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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

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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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About us

 

First Steps Nutrition Trust

Studio 2.14
The Food Exchange
New Covent Garden Market
London SW8 5EL

 
 
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First Steps Nutrition Trust offers information and resources to support good nutrition from pre-conception to 5 years. Our aim is to produce clear and independent resources to support people who want to know more about eating well before and during pregnancy, eating well for infants and young children, and food composition and food quality.

First Steps Nutrition Trust takes no industry funding and fully supports the WHO Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly Resolutions. We are funded through grants and donations. We aim to provide a one-stop shop for useful and accurate evidence-based information on good nutrition from pre-conception to five years. To find out more about the Trust, visit our homepage.

Follow us on twitter @1stepsnutrition