Welcome to another bumper edition of our newsletter – contents below. We will be taking a break over the Christmas period, so our next newsletter will be in early February. Wishing you all a happy Christmas and the very best for the New Year.
Updated: Eating Well for a Healthy Pregnancy: A practical guide
This practical guide is all about supporting pregnant women (and their families) to shift the balance towards better food choices wherever possible, and making it clear what eating well really looks like with practical advice on how to do it. It shows the sorts of foods, and amounts of foods, that will meet the nutritional needs of women in pregnancy and give the best start to the baby.
As with all our resources, this guide is evidence-based and has been produced independently of any industry support. We noticed when we updated it that there remains a paucity of truly independent advice on diets in pregnancy, and caution that commercially supported advice may provide recommendations that are inconsistent with public health recommendations.
The changes we have made in this 2025 update mostly reflect either the new NICE Maternal and Child Nutrition Guidelines (NG247) or the more challenging context in which pregnant women are trying to eat well since we last updated the resource in 2022. Changes include:
Revised content on weight management in line with NICE guidelines
Additional signposting for women on low incomes, as recommended by NICE
Updated content on Healthy Start
Updated meal and snack price banding (as prices have gone up)
Updated content on sweeteners and plant-based milk alternatives in line with SACN recommendations
Updated recommendations on micronutrient supplementation in line with NICE guidelines
Updated content addressing common barriers to eating well in pregnancy, especially related to poverty.
A couple of additions to foods to avoid (products containing cannabidiol and raw enoki mushrooms)
Updated directory of additional resources
Thanks to Clare Livingstone (Professional Advisor, Policy and Public Health, Royal College of Midwives) for peer review of this updated eating well guide, and our nutrition officer Jasmine who worked on updating this guide during her own pregnancy.
We will update our Eating Well guide for pregnant teenagers in line with the updates made in this resource in the coming couple of months. Watch this space…
To download a FREE PDF copy of this Eating Well guide for a healthy pregnancy, and any of our other 12 Eating Well guides, visit our website here. Donations are welcome. Selected Eating Well guides are available for sale as hard copies; access our shop here.
New: Eating Well 6 months to 2 years for South Asian children, now available in hard copy
We’ve done a print run of this resource for a health visiting service in Bristol, and printed extra copies if anyone would like to buy one or also place a bulk order. This resource was prepared in collaboration with the Nurture Early for Optimal Nutrition (NEON) programme and 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.
Order your hard copy or download a FREE PDF (in English or Bangla) from here.
New series: Lancet series on Ultra-Processed Foods and Human Health
This new three-part series was launched last month on 19 November at the Royal College of Physicians in London, at an event attended by several of the First Steps Nutrition Trust team. The series consolidates the evidence linking the UPF dietary pattern with ill health (paper 1), outlines policy options to tackle UPF consumption (paper 2) and wider public health strategies to promote, protect, and support diets based on fresh and minimally processed foods and prevent their displacement by UPFs (paper 3). Consideration of early years diets and drivers of UPF consumption during infancy and early childhood is woven throughout, and there is also a Unicef report (UNICEF’s State of the Art review on Ultra-processed Foods and Children) specifically focusing on UPFs and children published yesterday, covered inthe next news item. The 3 papers were accompanied by two editorials and two comments, see below.
Here is a summary of the core content of the papers, and reflections from a UK early years’ nutrition perspective.
Paper 1 by Carlos Monteiro and colleagues is on the main thesis and the evidence. It combines narrative and systematic reviews with original analyses and meta-analyses and proves 3 hypotheses on the UPF dietary pattern (also summarised in the figure 5 of the paper below):
1) This pattern is displacing long-established diets centred on whole foods and dishes and meals prepared with them. This is confirmed by decades of national food intake and purchase surveys and recent global sales data. The same could be said for the displacement of breastfeeding by commercial milk formulas, and of home prepared complementary foods by commercial baby and toddler foods, as shown in Chapter 4 of UNICEF’s State of the Art review on Ultra-processed Foods and Children (see below).
2) This pattern results in deterioration of diet quality, with negative implications for chronic disease prevention. This is confirmed by national food intake surveys, large cohorts, and interventional studies showing gross nutrient imbalances; overeating driven by high energy density, hyper-palatability, soft texture, and disrupted food matrices; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives. UNICEF’s State of the Art review on UPF and Children looks at available evidence for children, showing similar concerns.
3) This pattern increases the risk of multiple diet-related chronic diseases through various mechanisms. This is shown by more than 100 prospective studies, meta-analyses, randomised controlled trials, and mechanistic studies, covering adverse outcomes across nearly all organ systems. Again, UNICEF’s State of the Art review on UPF and Children reviews the evidence for children which is equally concerning.
“The totality of the evidence supports the thesis that displacement of long-established dietary patterns by ultra-processed foods is a key driver of the escalating global burden of multiple diet-related chronic diseases”.
Panel 3 on page 10 addresses scientific criticisms of the Nova classification and UPF diets and future areas for research. The paper flags the need for more research on UPF health effects on children and in pregnancy.
The paper concludes: “The need for further evidence should not delay public health action. Policies that promote and protect dietary patterns based on a variety of whole foods and their preparations as dishes and meals*, and that discourage the production and consumption of UPFs, cannot be postponed… These policies should complement – not replace – existing policies and actions designed to reduce consumption of products high in added fats, sugar or salt (HFSS), and excessive red meat intake…”. *The Lancet series as a whole and the Unicef report make clear this should start with breastfeeding.
Paper 2 by Gyorgy Scrinis, Barry Popkin and Camila Corvalan and colleagues, proposes government policies to halt and reverse the rise in UPF production, marketing and consumption. This paper acknowledges that to date, policies have mainly focused on reducing consumption of HFSS (high fat, salt and sugar) products. However, they propose strengthening and expanding efforts, broadening the policy focus from HFSS to HFSS and UPF, and doing more to address food system drivers influencing UPF production through targeting corporations and retailers.
As shown in the infographic, policy focus on UPF requires addressing processing in dietary guidelines and education, including UPFs in dietary surveillance and identifying UPFs in regulations e.g. by adding UPF markers like sweeteners, colours and flavours to nutrient profile models. It is important to note, however, that this will not work well for some commercial milk formulas and commercial baby and toddler foods in the UK given limitations on the use of certain additives to these products, which means other policy approaches are more appropriate. These are covered in detail in Chapter 4 of the Unicef report, below.
“To more effectively reduce the share of UPFs in diets, dedicated policies that explicitly target UPFs are needed to complement the existing nutrient-based approach”.
The infographic also shows the four studied food policy domains, which are also used to frame example policy actions to reduce UPF consumption:
1) Policies for UPF products
Policies to extend restrictions on UPF ingredients and additives like emulsifiers and sweeteners, and foods/drinks containing them
2) Policies for food environments i.e. policies to restrict the marketing, availability and affordability of UPF and improve the same for minimally processed foods
Policies like front of pack warnings on UPFs – especially on commercial infant and toddler foods (high sugar warnings on commercial baby foods would be a good start in the UK).
Plain packaging on certain UPFs (as we are proposing for infant formula, see below).
Marketing restrictions for children, including ad bans on UPFs – the paper specifically calls for including all commercial milk formulas, in line with the Code – and better oversight of brand-level marketing.
Taxes on specific UPFs (as we had hoped to see in the UK on toddler milks when the Government committee to extend the Soft Drinks Industry Levy, although they remain exempt) and corresponding subsidies for minimally processed foods (e.g. through the Healthy Start and Best Start Food schemes).
Retail and food service policies which limit UPFs.
School and early years settings procurement and food policies which limit UPF
3) Policies for UPF manufacturers, fast-food and supermarket corporations: “The well documented harms of UPF-based diets, the persistent failure of industry self-regulation, and the structural barriers individuals face in pursuing healthy eating within UPF-dominated environments*, underscore the urgent need for strong policy and regulatory action to curb excessive influence from UPF corporations” *starting with breastfeeding
Adaptation of policies like removing marketing tax deduction for UPF companies and interventions to control corporate monopolisation (noting this is extreme for commercial milk formula companies at a global and national level).
Regulating UPF sales at the corporate level by restricting or applying penalties based on the proportion of total sales of UPF products (in the UK the new mandatory health food standard is based on the Nutrient Profile Model at present, so some UPFs will be excluded, and all products marketed for infants and young children too).
Restricting membership of scientific committees to exclude those involved with the UPF industry (we have seen good progress in this regard with changing procedures in the Scientific Advisory Committee on Nutrition).
4)Policies for food supply chains
Changing policies towards supporting diverse, locally oriented food production.
Reforming international trade rules to incorporate public health exceptions.
Instituting robust environmental policies including prohibiting green washing and sustainability claims (which are so commonly seen in commercial milk formula and commercial baby and toddler food marketing, e.g. no palm oil, British-made, recyclable packaging).
The paper also examines policies to protect, incentivise, and support dietary patterns based on fresh and minimally processed foods, particularly for lower income households, acknowledging the need to address the socio-economic and gender inequalities that drive demand for UPFs. Policies include public procurement, nutrition-sensitive economic policies like targeted food subsidies and cash/voucher programmes as well as policies to address structural inequalities and promote equity. This section is worth quoting as it is so relevant to the early years, where time pressures are a real problem but where demand for convenience foods is also cultivated by marketing:
“We recognise that the rising demand for UPFs, most of which are ready to eat or ready to heat, is shaped by broader socioeconomic shifts, including changing work and living patterns and increasing time and financial pressures on households. This demand is further intensified by the large-scale production and aggressive marketing of UPFs. Policies aimed at reducing UPFs will therefore also need to be complemented by policies that increase the availability and affordability of healthy, unprocessed or minimally processed foods (ie, Nova group 1 foods)—including ready-to-consume or ready-to-heat forms, and other time-saving options. These efforts should also address the underlying socioeconomic inequalities that drive demand for UPFs for much of the population, including the unequal gendered burden of cooking, feeding children, and other domestic work”.
The authors make clear that country-level policy actions will vary depending on the extent of reliance on UPFs. For the UK where UPFs dominate our national diet, reduced UPF consumption should be the aim, through perhaps targeting discretionary subgroups of UPFs (the example given is sugar sweetened beverages) alongside support for promoting fresh and minimally processed foods, particularly among vulnerable, low-income groups (the Healthy Start and Best Start Food schemes are relevant here).
Paper 3 by Phillip Baker, Scott Slater, Mariel White and colleagues examines the political economy of UPFs. It seeks to improve understanding of the commercial determinants driving the rise in UPFs, counter corporate power and mobilise a public health response. The focus is on the root causes.
Firstly, the paper shows that the UPF industry is a key driver of the problem, as its leading corporations and co-dependent actors (shown in the figure below) have expanded and restructured food systems globally in favour of ultra-processed diets. Notably these include the big commercial milk formula companies – Nestle, Danone, Reckitt Benkiser and Abbott - their ingredient suppliers and scientific institutes.
The higher profitability of UPFs compared with other types of food fuels this growth, by financially incentivising the ultra-processed business model over alternatives and generating resources for continued expansion. Commercial milk formulas exemplify this; in February 2025, the UK Competition and Markets Authority exposed profit margins of between 50 and 75% for commercial milk formulas.
High profits also permit large spends on marketing: “Marketing is a form of ideological power in food systems, tapping into core values, consume aspirations, and cultural preferences to generate demand and normalise consumption”. The authors give toddler milks as an example of how marketing is adapted to ensure growth continues, in the face of regulations on the marketing of infant formula.
Secondly, the paper highlights that the main barrier to advancing policy responses is the industry’s corporate political activities, coordinated transnationally through a global network of front groups, multi-stakeholder initiatives, and research partners (see the figure above), to counter opposition and block, weaken or delay regulation. The very slow progress on strengthening regulations on commercial baby and toddler foods in the UK appears to be a good example of corporate influence.
Corporate political activities include direct lobbying, infiltrating government agencies, and litigation (direct corporate action); promoting corporate-friendly governance models, forms of regulation (including voluntary measures), and civil societies (corporate institutions); and framing societal debate, deflecting blame, generating favourable evidence, and manufacturing scientific doubt (corporate ideas) (an example given here is the formula industry’s influence on cows’ milk allergy guidelines).
Third, it presents strategies for reducing the UPF industry’s power in food systems and for mobilising a global public health response. The authors state: “The current policy emphasis of many governments on consumer responsibility, product reformulation, and industry self-regulation does little to disrupt the ultra-processed business model”.
Reducing the industry’s power in food systems involves strongly disincentivising UPF production, reducing the power of marketing (the authors specifically highlight that governments can implement the Code and take action on commercial baby and toddler foods), and redistributing resources to other types of food producers; excluding the UPF industry from food governance; ending reliance on voluntary corporate actions; and reforming policy, health professional, and scientific practice to minimise corporate interference (e.g. journals can reject industry sponsored advertising (see our news piece on Mark Allen’s activities below).
Mobilising a global response includes framing UPFs as a priority global health issue; building advocacy coalitions; generating legal, research, and communication capacities to empower advocacy and drive policy change; and ensuring a just transition to low-UPF diets. These should be anchored in policies that foster sustainable food systems through participatory governance, economic inclusion, and support for families, ensuring actions promote food security and gender equity, and minimise stigma. The need for a gender just transition is defended as follows, with tangible policy recommendations including on the protection, promotion and support of breastfeeding:
“Simply urging a return to home cooking risks exacerbating the unequal distribution of unpaid food and care work that, in many contexts, disproportionately fall on women. Households often rely on convenience foods to balance the competing demands of paid work, with caring for children and other family members. A just transition requires ensuring their access to affordable, nutritious, and time-saving alternatives to UPFs. Public investments in collective food provisioning systems, including school meal programmes and community kitchens, can help to alleviate their time and resource pressures. Gender-responsive budgeting and social protections, such as income transfers and paid maternity and parental leave, can help to resource families and redistribute women’s care work burdens. Campaigns that frame breastfeeding as a free or costless activity ignore the time, labour, and skill required; policies should therefore focus on protecting, promoting, and supporting breastfeeding women and families, recognising their central role as sustainable food producers. Some UPFs (eg, infant formula) are necessary when breastfeeding or human milk is unavailable, and care is needed to avoid stigma. Responses should focus on curbing exploitative marketing practices and structural forces that drive breastfeeding displacement and milk formula overconsumption, including of nutritionally unnecessary toddler milks”.
The authors conclude: “The continued proliferation of UPFs is not inevitable. A just and effective transition away from ultra-processed diets is possible, but requires bold, coordinated and sustainable global action”.
The 3 papers were accompanied by two editorials and two comments as follows:
Editorial: “Ultra-processed food: from first tastes to lifelong habits” by the Lancet Child and Adolescent Health (**which signposts our eating well resources**). This editorial piece is obviously very relevant to early years nutrition including our work at First Steps Nutrition Trust. It highlights that “the hyper-palatability and soft texture of UPFs create products that shape children’s appetitive traits and preferences for these foods for life”. It calls for child-focused policies including banning UPF advertising to under 19s including in digital spaces and restricting UPFs in school meals and environments. And for expanding front of pack warning labels on unhealthy foods and stricter regulations on claims to help parents make informed choices. It highlights “A key gap in regulations is baby and toddler foods and beverages, many of which are ultra-processed and have high sugar content… but marketed as natural and healthy”. We fully support its closing statement: “We cannot allow commercial interests and profits to dominate children’s diets – from first tastes to lifelong habits – at the expense of their health and wellbeing”.
Editorial: “Ultra-processed foods: time to put health before profit” by the Lancet.
Comment: “Global action on ultra-processed foods: a health, equity, and sustainability imperative” by Luz Maria De-Regil and colleagues from WHO.
Comment: “Protecting children from ultra-processed foods” by Joan N Matji and Mauro Brero from Unicef. This comment summarises some of the key findings from their state-of-the-art review, published yesterday and covered in the next news item below.
New review: UNICEF Ultra-processed Foods and Children, State of the Art review
This new review was published yesterday, 3 December. Our director Dr Vicky Sibson was honoured to be invited to be a co-author of chapter 4: “Commercial foods for infants and young children: The first ultra-processed foods”, which draws on our work at First Steps Nutrition Trust. The other chapters look at 1. Food systems and the global threat of ultra-processed foods to children; 2. Ultra-processed foods as an emerging concern for children’s and adolescents’ diets; 3. Sugar-sweetened beverages; and 5. Ultra-processed foods and children’s diets in developing economies, focusing on West Africa.
The review builds on the 2025 Lancet Series on UPF and human health (see above), consolidating the evidence on how UPF consumption negatively affects children’s health and well-being. The evidence linking UPF intake in children with poor diet quality, overweight and obesity, and dental caries is described as strong and the growing body of research on other outcomes (undernutrition, micronutrient deficiencies, mental health concerns, metabolic changes and chronic diseases) is highlighted.
As Lancet series paper 1 above highlights, throughout the world, traditional meals, based on whole and minimally processed foods, are increasingly being displaced by diets dominated by UPFs. This review shows that this is the case from early life, starting with commercial milk formulas and commercial baby and toddler foods. Their long shelf-life, low production costs and pervasive marketing enable UPFs to out-compete more nutritious foods. The marketing is described as sophisticated and targeted at children in the places they go and online. “Such tactics normalize daily UPF consumption and exploit children’s limited ability to recognize persuasive intent…. [The UPF industry’s corporate practices] shape food systems and violate children’s rights to health, adequate food, information and protection from commercial exploitation. Protecting children from harmful food environments is not only a public health imperative; it is also an ethical and legal obligation for governments”.
The review highlights the proven policies that exist to reduce UPF purchasing and consumption (as described in Lancet series paper 2) that are relevant to children, including front-of-pack labelling, marketing restrictions, school food standards and taxes on sugar-sweetened beverages. The importance of countries fully implementing the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions is acknowledged. The need to pair these measures with policies that incentivize the production, distribution and consumption of nutritious, safe, affordable and sustainable foods is stressed.
This review includes a call to action “to governments, United Nations agencies, research institutions and civil society to counter the rise of UPFs through actions that protect children’s food environments and place child rights before commercial interests”.
Chapter 4 by Phillip Baker and colleagues focuses on the global rise of “commercially produced foods for infants and young children” (CFIYC), many of which are ultra-processed. The focus is on follow-on and growing up milks and commercial baby and toddler foods, implicitly acknowledging that while UPF, infant formula is essential for babies under 6 months who are not breastfed or who are partially breastfed.
The chapter presents global sales data for products marketed for use from 6-36 months and available literature to explain the negative implications of the proliferation of CFIYC on diet quality, nutrition, health and sustainability.
It also shows how consumption is rising globally, especially in middle-income countries, driving poor diet quality, reduced breastfeeding duration, elevated risk of overweight and obesity, micronutrient deficiencies and poor oral health. It also acknowledges the environmental harm of non-essential products including follow-up formulas and toddler milks.
The determinants of this rising consumption are described, including the lived experience of children and their caregivers, the marketing which is shaping their food environments, and the corporate political activities challenging the adequacy of government policy responses.
The chapter concludes by presenting multi-pronged recommendations for governments, international development agencies, civil society organizations, researchers and the media to curb production, restrict marketing and discourage consumption of CFIYC. “The child rights obligations of governments require comprehensive responses, anchored in the use of public policy and law, and not ineffective voluntary corporate action. Mutually reinforcing interventions include strong implementation and enforcement of the Code, regulation of the composition and promotion of CFIYC based on well-designed food profiling models and guidance, comprehensive restrictions on child-directed marketing, standards in early child education and care, and safeguards against conflicts of interest and corporate political interference in policymaking”.
“Equally, caregivers and families need enabling conditions – social protection, time, skills, safe water, supportive services and food systems – so that nutritious, culturally appropriate foods are the default. With coherent policies, and independent monitoring and accountability, governments and partners can reshape food environments so every child can be nourished without reliance on unhealthy products”.
New: National Childhood Measurement Programme Data, school year 2024/25
On 6 November 2025, OHID published the findings from the 2024 to 2025 NCMP showing the latest patterns and trends in child body mass index (BMI) category for children in reception and year 6 in England. Key findings are as follows:
1.15 million children were measured, and 75.4% in reception and 62.2% in year 6 were a healthy weight, with girls more likely than boys to be a healthy weight.
However, 10.5% of children in reception and 22.2% of year 6 children were living with obesity. Excluding the COVID peak this is the highest obesity prevalence seen in reception since the NCMP began in 2006 to 2007, as the trends graph shows.
Large differences in prevalence remain between ethnic groups, with children from Black ethnic groups more likely to be living with obesity, and children from the Indian ethnic group more likely to be underweight.
Large differences in prevalence by level of deprivation also remain; obesity prevalence continues to be more than double in the most deprived areas compared to the least deprived areas for both reception (14.0% compared to 6.9%) and year 6 (29.3% compared to 13.5%), with the deprivation gap increasing since the early years of the NCMP. In 2024 to 2025, unlike in most previous years, there has been an increase in obesity prevalence in reception children in both the most and the least deprived areas.
At a regional and local level, variation in obesity prevalence is mostly driven by persistent inequalities by ethnic group and deprivation.
The high and rising levels of overweight and obesity in reception age children points to the urgent need for Government prioritisation of actions to enable healthy early years diets, as outlined in our joint policy position below.
New joint policy position: Healthy Early Years Diets
We have been working with peer members of theObesity Health Alliance and members of the Baby Feeding Law Group UKto update the original version of this joint policy position published on the Obesity Health Alliance website in February 2024. The new version provides updated context, and policy asks, but remains broadly similar to the original, highlighting the policies that still need to be prioritised by Government if we are to see progress on reducing levels of overweight, obesity and dental decay.
You can find the joint policy position on our website here.
New paper: Household food insecurity, nutrient intakes and BMI in New Zealand infants
In November, this new study was published by Ioanna Katiforis and colleagues in New Zealand, examining how household food security affects infant nutrition. The research used cross-sectional data from the First Foods New Zealand study. It included infants aged 7–10 months, with data collected between July 2020 and February 2022, and examined how nutrient intake and BMI vary according to a family’s access to food. This study is the first to provide a detailed look at nutrient intake in food-insecure infants and the first to explore the relationship between BMI and food insecurity in infants outside the United States.
The study is relevant to families with infants facing food insecurity in the UK, where levels of food insecurity are similar to those in New Zealand.
Existing data from the US show that food insecurity is associated with poorer dietary intake in adults and children, and data from New Zealand show low consumption of fruits and vegetables and high consumption of energy-dense, nutrient-poor foods in infants living in food insecurity. The authors highlight particular concern for infants from six months of age, who require a variety of nutrient-dense complementary foods to support optimal growth and development.
The study found that nutrient intakes were largely similar between infants living in food-secure and food-insecure households. Food-insecure infants had slightly higher intakes of free and added sugars (approximately one-quarter of a standard 5 ml teaspoon), but overall sugar intake remained low. This is surprising given that recent research from the same authors found that infants in severely food-insecure households frequently consumed commercial baby food pouches (see our October newsletter). However, the authors of this study did not classify sugars from fruit purées as free sugars, as per WHO Europe (and UK) definitions. Total energy intakes were similar across groups and generally exceeded estimated requirements for 7–12-month-old infants. Iron intake was low across all groups, with 50–62% of infants not meeting requirements but no significant difference by food security status.
Most infants were a healthy weight, and weight category differences (underweight, healthy weight, overweight) were not significant by food security status, though severely food-insecure infants had higher mean BMI z-scores than those in food secure families. Excess weight in infancy can raise the risk of childhood obesity and later health issues.
The authors concluded that, in the short term, household food insecurity does not appear to adversely affect the nutrient intakes or weight status of infants (although in our view not counting the sugars from commercial fruit purées in commercial infant foods as free sugars may have led to an underestimation of free and added sugar intakes, particularly among infants consuming large amounts of these products.) The authors suggest this may be partly because mothers often limit their own food intake to ensure their infants’ diets are not compromised. It is also possible that infants’ largely milk-based diets protect them from inadequate nutrient intakes, provided their access to breast milk or formula is not threatened.
Those supporting food-insecure families with infants should continue to support them to meet UK public health recommendations, which include that infants should be introduced to a wide range of solid foods in an age-appropriate form at around six months old alongside their usual milk feeds (ideally breastmilk), preferencing healthy home-prepared foods, that snacks are not recommended before 1 year of age, and that flavour and texture should be gradually diversified over time.
For more information on supporting families in resource-poor settings, our guide on Eating Well for pregnant & breastfeeding women, babies and young children living in temporary accommodation can be found here. Our Healthy Start and Best Start Foods Practical Guide may also be relevant for families enrolled in these schemes, which can also be found here.
Updated:Specialised milks marketed for infants with allergies in the UK
We have updated our report “Specialised milks marketed for infants with allergies in the UK” which was last updated in 2024, as an independent guide for health professionals on the infant milks available in the UK for this population group and the evidence and guidelines for their use. The reason for this update is that there have been two significant changes to the offering of specialised infant milks for infants with cows’ milk allergy in the UK. These are the exit of soya formula from the UK market and the entry of a new hydrolysed rice formula called ‘Arize’ by Abbott (see our March andAprilnewsletters).
The report provides information on all the infant milks currently being marketed for infants with diagnosed cows’ milk allergy (and potentially other allergies), including their composition, indications for use and suitability for special diets or religious requirements. We also review and de-bunk some of the claims made by manufacturers for the efficacy of their products. It also covers prescribing and costs and provides information on breastfeeding infants with cows’ milk allergy. There is a section on making up these specialised formula milks safely.
The purpose of this report is to provide independent information on these products, situated in the context of evidence on breastfeeding and allergy. We urge health workers to be circumspect of company marketing and review the evidence behind claims when making decisions regarding these products.
Parents/carers should be aware that all of the products covered in this report are regulated as Foods for Special Medical Purposes and available on prescription only which means they should be used under medical supervision. Families should discuss their use and/or any concern about suspected cows’ milk allergy with their GP. This report may be useful in those discussions.
Thanks to Aisling Phelan (Specialist Dietitian, Imperial College Healthcare Trust and University College London Hospitals NHS Foundation Trust) for peer review of this updated report. This updated report can be found on the www.infantmilkinfo.org website here.
Updated: Specialised milks for infants who are premature, low birth weight or have faltering growth
We have also updated our report “Specialised milks for infants who are premature, low birth weight or have faltering growth” which was last updated in 2021. This is intended as an independent guide for health professionals on the infant milks available in the UK for these population groups and the evidence and guidelines for their use.
The products in this report are regulated as Foods for Special Medical Purposes for use under medical supervision and are only available on prescription.
Since 2021, there have been no new infant milks added to the UK market that are marketed for use for infants that are premature, low birth weight or have faltering growth, although there have been some changes to some products; see below.
As of 2025 there are still no published UK guidelines for optimal enteral nutrition for preterm and low birth weight infants, and global guidelines published by WHO have not been updated since 2006. However, this updated report reflects the recently published ESPGHAN (European Society for Paediatric Gastroenterology Hepatology and Nutrition) position papers on enteral nutrition in preterm infants by Embleton et al (2023) and assessment of growth status and nutritional management of prematurely born infants after hospital discharge by Haiden et al (2025), among other up to date recommendations. The report also reflects new trials and systematic reviews that have been published since 2021.
The updated guidelines continue to recommend mothers’ own milk as the first line for enteral nutrition in preterm infants, due to higher content of macronutrients, immunoactive and trophic factors than pasteurised donor milk. Human milk reduces the risk of necrotising enterocolitis, sepsis, feeding intolerance and retinopathy. When mother’s own milk is unavailable, pasteurised donor milk is recommended as the second line for enteral nutrition. In 2023, BAPM (British Association of Perinatal Medicine) produced a Framework for Practice about the use of human donor milk in neonates which recommended that donor milk may be considered in babies born at <32 weeks gestation and/or <1500 grams to establish enteral feeding when mother’s own milk is unavailable or insufficient to meet their baby’s requirements.
When human milk is unavailable, specialised infant milks are advised to meet nutritional requirements for this population group. This report outlines the updated costs, nutritional composition, suitability for special diets or religious requirements, claims and evidence for these specialised infant milks. There is also section on making up these specialised formula milks safely.
The purpose of this report is to provide independent information on these products, situated in the context of evidence on breastfeeding and breastmilk feeding for these babies. We urge health workers to be circumspect of company marketing and review the evidence behind claims when making decisions regarding these products.
Product changes
The main product update has been that Cow & Gate Hydrolysed Nutriprem, Nutriprem 1 and Nutriprem 2 were re-branded to Aptamil Hydrolysed Nutriprem, Nutriprem 1 and Nutriprem 2 in July 2025.
Despite re-branding from Cow & Gate to Aptamil, there have been minimal recipe changes in the Aptamil range of preterm specialised infant milks.
SMA Gold Prem 2 has an increased iron content to 1.2mg per 100ml prepared infant formula and now meets the requirements of preterm infants.
A local clinical guideline developed by Greater Glasgow and Clyde NHS Trust recommends that volumes are limited to 150ml/kg/day if using SMA Gold Prem 1 to avoid excessive protein intake.
Thanks to Nick Embleton (Professor of Neonatal Medicine at Newcastle University and Consultant Neonatal Paediatrician at Newcastle Hospitals NHS Trust), and Sara Clarke (Lead Neonatal Network Dietitian Chair Neonatal Dietitians Interest Group and Birmingham Women's and Children's Hospital) for their peer review of this updated report.
New: Study on the acceptability and feasibility of plain labelling infant formula in the NHS
We are excited to be collaborating with Professor Amy Brown and colleagues at Swansea university and Public Health Wales on an ESRC-funded study to explore the acceptability and feasibility of a prototype plain label for infant formula we developed for NHS supply chain in 2022/23, pictured in the poster below.
This poster which shared more information about what we’re doing was prepared by Amy and was presented at the Unicef UK Baby Friendly Initiative Conference in Telford on the 12th and 13th of November and won the poster prize! (Please don’t try to complete the survey at the QR code shown. We will be circulating more information about the study and encouraging health workers and parents to complete relevant surveys once these have been designed and given ethical approval, sometime in the new year).
The context, as many of you will be aware, is that where babies are fed formula, parent loyalty to a given brand is very high. A key opportunity companies use to secure this loyalty to their brand, is provision of formula to maternity units. The final report of the Competition and Markets Authority infant and follow-on formula market study published in February 2025 covers this phenomenon in its chapter on consumer behaviour (pages 57-70).
One of the 11 recommendations made by the CMA was “that the UK, Northern Irish, Scottish and Welsh governments, working with the NHS/NHS Supply Chain in England and Wales, NHS Scotland/NHS National Services Scotland and HSC/Public Health Agency/Procurement and Logistics Service in Northern Ireland, as appropriate, take steps to ensure that, where parents are provided with infant formula in healthcare settings, it has standardised labelling so that branded products have less influence on parents’ decision-making(meaning generic labelling which does not have any brand names, logos or promotional text from an infant formula brand)”.
This study we are undertaking is intended to support the Governments to implement this recommendation.
Cow & Gate have updated their packaging, stating that their aim is to make it easier for parents and caregivers to identify each product and understand its intended use. The formulations of its infant and follow-on formula powders remain unchanged.
We assessed the new packaging for compliance with UK legislation, the accompanying Guidance Notes, and the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions (the Code), using the same methodology as our study published earlier this year in Maternal and Child Nutrition.
Although the rebranding gave Cow & Gate an opportunity to improve alignment with these standards, no meaningful progress has been made. The updated packaging still violates national legislation, the Guidance Notes, and the Code.
Our study found overall percentage compliance of formula labels was only 50% for the legislation, 32% for the Guidance Notes and 40% for the Code. Low compliance stems from several recurring issues:
Idealising imagery and text: Labels still include wording or photographs that idealise formula or may discourage breastfeeding
Cross-promotion: Products continue to use similar colours, images, and text across products, effectively promoting infant formula through the marketing of follow-on, growing-up, and toddler milks
Unclear warnings about health risks from incorrect preparation: Product labels fail to clearly state that improper use can increase the risk of serious stomach upsets, diarrhoea and vomiting, constipation, and dehydration.
We recommend that the Department of Health and Social Care (DHSC) should accept and act on the Competition and Market Authority (CMA)’s 11 recommendations, including those on strengthening labelling and advertising rules for infant and follow-on formula (and ideally extending these to growing up and toddler milks/drinks). Stronger enforcement of legislation is also essential to protect breastfeeding, support safe and appropriate formula feeding, and reduce undue commercial influence on infant feeding decisions.
Our position on the CMA’s formula market recommendations can be found here.
To enhance the value we provide and better understand our audience, we are transitioning our infantmilkinfo website to a subscription-only model. This change will help us ensure we are reaching the right people with the right information and making the site as useful as possible. In due course, when you navigate to the site, you will need to create a username and password. Additionally, we kindly ask you to complete a short survey during your first login. It should take no more than 5 minutes of your time. Your data will be managed responsibly in compliance with GDPR. Thank you for your continued support in helping us provide conflict of interest-free information to support health workers and parents who use formula to feed their babies.
News: Infant botulism outbreak linked to contaminated infant formula in the US
US health authorities, including the Food and Drug Administration and the Centers for Disease Control and Prevention, are examining a multistate outbreak of infant botulism linked to ByHeart Whole Nutrition infant formula. To date, 31 infants in 15 states have been hospitalised with suspected or confirmed cases of the illness following exposure to the product. Epidemiological and laboratory evidence suggests the formula may be contaminated with Clostridium botulinum, the bacterium responsible for infant botulism, a rare but potentially fatal condition that can result in respiratory failure if untreated. All ByHeart Whole Nutrition Infant Formula products have since been recalled and it is advised that parents and caregivers should stop using any ByHeart infant formula products immediately.
Although ByHeart represents only 1% of U.S. formula sales, and no national shortage is anticipated, this is the company’s second recall and third warning in recent years. Despite the mounting evidence, the company publicly denied any link between its products and the outbreak, putting infant health further at risk. Of particular concern are families who received formula through ByHeart’s donation program and as such may not be aware of the risks, since they didn’t purchase the tins themselves. Targeted outreach is needed to ensure they are informed, but it remains unclear what steps are being taken to notify them of the recall.
These products are not available in the UK, but we are sharing this news as this outbreak highlights the ongoing need for vigilance around the microbial safety of powdered infant formula. Unfortunately, this is not an isolated incident. In recent years, multiple contamination problems have surfaced in formula manufacturing, including the health and safety failures at Abbott’s Michigan plant that we reported on in 2022, which led to non-life-threatening illness in 80 infants, the hospitalisation of 25 infants with severe infections, and the deaths of 9 infants.
When working with families, it is important to emphasise the need to follow NHS guidance when preparing powdered infant formula, which cannot be made sterile and may contain harmful bacteria. A crucial part of this guidance is ensuring that the water used to reconstitute the powder has been boiled and then cooled to no less than 70°C, in order to kill any bacteria present. There appears to be a persisting widespread misunderstanding among parents about why water must be this temperature, and limited awareness that although the risk of illness from contaminated formula is low, the consequences can be fatal.
It should also be noted that there is no evidence that breastfeeding increases the risk of infant botulism; in fact, some research suggests it may offer a protective effect (R Lawrence et al, 2022). Therefore, breastfeeding should continue if botulism is suspected in either the mother or the infant.
More information on safe formula preparation can be found here.
Infographics on safe formula preparation, suitable for sharing directly with families, are available here.
News: New allergy conference criticised over sponsorship links
On Tuesday 18 November, a new conference, the Infant Allergy & Paediatrics Conference 2025 was hosted by the Journal of Family & Child Health, a journal published by the Mark Allen Group, with sponsorship from Kendamil and Danone.
Following our engagement, on 4 November 2025 the British Medical Journal published this news piece about this conference:
We cited this BMJ piece in individual letters sent to each of the 9 speakers that were listed on the conference website, explaining the problems with the conference and the conflicts of interest created by the conference sponsorship. Four speakers withdrew, in addition to another speaker who withdrew over a month ago already, after being contacted. While the conference still went ahead, we were do believe that awareness is improving regarding the problems created by conferences sponsored by the formula industry. Hopefully, with reduced attendance by health professionals, organisers of such conferences will start to seek alternative funding sources, including as suggested by WHO guidance on alternative funding sources for events, published in 2024.
Mark Allen publishers are now advertising their annual British Journal of Midwifery conference for 2026, which also has formula industry sponsorship. We have written letters about this conference to speakers in 2021 and to the organisers in 2022), have had opinions on it published in the British Medical Journal in 2024 and2025, and yet still the conference continues with industry formula industry sponsorship. We would encourage other health professionals to write to the organisers (see our website here for guidance on how to write about this or you are welcome to email us and we can share our previous letters with you). We strongly urge health professionals to carefully consider their attendance at this conference.
Updated: Unicef UK Baby Friendly Initiative Guide on the International Code of Marketing of Breastmilk Substitutes for health workers
At the November 2025 Conference, Unicef UK’s Baby Friendly Initiative published the 2025 update to their Guide for Health Workers to working within the International Code of Marketing of Breastmilk substitutes and subsequent World Health Assembly (WHA) resolutions. We at First Steps Nutrition Trust are proud to have supported this update through expert input and review of the guide.
This most recent edition incorporates findings and recommendations from the latest global guidance as well as UK advocacy action, to provide a comprehensive guide for health workers and health services in the UK on how to adhere to the Code. Sections include: a summary of the regulatory and policy frameworks (globally and in the UK); advertising; provision and procurement of infant formula in health and community services; education, information and conflicts of interest; research and a section of Frequently Asked Questions (FAQs). Throughout the document, further resources are provided, including summaries and reference to other important and complementary documents and some examples of best practice. Some sections have specific and practical guidelines for compliance in Baby Friendly accredited services.
The guide exists to help health professionals to use the Code in daily practice and to negotiate some of the challenges and questions faced at work, enabling them to approach tricky situations with confidence and integrity. In doing so, this will ensure adherence to the Code, protecting breastfeeding and ensuring that parents who formula feed have access to accurate and evidence-based information.
An update of Eating Well Vegan infants and under 5s
We last updated this resource in 2021 and some changes are now due. These will be on the information on vitamin supplements and infant formulas available in the UK (noting there is still no vegan infant formula), and on plant-based milk alternatives given the recommendations of SACN and COT published in July this year (read more about this in our August newsletter). We hope to have this update with you ASAP.
We’re excited to announce the safe (and speedy) arrival of Cora Jean, a daughter for Jasmine and Hugo, born at 3.44am on Friday 21st of November weighing 7lb2oz. Jasmine reports that so far, Cora Jean loves sleeping night and day, breastfeeding and cuddles.
Registered Associate Nutritionist Jasmine Brand-Williamson joined the Trust as a Nutrition Officer this time last year, to provide maternity cover for our Senior Nutritionist Rachel, who will be back with us in the new year.
