of household with children in January 2023 compared to 11.6% in January 2022), demonstrating the need for urgent policy action to ensure children can access the food they need. Households report switching to lower cost foods (which are more likely to be unhealthy) and less often but with a worrying increase in frequency, skipping meals altogether.

In this context and given the important gaps in the Spring budget (notably NOT including any improvements to the Healthy Start scheme), we remain deeply concerned about the likely negative effects on infants and young children. Below are some welcome relevant initiatives.

 

The Food Foundation’s Cost of Living briefing and Kids Food Guarantee

In March the Food Foundation and City University published a new briefing highlighting how the cost of living crisis will be negatively affecting UK diets, with particularly serious long term health consequences for low-income families.

Drawing on ongoing research they outline 5 pathways driving families towards making “unhealthy dietary decisions” (i.e. those which prioritise high fat, salt and sugar foods/drinks and ultra-processed foods/drinks) during times of crisis:

 

1.   The unaffordability of healthy food and of fuel

2.   Time pressures, which make convenience foods more appealing

3.   Poor quality housing, which stands in the way of eating well

4.   The unaffordability of leisure options to meet social and emotional needs compared to unhealthy, cheaper foods

5.   The availability and appeal created by food environments

Off the back of this briefing, and speaking primarily to the first driver, the Food Foundation launched the ‘Kids Food Guarantee’. This new initiative is aimed at retailers and calls on them to do more to prevent the cost of living crisis negatively impacting on child health through signing up to a comprising 3 actions – as shown. The logic is that more affordable healthy food would help prevent lower income families from being forced to switch to cheaper less healthy options.

 
 

We support this initiative, and taking an early years lens to it have the following reflections.

We are particularly glad to see infant formula acknowledged a staple given high product prices and the fact that most families with babies use infant formula. Spreading the message that ALL first infant formula are, by law, nutritionally equivalent and able to support adequate growth and development is important to counteract ongoing inappropriate and exploitative marketing. Parents can be signposted to this page on our website here for more information on choosing formula.

Putting together a nutritionally balanced packed lunch for a young children aged 1-<5 years old needs additional guidance, which can be found in our Eating Well guide on packed lunches here.

We are were pleased to see frozen and tinned fruits and veg mentioned alongside fresh. It is relevant to promote these as healthy and economical choices (as long as those canned in brine or syrup are avoided). As ever, for practical advice on eating well on a budget in the early years (including for those signed up to the Healthy Start scheme, for which there is a special resource) see our free to down load Eating Well resources.  

Lastly, reflecting on what’s for sale on supermarket baby food aisles it might be worth remembering that there are whole product categories that can actually be completely avoided (as per our pictured infographic, which can be downloaded here), meaning cost savings as well as benefits to child health. These are commercial baby snacks (as infants under 1 should be given their usual milk feeds between meals) and ‘growing up and toddler milks (as from 1 year of age cows’ milk or an unsweetened, fortified plant-based milk alternative is more appropriate).

 

IFAN-UK Scotland briefing

In February, the Independent Food Aid Network (IFAN) ran a survey of its member organisations across the UK to track demand and their capacity to cope with increasing need. Additional questions related to supporting parents/carers struggling to feed infants were included. In March they reported their results for Scotland here, which come from 17 contributing organisations running 30 independent food banks in 16 local authorities.

Among the findings:

·         A third of these surveyed organisations reported that more parents/carers had asked for their support to feed their babies from December 2022 to January 2023 compared to the same two-month period a year ago.

·         The most common route of referral was self-referral, followed by referral through a health practitioner.

·         41% of contributing organisations were not aware of any local authority guidance on how to support food insecure families with babies (noting that available guidance is available here: Supporting families with infants in food insecurity - Baby Friendly Initiative (unicef.org.uk)[VS1] [PM2] 

·         Organisations reported supporting families most commonly through purchasing the required infant formula, and less commonly through the provision of donated formula from the food bank or providing vouchers for the purchase of formula.

The briefing highlights that the current cost-of-living crisis, on top of pre-existing poverty, is putting increasing pressure on parents/carers to be able to feed their babies, as well as independent food banks’ capacity. It states that the provision of charitable food aid is not an effective or sustainable response to the growing food insecurity experienced by many parents/carers with babies and young children and highlights the urgent need to embed a cash first approach.

We back IFAN’s call on the UK Government to take immediate action to increase social security payments to levels that match the cost of living. And we agree that it is vital that fair wages and job security become the norm.

We are pleased that IFAN supports our recommendations for the Government (Defra) to address the fairness of infant formula pricing, including the price differentials between products and the rise in cost beyond general food inflation.

The Scottish Government are taking some steps which will improve vulnerable young families access to food, which we hope the UK Government will consider.  These include increasing the Best Start Foods payment. However more action is urgently needed. See the briefing here for full recommendations.

We will share the UK-wide data when this is available.

Policy insight: How secure is our infants’ food supply? Why the Government’s food security assessment must include breastfeeding and infant formula in the supply chain

 

In this policy briefing, our director Dr Vicky Sibson and collaborators Naomi Fallon and Dr Natalie Shenker, outline what infant food security means in the UK and why we’re concerned about it. In short, a combination of the UK’s formula feeding culture and highly concentrated infant formula supply chain renders British babies highly food insecure, particularly in the event of a significant emergency. We make seven recommendations to better safeguard the food security of the nation’s infants in the medium / long term (as distinct from the urgent necessary actions to the cost of living crisis above) as follows:  

1. Include infant formula in the UK food security assessment

2. Include infant feeding in emergency planning 

3. Mandate more transparency in supply of infant formulas

4. Minimise the risks of bacterial contamination of powdered formulas

5. Secure access to specialised infant milks for those infants who need them

6. Enable breastfeeding

7. Widen access to donor human milk

Read the full briefing here.

 

Baby Feeding Law Group UK news

New infographic: Infant milks marketed as Foods for Special Medical Purposes (iFSMPs)

 

This infographic summarises some key points from our recent report (published in December 2022) entitled “Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health”.

 Both the infographic and report are on our website - https://bflg-uk.org/our-work. This infographic can be printed out and distributed to health care professionals as a reminder of some of the special considerations required for this group of products.

You can follow the work of the Baby Feeding Law Group on twitter @BflgUK and at www.bflg-uk.org

For questions about the BFLG-UK please email katie@firststepsnutrition.org

 

Forthcoming

Taking stock

We are working on an evaluation of our current communications and resources and their uses/usefulness in order to improve what we do and better support you, our key audience, in providing evidence-based, independent advice to support healthy eating from preconception to five years. As part of this evaluation, over the next few months we’ll be sending out a number of short surveys to collect your valuable feedback. If you are signed up to our mailing list, please look out for the first survey in your inbox next week!

The 2023 City Food Policy Symposium: April 27th, London

 
 

This year’s symposium is: From trade-offs to co-benefits in times of crisis: finding positive food policy solutions to multiple food system challenges. It will address policymaking in times of many overlapping crises — climate, biodiversity, food insecurity, malnutrition, inequality and more — with systemic solutions. We will be making sure infants and young children are not forgotten in the discussions, and hope to see you there. You can book a place here.

Children’s Food Summit: May 16th, Leeds

 

Sustain’s Children’s Food Campaign are holding their first ever summit in Leeds on May 16th. The event will bring together leading voices from the world of children’s food and the opportunity to network with those campaigning to improve children’s food. We anticipate early years will be on the agenda and plan to attend. Registration is not yet open but we suggest you keep an eye out here.

 

HR Update

Welcome Priscilla!

 

We’re delighted to welcome Priscilla to our team as our new part-time administrator.

Priscilla has worked in fundraising and communications in the 'not-for-profit' sector for almost two decades. She is passionate about access to information and food security.

 
 
 
 
 

 Welcome to our February newsletter. We hope you are enjoying the slightly longer days and the first of the spring flowers.  

Before we get on to news, we’d like to highlight that we have a surplus of our “Eating Well: Packed lunches for 1-4 year olds” (particularly useful for early years settings whose children eat packed lunches, to share with parents). If anyone is interested in purchasing at a reduced price please visit our shop, or if you would like to make us an offer for a bulk order please email admin@firststepsnutrition.org.

This month we share with you: news on ultra-processed foods; an overview of the Lancet 2023 breastfeeding series; results of a survey about food provision in Early Years settings; headlines from the Food Foundation’s new report on preconception, pregnancy and healthy weight in childhood; key points from the Government’s progress report on implementation of the ‘Best Start for Life’ vision; and lastly, headlines from our submission to the Health and Care Select Committee Prevention Inquiry.

In infant milk news we summarise the findings of a large cross sectional study exposing the issue of improper health and nutrition claims on infant milks in 15 countries, including the UK.

As secretariat of the BFLG-UK, we update you on what we know about the retained EU Law reforms bill, potential implications and what we’re doing about it.

For forthcoming events, the Food Policy Research Group at City will shortly be publishing a collaborative paper we co-authored, shining a light on the UK’s infant formula supply chain.

Lastly, we’re very sad to say that our administrator Sian is moving on to a full time job elsewhere, meaning our part time administrator role is open for applications NOW! Please share widely.

Happy reading.

News

Mounting concern over Ultra-Processed Foods

This month, the Soil Association launched #TakingTheBiscuit, a campaign calling on the Government to take action on ultra-processed food (UPF). The campaign builds on the Soil Association’s latest Taking the Biscuit report, which outlines how the UK government is promoting UPF to families, despite evidence that they present risks to health.
 
UPFs are the foods and drinks which fall in to the fourth category in the NOVA classification of commercially-available products, created by the Brazilian academic Carlos Monteiro (Monteiro C et al, 2019). This classification groups foods according to the extent to which they have been industrially processed, and defines ultra-processed foods as “formulations of ingredients made by a series of industrial processes”.
 
UPFs are ubiquitous and heavily marketed, including in the baby food aisle (Grammatakaki et al, 2021). This is reflected in the diets of young children, with 61% of total energy intake in children aged 2-5 years of age coming from UPF (Neri D et al, 2021). This data was recently highlighted in this Telegraph article: 'British toddlers' diet among worst in world, experts warn', written following our presentation of this data at the Unicef Baby Friendly Initiative conference last November in our talk “UPFs in the diets of infants and young children in the UK”.
 
As the Soil Association summarises in their Taking the Biscuit report, a growing body of research now links high intakes of UPFs with negative health outcomes, including in children. This has prompted governments around the world to recognise and start taking action to  reduce UPF consumption. However, the UK Government is not only failing to acknowledge the issue of UPFs but promoting their use through the NHS Food Scanner App, with worrying nutrition and health implications for infants and young children.
 
More information about the campaign can be found here, including a link to sign their petition. We support their calls for the UK government to revise guidance on healthy eating to reflect the latest evidence, and to take action to reduce the contribution of UPFs to average diets.
 
First Steps Nutrition also welcome news that the Scientific Advisory Committee on Nutrition is carrying out a “scoping review of the evidence on processed foods and health”, and we look forward to seeing their position statement on this issue when it is published in the summer.

 Launch of the Lancet Breastfeeding Series 2023

On the 8th of February the much-awaited Lancet Breastfeeding Series 2023 was launched at a hybrid event in London. The launch recording is available to watch for those who missed it. A key message from the launch event was clear: marketing by commercial milk formula companies has no boundaries and company profits come before health and rights. This marketing needs to be controlled to protect breastfeeding and ensure that all parents/carers and health care professionals can make informed decisions about infant feeding which are not unduly influenced by commercial pressure.

The three papers in the series provide up-to-date reviews of the most recent evidence on breastfeeding and on commercial formula marketing, together with many recommendations on how this marketing can be curbed.

          Paper 1: Breastfeeding: crucially important, but increasingly challenged in a market-driven world.

This paper documents how common baby behaviours, such as waking and crying, are often used to undermine breastfeeding by implying that there could be a formula solution. It provides many examples of policy and programmatic actions that could be implemented to create an enabling environment that would support mothers wanting to breastfeed.

          Paper 2: Marketing of commercial milk formula: a system to capture parents, communities, science, and policy.

This paper illustrates the various routes and strategies whereby commercial milk formula companies actively and deliberately target parents, health professionals and politicians. It concludes with a strong statement that “Fact-based information on feeding infants and young children that is free from commercial influence is a human right that must be available to all.”

           Paper 3: The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress.

This paper shows how power imbalances and political and economic structures determine feeding practices and presents a framework for investigating the political economy of infant and young child feeding. It suggests six high-level recommendations that extend beyond the issue of breastfeeding and the health sector to include societal, political, and economic reforms.
 
The findings from paper 2 are particularly relevant to First Steps, given our role providing conflict of interest-free information on infant milks marketed in the UK, and our focus on maintaining and promoting our Eating Well resources. We will also continue, through our role as secretariat for the Baby Feeding Law Group-UK, to promote better regulation of the marketing of commercial milk formula and other baby feeding products through advocating for alignment of UK laws with the International Code of the Marketing of Breastmilk Substitutes, including all subsequent relevant WHA resolutions. Meaningful enforcement of the relevant laws also remains an important priority of the BFLG-UK.
 
Following the Lancet launch, Alison Thewliss, MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities secured an Adjournment Debate on Government support for breastfeeding and the 2023 Lancet Series, which took place on the 20th of February. You can watch the debate here (from time 20:08:30 until 20:30:50) and the full transcript of the debate is available here. Alison provided an accurate summary of the most pertinent findings and recommendations from the Lancet Breastfeeding Series 2023 and the implications for the UK, including the role the UK Government needs to play in stopping the aggressive marketing by the commercial formula milk industry.

Results of a survey on food provision in Early Years settings

The Early Years Alliance and London Early Years Foundation (LEYF) conducted a joint survey in October 2022 to better understand how the early years sector is coping with increased food prices and how they can best be supported. Results of the survey were recently published here, to support the launch of the #EarlyNutritionMatters campaign, which calls for additional Government early years funding to ensure that all young children have access to healthy and nutritious food.

The survey captured experiences and opinions from 500 settings, representative of the early years sector across England. 94% reported being negatively impacted by rising costs, rooted in systematic early years funding shortages. Despite settings finding creative ways to stretch their budgets, including using seasonal foods, reducing meat consumption and making use of deals and offers in the supermarkets, 62% still reported needing to use cheaper ingredients, 15% needing to reduce portion sizes and 7% needing to reduce the number of meals or snacks offered. This has worrying implications for young children, who require appropriate quantities of nutrient-rich foods for optimal growth, health and development.
 
In the current context, where 25.8% of households with children were food insecure (Food Foundation, 2022), Early Years settings have a crucial role in protecting the nutritional status of young children through the provision of nutritious snacks and meals. However, survey results show that many settings felt compromised in their ability to do this, and revealed concerns that the most vulnerable children are often disproportionately affected. Despite doing their best to cope with increasing food prices, two-thirds of settings felt required to ask families with funded-only children to pay top-up fees to cover the cost of food.
 
These findings, alongside data on increased levels of food insecurity among UK households, highlight the need for additional early years funding specifically to cover the cost of meals and snacks in early years settings. This is especially true for children from 4 years of age attending Early Years settings whose families were eligible for Healthy Start, but only until they turned 4.

The Early Years Alliance and LEYF are jointly calling on the Government to ensure that all young children have access to healthy and nutritious food as part of their #EarlyYearsMatters campaign. You can support this by posting on social media using the #EarlyNutritionMatters hashtag, tagging the Department for Education (@educationgovuk).

First Steps Nutrition Trust support this ask and continue to advocate to the Government to make early years food standards mandatory in order to safeguard access for infants and young children to an appropriately nutritious diet.

New report: Preconception, Pregnancy and Healthy Weight in Childhood

This report from the Food Foundation is the first to be published in what will be a series that will progress, stage-by-stage, through a child’s early years, building on our 2021 report “Enabling Children to be a healthy weight: What we need to do better in the first 1000 days”. The series will explore the underlying systemic failures in the food system that lead to the high levels of child overweight or obesity by the start of primary school and will make recommendations to policy makers and businesses to enable the consumption of a healthy diet during the early years.
 
In this first report, the Food Foundation argues that greater support is needed to support low-income women of child-bearing age and expectant parents during pregnancy to eat well. It highlights how policies targeting preconception and pregnancy are largely absent from Government strategies to improve diet-related health, yet this is the crucial time point to lay foundations for a child’s healthy growth trajectory – which, in turn, impacts adult health and future generations.

Government publishes ‘Best Start for Life’ vision progress report

On February the 9th, the Departments for Education and Health and Social Care released a progress report on the delivery of the Best Start for Life vision as outlined in the March 2021 policy paper: ‘Best Start for Life: a vision for the critical 1,001 days’. Key to this vision is the creation of ‘Family Hubs’, which are meant to be one stop shops to provide families help and support with a wide range of issues such as infant feeding, mental health and relationship building as well as bringing together wider wraparound services such as advice on getting into work.

The report lists the following achievements to date:

• The announcement in autumn 2021 of over £300 million to fund a 3-year Family Hubs and Start for Life programme in 75 local authorities in England;
• Appointment of 14 local authorities as ‘trailblazers’;
• Planned investment of £10 million between April 2023 and March 2025 in Start for Life workforce pilots in approximately 5 areas;
• Planned investment of £12 million in a separate Family Hubs Transformation Fund to support an additional 12 local authorities across England to move to a family hub model by March 2024;
• Setting up an evaluation of the Family Hubs and Start for Life programme investments;
• Publishing guidance for local authorities to provide a universal Start for Life offer.

The progress report goes on to highlight that the 3 priorities in the coming months are:

1. To ensure the Family Hubs and Start for Life programme delivers rapid, visible support for families
2. To develop a digital version of the personal child health record
3. To develop a Start for Life outcomes framework, review the regulatory framework for children’s health services and ensure there is a proportionate and effective inspection regime.

Prevention in health and social care: Health and Care Select Committee inquiry launched

We made a submission in to this inquiry, which will involve a two stage process. The first stage will inform the Committee’s focus in subsequent stages, when they will invite submission of more evidence on chosen topics. 

 
Read our submission here.

Our submission is based on our 2021 report “Enabling Children to be a healthy weight: What we need to do better in the first 1000 days”. We highlight that the  lack of necessary attention to the specific nutritional needs and vulnerabilities of infants, young children and their mothers is leading to preventable ill health. A key indicator is persistently high rates of childhood obesity, which will only be brought down if preventive efforts include sufficient action in the first 1,000 days, from pregnancy to age 2. We urge the committee to include in the inquiry a focus on the adequacy and coherence of Government interventions intended to meet the target of halving childhood obesity by 2030.

Infant Milk News

There are no new or discontinued infant milks to report this month, but we have have refreshed the product data on our website infantmilkinfo.org to reflect the formulation, availability and cost of infant milks on the UK market as of January 2023.

New study: Health and nutrition claims for infant formula: international cross-sectional survey

This paper published by Cheung and colleagues in the BMJ on the 15th February reviewed and evaluated health and nutrition claims for infant formula, follow-on formula and specialised infant milks for the dietary management of cows’ milk allergy on official formula company owned or managed public and health care professional (HCP) facing websites in 15 countries including the UK. Where claims were supported by evidence from clinical trials, the evidence used was formally evaluated for risk of bias using proprietary tools. 

Across 757 products a total of 1884 claims were identified, the majority relating to ingredients. The most common claim types were “helps/supports development of brain and/or eyes and/or nervous system”, “strengthens/supports a healthy immune system”, and “helps/supports growth and development”. The most common ingredients used in claims were long chain polyunsaturated fatty acids. Only 26% of products with more than one claim provided a supporting scientific reference. The reference types most frequently used were clinical trials, of which only 26% were registered, and reviews. An astonishing 90% of claims referenced registered clinical trial outcomes at high risk of bias, and all cited systematic reviews and pooled analyses carried a high risk of bias. The authors noted ‘a high level of redundancy in relationships between claims and ingredients and little scientific substantiation of claims’ which exposes their role as vehicles for marketing.

This important work considerably strengthens existing evidence of inappropriate marketing of commercial milk formulas. It emphasizes the need for better regulation and monitoring of claims to protect babies and their parents from commercial interests, which would ideally be achieved by prohibiting the marketing of all breastmilk substitutes through enforced legislation which at least matches the WHO Code and resolutions.

You can read the full paper by Cheung et al, here.

Other investigations both globally and in the UK have found that commercial milk formula companies fail to comply with the Code. You can access some of these on the BFLG website. We have reviewed health and nutrition claims for infant milks which have appeared in healthcare professional facing journals in our report Claims made for infant formula ingredients and formulations; and in our reports “Scientific and factual?” A review of infant formula advertising to healthcare professionals and “Scientific and factual?” A further review of infant formula advertising to healthcare professionals.

 
 
 
 

More information on UK regulations around the marketing of infant milks is available on the BFLG website here.

For infant milk information please visit our dedicated 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

Retained EU Law reforms bill: what we know so far and potential implications

On 22 September 2022 the Retained EU Law (Revocation and Reform) Bill was introduced to Parliament. The intention of the Bill is to end the special status of retained EU law in the UK by 31 December 2023, by allowing Government to more easily, repeal and replace (or retain) retained EU Law. The Bill will also include a sunset date (which may be extended for specified pieces of retained EU Law until 2026) by which all remaining retained EU Law will either be repealed or assimilated into UK domestic law. The Bill had a second reading and general debate on 6 February 2023, and a line-by-line examination of the Bill began on 23 February 2023.
 
Like many others we are concerned that this Bill introduces the possibility for laws to be repealed or revoked. There are many laws that fall within the remit of the Department of Health and Social Care which aim to ensure that the foods we eat are safe and comply with composition, labelling and marketing requirements. We are engaging in targeted advocacy with relevant key stakeholders to highlight that the current laws relating to the composition, labelling, and marketing of formula and foods for infants and young children need to be retained as they represent the minimum legal requirements to protect infant and young child health.

APPG on Infant Feeding and Inequalities Meeting: Tuesday 14th March

The All-Party Parliamentary Group on Infant Feeding and Inequalities will be hosting a hybrid meeting on the 14th of March from 1-3pm. If you are interested in attending this meeting you can sign up for updates and the Zoom link via this form and visit the APPG website. If you wish to attend the upcoming meeting in-person spaces are limited and first come first served, and you will need to email Alison.thewliss.mp@parliament.uk.
 
You can follow the work of the Baby Feeding Law Group on twitter @BflgUK and at www.bflg-uk.org.

For questions about the BFLG-UK please contact Katie at katie@firststepsnutrition.org

Forthcoming

‘Policy insight’ on infant food insecurity and the UK’s formula supply chain

Watch out for this policy piece written by Dr Vicky Sibson and Naomi Fallon for the Food Research Collaboration at City University, outlining what infant food security means in the UK and why we’re concerned about it. In short, a combination of the UK’s formula feeding culture and highly concentrated infant formula supply chain renders British babies highly food insecure, particularly in the event of a significant emergency. We make seven recommendations to better safeguard the food security of the nation’s infants. We will summarise this report in the March newsletter, and in the meantime will share via Twitter as soon as it has been published.  

HR Update

Goodbye Siân!

Sadly our administrator Siân is leaving for a full time job elsewhere. This means we are currently recruiting for a new part-time (2 days a week) administrator to join us, playing a critical role in supporting our small team.
 
The role involves managing our financial accounts, administration and communications. A full job description and how to apply can be found here.
 
Do you know someone who has relevant experience and is looking for a new role?
 
Please share widely to help us find the ideal candidate. 

 
 
 

Welcome to our January newsletter. We hope you had a nice Christmas and New Year and have been able to enjoy the recent winter sunshine.  

This month we share with you our updated cost of living briefing, examining likely effects of the ongoing crisis on the diets of infants and young children. We make nine recommendations which we hope many peer organisations might consider getting behind. We include a couple of items relevant to ‘Veganuary’ and early years diets. We promote the new Nutrition Profile and Promotions Model and tool launched by WHO Europe in December, which we strongly advocate should underpin future efforts by DHSC to improve the composition, marketing and labelling of foods and drinks aimed at the under 3s. And we summarise the recently published paper ‘Becoming breastfeeding friendly in Great Britain – Does implementation science work?’.

There’s no recent news in the UK infant milk market to share (aside from the worrying upward cost trends highlighted in our cost of living briefing), but from the BFLG-UK we can finally share our completed report on the issues surrounding infant milks marketed as Foods for Special Medical Purposes. We also highlight some of the headline findings of a study in to the labelling of infant formula and follow on formula which we presented at the December APPG on Infant Feeding and Inequalities.

For forthcoming events, the APPG on Infant Feeding and Inequalities is meeting again in February, and there is also going to be a big launch of a hotly awaited 2023 Lancet series on breastfeeding.

Lastly, we’re delighted to share that Katie Pereira-Kotze who has been working for us as a consultant since last summer, has joined our team as a second Senior Nutritionist and will, amongst other things, be taking a lead on our work for the BFLG-UK. We’re delighted to benefit from her skills and experience.

Happy reading!

News

Updated: “What the Cost of Living Crisis means for the diets of babies and young children and recommended actions” (December 2022)

Our updated briefing note outlines our analysis of the likely effects of the ongoing cost of living crisis on the diets of infants and young children, and makes a series of recommendations on how these effects could be mitigated, which we hope peer organisations sharing our concerns may support.
 
Key points include:

  • 40,000 babies and 184,000 young children are living in food insecure households, with likely negative health effects in the short and long term

  • The Healthy Start and Best Start Food Schemes monetary allowances are not keeping up with food inflation and the schemes are not sufficiently accessible to ensure beneficiaries can access adequately nutritious diets

  • Between March 2021 and November 2022 the most widely available and purchased infant formulas increased in cost by 15-23% and the cheapest and only ‘own-brand’ infant formula (Aldi’s Mamia) increased by 33%

  • There are no infant formulas that are affordable with the Healthy Start allowance

  • Infant formula price rises are safeguarding company profits, whilst families who cannot afford increasingly expensive infant formula may resort to unsafe practices, putting their baby’s health at risk

  • Negative impacts of the cost of living crisis on food safety behaviours have worrying implications as babies and young children are more vulnerable to food borne illness than adults

  • Ongoing inappropriate marketing by the baby food industry is misleading families in to purchasing discretionary products when limited incomes would be better spent on healthy foods and drinks

 
 

Alongside urgent measures to alleviate poverty and food insecurity more generally, we recommend 9 specific actions (please see the briefing for more details):

  1. DHSC should urgently improve the Healthy Start and Best Start Food Schemes

  2. Local Authorities and Health Boards should support families with infants under 12 months experiencing food insecurity

  3. DEFRA should address the fairness of infant formula pricing

  4. DHSC and those working with young families should publicise messages about appropriate, healthy and economical food choices <5 year olds

  5. Retailers should take action to enable and encourage families to make appropriate, healthy and economical food choices for < 5 year olds

  6. DHSC and local authorities should invest in universal breastfeeding support

  7. DHSC should regulate against the inappropriate marketing of commercially-produced baby and toddler foods and drinks

  8. DHSC/DFE should make early years food standards mandatory and provide settings with adequate resources to achieve these standards

  9. Data/research is urgently needed to assess the scale and scope of the impact of the cost of living crisis on the diets and health of babies and young children

    For more information contact vicky@firststepsnutrition.org

'Veganuary' and eating well for vegan infants and under 5s

As Veganuary comes to an end, we thought it pertinent to highlight our resource: ‘Eating well: vegan infants and under 5-s’.  Although planning a vegan diet is without doubt challenging, with careful planning and the use of fortified foods and supplements, it is possible to provide a healthy and balanced vegan diet for babies and young children that meets all of their nutritional requirements for growth and development.

Families who choose a vegan diet and wish to bring their children up as vegans from birth may have been a little alarmed by an article in the Daily Mail on 16th January headlined ‘Warning to parents over making babies VEGAN: Dietitians say plant-based diet can stunt growth of infants’. Attention was drawn to issues such as stunting, compromised brain and nerve development and anaemia that may arise when vegan diets are not properly planned, resulting in energy and nutrient requirements not being met. However, this could be said of any diet that is nutritionally inadequate and with careful planning and use of fortified foods and supplements, it is possible for parents/carers to ensure that their babies and children's nutritional needs are met through a vegan diet.

Parents/carers who wish to bring their children up on a vegan diet are advised to seek expert advice on how to ensure their diet meets their needs for energy and nutrients. Our resource provides practical advice and ideas for first foods and meals for babies and young children, as well as advice on appropriate use of supplements and photos of portion sizes suitable for different age groups. It also contains information on milk alternatives, cooking for vegan children and signposts sources of additional information to help health care professionals and those working in early years settings support vegan infants and children to eat well

Anything is Pulse-able, even for babies and young children

On the 12th of January, the Eating Better alliance launched their Anything is Pulse-able campaign, aiming to raise awareness about the health, cost-saving and environmental benefits of pulses. As an Alliance member, we contributed this blog: Anything is Pulse-able, even for babies and young children to highlight how and why pulses are great first foods for infants from 6 months.

Launch of the WHO Europe Nutrient Profile and Promotion Model

Created by WHO’s Collaborating Centre in Nutritional Epidemiology at the University of Leeds, the Nutrient Profile and Promotion Model tool was launched at the end of 2022. The model is the first to be developed to assess foods and drinks marketed for infants and young children, and looks at both nutrient composition and the way the products are promoted against WHO guidance. It includes an online tool enabling users to easily recognise products which are inappropriate for infants and young children. The model and tool is meant to be used to restrict the inappropriate marketing of formula, foods and drinks for infants and young children up to 36 months of age. It is rooted in World Health Assembly Resolution 69.9 on ending the inappropriate promotion of foods for infants and young children, which was approved in 2016.

First Steps are actively promoting that the NPPM be used by the DHSC to inform efforts to regulate the composition, marketing and labelling of foods and drinks aimed at infants and young children up to 3 years of age.

For an example of how it works, we used the tool to assess an “Organic Banana Blueberry & Apple” baby food pouch labelled as suitable for infants from 4 months of age. The tool assessed the food as unsuitable, being high in free sugars, advertised as suitable for infants before 6 months of age, using a misleading name and making inappropriate nutrition and health claims.

 

New paper: Becoming breastfeeding friendly in Great Britain – Does implementation science work?

“Becoming breastfeeding friendly” is an implementation science process focused on assessing the extent to which a country’s policy environment is suitably enabling to improve breastfeeding rates. The BBF uses a gear model (as shown), and involves national stakeholder groups reaching consensus on scores for each gear, as a means to identify priority areas for action to remove barriers to breastfeeding.

This paper by Sally Kendall and colleagues, reports on the results of the BBF process being applied in England, Wales and Scotland in 2017-2019. It outlines how each of these countries has different strengths and weaknesses with respect to the gears needed to drive increased breastfeeding, and shares the specific gaps and recommendations that came out of the process as applied in each country. The authors also outline some of the positive advances that have been observed in the policy environment since, which the authors attribute in part to the BBF process. These are: NHS England inclusion of structured accreditation programmes such as Unicef UK Baby Friendly standards in the NHS Plan and agreement to do the same in Wales; improvements in data collection on infant feeding in England by NHS Digital [and since this paper was published DHSC has also confirmed that an Infant Feeding Survey will be implemented in 2024]; and commitment of £50 million towards community support and interventions for breastfeeding in England.

The paper ends by sharing that it has not been possible to initiate the next stage of BBF in GB, which would involve repeating the process to compare the countries’ scores and degree of achievement scaling up within 5 years of BBF. The authors share their intention to find the means and political will to continue the BBF process across GB and to establish the health and social value of improving the environment for promoting, protecting and supporting breastfeeding.

Read the full paper here.

Baby Feeding Law Group UK news

Infant milks marketed as foods for special medical purposes (iFSMP) - The case for regulatory reform to protect infant health

On the 7th of December 2022, the much-anticipated report entitled "Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health" was published on the BFLG website here. The report highlights concern about the commercial milk formula industry’s exploitation and misuse of the FSMP regulatory category. Whilst regulation around the composition and marketing of specialised infant milks should ensure their safe and appropriate use, we show in this report that the current approach is not fit for purpose.

To protect breastfeeding and infant health, we recommend that the UK Government takes a two-step approach to closer enforcement and improved regulation of the marketing practices of the commercial milk formula industry.

STEP 1: To urgently ensure greater compliance with existing laws on the marketing of infant formulas and iFSMP, and to close a loophole in the legislation. This will require robust and independent oversight of formula classification rather than leaving it to the manufacturers themselves, and greater enforcement.

STEP 2: To update the existing legislation on formula marketing to align with the International Code of Marketing of Breastmilk Substitutes and all subsequent World Health Assembly resolutions. This would put a stop to companies taking advantage – for marketing purposes – of the necessary distinctions between infant formula and iFSMP. We also highlight that rigorous, independent, and regular monitoring and enforcement of the commercial milk formula industry’s compliance with the law should be a key feature of an updated regulatory framework.

The BMJ wrote a news article on our report which can be accessed here.

The report has been shared with all members of the BFLG-UK, key stakeholders and on social media. We are seeking meetings with key stakeholders in the near future to discuss how to take forward the key recommendations of the report. Please read and share the report with anyone you feel may be relevant, and feel free to contact Katie (katie@firststepsnutrition.org) if you have any questions or suggestions.

“A report on the labelling of infant formula & follow-on formula in the UK, & companies' adherence to UK laws, Guidance Notes, & International Code of Marketing of BMS”

At the All Party Parliamentary Group on Infant Feeding and Inequalities meeting on the 6th of December 2022, LSHTM alumni Maiko Kamata and Katie Pereira-Kotze presented the findings of Maiko’s MSc summer project on the labelling of infant and follow on formulas marketed in the UK. There was interest and engagement at the APPG IFI around the research results, which showed that many product labels are not fully compliant with UK legislation or the Code, with 100% non-compliance in the categorising of idealising products, cross-promotion and nutrition and health claims. This research shows that inappropriate formula marketing is an ongoing problem; monitoring and enforcement of compliance with the law is not happening, and legislation needs to be strengthened. We are currently preparing a paper for peer review and will share once this has been published.

Forthcoming

Launch of the 2023 Lancet series on breastfeeding

On Wednesday the 8th February, the 2023 Lancet Series on Breastfeeding will be launched at a hybrid event, co-hosted by the World Health Organization, The Lancet, and Children in All Policies. The in-person event is taking place at The Royal Society of Medicine in London (requiring a ticket for attendance and there is currently a waitlist to reserve a spot) and the event will be livestreamed here. A panel of experts will unpack the new three-paper Lancet Series, which explores how the value of breastfeeding is undermined and exploited by the formula milk industry. The authors of the papers call for breastfeeding to be a collective responsibility, that is effectively protected, promoted, and supported at all levels.

APPG on Infant Feeding and Inequalities Meeting: Tuesday 7th February

The All-Party Parliamentary Group on Infant Feeding and Inequalities will be hosting a hybrid meeting on the 7th of February at 1pm. If you are interested in attending this meeting (which is open to anyone), you can sign up for updates and the Zoom link via this form and visit the APPG website.

HR Update

Welcome Katie!

We’re delighted to welcome Katie Pereira-Kotze in to our team as a second Senior Nutritionist. Katie is a dietitian by training and has worked in the field of public health nutrition since 2005. She has a Masters in Nutrition from Stellenbosch University and is currently completing her PhD in Public Health through the University of the Western Cape. Katie has worked in government, research, and academia and most of her previous work was in South Africa, but she relocated to the UK in 2020. Katie has a special interest in and looks forward to continuing advocating for the protection, promotion and support of optimal maternal, infant and young child nutrition at First Steps Nutrition Trust.

 
 
 

November 2022

Welcome to our November newsletter. We hope you’re beginning to feel festive and have some nice plans for the forthcoming holidays.

This month we share with you the latest data on childhood obesity, a summary of the Food Active conference which is relevant in this regard, some advice on the use of rice and rice-based products in the diets of infants and young children, and also on supporting formula-feeding families in the event of a planned power cut.

We have a lot of ‘Infant Milk news’ for you, with several discontinued products, some new more economic formula pack sizes, and an update of our infant milk cost report.

As secretariat of the Baby Feeding Law Group (BFLG) UK, we highlight a news article arising from a presentation by Dr Nigel Rollins at last week’s the Unicef Baby Friendly conference, “How the marketing of formula milk influences our decisions on infant feeding”. We also share an update on our forthcoming report on infant milks marketed as foods for special medical purposes.

Lastly, we hope that we may have the opportunity to meet some of you at two forthcoming events: a meeting of the APPG on Infant Feeding and Inequalities on Tuesday December 6th and the iHV leadership conference in London on December 7th.

We will not be sending a newsletter in December so wish you all a Merry Christmas, however you choose to celebrate, and best wishes for a happy New Year. Our next newsletter will be sent to you in late January 2023.

News

Latest data from the Government's National Child Measurement Programme

The most recent findings from the Government's NCMP for England were published on 3rd November. Launched in 2005/06, the programme provides data on the number of children in Reception (aged 4-5 years) and Year 6 (aged 10-11 years) in mainstream state-maintained schools in England living with overweight and obesity. The results for the 2021/22 school year can be found here.

The news is somewhat positive, as the prevalence of reception-aged children living with obesity has decreased from 14.4% in 2020/21 (during the covid-19 pandemic) to 10.1% in 2021/22. However, rates of obesity and overweight in young children remain unacceptably high. An analysis of trends among reception aged children reveals that, although rates of children living with severe obesity have decreased since 2020/21, they remain higher than their pre-pandemic levels. Furthermore, the most deprived children are disproportionately affected. In 2021/2022, children in the most deprived areas were more than twice as likely to be living with obesity compared to those living in the least deprived (13.6% compared to 6.2% respectively), a difference which has widened by 1.3% since 2013/14.

 
 

As the cost of living continues to rise, this is particularly worrying news for infants and young children living in the most deprived households in England, especially as latest data shows that nearly one in five families in the UK are now food insecure, and close to a half of food insecure households reported decreases in dietary quality, which are both known risk factors for overweight and obesity.

Greater efforts to prevent excess weight gain during the first years of life (particularly among the most disadvantaged), are necessary to ensure children arrive at school a healthy weight.

Our 2021 report, Enabling children to be a healthy weight, outlines what a journey which promotes a healthy weight in the early years would look like, and what actions we believes need to be funded and implemented in England, to achieve this.

 

#Foodactive2022 - Prioritising child healthy weight in an age of crises

Earlier this month, Food Active held their annual conference, bringing together leaders in child health to reflect on the impacts of the covid-19 pandemic, and to consider learning that could inform the current cost of living crisis. A full recording of the conference can be found here.

The importance of safeguarding the health of UK children during crises was highlighted, informed by data from the covid-19 pandemic which showed significant increases in the prevalence of overweight in young children and widening disparities in the nutritional status of children from the most and least deprived households. The speakers outlined how the social and economic factors that contributed to child health disparities during the covid-19 pandemic remain unchanged. Cuts to public health budgets and services, an increased number of households at risk of income poverty, and the government withdrawal of policies to tackle overweight and obesity are some of the factors leaving children at risk of poor health in the short-term and long-term.

A “whole systems approach” was presented as a helpful framework to understand the wider conditions that impact on child health and can be used to inform multisectoral actions to tackle overweight and obesity in children. More information can be found here, alongside a range of resources launched at the conference, to provide evidence, information and tools to help promote healthy weight across the life cycle.

Infants and young children are not being considered systematically in discussions about food security as the cost of living continues to rise, and in our opinion they need to be. We will be updating our Cost of Living briefing and asks iminently, and continue advocating across the sector for the unique needs and vulnerabilities of infants and young children to be better taken in to account.

Baby rice and rice-based products for babies

Over the last few weeks, we have received a flurry of enquiries from healthcare professionals, the catering sector and parents related to arsenic in rice and rice-based products for babies and young children.

Inorganic arsenic, which is the form of arsenic that poses a risk to health, occurs naturally in the environment and is therefore present in the food we eat. Rice takes up more arsenic from the environment than other cereal crops which is why it is a greater cause for concern. Long term exposure to high levels of arsenic causes skin lesions and may be a precursor to skin cancer (WHO, 2018). Although arsenic can’t be eliminated from food and we are all exposed to it to some degree, the concentration of arsenic in rice-based foods is regulated. New regulations, introduced by the EU in January 2016, set out maximum concentrations of inorganic arsenic permissible in rice and rice-based products, with stricter limits for rice destined for the production of foods and drinks marketed for infants and young children.

We are not aware of any independent monitoring of or any robust reports on the arsenic content of rice-based foods made for babies or young children since the regulatory changes in 2016. One report on the arsenic content of rice in the UK suggests that about 50% of the rice samples collected would not be suitable for baby food production (Menon et al, 2020). However, there is no evidence to imply that this rice is used in the production of baby foods.

The Food Standards Agency (FSA) states that rice can be consumed as part of a healthy, balanced diet, but, as a precaution, advises that rice-based milk alternatives should not be given to children under the age of 5 as a substitute for breast milk, infant formula and cows’ milk. This includes rice-based infant formula and follow-on formula. The rationale for the recommendation is that compared to other consumers, infants and young children tend to drink more milk and their lower body weight means their relative exposure to arsenic from rice-based milk alternatives is higher. Although it is possible to buy rice-based formula milk online, UK law does not permit its sale. You can find out more about alternative plant based milks for young children in our briefing paper: Plant-based milk alternatives in the diets of 1–4 year-olds.

A common-sense approach to the question of how to safely approach rice and rice-based products in the diets of infants and young children would be to ensure that they are only offered in moderation. Our Eating well guides – Eating well: the first year and Eating well: vegan infants and under-5’s - provide practical examples of how to do this, incorporating rice and rice-based products alongside a range of other grain and cereal based foods as part of the complementary diet and beyond. Eating well: snacks for 1- to 4-year-olds shows examples of snack options, including rice cakes, that can be taken out and about (noting that babies under 1 year old do not need any snacks). Whilst rice-based milk alternatives should not be offered as a substitute for breast milk, infant formula and cows’ milk, using rice milk in moderation in recipes should not pose a risk to infant health.

Planned power cuts and advice on safer formula feeding


Given news reports of possible planned power cuts in January and February, we wanted to provide some initial and headline advice for those of you working with families feeding their babies formula. You may want to encourage them to think ahead about how they would safely prepare their babies feeds in the event of such power outages.

The good news is that, at the moment, it appears that outages will be planned and will last no more than 3 hours, between 4 and 7pm. This means that the NHS advice on formula feeding away from home should be suitable:

If using a vacuum flask, it is important to fill it up to the top to ensure the water stays hot (you can read more about this in our FAQ about making up formula away from home here).

If using a ready to feed formula, it is important to note that these are much more expensive than powdered formulas. You might want to remind families that in terms of the nutritional composition (and as for powdered infant formula), there is no difference between brands despite price differences (which are shared in our cost report). It is also important to follow instructions for the safe disposal of unused formula. In short, unfinished bottles should be discarded after a feed, and opened products which have not been used should be discarded if not refrigerated (as will be the case in a power cut).

Finally, families may wish to contact their energy provider to see if they can get on their “Priority Service Register” in order to receive pre-warnings about planned power outages and to find out what other support they can offer.

 We hope you can find all the answers to queries about infant milk safety on our Infant milk info website, here: Questions about infant milk safety and if not please feel free to email us: vicky@firststepsnutrition.org.

Infant Milk News

New Products

Danone have now introduced ‘Big packs’ of Aptamil First Infant Milk and Follow-on Milk. These 2 x600g packs would be expected to last 50% longer than the standard 800g can and, on the basis of cost per gram, are less expensive than the equivalent standard packs.

 

Discontinued Products

All discontinued products this month are follow-on milks. Although follow-on milk is not recommended by the NHS and offers no nutritional benefits to infants compared to infant formula, parents who used these products and wish to continue using follow-on milk will need to find alternatives.

Danone have discontinued Aptamil ready-to-feed Follow-on Milk and Cow & Gate ready-to-feed follow-on milk in 1 L bottles.

Aldi have now discontinued their Mamia follow-on milk. This was the least expensive follow-on milk on the UK market.

 

Cost of Infant milks


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’ has been updated and can be accessed at infantmilkinfo.org/costs. Although the weekly cost of feeding a 2–3-month-old baby the most or least expensive powdered infant formula has remained reasonably stable since our last report in April 2022 at £21.25 per week and £7.73 per week respectively, it will come as no surprise that there have been some significant price increases across all types of formula and at all price points in between these figures. Over the last seven months, price increases have affected mainly Danone products (Aptamil and Cow & Gate), which have risen by up to 9%. This is significant as Danone dominates the infant milk market, holding 76% of the market share in 2021 (Mintel, 2022).

For those eligible for the Healthy Start scheme (in England, Wales and Northern Ireland), families with one infant receive a healthy food allowance worth £8.50 per week which is equivalent to 2x £4.25 healthy start payments. Unfortunately, this no longer covers the cost of a 900g can of the least expensive infant formula on the market, Aldi’s Mamia, which is now £8.59. (In Scotland, the Best Start Foods scheme payments are worth £9/week for eligible families with babies under 1, meaning this formula can be purchased without the family needing to add a contribution).

For families who cannot access the Aldi formula, the least expensive of the more widely available alternatives (on the basis of a week’s average consumption), now cost between £8.99 and £11.00 per can. Healthy Start beneficiary families using these products now need to find from their other income sources, the additional 49p to £2.50 for each can purchased (or up to £2 for Best Start beneficiaries).

'Big packs' of formula are less expensive per 100ml than standard pack sizes. However, purchasing a larger pack will require families to pay a greater up-front cost, and these packs are not available in all retail contexts.

 

As the Chancellor’s Autumn Statement did not include Healthy Start in the list of benefits that would be uprated from April 2023, we will continue to support calls for Healthy Start allowances to be increased (alongside other improvements) to ensure that the scheme can better act as the nutritional safety net it is meant to be.

Watch out for more in depth analysis of infant milk cost trends which will be included in our updated Cost of Living briefing.

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

Baby Feeding Law Group UK news

Milk formula firms target women looking for pregnancy advice

On 27 November, the Observer shared some key highlights from Dr Nigel Rollins’ presentation from the UNICEF Baby Friendly annual conference, held last week. The piece by Rosie Taylor highlighted how manufacturers of commercial milk formula use sophisticated algorithms to target advertising of milk formula on digital platforms (including social media) to women whose online behaviour suggests they may be pregnant.

Since infant formula advertising is prohibited in the UK, Dr Rollins shared research demonstrating how companies use loopholes to provide information to pregnant women, mothers, and parents, including promoting brands through sponsored social media posts (on Facebook, Twitter, and Instagram), through the development and promotion of company apps, online “baby clubs”, helplines offering advice and various other strategies. This information comes from reports shared by the WHO this year on the Scope and impact of digital marketing strategies for promoting breast-milk substitutes and How the marketing of formula milk influences our decisions on infant feeding.

Nigel Rollins’ presentation and this news article again remind us how UK laws on the marketing of breastmilk substitutes need to be urgently strengthened, in line with the International Code of Marketing of Breastmilk Substitutes and all subsequent World Health Assembly resolutions, to better protect families from undue commercial influence on how they feed their babies.

Update on our forthcoming report: Infant milks marketed as foods for special medical purposes (FSMP) - The case for regulatory reform to protect infant health

This upcoming report sets out the case for the strengthening of UK law around the marketing of infant milks marketed as foods for special medical purposes (iFSMP). It addresses serious issues arising from shortcomings in the current law and examines the exploitation and misuse of this regulatory category by commercial milk formula companies, which undermine breastfeeding and threaten the health of babies who are not fully breast(milk)fed. It explains why, without independent expert monitoring of company compliance with the law, these issues will not be resolved, and recommends government actions to address these issues, most notably, by embedding the International Code of Marketing of Breastmilk Substitutes and all subsequent World Health Assembly resolutions into UK law.

We have now finalised this report and plan to publish it in early December, so please keep watch on our Twitter feeds and Facebook if you’re interested.

Forthcoming

APPG on Infant Feeding and Inequalities Meeting: Tuesday 6th December

The All-Party Parliamentary Group on Infant Feeding and Inequalities will be hosting a hybrid meeting on the 6th of December at 1pm. First Steps have a slot on the agenda, and Maiko Kamara and Katie Perira-Kotze will be presenting “A report on the labelling of infant formula and follow-on formula in the UK, and companies' adherence to UK laws and Guidance Notes, and the International Code of Marketing of Breast-milk substitutes." If you are interested in attending this meeting (which is open to anyone), you can sign up for updates and the Zoom link via this form and visit the APPG website.

iHV conference ‘Translating vision in to reality: London, December 7th

 
 

Our Director Vicky, and nutritionist Rachel, will be exhibiting at this iHV conference in London next month. We will be sharing our work and resources with health visitors and hope to receive feedback to improve the work we do towards our objectives, which includes providing resources for health workers to support them in their work with pregnant women and young families. Please do come and meet us in person. For more information please click here.

 
 
 
 

October 2022

This month our newsletter is brought to you by Susan, our Senior Nutritionist.

Welcome to our October newsletter, I hope you are enjoying this colourful, fruitful season and have the opportunity to get outdoors and kick a few leaves or just enjoy the autumn colours. For those of you who don’t already know me, I have worked with FSNT from the very beginning, 11 years ago. Since then, I have had a hand in many of our resources including co-writing our first ever report ‘Infant Milks in the UK – A practical guide for health professionals’ (which is now incorporated into our website) as well as a number of other publications on sustainable diets and baby food composition. I am a registered public health nutritionist and senior nutritionist here at FSNT. My particular area of interest is breastmilk substitutes and, as well as curating and writing content for our website infantmilkinfo.org, much of my time is spent working to protect infants and young children from commercial interest by promoting better regulation and marketing of breastmilk substitutes.

As the political musical chairs and worsening economic outlook that influence our collective efforts continues to frustrate, we remain concerned that the Government is not doing enough to protect families from the impact of the cost of living crisis. In our ‘News’ we look at the impact of the cost of living crisis on the quality of the diets of infants and young children and what actions government can take to address their specific needs. We introduce the updated guide for Local Authorities: Supporting families with infants under 12 months experiencing food insecurity (by UNICEF UK Baby Friendly Initiative, First Steps Nutrition Trust and the National Infant Feeding Network) and we share news on the new Unicef UK #EarlyMomentsMatter campaign.

In ‘Infant Milk News’ we discuss the impact of rising food costs on formula milks and reiterate the importance of safe preparation of powdered infant formula and as secretariat of the Baby Feeding Law Group (BFLG) UK we share our work and the work of others around conflict of interest in infant feeding, particularly formula industry sponsorship. We share our feedback – related to formula industry sponsorship - to the WHO consultation ‘Clarification on Sponsorship of Health Professional and Scientific Meetings by Companies that Market Foods for Infants and Young Children; link to a BMJ feature published in October that reflects on the problems associated with health professional associations accepting sponsorship from the BMS industry and signpost a WHO/BMJ webinar series that asks the question ‘should health professional associations refuse industry funding?’. Looking forward, we also introduce our forthcoming report on infant milks marketed as foods for special medical purposes (iFSMP) which makes the case for regulatory reform of this category of infant milks in order to protect infant health.

Lastly, we have two forthcoming events to highlight, Sugar Awareness Week and the Unicef BFI conference.


Happy reading!

News

Rising household food insecurity: What we propose Government needs to do to protect infants and young children

News headlines that ‘families are forced to skip meals’ or ‘struggle to buy healthy food’, were once unimaginable in the UK. However, with food inflation now at 14.5%, this is now a reality for nearly one in five families in the UK, according to the latest data collected by the Food Foundation.

Families reported eating smaller meals, skipping meals, feeling hungry or skipping food for a whole day because they could not afford or access food. There are now 4 million children living in food insecure households, an increase of 100,000 children since we wrote our Cost of Living Briefing Note in May of this year. Using the latest Office for National Statistics (ONS) data we estimate that these figures are likely to include 40,000 infants under the age of 12 months and 184,000 children aged 1-4 years.

The Food Foundation’s data also reveals that food price increases are negatively impacting on the quality of children’s diets, reducing their consumption of balanced meals and access to fresh vegetables. Their figures show that close to a half (48%) of food insecure households reported buying fewer vegetables, and 58% less fruit, in addition to a quarter of all households cutting back on the quality of food purchases.

Babies and young children are undergoing rapid growth and development and if they cannot get the food and nutrition they need, they may suffer life-long negative impacts.

Although infants under 6 months of age may be entirely protected from food insecurity if they are breastfed, and continued breastfeeding also offers significant protection in the second half of infancy and beyond, the UK has a formula feeding culture. There are complex reasons for this, and it should be noted that most women want to breastfeed but are not enabled to meet their breastfeeding goals. The reality is therefore that infant formula is an essential household purchase for most families with a baby under a year of age. However, between August 2021 and August 2022, the cost of the least expensive powdered infant formula (Mamia, available only from Aldi) rose from 10p to 12p per 100ml or from £6.44 to £7.73 per week for a 3-month-old. The cost per 900g can of Mamia first infant milk has risen more recently from £8.49 to £8.59, pushing it beyond the value of the weekly Healthy Start payment of £8.50 for a family with a baby under 12 months old (for more information on the rising cost of infant milks see infant milk news). The lack of affordability of infant formula will be putting some babies’ health at risk as families struggling on tight budgets may resort to unsafe practices to feed them, including watering down feeds (as was reported in the 2018 inquiry report into the cost of infant formula in the United Kingdom).

As continued food price increases and subsequent increases in food insecurity are forecast, it is vital that protecting the nutrition and health of our youngest children should be a top priority for our government. Improved household food security will benefit the nutritional status of infants and young children. For that reason, we fully support the Food Foundation’s call for renewed Government commitment to increase benefits in line with inflation and action by retailers to make it easier for people to afford the food they need, and to make healthy options more affordable. However, urgent action to address the specific needs of infants and young children are also needed. Here are our three calls on Government:

1.   Invest in universal breastfeeding support, because breastfeeding is infant food security

All Local Authorities should be given the means to commission, and consistently fund, evidence-based, universal breastfeeding support programmes. To enable more women to meet their breastfeeding goals, these programmes should be delivered by specialist/lead midwives and health visitors or suitably qualified breastfeeding specialists alongside trained peer supporters with accredited qualifications.

 

2.   Expand and strengthen the Healthy Start scheme and Best Start Foods in Scotland

In agreement with the Food Foundation’s latest statement to MPs, the Healthy Start scheme and Best Start Foods in Scotland must be expanded and strengthened to ensure that pregnant women and infants and young children can access adequately nutritious diets. This includes; autoenrollment, increasing the eligibility criteria and value of the schemes, and resolving outstanding issues associated with the schemes’ digitisation process.

 

Nb. Whilst there is significant work to be done to ensure that these schemes are sufficiently impactful, it is crucial that Local Authorities support families with infants under 12 months struggling to cope due to food insecurity (see new guidance below).

 

3.   Deliver on the promised consultation to improve the marketing and labelling of commercial food and drink products for infants and young children

At a time when families are struggling to provide essential foods for their children, misleading marketing that encourages households to purchase high-cost, discretionary items that are often too high in sugar and/or ultra-processed, must be stopped. This could be achieved by upgrading existing legislation covering the marketing of breast-milk substitutes and foods for infants and young children to reflect in full, the International Code of the Marketing of Breastmilk Substitutes and all subsequent World Health Assembly resolutions. The Nutrient and Promotion Profile Model (NPPM), designed to assess commercial baby foods against World Health Organization permitted standards, would be a useful tool to support this, by assessing the suitability of food and drink marketed for infants and young children on the basis of nutrient, ingredient and promotional criteria.

NEW: A guide for Local Authorities: Supporting families with infants under 12 months experiencing food insecurity (by UNICEF UK Baby Friendly Initiative, First Steps Nutrition Trust and the National Infant Feeding Network)

In 2020, UNICEF UK BFI, First Steps and NIFN wrote a guide for Local Authorities on infant feeding during the coronavirus outbreak. The guide provided advice on the implementation of emergency food-related measures to support families with babies, who were self-isolating and/or affected financially. This 2020 guide has recently been re-written to take in to account the current context of worsening food insecurity and the cost of living crisis.

The 2022 version (below) outlines how Local Authorities can develop pathways and wrap around support for food insecure households with babies, taking in to account their unique nutritional needs and reliance on breastmilk and/or infant formula. The guidance provides tools and resources to support Local Authorities in developing these pathways, including case studies and a self-assessment checklist. It also outlines how Local Authorities can coordinate good practice; including in the appropriate procurement and provision of infant formula for families who need it (alongside support for safe use) and the protection and support of breastfeeding. It provides a timely reminder that breastmilk, as well as improving the short and long-term health and wellbeing outcomes for mothers and babies, can protect babies against food insecurity in times of financial hardship and food crises. The guidance also reminds Local Authorities of the need to protect carers from the inappropriate marketing and provision of breastmilk substitutes and of unnecessary commercial baby foods which can undermine the development of good eating habits in infants and young children.

We would like to hear feedback from Local Authorities on this guidance document, including additional examples of crisis support pathways for inclusion as case studies, and any data local authorities have on the number of food insecure households with babies and how they are being assisted. If you would like to submit any relevant information, please contact bfi@unicef.org.uk.

Unicef UK #EarlyMomentsMatter campaign

This month Unicef UK launched #EarlyMomentsMatter, a campaign calling on the Government to deliver a National Baby and Toddler Guarantee, including support for infant feeding. The campaign builds on a policy report that details the scale of the challenges facing parents and carers of infants and young children as the UK recovers from the COVID-19 pandemic and faces an unprecedented rise in the cost of living.

Included in the report (above) is research which shows that 32% of parents in Great Britain are struggling to access essential support for early childhood health and development, with significant disparities in access to services by location, gender and ethnicity. This includes support for infant feeding and breastfeeding, which is currently under significant pressure as health visiting teams, maternity services and peer support workers are overstretched, undervalued and under-resourced. This is evidenced by the fact that, despite breastfeeding being an evidence-based UK public health priority, delivery of support services is patchy with no national level mandate for delivery, resourcing gaps and no guarantee of long-term support for services.

The report also highlights how the Government’s ‘baby blind spot’ means they continue to make decisions without considering their impact on the wellbeing of babies and young children (as our Director Vicky Sibson has written about with respect to evolving national food policy in this Food Research Collaboration Policy Insight). 

The #EarlyMomentsMatter campaign calls on the UK Government to guarantee accessible, quality and fully resourced maternity services, health visiting support and infant feeding support in addition to other services. In order to achieve this, it appeals to Government to make early childhood a national priority, with services delivered as part of a cross-government strategy with cabinet-level leadership to ensure accountability.

We support this campaign in recognition of the essential role of midwives, health visitors and the wider health and social care workforce in the provision of support for infant feeding. We also call on Government to protect parents/carers and health care professionals from inappropriate and misleading marketing that undermines this support.

Click here to join us in supporting the campaign: signing the petition.

Infant Milk News

As the cost of living crisis continues to bite, we remain concerned about the impact on the cost of infant milks. Since we last updated our report on the cost of infant milks in the UK, prices have risen across Aptamil, Cow and Gate, Kendamil and Mamia products, some by as much as 10%. In this context, it is once again a good time to remind families that because of UK regulations, all first infant formulas have a comparable nutrition composition; the implication being that premium products are not worth the extra cost. We plan to provide a more comprehensive review on the cost of formula milk by the end of the year when we update our report on the cost of infant milks in the UK.

The rising cost of energy also has implications for formula feeding families and it may also be a good time for HCPs to remind parents of the importance of following NHS guidelines on the safe preparation of powdered infant formula.

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

Baby Feeding Law Group UK News

Conflicts of interest and funding from manufacturers of breast-milk substitutes

On 23 September 2022, the WHO launched an online public consultation to clarify guidance on the Sponsorship of Health Professional and Scientific Meetings by Companies that Market Foods for Infants and Young Children. The resulting draft information note was available for public consultation until 17 October 2022. The Baby Feeding Law Group (BFLG) UK made a submission to the online consultation reflecting inputs from members. We look forward to seeing the final version and are hopeful our suggestions are taken on board to improve protection from industry influence for infants and young children.

Sponsorship of health professional associations was also the subject of a feature published by the British Medical Journal (BMJ) on 14 October 2022. The feature entitled Formula milk: why WHO has taken a hard stance on sponsorship describes the BMJ’s decision to end all marketing of breast-milk substitutes (BMS) in its journals and highlights the problem with health professional associations accepting sponsorship from the BMS industry. A news piece was published at the same time, entitled Formula milk: WHO Foundation refuses to take further financial donations from Nestlé which details how a foundation set up by the WHO will no longer accept funding from Nestlé.

The Baby Feeding Law Group UK website has guidance on how to work within the International Code of Marketing of Breast-milk Substitutes and protect breastfeeding and formula fed babies from the commercial influence of the BMS industry, by avoiding conflicts of interest. The following documents are available:

WHO/BMJ webinar series: The Problem with the Formula Milk Industry

On Thursday 29 September 2022, the second of two webinars hosted by the World Health Organization (WHO), British Medical Journal (BMJ), Partnership for Maternal, Newborn & Child Health (PMNCH) and Children in All Policies 2030 (CAP2030) took place. This webinar was entitled The problem with the formula milk industry: should health professional associations refuse industry funding? The webinar (1 hour 15 minutes) is available to watch on the BMJ YouTube channel.

The webinar was once again hosted by Dr Chris van Tulleken and included inputs from different leaders of various international professional associations as well as a presentation from the WHO (Dr Laurence Grummer-Strawn) and UNICEF (Grainne Moloney) on what constitutes sponsorship. Notice about the WHO public online consultation to clarify guidance on the Sponsorship of Health Professional and Scientific Meetings by Companies that Market Foods for Infants and Young Children was also shared on the webinar. The webinar ended with a call to interpret the International Code as best we can without trying to find loopholes around its guidance and the need to ensure that the commercial determinants of health are given adequate consideration.

Introducing our forthcoming report: Infant milks marketed as foods for special medical purposes (FSMP) - The case for regulatory reform to protect infant health

This report sets out the case for the strengthening of UK law around the marketing of infant milks marketed as foods for special medical purposes (FSMP). It addresses serious issues arising from shortcomings in the current law and examines the exploitation and misuse of this regulatory category by commercial milk formula companies and how this undermines breastfeeding and threatens the health of babies who not fully breast(milk)fed. It explains why without independent expert monitoring of company compliance with the law, these issues will not be resolved and recommends actions government departments can take to address them, most notably by embedding the International Code of Marketing of Breastmilk Substitutes and all subsequent World Health Assembly resolutions into UK law.  We hope to publish this report by the end of November so look out for a link in our next newsletter.

Forthcoming

Webinar: Who benefits from undermining breastfeeding? Virtual report launch

On Friday 28 October 2022, the virtual report entitled “Who Benefits from Undermining Breastfeeding?” will be launched at a webinar hosted by the United Nations University International Institute for Global Health (UNU-IIGH). The webinar will take place from 1-2:30pm UK time and registration can take place here.

The webinar will present new research on the economics of the commercial milk formula industry with various keynote remarks and a presentation on perspectives from the World Health Organization and two non-government organizations (Third World Network and Save the Children). Details on the speakers for the event are available here.

Sugar Awareness Week: November 14th – 20th

Action on Sugar is running its annual Sugar Awareness Week from November 14th to 20th this year, to raise awareness of the health impacts of consuming excess sugar and calories. This year the focus is on breakfast and how commercial products contribute to daily sugar intake. They say:

“Breakfast provides us with a great opportunity to start our day consuming a variety of essential nutrients, but unfortunately, commercial breakfasts such as cereals, pancakes, jams, yogurts, pastries and even porridges are often high in free sugars. It’s time to highlight that we shouldn’t be sold a dessert for our first meal of the day.”

And we agree! Highly processed products often have a lot of unnecessary sugar, as well as salt and preservatives added. Making meals from scratch is both healthier and cheaper! Our Eating well resources provide numerous examples of healthy breakfast recipes for those working with infants and young children (1-4 years old).

We look forward to supporting Action on Sugar’s activities during the week.

Unicef BFI conference: November 23rd & 24th

Unicef’s Baby Friendly Initiative annual conference 2022 takes place, virtually, over two days this year: 23-24 November.

The event includes a roster of interesting speakers including Nigel Rollins (WHO), Dr Robert Boyle (Imperial College London), and our own Director, Dr Vicky Sibson, presenting on Ultra Processed Foods at midday on the 23rd.

View the full line-up of speaker and events and book your tickets here. Please note booking closes at 5pm 18th November 2022.

 
 
 
 

September 2022 News

 

We hope you have had a nice summer, and back to work/school/study has not been too difficult. After a quiet August, September has been a busy month for us, although of course overshadowed by the passing of the Queen and the ongoing and worsening political and economic turmoil. These are extremely worrying times for the population as a whole, with macro-level issues that need urgent attention to ensure families can afford to heat their homes sufficiently, pay the bills and buy food and other essentials. In the midst of these challenges, ensuring that infants and young children and their families can eat well remains more important than ever, especially given the life-long health impacts of poor diets in the early years.

In ‘News’ we share the highlights of SACN’s (unsurprising and concerning) analysis of what young children are eating in the UK, we share more positive news from a Scottish government evaluation of the Best Start Foods scheme, and the link to a blog we wrote for the iHV on recognising and refuting claims made on baby food pouches. In case you missed it in August, we also share again our new FAQ on water in infancy (something to file for next summer!).

We have one piece of ‘Infant Milk news’, as we finally have confirmation that Piccolo have discontinued selling infant milks.

In ‘news from the Baby Feeding Law Group UK’ we share our submission to inform the UN Committee on the Rights of the Child of the lack of necessary progress in the UK towards ensuring the right of the child to the enjoyment of the highest attainable standard of health (i.e. to be breastfed, where this is desired and possible), among other rights, and our recommended actions to realise these rights. We also share highlights from the first in a series of two WHO/BMJ webinars on “The Problem with the Formula Milk Industry”, and a link if you missed it and want to catch up.

Lastly, we have three forthcoming infant feeding-related events to highlight, in case of interest (nb. one is TODAY at 2pm, scroll down to find out more).

Happy reading!

News

SACN: Feeding young children aged 1-5 years - DRAFT: Analysis of prevailing diets

As shared in the July newsletter, the Scientific Advisory Committee on Nutrition (SACN) published a consultation on the draft report ‘Feeding young children aged 1 to 5 years’ which closed on 20 September. We submitted a response and look forward to the release of the final report, after which we will share with you a summary of what recommendations have changed with respect to feeding of children aged 1-5 years, and will start updating our resources accordingly. In the meantime, we wanted to share with you the committee’s summary of their analysis of the prevailing diets of young children (from the 2011 Diet and Nutrition Survey of Infants and Young Children (DNSIYC) and National Diet and Nutrition Surveys (NDNS)), highlighting concerning issues which need addressing urgently, as follows:
 
Energy and macronutrients:

  • Mean intakes of energy for children aged 12 to 35 months are above the estimated average requirement (EAR) for dietary energy

  • Mean intakes of protein exceed the Reference Nutrient Intake (RNI)

  • Mean intakes of free sugars for children aged 18 to 60 months exceed current recommendations of no more than 5% of Total Dietary Energy Intake (TDEI) (currently applicable from 2 years of age)

  • Mean intakes of saturated fats exceed the population recommendation of no more than 10% TDEI (currently applicable in full from 5 years of age)

  • Foods high in (total) fat, salt and free sugars provide over a quarter of TDEI in children aged 18 to 47 months and over a third of TDEI in children aged 48 to 60 months

  • Mean intakes of dietary fibre for children aged 18 to 60 months are below the recommended intake of 15g a day

 
Micronutrients:

  • Certain groups of children, including children from lower socioeconomic status households (as measured by the Index of Multiple Deprivation) and ethnic minority groups, may be at risk of inadequate intakes of iron, zinc and vitamin A, and inadequate dietary vitamin D intakes and vitamin D status.

There is evidence of low uptake of government advice that children aged up to 5 years should be given vitamin supplements.

Scottish Government evaluation of the Best Start Foods scheme

 
 

The Scottish Government have recently published an evaluation of their Best Start Foods scheme, providing a vital safety net for those on low incomes through provision of vitamins and digitised payments to young and low-income pregnant women and low-income families with children up to 4 years of age. Payments are higher than those offered under the Healthy Start scheme and are intended to enable recipients to purchase specific foods including fresh eggs, milk (plain cow’s milk and first infant formula), fruit, vegetables and pulses (full details of both schemes are in this First Steps report: Healthy Start and Best Start Foods: A practical guide).

The results of the evaluation were broadly in line with those of the 2014 evaluation of the Healthy Start scheme (published here). Positively, the evaluation provides clear evidence of the value of the scheme, with indicators showing progress towards improving the dietary habits and wellbeing of infants, young children and their carers. The scheme decreased pressure on household finances, enabling recipients to afford essential food items for their children, and reducing the burden of financial worry. Participants reported being able to replace frozen and processed foods with fresh fruit and vegetables, enabling families to experiment preparing new types of meals with more fruit and vegetables. Recipients found introducing new foods to their children more enjoyable, and some reported a more positive attitude towards healthy eating, especially those who consumed minimal fruit and vegetables when they were younger. It was also reported that the payments were especially valuable for children with intolerances, digestive problems and for fussy eaters as catering for their needs is more expensive.
 

Although payments are not restricted to the purchase of specific product types, the evaluation found that recipients largely used the vouchers in line with recommendations, purchasing cows’ milk, ‘baby formula’, fresh fruit and veg and other foods including bread, pasta and poultry, but also other baby essentials such as nappies, toiletries and clothes. There were concerns captured around the payment value halving when children reached 1 year of age (from £9 to £4.50 a week) as recipients felt that cutting payments sacrificed the quality and quantity of fruit and vegetables purchased. It was also not well understood that the payment value in Scotland is higher up to 1 year of age to support breastfeeding mothers.

 
 

The full evaluation report can be accessed here Best Start Foods: evaluation - gov.scot (www.gov.scot).

We recognise the value of the Healthy Start and Best Start Foods Schemes in providing a vital safety net that protects infant and young child nutrition. In order to ensure the effectiveness of the schemes and to improve their coverage, and in support of the findings of the Best Start Foods evaluation, we continue to advocate for:

  • Monitoring of the value of the Healthy Start/ Best Start Foods schemes payments in relation to food prices

  • Extending eligibility

  • Improving accessibility and uptake of the newly digitised scheme

  • Increasing visibility

  • Integrating the schemes with other benefits and services for young families

  • An enhanced offer for breastfeeding women

Marketing of baby food pouches: Recognising and refuting misleading claims

In our July newsletter, we shared details of the British Dental Association research on the sugar content of baby food pouches (‘Boutique’ baby food more sugary than Coca-Cola ‘rotting children’s teeth’ (telegraph.co.uk)) and its implications for infant and young child nutrition and health. We outlined how some UK baby foods marketed for infants and young children can contribute to dental decay, and overweight, obesity and other chronic diseases later in life, through promoting overconsumption and altering taste preferences in support of highly processed foods.

In August, we shared further information on recognising and refuting the misleading claims often used to advertise baby food pouches as a Blog for the Institute of Health Visiting, which interested readers can access here.

Government action is urgently needed to tackle the ongoing and inappropriate marketing of these types of baby food products, and all infant milks, foods and drinks aimed at infants and young children. We remain hopeful that the promised consultation on the marketing and labelling of baby foods will go ahead at some point soon, although we have failed to get confirmation from the DHSC that this will be the case.

More information on commercial baby foods marketed in the UK can be found here: Marketed food for children — First Steps Nutrition Trust

FAQ: What are the recommendations for giving water during infancy?

During August, following another heatwave in the UK and after being asked a lot of questions about giving water to babies, we produced and shared a detailed FAQ document. This FAQ provides an overview of evidence-based UK public health recommendations regarding water for infants aged 0-12 months to help health workers to advise families appropriately. We also produced this supporting infographic with the key points to share on social media.

 
 

Please click here to access the full FAQ and here for the accompanying infographic.

These resources are on this webpage of our main website: Infants & new mums — First Steps Nutrition Trust.

Infant Milk News

Discontinued products

Piccolo infant milks

Having previously reported being unable to find Piccolo organic infant, follow-on and growing-up milks for sale in either high street or on-line retailers, we can now confirm that these products have been discontinued.

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

Baby Feeding Law Group UK news

BFLG evidence submission for the UN Committee on the Rights of the Child 2022

In July, the Children’s Rights Alliance for England (CRAE) published a call for Written Evidence to the Civil Society Alternative Report to the UN Committee on the Rights of the Child 2022. This was an important opportunity to highlight areas in which the rights of children in the UK have not changed for the better since the CRAE published its submission to inform the List of Issues Prior to Reporting (LOIPR) in November 2020; including the right of the child to the enjoyment of the highest attainable standard of health, i.e. to be breastfed, where this is desired and possible.

On behalf of its 31 organisational members, the BFLG-UK submitted a response highlighting what we believe to be important inaccuracies and omissions in the UK State Party response to the UN Committee’s List of Issues on the Rights of the Child 2022, particularly relating to infant and young child feeding. Our specific recommendations that we proposed the UNCRC should make to the UK Government were as follows:

1. Ensure accessible, evidence-based, and independent information about infant and young child feeding, and provide effective universal coverage of support for mothers who want to breastfeed
2. Acknowledge and address the association between the use of breast-milk substitutes and the increased risk of obesity in children
3. The UK should fully implement the International Code of Marketing of Breast-milk Substitutes and its subsequent WHA resolutions through updated legislation together with ensured compliance through monitoring and enforcement.

The letter from the BFLG is available here.

We will follow up on the final, full civil society alternative report and to the response of government to this, and will keep you informed.

WHO/BMJ webinar series: The Problem with the Formula Milk Industry. Webinar 1: ‘Unhealthy Influence on Health Professionals?'

On Thursday 8 September, the first of two webinars hosted by the World Health Organization (WHO), British Medical Journal (BMJ), Partnership for Maternal, Newborn & Child Health (PMNCH) and Children in All Policies 2030 (CAP2030) was held, entitled ‘The Problem with the Formula Milk Industry: An Unhealthy Influence on Health Professionals?' The webinar (1 hour 11 minutes) is available to watch on the on the BMJ YouTube channel: https://www.youtube.com/watch?v=THRNOTDe2WM

The webinar was hosted by Dr Chris van Tulleken and included reflections from various researchers, health professionals, clinicians and experts in marketing and journalism. One issue highlighted was that currently, in the UK, patients have no way of finding out if the health professionals treating them receive any payment, sponsorship or funding from a pharmaceutical company or the formula milk industry. This is problematic because funding-related conflict of interest has the potential to influence the treatment and products that these professionals are recommending. A solution proposed by Rebecca Coombes, Head of Journalism at the BMJ, was to establish a register for health professionals in the UK, requiring them to declare any industry funding, sponsorship or financial incentives received.

This webinar provided an important opportunity to reflect on how conflicts of interest arising from the engagement of health care professionals with the formula milk industry can unduly influence infant feeding practices. See below for the second webinar in the series (taking place TODAY).

Forthcoming

WHO/BMJ webinar series: The Problem with the Formula Milk Industry. Webinar 2: ‘Should health professional associations refuse industry funding?’: September 29th

This second webinar in the series takes place on Thursday 29 September at 2pm. You can register and join the webinar here.

APPG on Infant Feeding and Inequalities Meeting: October 18th

An All-Party Parliamentary Group on Infant Feeding and Inequalities meeting will be taking place on 18th October 2022 at 1pm. It will be the first meeting by the group this year and will take place in a hybrid format. The meeting will feature guest speakers including our trustee Professor Amy Brown and will by lead by MP Alison Thewliss. If you are interested in attending this meeting (which is open to anyone), you can sign up for updates and the Zoom link via this form and visit the APPG website.

iHV conference ‘Translating vision in to reality: London, December 7th

Our director Vicky, and nutritionist Rachel, will be exhibiting at this iHV conference in London in December, sharing our work and resources with health visitors and hoping to receive feedback from our service users to improve the work we do towards our objectives, which includes providing resources for health workers to support them in their work with pregnant women and young families. Please do come and meet us in person. For more information please click here.

 
 

July 2022

This month’s political turmoil means the promised health disparities white paper has been delayed until post recess (best case scenario), if indeed it is ever even realised (worst case scenario). This is really disappointing given the opportunity it created to address the food and nutrition needs of infants and young children. However, other opportunities to shape early years diets for the better have arisen, and we have lots of interesting new reports, research, updated resources and more to share with you.

In ‘News’: two public consultations have just opened, one is the Scientific Advisory Committee on Nutrition’s draft report on feeding young children aged 1-5 years old, and the other a draft WHO guideline on the use of non-sugar sweeteners; the Food Foundation launched their 2022 Broken Plate report on the state of the nation’s food system and the Grocer released their 2022 infant and childcare report. We also share with you some new research relevant to eating well in the early years, and updates of our Eating Well in pregnancy guides and our Healthy Start and Best Start Foods Practical Guide.

In ‘Infant Milk news’ we have one new ‘growing up’ drink to highlight.

And lastly, we have no less than four forthcoming infant feeding-related events to highlight in case of interest.

Happy reading!

Please note as we’ll all be taking some time off in August, our next newsletter will be late September.

News

Open Consultations

SACN: Feeding young children aged 1-5 years - DRAFT

The Scientific Advisory Committee on Nutrition (SACN) has published a consultation on the draft report ‘Feeding young children aged 1 to 5 years’. The consultation is open for comment from 20 July to 16 September 2022 and interested parties are invited to draw SACN’s attention to any evidence that it may have missed. You can find more information in the link.

Once the report has been finalised we will share with you a summary of what recommendations have changed with respect to feeding of children aged 1-5 years, and will start updating our resources accordingly.

WHO Guideline on Use of Non-Sugar Sweeteners – DRAFT

The WHO have drafted these guidelines based on the results of an updated systematic review and meta-analysis of the health effects of the use of non-sugar sweeteners (which can be accessed here). The background is that efforts to limit free-sugars intake (the consumption of which have been linked to overweight and obesity, and other non-communicable diseases), have undoubtedly led to an increase in the popularity of non-sugar sweeteners. These low calorie/no calorie alternatives to free sugars are marketed as aiding weight loss or maintenance of healthy weight and are considered to be healthier (e.g. by the NHS Better Health brand its Food Scanner app). However, although individual sweeteners undergo toxicological assessment to establish safe levels of intake, there is no consensus on whether sweeteners are effective for long-term weight loss of if they are linked to other long-term health effects at habitual ‘safe’ consumption levels.
 
Key remarks from the online launch of the guidelines which took place on July 15th included the following:
 

  • “Efforts to reduce free sugars intake should be implemented in the context of achieving and maintaining a healthy diet. Because free sugars are often found in highly processed foods and beverages with undesirable nutritional profiles, simply replacing free sugars with non-sugar sweeteners results in a food or beverage in which any other unhealthy elements are mostly retained, and as a result the overall quality of the diet remains largely unchanged”.

  • “Replacing free sugars in the diet with sources of naturally occurring sweetness, such as fruits, as well as minimally processed unsweetened foods and beverages, will help to improve dietary quality and should be the preferred alternatives to foods and beverages containing free sugars”.

 
Drawing on the updated review of evidence, the WHO have developed the draft guidelines which are open for public consultation until August the 14th. To access the guidelines and submit your views, click here.
 
For our 2019 report on sweeteners in the diets of infants and young children (including recommendations which remain relevant given the WHO stance) see here.

 
 

If any organisation would like to liaise about our responses to these consultations please email vicky@firststepsnutrition.org.

Just launched

The Broken Plate 2022

The Food Foundation launched their annual report on the state of the Nation’s Food System on June 19th. The report examines ‘vital signs indicating the health of our food system, how it impacts on our lives and how we must change the food environment so that it delivers healthy and sustainable diets for everyone’. It highlights that unhealthy and environmentally unsustainable foods are now the norm, driving obesity and other diet-related disease, as well as climate change. After assessing ten key metrics providing an indication of the state of our food system and food environment, it outlines how changes are needed to make healthy foods more affordable, available and appealing. The report assesses whether policy is adequate to enable the progress needed in these three areas, and assesses six outcome metrics which reflect the impact that the food system is having on our health and environment and the impact that it will continue to have in the future if nothing changes.

The report and the annual initiative it is a part of is insightful and important. Improving the wider food environment and diets in general is essential for babies and young children whose diets are influenced by what their families eat. However, we have recommended to the Food Foundation that greater attention is given to what the under 5’s eat and why in their future analyses of the food system, so that appropriate actions can be recommended to improve their diets for the better. Babies are routinely being forgotten in wider food systems discourse in the UK (e.g. in the Government Food Strategy released in June, as explained here) and yet without improving diets in the first 1,000 days, the high rates of childhood obesity being observed will not be brought down.

You can read the Food Foundation’s Broken Plate 2022 report here.

The Grocer infant and childcare 2022 report

The Grocer published its infant and childcare 2022 report on June 16th. Interestingly given the content of previous years, it focuses on the ongoing inappropriate marketing of formula by industry asking “Will the tactics of brands prompt tougher rules?”. We hope so! In our opinion stronger regulations (at minimum, reflecting the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly Resolutions) are needed to protect parents and babies from misleading marketing, as well as meaningful enforcement of compliance with the regulations.

The report also states “Rising prices have helped the infant & childcare category grow in value on flat at volumes”. Indeed data within show that baby milk sales have grown in value 8.6% over the last year whilst volumes have only grown 6.7%, highlighting that the price increases we captured in our cost report update in April 2022 are clearly driving sales value gains. This is supported by the fact that branded baby milk value sales surged 9.7% while own label baby milk value sales fell 14.1%. There is only one own label infant formula, Mamia by Aldi, the price of which has only recently increased (to £8.49 per 900g, from £7.99 in April) whereas many branded products increased in price earlier in the year and by higher relative amounts.

In the midst of the cost of living crisis we remain concerned that infant formula prices may be unaffordable for many, especially with the Healthy Start payment amounts not keeping up with inflation, and we will continue advocating for appropriate actions.

New research

British Dental Association research on baby food pouches

The BDA recently researched the sugar content of baby food pouches marketed to infants and young children (‘Boutique’ baby food more sugary than Coca-Cola ‘rotting children’s teeth’ (telegraph.co.uk)). Results were alarming, with pouches containing up to 5 times as much sugar per 100g as Coca Cola. The full results of the research, including details on specific items, can be found here. They reveal that the highest levels of sugar are found in the ‘boutique’ brands such as Ella’s Kitchen and Annabel Karmel.

Although parents are led to believe that commercially-produced fruit and vegetable-based purées are appropriate ‘first foods’ for infants, they are often high in the free sugars associated with dental decay; the primary reason for hospital admissions in young children in the UK. In addition, the foods infants are exposed to at an early age have long-lasting effects on their liking of specific tastes as infants learn to recognise the flavours, texture and appearance of individual fruits and vegetables. Evidence suggests that feeding infants bland, sweet, highly processed purées may lead children to develop fussy eating patterns, rejecting healthy family foods in favour of highly processed foods, one of the causes of overweight, obesity and other chronic diseases later in life.

As we reported in our 2017 review of UK baby foods, processing fruits and vegetables into a puréed form may also promote over-consumption, as the energy density and physical structure of foods is altered, impacting on satiety and energy intake. Additionally, puréed foods are smoother than their unprocessed or minimally processed counterparts and so can be rapidly swallowed, making it more difficult for care-givers to know when their infant has had enough to eat.

Unfortunately, the clever but inappropriate marketing on baby food pouches we highlighted in 2018 still persists, and the numerous misleading health and nutrition claims make it hard for parents and carers to make informed choices on what to feed their children. Here are some of the misleading claims documented by the BDA survey, and the evidence or public health guidance refuting these claims:

  • Suitable for children 4m+ – The NHS recommends introducing solid foods from around 6 months of age when the baby is showing signs of developmental readiness

  • Nutritionally approved / in line with infants nutritional and developmental needs – the UK Government’s Scientific Advisory Committee on Nutrition recommend that the average intake of free sugars should not exceed 5% total dietary energy intake for young children over 2 years of age. This equates to a maximum of 13g per day for girls aged 2-3 years and 15g per day for boys of the same age. Roughly 60% of the pouches surveyed by the BDA contain enough free sugar to exceed the maximum daily intake for girls aged 2-3 years if two pouches were consumed in a day, and a further 10% exceeded the maximum intake among this age group in a single pouch.

  • High in fibre/contain one of your five a day – although intact fruits and vegetables are a good source of fibre and vitamins, processing may result in changes in the quantity and bioavailability of nutrients and phytonutrients in foods. The evidence we reviewed for our 2018 report on baby food purées suggests that the processing techniques required to produce baby foods are linked with losses of total fibre, glucosinolates and heat-sensitive nutrients such as vitamin C.

It is also important to note that on-pack instructions to “eat straight from the pouch” are against NHS guidance. Sucking from the pouch increases the risk of dental decay, does not allow children to see the food they are eating, does not allow infants or care-givers to know how much they are eating and changes eating from a chewing to a sucking experience.

We support the BDA’s call for action to tackle the inappropriate marketing of baby food pouches, which needs to be a part of efforts to prevent the inappropriate marketing of all formula, foods and drinks aimed at infants and young children, in order to protect the short and long-term health of this vulnerable group. We await the promised Government consultation on the marketing and labelling of baby foods.

See our Eating Well: the First Year guide on introducing solids and eating well up to baby’s first birthday for evidence-based and conflict-free information and practical advice on feeding babies.

A content analysis of ‘junk food’ content in children’s TV programmes: a comparison of UK broadcast TV and video-on-demand services

 
 

Barker and colleagues report on and compare the results of two content analyses of high in saturated fat, sugar or salt (HFSS) food imagery, one of popular UK children’s TV channels (for pre-school children and older) and the other of a selection of children’s programmes available on video-on-demand (VOD) services. They found HFSS images to be common on the kids TV and the VOD services and state that this is likely having an effect on HFSS consumption in children, therefore being one driver of overweight and obesity.

The authors urge Ofcom to consider the implications of allowing children to be exposed to HFSS content through programme content and to put regulations in place to prevent this from happening. They also recommend that the DHSC considers whether the current plan to ban ‘junk food’ adverts before the 9 p.m. watershed goes far enough to prevent exposure to HFSS content, and to consider HFSS content in programmes broadcast before this time.

Read the full paper here.

Trends in use of specialized formula for managing cow's milk allergy in young children

Co-authors Mehta and Allen and colleagues undertook a cross-sectional analysis of national prescription databases in the UK, Norway and Australia and examined volume and cost of specialised formula, and the proportion of infants prescribed specialised formula. Expected volumes assumed 1% cow's milk allergy incidence and similar formula feeding rates between infants with and without milk allergy.

Results from England were that prescribed volumes of specialised formula for infants rose 2.8-fold from 2007 to 2018, with similar trends in the UK. In 2020, total volumes were 9.7- to 12.6-fold greater than expected and specialised formula for infants cost the equivalent of 103 euro per birth. In 2020, 30%–50% of prescribed specialised formula across the three countries was amino-acid formula.

The authors conclude that in England (as well as Norway and Australia), specialised formula prescriptions have increased in the early 21st century and exceed expected levels, and that unnecessary specialised formula use due to overdiagnosis may make a significant contribution to free sugars consumption in young children.

Read the full paper here.

For independent information about the specialised formulas being marketed in the UK for infants with cows’ milk and other allergies, see our specialised milk report.

 
 

The “Cinderella sector”: The challenges of promoting food and nutrition for young children in early years’ settings in England

This paper by Warren, Williams and Knai points out that the quality of food that children eat in early childhood has profound impacts on their future wellbeing, and that many young children eat most of their food whilst at nursery or a childminders. The paper highlights that Ofsted includes a welfare requirement that early years settings (EYS) provide food and drink that are ‘healthy, balanced and nutritious’ but that despite this requirement there are no mandatory standards for assessment. The research involved interviewing various stakeholders about food provision in EYS in England, the use of the voluntary food and drink guidelines and the effects of government support on the early years’ sector. Those consulted felt insufficiently consulted, under-valued, lacking in support and underfunded. Some EYS had never heard of the voluntary food and drink guidelines or did not use them. There was disagreement about the role and effect of the voluntary standards, but most believed that they should be made compulsory for a range of reasons, including establishing healthy food preferences and food-habits, reducing the burden of childhood (and related adulthood) obesity, providing consistency across the sector, enabling EYS to feel more confident in interpreting the EYS food and drink requirements, and improving equity.

Read the full paper here.

Updated Eating Well guides

We have updated our Practical Guides “Eating well in pregnancy: A practical guide to support teenagers”, “Eating well for a healthy pregnancy” and “Healthy Start Best Start Foods A practical guide” and they are available on our website here. Edits to all three resources now reflect the most recent changes to the Healthy Start scheme and include Best Start Foods (Scotland) and changes in contact details of relevant organisations. Other changes are outlined below.

“Healthy Start and Best Start Foods A practical guide” explains the Healthy Start scheme in England, Wales and Northern Ireland, and the Best Start Foods scheme in Scotland, and how families eligible for these schemes can be supported. It has been updated to take in to account the digitization of the scheme, the change in the payment amounts and other changes to the schemes. The resource gives examples of how the food payments can be spent (and takes in to account recent food price increases), with recipes and advice for health professionals who support families in their areas.

“Eating well for a healthy pregnancy” aims to enable health professionals to support pregnant women to better understand their food and nutrition needs in pregnancy and how best to meet them. It was updated in February 2022 so the current changes are minimal and mostly relate to changes in the Healthy Start and Best Start Foods schemes.

“Eating well in pregnancy: A practical guide to support teenagers” aims to enable health professionals to support pregnant teenagers to better understand their additional food and nutrition needs and how these needs might best be met. It includes recipes and meal ideas and can sit alongside other local public health guidance to provide a practical explanation of what 'eating well' looks like.
The main updates that have been made are around the advice on foods to limit or avoid during pregnancy, which are now in line with recent changes to NHS advice, and tips for eating well out of the home now better recognise the increasing contribution of home food delivery to many pregnant women’s diets.

Infant Milk News

New products

SMA Little Steps Plantygrow

Nestlé have recently launched a plant-based milk alternative “growing-up” drink for 1-3 year olds. This is now the second plant-based milk alternative growing-up drink available in the UK, the other being Alpro soya growing-up drink. The product is branded as part of the Little Steps sub brand which has now grown to include cows’ milk-based formula milks, Plantygrow plant based growing-up drinks and a range of finger foods and cereals for toddlers from 12 months +.

The main ingredients in Plantygrow are water, hydrolysed flour from wheat, oat, barley and rye, maltodextrin and vegetable oil. As there are no specific compositional, marketing or labelling regulations for either growing-up milks or plant-based milk alternatives, their composition is highly variable and they may have limited nutritional equivalence to animal milks. Although manufacturers of plant-based growing-up drinks recommend their products as suitable for young children, this evaluation is entirely their own.

In the UK, public health guidance is that unsweetened, fortified milk alternatives, but not those that are rice based, can be included as the main milk drinks from the age of 1 year. It is important however, to note that there are some issues related to the macro and micronutrient content of plant-based milks and the bioavailability of the fortificants added. Plantygrow has a greater energy content than many plant based milk alternatives on the general market but is lower in protein and contains added free sugars.

Families should be made aware that young children require an energy and nutrient dense diet, and that perceived health benefits of a plant-based diet may not be relevant or health promoting for young children. You can find a broader discussion on issues related to the use of plant-based milks in young children’s diets in our briefing paper: Plant-based milk alternatives in the diets of 1–4 year-olds
Plantygrow is marketed as a “growing-up” drink, and like cow’s milk based “growing-up” and “toddler” milks, it is an ultra-processed food with added free sugars; in Plantygrow the free sugar added is maltodextrin. This is of concern as the taste profile of sweetened, ultra-processed foods does not accustom young children to the real taste of the unprocessed and minimally processed foods recommended as the basis of a healthy diet during childhood. The NHS and the European Food Safety Authority say that growing up and toddler milks are not a necessary part of a young child’s diet.

Given the current cost of living crisis, a particularly pertinent feature of Plantygrow is that it is expensive. Plantygrow retails at 75p per 200ml and Nestlé recommend 2x200ml per day. Feeding a young child 400ml a day as recommended by the manufacturer would cost parents £10.50 per week or £45 per month. This compares to £2.80 per week and £12.00 per month should an equivalent amount of supermarket own brand unsweetened fortified, soya milk be used. There are implications for both the diet of the toddler and the rest of the family if expensive unnecessary products are purchased which reduce the amount of household income available for buying healthier staples for the family. For a broader discussion about the use of milks marketed as “growing-up” and “toddler” milks in the diets of young children see our briefing paper: Drinks for young children marketed as ‘growing-up’ and ‘toddler milk’.

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

Forthcoming

World Breastfeeding Week – 1st-7th August 2022

WABA are running the annual World Breastfeeding Week campaign, with this year’s theme being ‘Step up for breastfeeding – educate and support’. The campaign aims to strengthen the warm chain of support for breastfeeding by improving the capacity that healthcare, community and workplace actors have to protect and promote breastfeeding-friendly environments in a post pandemic world. WABA invite all of us to identify our role in the warm chain and understand how we can protect, promote and support our role using their resources. More information can be found here.

We look forward to seeing everyone’s social media coverage using #WBW2022 #WorldBreastfeedingWeek2022

UNICEF Baby Friendly conference November 23rd-24th 2022

A reminder that an *early discount is still available until the end of August* for this year’s Baby Friendly Annual Conference (Virtual) which will take place over two days, the 23rd and 24th of November 2022. There will be in-depth updates on recent research and innovations related to infant feeding and relationship building, live Q&As and virtual posters. Interactive new networking opportunities will also be made available so delegates can catch up between talks and after the conference. The speaker line up covers a broad range of topics, and includes our Director, Vicky Sibson:

  • Latest updates on Sleep Safety and ‘Sleep, Baby & You’ – Professor Helen L. Ball, Professor of Anthropology & Director, Durham Infancy & Sleep Centre, Durham University

  • Compassionate care: compassionate leadership – Sheena Byrom, Midwife, Director, All4Maternity

  • How the marketing of formula milk influences our decisions on infant feeding – Nigel C Rollins, Scientist, World Health Organization

  • Ultra-processed foods – Vicky Sibson, Director, First Steps Nutrition Trust

Booking closes at 5pm on November 18th.

Find out more and book tickets for the UNICEF Baby friendly 2022 conference here.

WHO and BMJ webinars on “the problem with the formula milk industry”

Following on from the WHO and partners two revealing reports on the ongoing problem of inappropriate marketing of breastmilk substitutes by the baby food industry (as reported on in our February and April newsletters), the WHO and the BMJ are convening two webinars in September about “the problem with the formula milk industry”. The first 'An Unhealthy Influence on Health Professionals?' on September 8th will be facilitated by Dr Chris van Tulleken and will have speakers from Saatchi World Services and WHO, reflections from a range of health professionals and a series of propositions about what can be done.

Register for the event here.

The Association of Breastfeeding Mothers annual Virtual Conference on the 17th September 2022

The ABM are hosting their third Virtual Conference in the autumn, promising a line up of speakers covering a topics including: Supporting the Allergy Dyad, Breastfeeding Through Medical Complexity, Colonisation and Artificial Milk, Why Cultural Safety in Breastfeeding Matters and Body Work and Infant Feeding - An IBCLCs Perspective. You can get tickets here.

 
 
 
 

June 2022

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

News

DHSC confirms 2023 Infant Feeding Survey for England

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

Government releases its ‘Food Strategy’ for England

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You can read the full paper here.

Infant Milk News

The VITAL importance of safer preparation of powdered infant formula

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

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

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

 

“We know very little about the nine infants who died. For privacy reasons, their names, ages, genders, where they lived, and when they died have been withheld. They are identified only by their unique Complaint ID numbers.

In Memoriam

Complaint ID #171222, reported December 1, 2021. Infant arrived to the ER in cardiac arrest. Cronobacter sakazakii and Proteus mirabilis. Infant had consumed Similac Pro-Total Comfort (Powder) infant formula, Lot #23495K80.

Complaint ID #172435, reported February 22, 2022. Vomiting, swollen organs, trouble breathing. Infant had consumed Similac Advance, Lot #34875K80.

Complaint ID #172477, reported February 22, 2022. Screaming. Infant had consumed Similac Total Comfort Easy-to-Digest Gentle Protein & Prebiotics, et al, infant formula powder, Lot #34869K80.

Complaint ID #172479, reported February 23, 2022. Fever, diarrhea, loss of appetite, vomiting. Infant had consumed Similac Advanced infant formula. Lot number not available.

Complaint ID #172541, reported February 24, 2022. Tested positive for Cronobacter sakazakii. Infant had consumed Similac PM 60/40, Lot #27032K800.

Complaint ID #172585, reported February 24, 2022. No details available. Infant had consumed EleCare infant formula, Lot number not available.

Complaint ID #172607, reported February 28, 2022. Cause of death and opinion pending further studies (Congenital). Infant had consumed Similac Elecare powdered infant formula, Lot #34771Z21 1306305
Complaint ID #172632, reported March 2, 2022. Salmonella meningitis, ventriculitis, vomit, diarrhea, seizures, bradycardia. Infant had consumed Similac Pro Advance infant formula, Lot #25598SHO 0557 015 SIMESPWD.

Complaint ID #172636, reported March 2, 2022. Salmonella. Infant had consumed Similac Total Comfort, Lot #26834K80.

May they rest in peace.”

 

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

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

Baby Feeding Law Group UK news

 
 

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

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

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

Staffing update

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

 
 

May 2022

We hope you’ve all had a good month and have enjoyed the sunshine amid the showers. We’ve been really busy with all that has been going on, so have a lot to share in this bumper newsletter. In ‘News’ we share with you our briefing paper on the implications of the ‘Cost of Living Crisis’ for the diets of infants and young children, and our policy recommendations and key messages for health care professionals working with young families; we report on the Government’s U-turn on promised advertising restrictions for HFSS-foods; and we share a new report by the Parent Infant Foundation: “Why Health Visitors Matter”. In ‘Infant Milk news’ we share what we know about unavailable products, highlight some new FAQs about the safer preparation of powdered infant formula and formula feeding (prepared just in time for World Food Safety Day) and we share our thoughts on what the US formula shortages mean for the UK. As secretariat of the Baby Feeding Law Group UK we share with you how the UK’s laws governing the marketing of breast-milk substitutes are rated in the brand new 2022 “Status of the Code” report. Lastly, we share some details of the forthcoming ‘National Breastfeeding Week’.

News

Implications of the ‘Cost of Living Crisis’ for the diets of infants and young children in the UK, and recommendations for policy and practice

Briefing paper and policy recommendations:

In response to the rising cost of living and food insecurity, this month we produced a briefing paper to highlight the specific food and nutrition vulnerabilities of infants and young children. In it we emphasize how the exploitative marketing of infant milks and of commercially-produced foods for infants and young children may lead households to purchase more expensive products at no nutritional benefit to their child. We make eight policy recommendations, mostly focused on ensuring accessibility of infant formula for low-income, formula-feeding families but also to tackle inappropriate marketing and to improve the food offer in early years settings. We welcome you to share this briefing paper and our recommendations widely.

Read the briefing paper here.

Guidance for health care professionals working with young families looking to cut costs:

As the cost of living continues to increase, it is even more pertinent to counter the inappropriate marketing of commercial products aimed at infants and young children with the provision of independent advice to help households make a more informed decision on how they feed their children, given their means. Health care professionals have a role to promote and support mothers who can and want to, to breastfeed, and among health benefits there are likely cost savings for their households if they can be supported to meet their breastfeeding goals. Health care professionals can also signpost eligible families to the Healthy Start/Best Start Foods schemes. In addition to such actions, here are some suggested messages for health care professionals to share with families looking for ways to reduce their outgoings:

Some messages for families with babies:

1. There is no ‘best infant formula’ so you don’t need to buy an expensive product

All first infant milks must meet UK legal measures regarding nutritional composition, so the large cost differences between products do not translate in to health or nutrition benefits, regardless of what  company marketing claims.

If parents are interested in potential cost savings related to their formula choice, health care professionals can look up the cheapest infant milks currently available on the UK market here and advise them accordingly.

Parents can be directed to information on how to choose a formula here.

2. Specialist infant milks marketed as ‘Foods for Special Medical Purposes’ (FSMP) are more expensive than infant formula, they may cause harm and they may not be effective. Only use an FSMP on the advice of a health care professional

Buying a specialist infant milk over the counter instead of infant formula can cost between £16.50 and £198 more in the first 6 months. However, despite being freely available on supermarket and pharmacy shelves and heavily promoted to health workers, specialist infant milks marketed as FSMPs should only be used under medical supervision – as clearly stated on their labels. This would ensure that the formula is effective (because many are not evidence-based) and appropriate for your baby, and that potential harms are minimised as well as ensuring the extra cost you’re incurring (unless you can get the formula on prescription) can be justified.
 
More information on specialised milks can be found here.

3. Your baby doesn’t need snacks – especially ones from packets

Between about 6 and 12 months of age, the NHS advises that babies should progress from eating a few spoonfuls of healthy foods, to three healthy meals a day, in between which they should be given only water and their usual milk (breastmilk or infant formula). Babies should not be given snacks as these will fill them up and displace the nutrients provided by the meals and the milk feeds. Commercially-produced snacks marketed for babies are completely unnecessary as well as expensive. Because of a lack of regulations they are typically marketed as healthy when they are likely to be ‘ultra-processed’, may contain a lot of sugar and are not a good source of the nutrients babies need for their growth and development.
 
Some messages for families with toddlers:

4. Growing-up milks and toddler milks are unnecessary and cows’ milk is a cheaper and better choice

Many formula companies extend their formula product ranges by selling products labelled as ‘stage 3’ and ‘stage 4’ formulas, marketed for feeding toddlers and pre-school children. These are not subject to any regulations with regards to their composition, marketing or labelling and the NHS judge them to be unnecessary. If used daily, they could typically provide 400-500g of extra sugar a month to your child’s diet and would cost 2-3 times as much as an equivalent amount of cows’ milk.
 
Health care professionals can read more about these products here and animal milk and plant milk alternatives to cows’ milk here and here.
 
Some messages for pregnant women and young families:

5. Healthy Start/Best Start vitamins can help ensure adequate intakes of at risk vitamins 

If you are eligible for one of these schemes, you should be able to access the cash allowance to buy nutritious foods, but as well, vitamin drops (to be taken by pregnant and breastfeeding women and babies and young children as directed). It is important to use these supplements as advised, as they contain the vitamins which are commonly lacking in the diet, particularly among those with extra nutrient needs, including young children. This is even more pertinent given the negative impact the cost of living crisis is having on the quality of many people’s diets
 
NHS Healthy Start vitamin tablets and vitamin drops can be accessed using the Healthy Start Card for free. More information on eligibility criteria and how to access Healthy Start vitamins can be found here.
 
In Scotland, Healthy Start vitamins are available for free to:

(Midwifes and health visitors are able to instruct on how to access these vitamins as there are different arrangements in different areas of Scotland).

6. For ideas on how to eat well on a budget see First Steps Nutrition Trust resources

We appreciate that the rising cost of fuel and food, alongside squeezes in incomes and benefits make it a particularly challenging time to try to eat healthily. First Steps Nutrition Trust provides a range of ‘Eating Well’ guides with advice and costed recipes appropriate for babies, children aged 1-4, pregnant women and young families. It’s important to remember that from one year of age, toddlers and pre-school children can eat appropriate family foods, which as well as being nutritious are likely to be more cost-effective than commercial products marketed for toddlers, like packets of snacks and children’s ready meals.
 
You can read/download our Eating Well guides for free here.

 

Government U-turn on ‘HFSS’ advertising: Seeking your help!

The Government recently passed laws to introduce a 9pm TV watershed and total online restriction for advertising high fat, salt and/or sugar products (HFSS). It was also planning to restrict ‘junk food’ multibuy promotions from October 2022. However, mid-month the Government executed a U-turn, delaying these interventions to protect children's health for a year. These restrictions are evidence based: the more children watch ‘junk food’ ads, the more of that ‘junk food’ they want. In the midst of a cost of living crisis, multi-buy offers trick us into spending 20% more, not less: they’re bad for our wallets and bad for our health. However, it's not too late for the Prime Minister to reconsider. Sustain, Jamie Oliver and others are leading a growing movement calling on the Government not to U-turn on this important action to better protect child health. Please help by writing to your MP to ask them to tell Boris to put children’s health before politics.

NEW Parent-Infant Foundation report: “Why Health Visitors Matter: Perspectives on a widely valued service”

Earlier this month, the Parent-Infant Foundation published this new report bringing together evidence and reflections on the vital role of health visitors from parents, and professionals, including our director, Dr Vicky Sibson.

The report notes that there has been a 30% reduction in the health visiting workforce since 2015. In a context where many women want to breastfeed but fail to meet their breastfeeding goals, reductions in the health visiting workforce is worrying news as fewer new mums will have timely access to breastfeeding support and advice. Health visitors also provide evidence-based advice on other aspects of infant and young child feeding, countering the exploitative marketing of food and drink for babies and toddlers that pressures households into purchasing inappropriate, unnecessary and costly foods and drinks. However, service cuts have meant that this support from health visitors isn’t always available. A recent survey commissioned by OHID found that 59% of parents of 3-18 month olds wanted professional advice and support for introducing solids, but only 30% received this advice from a health visitor.

At a time where the cost of living is rising and obesity rates among young children are at their highest recorded levels, this report is a timely reminder of the vital role that health visitors play in providing expert and independent advice and support to parents as they seek to provide the best food and nutrition for their infants and young children. First Steps fully supports the Parent-Infant Foundation’s calls for proper resourcing for the health visiting service, ensuring that all households can access the advice and support they need at this critical period in a child’s life.

You can read the full report here.

Infant Milk News

Unavailable products

Some infant milk products are not currently available for purchase either from the manufacturer’s website, or as far as we can see online, from retailers’ websites or in store. These include Kendamil Medi+ Anti Colic, which the manufacturer informs us is being reformulated, and the Piccolo Organic range of infant milks. The Piccolo website simply states that the products are out of stock and the manufacturer has not informed us whether or not they have been discontinued or alternatively, when they will be back in stock. We will provide any updates we receive in subsequent newsletters.

New FAQs on infant milk safety

 

The 7th of June is “World Food Safety Day”. This annual campaign and celebration aims to draw attention and inspire action to help prevent, detect and manage foodborne risks.

This year the theme is “Safer food, better health”, highlighting the role that safe and nutritious food plays in ensuring human health and well-being. This could not be more relevant to our work currently, given the potential for the rising cost of formula to lead families to implementing unsafe feeding practices such as watering down formula milk, and formula shortages in the US having the same effect (see more on the US situation below). Whilst we cannot fully predict changes in the global supply chain, domestically we can protect infants from food contamination by ensuring that infant milks are prepared, stored and handled safely according to the NHS guidance.

In order to answer some of the questions you have been asking us about the safe preparation and storage of infant milk, particularly with respect to new formula preparation devices and storage of different types of infant formula milks, we have updated the questions about infant milk safety in the FAQs section of our www.infantmilkinfo.org website.

Amongst others, you can find answers to the following questions here.

- Are rapid cooling devices safe to use when preparing powdered infant formula?
- Is filtered water safe to use for preparing powdered infant formula?
- How long can I store ready to feed (RTF) infant milks once opened?

US formula shortages: Implications for UK families

The acute formula supply problems facing families in the US have been making UK news, and we’ve been giving some thought to the potential implications for UK families. Vitally, we’re not aware of any impact on the availability of formula in the UK (a message reiterated by DEFRA in a recent response to a parliamentary question). The reports we have read of supplies being redirected from Europe have been related to specific specialised infant milks and in the context of the manufacturer increasing their production, as opposed to diverting existing stocks. Given the root cause of the shortage being health and safety breeches in one US formula production facility leading to the bacterial contamination of products from that plant, there does not seem to be immediate cause for concern in the UK.

This unfortunate crisis serves to remind us how ongoing work to enable women who can and want to, to breastfeed, is as important as ever. And for those women and families who cannot breastfeed, who choose not to, or whose breastfeeding journey ends sooner than they might have liked, there are several relevant messages on formula choice and preparation (which overlap to some extent with the cost saving messages shared above):

1. No powdered infant formula is sterile, and the only way to kill any potentially dangerous bacteria in the powder is to follow the NHS instructions for making up formula which, critically, includes using water at a temperature of no less than 70˚C.

2. Among healthy, non-breastfed/partially breastfed babies between birth and 12 months of age (after which formulas are unnecessary), all infant formula brands are interchangeable, because the law requires that they all comply with the same nutrition composition standards. This means that all infant formulas can meet a healthy baby’s nutrient requirements for adequate growth and development and none confers any health or nutrition benefits over another, regardless of what the marketing messages may claim.

3. Follow-on formula marketed for use from 6-12 months old should never be given to a baby under 6 months of age as it could be harmful for them. It is also unnecessary for a baby from 6-12 months of age where infant formula is available.

4. Specialised infant milks marketed as ‘Foods for Special Medical Purposes’ should only be used following the advice of a medical professional - as stated on the label - as they may cause harm and/or lack evidence for effectiveness.

5. Infant milks marketed as ‘Growing up’ milks or toddler milks for use from 12 months of age should not be given to infants under 12 months of age as they could be harmful for them. These products are not subject to any laws with respect to their composition, marketing or labelling and they contain a lot of sugar as well as being expensive (you can read more about them here). These products are unnecessary and the NHS advises young children should be given cows’ milk to drink.

Guidance for parents/carers on choosing a formula can be found here.

 

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

Baby Feeding Law Group news

An assessment of the implementation of the International Code of Marketing of Breast-milk Substitutes in the UK, extracted from the 2022 Status Report

Earlier this month, WHO, UNICEF and IBFAN released their latest global status report on the national implementation of the International Code of Marketing of Breast-milk Substitutes (BMS) and subsequent relevant World Health Assembly (WHA) resolutions (collectively referred to as ‘the Code’), presenting data on 149 countries including the UK.

The report supersedes the 2020 report, since when significant contextual changes have occurred, including the COVID-19 pandemic which many formula companies were shown to exploit for marketing purposes. There has also been an increase in the use of digital media for advertising, which has been extensively analysed by the WHO report launched last month.

In order to systematically and objectively assess implementation of the Code, the report uses an algorithm that measures legislative adherence to each Code provision, ranking countries in to one of four descriptive categories. The UK scores 40/100 and is described as “some provisions of the Code included”. Key weaknesses include that legislation only applies to BMS for infants under 12 months (e.g. not to ‘growing up’ or ‘toddler’ milks), legislation does not prohibit promotion of BMS in the health system and compliance with legislation is not monitored or properly enforced.

The report recommends that countries, including the UK, with few legislative provisions of the Code, should analyse and address weaknesses or gaps in their existing legislation and take action to update their legal measures. The BFLG-UK recently commissioned a consultant-led piece of work to undertake this analysis and aide advocacy towards legislative change, and we will keep you informed of our progress in future newsletters.

The 2022 status report on National implementation of the International Code can be found here.

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

Forthcoming

National Breastfeeding Week, 27 June – 3 July 2022

Better Health - Start for Life are running a campaign to celebrate this year’s National Breastfeeding Week, for which the theme is 'Everyone has a part to play in helping mums to breastfeed'.

The key focus will be on the difference that can be made if everyone supports breastfeeding, including the mother’s partner, the wider family, the community, health and education services and workplaces. We hope you may find a way to participate and promote the messages.

 
 

April 2022

We hope you’ve all had a good month and enjoyed the Easter long weekend. This month we want to share with you highlights from two recent peer reviewed papers; one which reveals worrying data about the extent to which young children’s diets in the UK are dominated by ‘ultra-processed foods’ which are linked to rising rates of obesity among other negative health outcomes, and another which shows the pervasive problems of unfounded and inappropriate claims made on commercial baby foods (many of which are likely to be ultra-processed). In Infant Milk news we share with you a discontinued product, highlights from and implications of our updated infant milk cost report, and we unpack the evidence used in a new ad for the specialised infant formula Neocate Syneo. As secretariat of the Baby Feeding Law Group UK we share news of the launch today of a new WHO report on the digital marketing of breastmilk substitutes. And lastly, we share the details of two forthcoming events which might be of interest, find out more below.

New Papers

Ultra-processed food consumption and dietary nutrient profiles associated with obesity

Daniela Neri and colleagues published this paper in October 2021 examining ultraprocessed food (UPF) consumption in eight countries, stratified by age group, and including analysis of the UK National Diet and Nutrition Survey data from 2008-2014. It found that among UK children aged between 2 and 5 years old, close to two thirds (61%) of total mean energy intake came from UPFs. This compares to national estimates for the population aged 1.5 years and over from another study (by Rauber et al, 2018) of 1764 kcal/day average energy intake, of which 56.8% of calories comes from UPF. The Neri study indicated that among children aged between 2 and 5 years old, only 22% of kilocalories came from ‘unprocessed and minimally processed foods’ (on which diets should ideally be based), whilst ‘processed culinary ingredients’ contributed 3% of kilocalories and ‘processed foods’ contributed 4% of kilocalories (noting that these different food categories are from the NOVA classification). The contribution of UPFs to total energy intake of 2-5 year olds in the UK was the highest among all of the eight countries studied, and was higher than the estimated contributions of UPF to the total mean energy intakes for children aged 6-11 (at 57%) and adolescents (12-19) (at 55%).

At the moment there is little attention being paid to the extent to which UPFs dominate UK diets, despite consistent and mounting evidence around their negative health effects. This BBC documentary which aired last June provides an interesting overview of the problem (albeit without due attention to infants and young children) BBC One - What Are We Feeding Our Kids?. Watch this space for our forthcoming briefing note on ultra-processed foods in the diets of infants and young children in the UK.

Read the full paper by Neri et al, here.

Extensive use of on-pack promotional claims on commercial baby foods in the UK

Ada Garcia and colleagues published this paper in February 2022 exploring and categorising the nature of promotional claims on packaging of commercial baby foods for sale in the UK. A total of 6265 promotional claims were identified on 724 products. Marketing, composition and nutrient claims were found on between 99 and 85% of products, compared with health claims which were found on only 6% of products. Marketing claims were mainly texture (e.g. super smooth) and taste related (e.g. first tastes). The main composition claim was that the product was organic while nutrient claims were mainly around ‘no added’ or ‘less’ sugar and salt. Baby led weaning claims (e.g. encourages self-feeding) were found on 72% of snacks, with a significantly higher number of such claims on snacks compared with other product types.

The paper concludes that promotional claims on commercial baby food packaging are extensively used and, for the most part, unregulated. These products are being promoted using claims that act as ‘health halos’, highlighting the urgent need for regulatory action to stop inappropriate marketing.

As we have documented in our reports on commercially produced foods marketed for babies and in our report ‘Enabling children to be a healthy weight: What we need to do better in the first 1,000 days’, misleading marketing of food aimed at infants and young children is a critical issue that needs to be urgently addressed. The DHSC consultation on the labelling and marketing of baby foods is now long overdue, but apparently still forthcoming. This will provide an ideal opportunity to reiterate the recommendations of this useful study.

Read the full paper by Garcia et al, here.

Independent, evidence-based information and advice to support ‘eating well’ in infancy and for children aged one to five years of age, avoiding commercially produced (including ultra-processed) products, can be found on our website, here.

Infant Milk News

Discontinued products

SMA’s range of organic milks will be discontinued at the end of April 2022. Nestlé state on their SMA Baby website that the decision to withdraw the product has been made ‘following consumer feedback.

While consumers are highly concerned and focused on the sustainability of the products they are using, most consumers are not looking for an Organic formula. Therefore, we have made the decision to focus our efforts on the continued journey to improve sustainability across all SMA products including the investment into plant-based plastic for our packaging, electricity made from renewable sources and working with farms to make net zero dairy farms a reality.’

Cost of Infant Milks

As with reports of price increases for other food products, the cost of infant formula has risen since our last report update. All of the larger manufacturers including Danone (Aptamil and Cow & Gate) Nestlé (SMA) and Hipp Organic have raised the prices of their products, some as much as 14%. Price rises appear not to have impacted the more expensive formulations including Ready To Feed (RTF) hospital starter packs of infant formula and tablet formulations as comprehensively as they have affected the 200ml and 1L RTF infant milks.

 

The cost of most powdered infant milks has risen. Kendamil and Nannycare have not increased their prices, although Nannycare goats’ milk infant formula remains amongst the most expensive powdered infant formula milks. The cost of the least expensive powdered infant formula has risen from 10p to 12p per 100ml or from £6.44 to £7.73 per week for feeding a 2-3 month old baby, which translates into a weekly increase in cost of £1.29. For families using the most expensive brand of powdered non organic cows’ milk based infant formula, the weekly cost has risen from £16.10 to £17.39, a rise of £1.29 per week. Analysis of the ONS ‘Family Spending in the UK Survey April 2019 to March 2020’ (from an organisation called Nimblefins) suggests that households in the lowest 10% of incomes spend around £54 on food per week, which means an an increase of £1.29 in formula spend per week is huge when considered as just one item amongst many in the weekly shopping basket that will have risen in cost.

For those eligible for the Healthy Start scheme (or in Scotland Best Start Foods scheme), families with one infant receive a weekly healthy food allowance of £8.50 which is equivalent to 2x £4.25 healthy start vouchers. This can in theory cover the cost of a 900g can of the least expensive infant formula, however, this particular product is only available at one supermarket chain. In order to buy more readily available but slightly more expensive infant milks costing between £9.00 and £10.00, families would be required to find the additional 50p to £1.50 each week from their remaining income.

The rising cost of infant formula should be a concern given the findings of the 2018 All-Party Parliamentary Group on Infant Feeding and Inequalities inquiry into the cost of infant formula. This inquiry found that the lack of affordability of infant formula puts infants health at risk as families struggling on tight budgets may resort to unsafe practices in order to feed their babies – like skipping feeds, watering down formula or adding cereal.

Ingredient-based claims: there is no ‘best’ infant formula

Marketing and advertising are known to have a significant influence on families’ choice of infant formula. Given the pressure on family food budgets, particularly for those on the lowest incomes, now would seem a good time for healthcare professionals to remind families they care for that all infant formulas in the UK must meet the regulations with regards to nutritional composition, meaning cost differences between products are not related to health or nutrition benefits, and, there is no ‘best formula’, regardless of what companies may claim on the basis of the ingredients they use.

Differences between formula brands are often related to non-essential ingredients that manufacturers have added, but which expert committees have decided lack evidence of benefit to infant health. In 2014, The European Food Safety Authority (EFSA), compiled a list of unnecessary ingredients which includes prebiotics (also called GOS and FOS), probiotics, nucleotides, phospholipids and some structured fat components and a number of other components that may be used by companies to make claims about the superiority of their product. We would add dairy fat in the form of whole cows’ milk or anhydrous milk fat, as well as human milk oligosaccharides (HMOs) to this list, as there is no convincing evidence of any clinical benefits of their inclusion in infant milks.

For more information see ‘Reviews of claims made for infant milks or ingredients’ .

New ad for the amino acid formula Neocate Syneo

Nutricia published a new advert in the March edition of Network Health Digest for their product Neocate Syneo, an amino acid formula containing synbiotics for use in infants with Cows’ Milk Allergy (CMA). The ad references new evidence to support claims that use of this product is associated with lower rates of infection, fewer gastrointestinal symptoms, reduced use of medication and a shorter time to resolution of CMA, as well as making cost saving claims.

The new evidence is a retrospective matched cohort study by Sorensen et al 2021 that uses real world data to confirm results of previous clinical trials (which we have previously reviewed here).The study was funded by Nutricia, the product manufacturer, and examined data from The Health Improvement Network database. 148 clinical records were included in the study, 74 from children prescribed AAF-Syn and 74 children prescribed AAF without pre- or probiotics, matched by age at diagnosis, sex and observation period. No breastfeeding reference group was included and the study did not report on other baseline characteristics such as complementary feeding, breastfeeding or other formula use. A proxy was used to measure disease severity and designation of children to a group was determined as the proportion of time a specific formula was used (switches between formula were expected during the course of the study).

The study showed AAF-Syn use to be associated with a 35% lower rate of infections; however, no significant difference in the proportion of infections was found between groups. The study also found 50% lower gastrointestinal symptoms in children prescribed AAF-Syn as compared to those prescribed AAF, but no children experienced a gastrointestinal infection in the AAF-Syn group, so symptoms could not be attributed to an infection in all cases. In addition, the study associated Neocate Syneo use with a reduction in medication of one fifth. Significant difference was shown between groups of children in rates of medication but not proportions of medication use.

The study claimed a 31% shorter clinical journey was achieved for children prescribed AAF-Syn as compared to AAF. The resolution of the course of symptoms was assumed when children had presented with no clinical symptoms for a consecutive period of three months and no hypoallergenic formula had been prescribed.

Finally, the claim of cost saving was based in-part on extrapolations of costs associated with appointments, specialist referrals and hospital admissions. However, no statistically significant difference between groups was found in these outcomes.

Taking into account the study methodology and small group sizes, we feel it is unlikely that the associations reported are attributable to the synbiotic containing formula. In our view, the use of proxy measurements and assumptions regarding baseline characteristics in each group make it impossible to make valid comparisons between groups. In addition, confounding factors such as significant differences in AAF consumption data and the impact of complementary feeding mean that any conclusions drawn should be viewed as tenuous associations.

Independent information on all the available formulas marketed in the UK for infants diagnosed with CMA can be found on our infant milks website, in our report on the specialised milks for infants with allergy, which is available here.

 

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

 
 

Baby Feeding Law Group news

Launch of new WHO report on the scope and impact of digital marketing for the promotion of breast-milk substitutes

Today, Friday 29th April, the WHO are launching their latest report exposing the problem of inappropriate breastmilk substitute marketing, and this one focuses on the scope and impact of digital marketing. The report comprises a review of evidence about the digital marketing approaches used by the formula milk industry and the research has used a commercial social media intelligence gathering tool.

This report follows the publication of the multi-country research by WHO & UNICEF in February “Marketing a $55 billion formula milk industry: How the marketing of formula milk influences our decisions on infant feeding”, which we wrote about in our February newsletter.

These new findings raise considerable concern about the use of powerful digital marketing techniques to reach mothers online and influence the decisions they make about feeding their babies. This is a concern we also raised in relation to UK digital marketing in 2020, in our report “Why government should end online infant formula marketing to protect children from overweight”.

In this report we said:

“Online marketing of infant milks targets young women, provides no beneficial information (since there are regulations that control infant formula composition that all companies must abide by) and undermines messages from health professionals. Influencers and celebrities promote products and lifestyles that young women may aspire to and pop-ups and links to websites, blogs, vlogs and other social media content create an online world which undermines Government and health worker efforts to protect breastfeeding and protect families from spending money than they need to on more expensive formula brands. To help prevent obesity and to protect the health of mums and babies, online marketing of all infant milks marketed for children under 3 years of age should be totally restricted in the UK at the same time as a total online marketing restriction for high fat, salt and sugar foods”.

Given the unprecedent high rates of childhood obesity captured by the 2020/21 National Childhood Measurement Programme (and reported on in our November newsletter) and the current cost of living crisis, this issue remains as pertinent as ever.

Find out more about the WHO’s new report here and sign up to the petition to #EndExploitativeMarketing

Forthcoming

Launch of the “Mothers’ Milk Tool”: May 5th 2022

Julie Smith and colleagues at the Australian National University and Alive & Thrive Southeast Asia are launching this new “Mothers’ Milk Tool” on May 5th. The objective of the tool is to better enable breastfeeding and mothers’ milk to be counted in analyses of food systems and national economies.

The team state: “Money is the language of policymakers. Counting human milk production in food and economic statistics will assist in better policy decision-making and investments in women’s unpaid care work. The Mothers’ Milk Tool quantifies the volume of breastmilk and value of breastfeeding at national and global levels, as well as how much is lost if country environments and policies, or healthcare, work and community settings do not enable women’s and children’s rights to breastfeeding”.

Given the absence of anything about babies in the Independent Review for the National Food Strategy (as outlined in this policy brief), we will be doing our best to share this message with the relevant people ahead of the promised release of the White Paper, which latest intelligence suggests will be after the Queen’s speech in mid-May.

You can register for the Mothers’ Milk Tool launch webinar which is taking place on Thursday 5 May 2022, 6-8 pm Sydney time (AEST) here.

UNICEF Baby Friendly conference November 23rd-24th 2022

Booking is now open for this year’s Baby Friendly Annual Conference (Virtual) which will take place over two days, the 23rd and 24th of November 2022. There will be in-depth updates on recent research and innovations related to infant feeding and relationship building, live Q&As and virtual posters. Interactive new networking opportunities will also be made available so delegates can catch up between talks and after the conference. UNICEF will be announcing the speaker line-up and more details in due course.

There is a discount for signing up before the end of August and for group bookings of 10 or more. Booking closes at 5pm on November 18th.

Find out more and book tickets for the UNICEF Baby friendly 2022 conference here.

 

March 2022

 

It’s a pretty grim time with war in Ukraine, a cost of living crisis in the UK and COVID causing more disruption than ever (or at least it seems so in our team!). We hope our March newsletter doesn’t add too much of a downer in this context.

By way of news, we share with you what’s happening with the digitisation of Healthy Start, a ‘joint statement’ on feeding support for mothers and babies affected by the war in Ukraine, an overview of the Better Health, Start for Life ‘Starting Solids’ campaign, and lastly an overview of the changes we have made in our newly updated Eating Well guide for pregnancy. In Infant Milk news we share with you some rebranding and news about product price rises. As secretariat of the Baby Feeding Law Group UK, we share with you an editorial in the BMJ about the WHO/UNICEF formula marketing report launched in February, highlights of a parliamentary debate on breastfeeding support lead by Alison Thewliss MP, and an overview of a feature published in the BMJ on industry marketing of hydrolysed formulas. Lastly, we have some HR changes to share with you.

News

Healthy Start Digitisation

Paper Healthy Start vouchers will no longer be accepted from tomorrow, April 1st, after which the system is meant to work through pre-paid cards. However, there are serious and ongoing issues with the functionality of the new digital system, including: a faulty online application system which rejects many eligible individuals; issues in activating and using the card and with accessing balance information; an inability to make part payments or online payments; a customer service system that is not fit for purpose (including long waiting times, calls being cut off and a charge of 55p a minute); and inadequate technical support for individuals and health professionals, which is leading public health teams, local authorities and community groups reluctant to promote the scheme.

First Steps was among a long list of signatories on a letter written by Sustain and the Food Foundation to the Health Secretary Sajid Javid on March 10th calling for an extension of this March switch over and prompt actions on a range of practical and specific recommendations to resolve the issues as outlined. Since then, Sustain have met with the Department for Health and Social Care and have resolved national issue of eligible claimants being rejected, and we are hopeful that more positive actions will ensue.

Infant Feeding in Emergencies joint statement by UNICEF, the Global Nutrition Cluster and Partners

On the 8th of March, UNICEF, the Global Nutrition Cluster, and partners issued a joint statement calling for “ALL involved in the response to the Ukraine Conflict Crisis to protect, promote, and support the feeding and care of infants and young children and their caregivers”. We’re sharing this in our newsletter because it’s relevant to all the UK-based individuals and organisations who have mobilised to support conflict-affected Ukrainian families and civil society organisations working with them, and observations that this has included calls for and donations of infant milks, bottles and baby foods. Whilst this type of support is likely well intentioned, it is against Ukraine regulations and experience in prior humanitarian responses indicates it can cause serious harm. The statement highlights the need to prioritise the protection of and support for breastfeeding, and also to provide an appropriate package of support to the families of infants who are not breastfed. It is recommended that this should entail adequate supply of an appropriate and Code-compliant powdered infant formula or ready to use infant formula (procured by UNICEF), equipment and supplies for its hygienic storage, preparation and for cup feeding, practical training on hygienic preparation and storage, counselling on responsive feeding and regular follow up by service providers such as UNICEF and the Red Cross, who have the appropriate skills.

The statement concludes that adherence to the recommendations are critical to support child survival, growth, and development and to prevent malnutrition, illness, and death.

Better Health, Start For Life Introducing Solids campaign

On March 4th, the Department of Health and Social Care launched the Better Health, Start for Life ‘weaning’ campaign to address “common areas of confusion for parents around introducing solid foods for their baby and to explain the government’s advice to gradually introduce a wide variety of foods, flavours and textures from around six months, alongside breast milk [optimally] or infant formula” (our additions in square brackets).

The campaign aims to offer parents support and advice on introducing solid foods to their baby, acknowledging that this process is a crucial early milestone shaping children’s food preferences and eating habits with consequences for later health and development outcomes. It is informed by the discrepancy between prevailing feeding practices which, for example, commonly include the introduction of solids before six months, and the 2018 recommendation from the Scientific Advisory Committee on Nutrition (SACN) which include that most infants should not

start solid foods until around the age of six months, having achieved developmental readiness. Parents are directed to the “weaning hub” on the Start for Life website for advice and recipes.

The campaign has also been informed by the results of an online survey with a nationally representative sample of 1,000 parents of children aged 3 to 18 months living in England. Key findings included that:

  • 40% of parents feel unsure as to what age to start introducing solid foods and 64% have received conflicting advice on the same

  • 41% of first-time mothers have already introduced solid foods by the time their baby is 5 months old

  • 45% said they found how much food to give their baby confusing and 43% found when to progress from certain tastes and textures confusing

  • 28% of first-time mums reported that their mother had the biggest influence on their decision to start weaning

Clearly many parents need more evidence-based, independent information on complementary feeding. As well as the Start for Life information offer, we’d like to remind our followers of our popular resource “Eating well: the first year. A guide to introducing solids and eating well up to baby's first birthday” which can be downloaded and printed for free, and hard copies can be purchased at cost price here.

Updated Eating Well in Pregnancy Guide

We have updated our Practical Guide “Eating Well for a healthy pregnancy” (the last version was updated in 2017) and it is available on our website here. This guide aims to enable health professionals to support pregnant women to better understand their food and nutrition needs in pregnancy and how best to meet them. It includes recipes and meal ideas and can sit alongside other local public health guidance to provide a practical explanation of what 'eating well' looks like.

The main updates that have been made are as follows:

  • Information on the Healthy Start scheme now better reflect recent changes and include the Best Start Foods (Scotland) scheme

  • Advice on foods to limit or avoid during pregnancy are now in line with recent changes to NHS advice

 

  • Tips for eating well out of the home better recognise the increasing contribution of home food delivery to many pregnant women’s diets

  • Edits to the resources section to reflect changes in contact details of relevant organisations


We will be updating our pregnancy resources for teenagers in the coming month and will let you know when these have been revised in a future newsletter.

Infant Milk News

Rebranded products

Following the rebranding of Aptamil Profutura products to an “Aptamil Advanced” range, Danone have rebranded their Aptamil range of products including their Aptamil infant formula, follow-on formula, toddler milk 1-2 years and toddler milk 2-3 years and hungry infant milk. The products themselves have not been changed, the only changes are in the packaging. These are some examples of the new pack design:

These old pack designs…

have been changed to look like this:

The law states that the labelling of infant formula and follow-on formula should avoid any risk of confusion between them. This requirement also serves to prevent cross promotion and the indirect marketing of infant formula, by advertising a product (follow-on formula), that looks almost identical. It is disappointing but not surprising that the problem of similar packaging styles for infant and follow-on formula, which is common across the infant milk market in the UK, is not changing despite the recent strengthening of the DHSC guidance around what is an acceptable degree of distinction.

Rising cost of infant milks and implications for formula choices

On March the 17th, the food industry trade magazine, The Grocer, reported “Baby milk prices on the rise as brands battle cost inflation”. We are shortly about to undertake the scheduled update of our infant milk costs report, in which we will share as usual comparable cost data for all infant milks on the UK market, which will shed more light on what’s going on. Given what is being reported about food price rises more generally, we anticipate that infant milk prices will have risen across all brands. In the context of the looming ‘cost of living crisis’, and given what we learnt from the enquiry in to formula costs First Steps led for the APPG on Infant Feeding in Inequalities in 2018, it becomes even more pertinent to share with formula-feeding families the information that, because of UK regulations, all first infant formulas have a comparable nutrition composition; the implication being that premium products are not worth the extra cost. Our resources on infant milks for parents may be useful for sharing in these challenging times.

 

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

 
 

Baby Feeding Law Group news

Editorial: “It’s time to stop infant formula marketing practices that endanger our children”

On March 9th, Helen Clark, former prime minister of New Zealand and Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, responded to a the WHO/UNICEF report “How the marketing of formula milk influences our decisions on infant feeding”, which we reported on in our February newsletter. Their view is that current unethical marketing of formula milk “represents one of the most underappreciated risks to the health of infants and children.”

The editorial outlines the dangers to child health posed by the unethical marketing of infant formula through its role in discouraging breastfeeding and the overconsumption of formula milk. Despite robust evidence that “scaling up breastfeeding could prevent an estimated 800 000 deaths of children under the age of five each year,” formula milk companies continue to disrupt informed decision-making on infant feeding and undermine the confidence of mothers.

The role of social media in accelerating the proliferation of misleading advertising is also addressed. Despite the introduction of the International Code of Marketing of Breastmilk Substitutes over four decades ago, companies continue to mis-represent scientific evidence across a range of child health topics including brain development and immunity.

The editorial concludes by calling on governments, health professionals, investors and social media platforms to play their unique role in stopping the unethical marketing of formula milk in order to protect child health.

Read the editorial here and if you haven’t done so already, sign the petition to #EndExploitativeMarketing

Highlights from Parliamentary debate on support for breastfeeding

On March the 8th, Alison Thewliss, MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, led a debate on Government support for breastfeeding in which she talked at length about the need to tackle inappropriate formula marketing. The full transcript of can be accessed here, and highlights include the following:

Alison Thewliss stated: “…the international code of marketing of breastmilk substitutes is 41 this year. It was written in response to the aggressive marketing of infant formula, which is of course to the detriment of breastfeeding… I believe that formula is an essential item that must be available to those who need it. People using formula deserve to receive impartial support and advice, not marketing and advertising”.

She stressed: “[the] … need to regulate the factors that can dissuade and diminish breastfeeding, such as aggressive marketing of infant formula—a global issue, but one on which the UK Government can play a leading role… I would like the Minister to agree to look seriously at the funding of all services and at the full implementation of the international code of marketing breastmilk substitutes, as the World Health Organisation and UNICEF have called for. She has the power to make this change to protect, promote and support breastfeeding now and in the future… There is an opportunity here to take the findings of the World Health Organisation and UNICEF report [which Alison spoke to in detail], and for the Minister to have a roundtable discussion with all the experts in this field—there are many—to see what more the UK can do and how we can move forward to make sure that everybody, whatever their feeding choices are, feels supported and that breastfeeding is protected and promoted within the whole of the United Kingdom”.

New article: “Formula milk companies push allergy products despite flawed evidence”

This feature in the BMJ looks at the infant milk industry’s marketing of formulas made with partially-hydrolysed proteins (i.e. proteins broken down in smaller pieces by using enzymes) using unevidenced claims that such products can prevent or reduce the risk of allergy development (typically allergy to cows’ milk and also eczema).

It reports that after heavy campaigning, the UK, Europe and US have taken steps to clamp down on these claims. In the UK this has involved changes in legislation in February of this year which prohibits the use of allergy claims unless manufacturers could prove the efficacy of each product. As we reported in February’s newsletter, this seems the logical reason for the withdrawal of SMA HA from the UK market.

The feature goes to highlight how BREXIT creates “an opportunity for the UK to become a global leader in responsible marketing” by upgrading UK laws to better reflect the International Code of Marketing of Breastmilk Substitutes. This would put an end to the advertising and promotion to the general public of all breastmilk substitutes, including not just infant formula but any milks (or products that could be used to replace milk) specifically marketed for young children up to the age of 3 years.

There is also a specific comment on the marketing of ‘Foods for Special Medical Purposes’, about which BFLG-UK independent member Dr Robert Boyle states: “The science behind these milks is generally very weak. Some do have an effect but most claims are spurious, for example, products that claim to help colic and crying but with no evidence that they do that. They are meant to be given under medical supervision but are freely available online and in shops the stated medical indication on FSMPs becomes another way that companies can effectively make claims for their baby formula products.”

Watch this space for news about BFLG-UK’s work advocating for improvements in the marketing of infant milks as FSMPs.

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

Staffing Update

Happy retirement to Pauline Styles

This month we’re saying a fond farewell to Pauline, who for many years undertook many of the administrative tasks required to keep First Steps functional on a day to day basis, and who in the last few years has been managing the distribution of our Eating Well resources through her business (a task that Siân is now taking on as we transition to moving this in house). We wish Pauline a happy retirement and lots of fun on the slopes.

Introducing our new nutritionist, Rachel Childs

We are really excited to welcome our new nutritionist Rachel to the team. Rachel is a Public Health Nutritionist with an MSc from the London School of Hygiene and Tropical Medicine. She has worked for international NGOs for a number of years, primarily on tools that assess access to nutritionally appropriate diets in different contexts. More recently she has worked as a primary school teacher and is passionate about ensuring that every child in the UK has access to the nutrition needed to grow up healthy, strong and able to learn. Rachel is looking forward to working with the First Steps Nutrition Trust team to influence policy and practices that benefit infants and young children in the UK.

 

February 2022

 

February always goes fast compared to January, but it’s still been a busy month. In 'News' we share with you a few reflections on the Levelling Up White Paper which was released on February the 2nd; our ‘Policy Insight’ piece on the ‘baby-shaped blind spot’ in the National Food Strategy, which was released on February 8th; and some highlights from the ever evolving plant milk market. In 'Infant Milk News' we share with you a re-brand, some discontinued products and an important recall notice. As secretariat of the Baby Feeding Law Group UK, we share with you news of a small but important change in the infant formula and follow-on formula regulations and highlight an important new report from the WHO on how the marketing of formula milk influences our decisions on infant feeding. Happy reading.

News

Levelling Up White Paper: Reflections from an early years food and nutrition perspective

On February the 2nd, the Government released the Levelling Up White Paper. The executive summary explains “Levelling up means … people everywhere living longer and more fulfilling lives, and benefitting from sustained rises in living standards and well-being”. The content on babies and young children falls under this ambitious mission (one of 12): “By 2030, the gap in Healthy Life Expectancy (HLE) between local areas where it is highest and lowest will have narrowed, and by 2025 HLE will rise by five years”.

We are told that the DHSC will shortly publish a White Paper on Health Disparities, tackling the core drivers of disparities in health outcomes, which sounds promising (although the lack of attention to the social determinants of health has been highlighted as an important omission; see Michael Marmot’s opinion in the BMJ). And in the meantime, we are reminded of the UK Government’s promised £300 million investment in Family Hubs and planned transformation of Start for Life services for parents and babies, carers and children in half of the local authorities in England. This investment is laudable and will no doubt ensure more families can access better information and support for breastfeeding, infant feeding and eating well in the early years. But given that health visitor numbers are at an all-time low, it needs to come with more funding for more staff if the services are actually to be delivered as planned.

The White Paper tells us that poor diet and obesity (“one of the biggest contributors to ill health”) will be dealt with now, by taking forward recommendations from the independent review towards a National Food Strategy, including piloting Community Eatwell (fruit and veg and other social support on prescription) and a ‘school cooking revolution’. It is commendable that the government are committed to developing a National Food Strategy “to help ensure that everyone can access, understand, and enjoy the benefits of a healthy and sustainable diet”. We can only hope that the baby-shaped blind spot we’ve highlighted in the Independent Review is being acknowledged behind the scenes (read more below).

Overall, we’re left with the familiar feeling that this White Paper has not systematically considered infants and young children, and that it is assumed that whatever needs aren’t covered in this particular policy document are dealt with elsewhere. Let’s hope that the various policy making endeavours underway join up so that is the case.

Policy Insight: The baby-shaped blind spot in the National Food Strategy: What it is and why it’s important

We still eagerly await the government White Paper response to the National Food Strategy (or more precisely, the Final Report of the Independent Review for the promised National Food Strategy), which lays out a vision and plan for a healthier and more sustainable food system. This new policy briefly outlines our thoughts on the Independent Review from an early years food and nutrition perspective. In our view, it fails to acknowledge the particular food and nutrition requirements of babies and young children, and the factors which make eating well a challenge for many young families.

This is a serious omission: if the way we feed our children in their earliest years is left out of food policy, we can make little progress in tackling rising rates of overweight or embedding eating habits that support sustainability.

The eight recommendations within build on the proposals of the Independent Review and would put infant and young child nutrition back into the White paper and National Food Strategy.

Read the policy report here.

Observations on the plant-based milks market

We’ve been keeping half an eye on the new product development in plant-based milks and the latest innovations have piqued our interest. As the trend towards eating more plant-based foods has grown, the variety of plant-based milk alternatives on the market has expanded rapidly.

Since our report Plant-based milk alternatives in the diets of 1-4 year-olds, the Swedish brand DUG has introduced a range of plant based milk alternatives made from potatoes. The manufacturers make significant claims about the sustainability credentials of their products and this is reflected in their current marketing.

Each of the three available versions of DUG are made from water, potato, rapeseed oil and pea protein and are fortified with calcium, vitamin D, Riboflavin, vitamin B12 and folic acid. Their nutritional composition therefore bears little resemblance to that of an unprocessed potato. Like many plant-based milks, DUG potato milk is lower in protein and energy than cows’ milk and the original and barista versions have the added sugars maltodextrin, fructose and sucrose.

Alpro have also introduced a new product, adding a high protein soya milk drink to their range. As the name suggests, this milk is significantly higher in protein (5g/100ml) than either whole cows' milk (3.4g/100ml) or the brand standard unsweetened, fortified soya milk (3.3g/100ml). Whilst protein is needed for growth and maintaining and repairing body tissues, it has been suggested that excess protein, particularly in the first two years of life, may promote more rapid weight gain (you can read more on this in our report: Enabling children to be a healthy weight).

Regardless of whether a child has an omnivorous, vegetarian or vegan diet, provided that a wide variety of protein rich foods such as meat, fish, dairy products, beans and pulses are eaten, they should be able to meet their protein requirements and it should not be necessary to use a higher protein soya milk.

Whilst none of these products are marketed for children, given the health ‘halo’ that often surrounds plant-based milk alternatives, it is likely that families perceive these products as healthy for the whole family. With that in mind it’s important to remember that breastmilk is the optimum main milk drink in the second year of life, and where young children are no longer receiving breastmilk, the NHS recommend full-fat cows' milk for children from their first to second birthdays. Full fat cows’ milk makes an important contribution to the provision of energy, macronutrients and micronutrients in young children’s diets in the UK. Plant-based milk alternatives have very variable composition and many have limited nutritional equivalence to animal milk. It is important that families are aware that young children need an energy and nutrient dense diet, and that perceived health benefits of a plant-based diet may not be relevant or health promoting for young children. You can find out more about the use of plant based milks as an alternative to cows' milk in the context of young children’s diets in our briefing paper: Plant-based milk alternatives in the diets of 1-4 year-olds.

Infant Milk News

February has been a busy month for product changes in the infant milk market.

Rebranded products

Aptamil Profutura products are in the process of rebranding and the range is now called “Aptamil Advanced”. The products are the same, and the only changes are in the brand name and the packaging. Unfortunately, in our view the new labelling is no improvement on the old in terms of being able to clearly distinguish between infant formula and follow-on formula as required by law.

Discontinued products

SMA have discontinued their SMA HA infant milk powder. This product contains partially hydrolysed 100% whey protein and was being marketed to reduce the risk of developing allergy to cows’ milk proteins, despite a lack of convincing evidence of effectiveness. See below an update on the regulations which we believe accounts for the discontinuation at this time. Nb. This product will be available from some retailers until the stocks run out.

Nutricia have discontinued their Cow & Gate Simply A2 Infant milk, Simply A2 Follow-on Milk and Simply A2 Toddler Milk. The Cow & Gate Baby club website explains that “At Cow & Gate, we are constantly reviewing our range and have decided to discontinue our Cow & Gate Simply A2 made with A2 protein milk range so that we can focus on our core Cow & Gate products at this time”. The brand was launched in February 2021 and so has been relatively short lived.

Each retailer will stop selling these products at slightly different times between March and July 2022. Products will still be available via Amazon.co.uk until the end of 2022 whilst stocks last.

Reckitt Benckiser have discontinued their ACBS-approved lactose free infant milk Enfamil O-Lac, which was marketed as a Food for Special Medical Purposes. Enfamil O-Lac was listed in the British National Formulary for Children which meant it was available on prescription. However, lactose free milks are also widely available for sale over the counter in supermarkets and pharmacies and are rarely prescribed. Lactose free infant formula that is marketed under infant formula regulations rather than under FSMP regulations can be purchased under the Healthy Start (England, Wales and Northern Ireland) and Best Start Foods (Scotland) schemes. You can find details of other lactose free infant milks on the product pages of our www.infantmilkinfo.org website here.

Recalled products

 
 

The US formula company Abbott has issued a global recall for several powdered formula products because of the possible presence of the bacteria Salmonella Newport and Cronobacter Sakazakii. The US Food and Drug Administration are investigating following the hospitalisation of four infants, one of whom tragically died.
The UK Food Standards Agency issued a food alert about this recall on Tuesday 22nd February (updating their first alert on Sunday the 20th), giving details of the affected batches of two infant formula powders which are prescribed Foods for Special Medical Purposes: Elecare Similac (an amino acid based formula) and Alimentum Similac (an extensively hydrolysed formula). The FSA state that: “Symptoms caused by Salmonella and Cronobacter sakazakii usually include fever, diarrhoea and abdominal cramps, although in severe cases may lead to sepsis or meningitis which include symptoms in infants including poor feeding, irritability, temperature changes, jaundice (yellow skin and whites of the eyes) and abnormal breaths and movements”.

This recall is a good reminder of why it is important to ensure parents/carers know, understand and follow NHS advice on safer preparation of powdered infant formulas, which are not, and cannot be made to be, sterile.

The NHS advice is available here and First Steps Nutrition Trust information here.

In addition, First Steps has contributed to a Unicef UK Baby Friendly Initiative statement which is intended to help health care professionals supporting affected parents/carers. The statement can be found here.

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

 
 

Baby Feeding Law Group news

Change in UK regulations

From February 22nd 2022, the regulations governing the composition, marketing and labelling of infant formula and follow-on formula now apply to such products made from hydrolysed proteins. In practice, because most infants milks made with hydrolysed proteins are now marketed as Foods for Special Medical Purposes and must adhere to these regulations (whether warranted or not given the lack of evidence of effectiveness for many of product types), this affects only two partially hydrolysed infant formulas: SMA HA and SMA Advanced, and the partially hydrolysed follow on formula SMA Advanced.

The DHSC’s guidance notes provide further clarification of legislative requirements for England, and the principles are similar throughout Great Britain (Scotland and Wales), including stipulating that “Manufacturers of infant formula and follow-on formula which are made from protein hydrolysates must demonstrate the safety and suitability of each specific formula containing protein hydrolysates has been established by clinical evaluation”. The Guidance Notes are accompanied by an application form for the authorisation of formula manufactured from protein hydrolysates, which sets out the steps which applicants need to follow for the authorisation of protein hydrolysates used in infant and follow-on formula.

A key implication of this change is that the product SMA HA which was marketed with the claim “To reduce the risk of developing allergy to cows’ milk proteins”, has been discontinued. This is insightful because Guidance Notes state: “Providing it has been demonstrated that a specific formula manufactured from protein hydrolysates reduces the risk of developing allergy to milk proteins, further consideration will be given to how to adequately inform parents and caregivers about that property of the product”.

We can only assume that the company had insufficient evidence to submit to support the continued marketing of this product, or that their submitted dossier of evidence was deemed insufficient.

We will be keeping an eye on the labelling and marketing of the SMA Advanced formulas made from hydrolysed proteins in the coming weeks and will address any concerns to the nutrition legislation team at the DHSC. We will also be looking in to what can be done about the way in which companies are preferentially choosing to market certain products as FSMPs instead of as infant formulas.

New report: Marketing the $55 billion formula milk industry

On February 23rd the WHO, UNICEF and partners launched a new report “How the marketing of formula milk influences our decisions on infant feeding”, which draws on interviews with 8,500 parents and pregnant women and 3,000 health care professionals in eight countries, including the UK. It reveals “systematic and unethical marketing strategies” used by industry to influence parents’ infant feeding decisions.

The research uncovered: unregulated and invasive online targeting (you can read more about online infant formula marketing in the UK in our report on this here); sponsored advice networks and helplines; promotions and free gifts; and practices to influence training and recommendations among health care professionals. Consequently, the messages that parents and health workers receive are often misleading, scientifically unsubstatiated and violate the Code.

Across all countries, women expressed a strong desire to breastfeed exclusively, including in the UK where this proportion was 84%. And yet exactly the same proportion of women reported being exposed to formula milk marketing in the previous year. The report says that "The sustained flow of misleading marketing messages reinforces myths about breastfeeding and breast-milk, and undermines women's confidence in their ability to breastfeed successfully".

To address these challenges, WHO, UNICEF and partners are calling on governments, health workers, and the baby food industry to end exploitative formula milk marketing and fully implement and abide by the Code requirements.
Read the report here and sign the petition to #EndExploitativeMarketing

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

 
 

January 2022

We hope you had a restorative Christmas break and the new year has got off to a good and healthy start. This month we have a bumper newsletter as promised. We share news on the DHSC’s new Better Health campaign and some thoughts on the Food Scanner App, news about the NICE Maternal and Child Nutrition guideline update and the latest on the DHSC consultation on the marketing and labelling of baby foods and drinks. In infant milk news we have some new supplements to make you aware of and we’re asking for your help, if possible, to recruit participants for our ‘Finding the Formula’ study. We also share with you news about a forthcoming ‘Policy Insight’ piece on what we perceive to be a baby-shaped blind spot in the National Food Strategy, and recommend a blog by our friends at Sustain, which provides a great overview of many of the important activities relevant to the food environment of young families forthcoming in 2022. We end with news of the happy arrival of our latest First Steps baby, Ava.

News

Launch of the DHSC’s new Better Health campaign and Food Scanner App

On January the 10th, the DHSC launched a new campaign to help parents improve their children’s diets, encouraging use of a new Food Scanner App. This campaign has been informed both by the shocking rise in childhood obesity and overweight captured by the National Childhood Measurement Programme (see our November newsletter), and by new statistics revealing the number of parents giving unhealthy snacks to their children (aged 5-11 years old) has increased during the pandemic.

The DHSC press release says: “The Food Scanner App works by scanning product barcodes and suggesting healthier alternatives to help the consumer make an easy swap. The app uses the ‘Good Choice’ badge to help signpost people to healthier food and drinks in line with the government’s dietary recommendations for added sugar, saturated fat and salt”.

We’ve tried using the app and whilst we appreciate it may be acceptable to parents because it suggests swaps between similar products with less sugar, saturated fat, and/or salt, we feel it is important to be aware of its limitations. For example, the swaps will have lower sugar, saturated fat and/or salt, but the level of these nutrients might not be low enough relative to children’s dietary reference values.

 

For example, these yoghurts contain 9.4g sugar/100g and 8.8g per serving, giving them an ‘amber’ traffic light label. In addition, suggested swaps are likely to be similarly processed (e.g. the app suggests lower sugar/less fatty/less salty ultra-processed foods, but the foods are still ultra-processed), rather than unprocessed or minimally processed foods, so there is no scope for the app to recommend fruits and vegetables as snacks.

Lastly, swaps may contain sweeteners in the place of sugar and no- or reduced- sugar products may qualify as a 'Good Choice' even when that qualification may seem clearly inappropriate (you can read more about this problem in our 2019 report on sweeteners: Sweet enough already: Artificial sweeteners in the diets of young children in the UK).

Fundamentally, the app suggests ‘healthier’ foods and drinks in terms of the specific three nutrients of focus but many such products would be hard to define as ‘healthy’, so our view is that the app would be best promoted to young families alongside and in the context of age-appropriate eating well messages, which can be found in our resources.

Updating of the NICE guideline on Maternal and Child Nutrition has commenced

The process of updating the NICE guideline on Maternal and Child Nutrition has started in earnest, with the first meeting of the guideline committee (on which our Director Vicky Sibson has been successful in gaining a place) taking place on 25th January. This guideline will fully replace the Maternal and Child Nutrition Public Health Guideline (PH11) (released in 2008 and last updated November 2014) and partially replace Weight Management Before, During and After Pregnancy (PH27) (released July 2010). Consultation on the scope of the guidance took place in October 2021 and the final scope was published on December 23rd and can be found here. The final guideline is expected to be released in November 2023.

An update on the DHSC consultation on guidelines for the marketing and labelling of baby foods and drinks

We are still awaiting this consultation (and the baby food composition guidelines), and given that there seemed to be a lack of clarity from DHSC about its likely scope when questioned late last year, we’re not sure if no news is good news... This is what the Parliamentary Under-Secretary (DHSC) Maggie Throup had to say about the consultation on December 20th: “Following the commitment in the ‘Advancing our health: prevention in the 2020s’ Green Paper, we plan to launch a consultation on measures to improve infant food marketing and labelling. This consultation will consider the marketing and labelling of all food and drink products for infants and young children up to 36 months. The objective is to ensure that commercial food and drinks products for infants are age-appropriate; aligned with dietary guidelines; and support healthy development. This includes ensuring parents and carers are equipped with clear, transparent and accurate product information that supports them to make healthier choices for their children. The consultation will be published shortly”.

As before, if anyone would like to see our consultation response prior to submission please feel free to get in touch at vicky@firststepsnutrition.org

Infant Milk News

New products

January has been a quiet month on the infant milk front; however, manufacturers have not been idle and Nestlé have stepped into the infant food supplements space with the launch of their “SMA Xpert” infant health range. The range includes two products, vitamin D drops and “ProCol”, a probiotic powder. These food supplements are designed to supplement either breast milk or formula milk in the first year of life and beyond and both products are currently available online only from Amazon.

The NHS recommend that babies who are being breastfed should be given a daily vitamin D supplement from birth. However, babies who are having more than 500ml (about a pint) of infant formula a day should not be given vitamin supplements as formula is fortified with vitamins A, C and D and other nutrients. Each daily dose of 2 drops of “SMA Xpert Vitamin D” contains 10 micrograms of vitamin D in line with Government recommendations.

It is important that healthcare professionals signpost women who may be eligible to the Healthy Start, or in Scotland, the Best Start Foods schemes which can provide them with free drops containing the recommended dose of vitamins A, C and D.

“SMA Xpert ProCol” is a probiotic supplement. Each sachet contains a minimum of 100 million units of the probiotic culture Limosilactobacillus reuteri. The supplement is marketed for use in either breast or formula milk.
Nestlé make the following claims on their website:
“L. reuteri† significantly reduces daily crying time in colicky infants by up to 78%”

“L. reuteri† supplementation has been shown to significantly reduce daily fussing times in infants with colic”
“When infants with colic are supplemented with L. reuteri† parents indicate improved family quality of life”

It is important to note that these claims relate to breastfed, or predominantly breastfed babies only and also that there are no independently agreed benefits for the addition of probiotics to breastmilk and the research cited is subject to considerable conflict of interest. Furthermore, breastmilk already contains probiotics which are absent from formula milk. No plausible mechanism of action for the observed amelioration of symptoms of colic in breastfed babies, but not formula fed babies, has been offered. 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 evidence supporting use of this supplement, the manufacturer’s instructions for adding “ProCol” powder to breast or formula milk is that it should be added when the milk is lukewarm. We are therefore concerned that the addition of a non-sterile powder to formula at a temperature lower than 70⁰C may increase the risk of contamination.

We hope that health workers will dissuade families from choosing a product that is not needed by healthy infants. The NHS state that there is little evidence that probiotic supplements are effective in the management of colic and NICE guidance also advises that that probiotics should not be recommended for the management of colic due to a lack of evidence of efficacy.

Information for parents on managing colic can be found at www.nhs.uk

More information for healthcare professionals on management of colic and constipation can be found on the GP Infant Feeding Network Website www.gpifn.org.uk

Your help needed for our study: “Finding the Formula”

This UKRI and FSA-funded collaborative community science project being led by our friends at the Swansea University, is now well underway. This study is being developed with formula feeding parents/carers of babies under 12 months of age and is aiming to understand better real-life powdered infant formula preparation practices. We hope this will generate more data around the extent to which parents follow NHS guidelines (or use devices) and if not, why not. We need to recruit 200 participants who will be asked to complete a questionnaire documenting their typical bottle preparation practices and to undertake an experiment making up a feed and taking the temperature of the water used to do so with a thermometer provided by the study team. We would welcome your help with participant recruitment by sharing this link to our study Facebook Group.

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

Forthcoming…

We await the government White Paper response to the National Food Strategy (or more precisely, the Final Report of the Independent Review for the promised National Food Strategy), which lays out a vision and plan for a healthier and more sustainable food system. But as outlined previously (see our September newsletter), we remain concerned about its baby-shaped blind spot which we believe makes it incapable of meeting its objectives. More specifically, we feel that it fails to acknowledge the particular food and nutrition requirements of babies and young children, and the factors which make eating well a challenge for many young families. The exclusion of England’s youngest citizens from the review is in our eyes, a missed opportunity that must be addressed, not least given the recent, devastating increases in childhood overweight and obesity prevalence documented in England and in Scotland too. Our director Vicky Sibson was asked to write about this for City University’s Food Research Collaboration Centre for Food Policy and her ‘Policy Insight’ will be published on February 8th. Keep an eye out on our website and social media and we’ll share it when it’s ready. Your help to raise this important issue with parliamentarians as the White Paper is developed would be much appreciated.

Final note:

For a fantastic overview of many of the important activities relevant to the food environment of young families forthcoming in 2022, we'd like to recommend this great blog by Barbara Crowther, the Campaign Coordinator of the Children's Food Campaign.

 
 
 
 

Baby News!

Our wonderful administrator Siân and her partner Robert welcomed baby Ava Malee into the world on December 23rd, describing her as the most perfect gift they could have ever hoped for 😊 She’s feeding brilliantly and we are raring for a cuddle.