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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.

April 2026

Welcome to our April newsletter, the contents of which are as follows:

Forthcoming

News

News: Launch of the Commercial Baby Food Review

We at First Steps Nutrition Trust are proud to announce that we have joined the Commercial Baby Food Review. Working alongside the Obesity Health Alliance, Bremner & Co, Sustain, Planetary Alliance and the University of Leeds. This new cross-sector initiative focuses on improving the nutritional composition and marketing of commercial baby and toddler foods in the UK, through stronger enforced regulations.

Funded by Impact on Urban Health, the Review brings together specialists in early years nutrition, food policy, public affairs, advocacy, public health and academia to drive population change with measurable benefits for child health and equality. The initiative will focus on tackling systemic inequalities in infant and young child feeding, including the disproportionate impact that unhealthy, inappropriate products and misleading marketing can have on low-income families.

The problems are not new, but they have long been ignored. Important new research published in the last year (summarised in our May 2025 newsletter) highlighted ongoing, serious concerns with the baby food retail offer. Key findings included:

Product Composition

Around a quarter of all products would need a front-of-pack warning for high sugar
41% of main meals were high in sugar
Cheaper options were often higher in sugar, more watery, and less nutritious, raising further concerns about affordability and inequalities

Labelling and Marketing

Every product carried nutritional or marketing claims
Many products labelled for use from 4 months of age, against public health recommendations

Parent Insight

92% of parents with children aged 0-3 use commercial baby and toddler foods
40% of parents with babies under 6 months use these products daily

The Review comes at a pivotal moment. With voluntary guidelines published in August 2025, the 18-month implementation period is well underway, and pressure is growing on manufacturers and retailers to make meaningful improvements. The Review will work to develop practical, evidence-informed policy solutions that strengthen accountability, support regulatory reform, improve the commercial baby food retail offer, and better protect babies’ and young children's health.

This opinion piece of ours in the Grocer “Baby food guidelines: Why we’re still waiting for real progress” highlights the need for sufficient scrutiny of baby food company actions in response to the voluntary guidelines.

You can read an interview about the Review, between our Director Vicky and Bremner and Co partner, Dayna Brackley here: “Baby pouches and health halos: the new partnership demanding better baby food”.

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New: Food Foundation survey showing the multiple barriers families face feeding under 5s healthy diets

The Food Foundation published the results of their latest food insecurity monitoring in March (see here) and reported that 15.3% of households with children reported experiencing food insecurity in January 2026, compared to 10.9% for households without children. Food insecurity means having to have smaller meals or skipping meals, not eating when hungry, or having to go a whole day without eating because of being unable to access or afford enough food at any point in the past month.

Food insecurity impacts on nutrition, with the survey finding food insecure households reporting cutting back on purchases of fruit (53.1%) and vegetables (39.9%), which could in turn impact on the diets of young children and contribute to some of the inequalities in consumption. Dietary inequalities fuel rising levels of childhood obesity and persistently high levels of dental decay.

Nearly three quarters (74%) of survey respondents with children aged 1-4 years reported at least one barrier to feeding their child what they would like. The graph shows the multiple barriers reported by families of young children:

This graph shows what families said would help them to feed their young children better:

We back the Food Foundation’s calls for:

Improving the Healthy Start scheme (expanding eligibility to include children aged four, increasing the payment amounts to ensure it keeps in line with food inflation, and automatically registering all eligible families onto the Healthy Start scheme).
Improving Free Early Years Meals (removing additional conditions attached to eligibility).
Strengthening regulations on the promotion and marketing of unhealthy foods directed at young children (including mandating standards for commercial baby and toddler foods, as per our work on the Commercial Baby Foods Review, outlined above).

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News: Investigation shows many branded, children’s vitamin D products do not contain enough vitamin D

On March 21st, the Times reported the results of an investigation in to branded, children’s vitamin D products which suggested that parents are being misled over dosages. The issue is that many supplements are labelled as meeting 100% of the ‘Nutrient Reference Value’ while containing less than the 10 micrograms of vitamin D that the NHS recommends is given to all children aged 1-<5 years daily (and to breastfed babies from birth, unless they are drinking 500ml or more formula a day).

This infographic from the BMJ summarises current public health recommendations for vitamin supplements for babies and young children (nb. Healthy Start vitamins can be used from birth).

Key takeaways for parents of <5s and health workers supporting them:

Branded supplements are usually not the best choice, they come with a price tag, they may not provide what the child needs (as outlined in the infographic above) plus may add to excess sugar intakes

Pharmacy own-brand vitamin D supplements are usually the better choice

Healthy Start vitamins (providing vitamins D, C and A) provide the right doses, are FREE to eligible, low-income families (and all families of <4s in some areas) and can be bought online at low cost.

Our Eating Well guides provide practical guidance on feeding babies and young children under 5 years of age and include advice on vitamin supplementation. These guides can be access for FREE or a donation (and some can be bought as hard copies) from our main website, here: https://www.firststepsnutrition.org/eating-well-resources.

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Conference Summary: Imperial Ultra-Processed Food Policy Forum -Assessing the science and advancing regulatory and policy responses to ultra-processed foods

Our Director, Vicky, was honoured to be among 15 distinguished speakers at this second UPF forum at Imperial College London on March 24th. The purpose of the event was to examine the latest evidence on Ultra-Processed Foods (UPFs) and to identify practical policy responses to their growing role in diets and disease.

Below are some highlights from Imperial’s Annabel Culley’s news piece on the event, and some extra detail from Vicky’s presentation.

The State of Evidence behind Ultra-Processed Food

Professor Carlos Augusto Monteiro gave the keynote, summarising the state of scientific understanding linking UPFs with ill health. He summarised and built on the Lancet series paper 1 published last year (read about this in our December 2025 newsletter), highlighting that the problem with UPFs lies not only in their nutritional profile, but in the very processes, ingredients and additive combinations used to manufacture them, which drive overconsumption and damage health through multiple pathways. He also addressed some of the criticisms of UPF research.

Dr Matilde Touvier presented her work on the mechanisms by which UPFs harm health.

Dr Ashley Gearhardt presented on the addictive properties of UPFs and how modern processing optimises sensory appeal and intensity, speed of delivery, and drives repeat consumption.

Dr Sam Dicken presented the UPDATE randomised controlled trial findings, comparing the health effects of two diets meeting the current UK national dietary guidelines, one UPF-based and one made of minimally processed foods.

UPF Policy Landscape

The second part of the conference focused on the direction of UPF policy research. Professor Adam Briggs introduced three new NIHR-funded research projects building the evidence base needed to develop and justify effective policy interventions in the UK. Thereafter, Professor Sassi, Dr Eszter Vamos and Dr Dan Derbyshire spoke about these three new projects and how findings will be translated into actionable policy recommendations. We at First Steps are collaborating on the project being led by Eszter (‘Identifying and evaluating policy mechanisms to reduce ultra-processed food consumption in the UK: health, equity and economic impacts’), along with friends at the Soil Association and Sustain’s Children’s Food Campaign

Dr Kremlin Wickramasinghe outlined the WHO’s current direction on UPF policy guidance, including work to establish internationally harmonised definitions and evaluate policy tools such as front-of-pack labelling, marketing restrictions, and taxation.

Dr Fabio Gomes of the Pan American Health Organisation presented evidence from Latin America, where countries including Brazil, Chile, and Mexico have implemented some of the most comprehensive food labelling and advertising regulations in the world.

Practical Steps to Action

In the afternoon, speakers including Vicky, spoke about specific policy levers available to governments seeking to reduce UPF consumption and improve diet quality.

Dr Austin Frerick spoke about anti-trust policies and institutional procurement to help break cartels and monopolies in the food system.

Dr Mathilde Touvier showed how front-of-pack labelling can empower consumers to identify and limit UPF exposure, while incentivising reformulation.

Dr Magdalena Muc presented evidence to show that loopholes in UK healthy food marketing restrictions need closing to limit young people’s exposure to UPF marketing.

And finally, our Director, Vicky presented on the policy options to rebalance early years diets away from UPFs, as follows:

Policies that seek to reduce UPF consumption in the early years:

Address processing in dietary guidelines and education as well as nutrients and foods
Restrict marketing of commercial milk formulas (and bottles and teats)

Mandate the International Code of Marketing of Breastmilk Substitutes in law, and properly enforce
Plain labels for infant formula

Tax unnecessary growing up and toddler milks and drinks
Restrict marketing of commercial baby and toddler foods

Update current laws in line with the WHO Europe Nutrient and Promotion Profile Model and UK public health recommendations (noting that while this would address many issues with the retail offer, additional work is needed to address texture, contaminants and additives)

Address UPFs in nutrition guidelines for early years settings (and school food) as well as nutrients and foods, e.g. explicit guidance to avoid commercial baby and toddler foods

Policies that seek to increase consumption of nutritious, minimally processed foods in the early years:

Ensure accessible, practical support for breastfeeding and legal protections (including adequate paid maternity leave)
Implement healthy food subsidy / nutrition safety schemes, e.g. Healthy Start
Ensure adequate practical support for complementary feeding based on nutritious minimally processed (requires adequate community health workers e.g. health visitors)
Mandatory food standards for early years settings, based on nutritious minimally processed foods

The Way Forward

Following the above presentations, Dr Dolly van Tulleken hosted a panel to investigate the gap between evidence and political action.

Ben Coleman MP emphasised that affordability and equity should remain a key focus in discussions around UPF policy. Baroness Walmsley stated that although the government has introduced a range of policies recommended within the House of Lords Report on Food, Diet and Obesity, the government need to go further and faster with its interventions.

Closing the conference, Henry Dimbleby concluded by highlighting the progress that has already been made, noting that 94% of people in the UK know that UPFs are bad for their health. He emphasised that the power lies in giving support for positive policies such as teaching cooking in schools and – reiterating the point Vicky made in her presentation - enabling breastfeeding.

To conclude, the forum highlighted growing international consensus regarding the growing evidence linking UPFs to poor health outcomes and how the policy debate is shifting from whether to act, to how to act.

Huge congratulations to the team at Imperial for a thought provoking and motivating day and for inviting us to share our expertise at the intersection of early years nutrition policy, practice and research and ultra-processed foods.

The presentations from the day can be watched on You Tube at this link: https://www.youtube.com/watch?v=Otuq6YRfLeU.

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Conference Summary: ‘Nourishing Our Future’: Turning Early Years Nutrition Guidance into Practice

On 14th March 2026, our nutritionist Sara attended and exhibited the Nourishing Our Future (NOF) Conference, an inspiring event that highlighted the impact of the NOF on nutrition in early years settings across Essex.

What is Nourishing Our Future?

Nourishing Our Future began as a research programme focused on food and nutrition in early years settings, including nurseries, pre- schools, childminders and nursery classes caring for children from birth to age five. While the importance of nutrition in schools is well recognised, there has historically been far less focus on food in early years settings, despite its critical role in children’s growth, development and longer-term health.

The research was led by Anglia Ruskin University and commissioned by Essex County Council Public Health, who identified early years settings as a key priority within the county’s Healthy Weight Strategy (2024 to 2034), in light of local data showing that 21% of children aged 4 to 5 in Essex live with overweight or obesity, and 22% experience tooth decay. These challenges are closely linked to diet and dietary patterns established in early childhood.

Despite the existence of national guidance, the NOF research identified that early years settings often found it complex and difficult to interpret in practice. While many settings already had food policies in place, practitioners frequently reported uncertainty around portion sizes, menu planning, lunchbox expectations and how to engage parents confidently around healthy eating.

From Research to Action: The NOF Award

In response to the research findings, the NOF Award was developed in 2025 to support settings to turn evidence and guidance into action. It provides a clear, practical and supportive framework that helps settings understand what good practice looks like and how to implement it in a manageable way.

Through three progressive levels (Rooting, Sprouting and Blooming), the award supports settings to review and strengthen food and nutrition policies, improve menus, snacks and portion sizes, embed food education and positive mealtime experiences into daily practice, engage parents and carers using consistent, evidence-informed messages, and build staff confidence and shared responsibility around nutrition. It offers practical tools such as templates, training videos, example policies and family-facing resources, enabling settings to make realistic and sustainable improvements rather than expecting rapid or unrealistic change.

Impact and progress across Essex

The Nourishing Our Future Impact Report (2026) demonstrates that the programme is already supporting meaningful change across early years settings in Essex.

Engagement and Reach:

Over 200 early years settings participated in the original research, across all Essex districts.
Within the first six months of the NOF Award launch, 110 early years settings signed up, including childminders, nurseries and preschools.
10% of participating settings are located within the 20% most deprived areas in the country, demonstrating the programme’s reach into communities where food inequality is greatest.
33 settings achieved the Rooting level award during the early phase, with some settings progressing to higher award levels.

Changes in Practice:

83% of settings reported doing something differently because of taking part in the original NOF research.
91% of settings achieving the Rooting level award stated that they had changed their food and nutrition practices. Examples of change included revising snack menus, reducing sugar and ultra-processed foods, introducing clearer lunchbox guidance, improving portion control, and offering a wider variety of fruit, vegetables and home-cooked foods.

Confidence, Knowledge and Culture:

87% of settings reported improvements in staff knowledge, confidence and nutrition-related practice.
67% reported a positive shift in behaviour, attitudes and setting culture, with food becoming more central to wellbeing and learning rather than an operational afterthought.
All settings achieving the Rooting level award reported feeling much more confident in understanding and applying national nutrition guidance.

Impact on Children and Families:

73% of settings reported seeing a positive impact because of changes they had implemented.
Settings described children being more willing to try new foods, showing greater curiosity about food, and experiencing calmer, more positive mealtimes.
Many practitioners reported stronger engagement with parents and carers, including healthier lunchboxes, improved portion awareness and more consistent messaging between setting and home.

Reflections from the Conference

A strong theme throughout the conference was the dedication of early years professionals across a wide range of roles, including head teachers, managers and catering staff, all contributing to children’s food experiences and nutrition. Their commitment was celebrated alongside honest discussion of the financial, practical and emotional pressures faced by many settings.

Practitioners shared practical examples of change, from improved menus and food policies to creative ways of involving children and families in food education. It was clear that NOF has helped build shared understanding and confidence, supporting settings to prioritise nutrition while promoting positive, pressure-free relationships with food.

Implications for Future Policy

The NOF award has been presented as a best practice case study of how to implement the new National EYFS Nutrition Guidance (read more about this in our June 2025 newsletter) and has been shared with the Office for Health Improvement and Disparities, the Department of Education and the Local Government Association. NOF provides a strong example of how national ambitions, including the Best Start in Life agenda, the NHS focus on prevention, and local Healthy Weight strategies, can be translated into meaningful action in early years settings.

While funding and capacity vary across local authorities, the programme highlights the potential benefits of prioritising early years nutrition as part of a preventative public health approach that can help reduce health inequalities. Over time, such investment has the potential to support improved health outcomes for children and families and reduce longer-term pressure on health services, reinforcing the case for sustained and targeted support for early years nutrition at both local and national levels.

Find Out More

To learn more about the Nourishing Our Future programme, visit:

Website: https://nourishingourfuture.co.uk/about/

Facebook: https://www.facebook.com/share/g/1DqiemrLNs/?mibextid=wwXIfr
Instagram: https://www.instagram.com/nourishingourfuture/

Supporting Settings with Trusted Resources

Access to clear, impartial, evidence-based resources can further support early years settings to put guidance into practice. At First Steps Nutrition Trust, we provide practical resources that many settings and parents find helpful, including:

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New: Best Start in Life Family Hubs and Healthy Babies guidance

On March 30th, the Department for Education issued new guidance to help local authorities provide Best Start Family Hubs and Healthy Babies services from April 2026 to March 2029.
As promised in “Best Start Family Hubs and Healthy Babies: preparing for implementation from April 2026” published in December 2025, the new guidance comprises:

The first two documents contain content related to infant feeding (i.e. breastfeeding and formula feeding) and (a small amount of information on) healthy growth and nutrition support. (Curiously there is no explicit mention of supporting families with complementary feeding or indicators related to this, which seems like an important omission which we will follow up on with the Department of Education).

Infant feeding is part of the core offer of every hub, as a part of the preventative and universal Healthy Babies services.

The guidance outlines that: “Local authorities should strengthen local provision through commissioning, workforce development and accessible support that enables informed choices and improved outcomes. These expectations aim to ensure families receive consistent, evidence based infant feeding support that enables informed choices and improved outcomes”.

Core service goals for infant feeding are: “promoting breastfeeding and infant feeding support, using community venues and peer networks, and normalising breastfeeding through campaigns and community partnerships”.

The guidance includes mention of:

Ensuring all infant feeding provision is informed by relevant NICE clinical guidance and UNICEF UK Baby Friendly Initiative (BFI) standards.
Ensuring BSFH staff can raise the topic of infant feeding with families, including fathers and co-parents, in an informed and sensitive way and are knowledgeable about: the benefits of breastfeeding for mother and child and safe and responsive feeding more generally, including formula feeding.

It states that local authorities receiving Healthy Babies funding should:

Provide clear, evidence-based information and advice so families can make informed decisions about feeding their baby.
Make evidence-based information available that explains the benefits of breastfeeding and supports all infant feeding choices, including guidance on safe formula use and the nutritional equivalence of all first-stage infant formula.

Our evidence-based resources at First Steps Nutrition Trust are relevant to the infant feeding offer expected in Best Start Family Hubs and under the Healthy Babies initiative, and to meeting the wider service expectations:

Our simple guide to breastmilk and breastfeeding is available here.

Parent/carer facing resources on infant milks are available here: https://www.firststepsnutrition.org/parents-carers.

Health worker facing resources on infant milks are available here: https://www.firststepsnutrition.org/infant-milks-health-workers and on our dedicated website www.infantmilkinfo.org.

Lastly, our FREE Eating Well resources provide practical, pictorial guidance for feeding babies under 1 (including the how, what and why of complementary feeding), and young children between 1 and <5 years of age, see here: https://www.firststepsnutrition.org/eating-well-resources. Of particular relevance to supporting complementary feeding are:

Eating+well+in+the+first+year_+weaning,+starting+solids,+complementary+feeding.jpeg

Eating+Well+6+months+to+2+years+For+South+Asian+Children.jpeg

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New: First Steps Nutrition Trust 2025 Impact Report

We published our 2025 impact report in March, which you can find on our home page here. Key achievements are summarised in this infographic:

Our work is made possible by the generous support of a small number of funders and individual donations. To maintain our independence, we do not take money from the baby food industry. If you’re interested and able to support our ongoing work in to the future, we would love to hear from you. You can make a donation here or email us on admin@firststepsnutrition.org.

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Infant Milk News

ICYMI: Useful resources in light of recalls and price rises

There are no new developments to report this month; however, the impact of earlier product recalls and price increases continues to affect many families. As we previously reported in our February newsletter, the Food Standards Agency issued alerts regarding several formula products contaminated, or potentially contaminated, with cereulide toxin, which can cause rapid-onset gastrointestinal symptoms including nausea, vomiting, diarrhoea and abdominal cramps. Healthcare practitioners should continue to advise parents and carers who use formula to check batch numbers carefully and avoid any recalled products, as outlined in our statement, here.

Practitioners should also reinforce that powdered infant formula is not sterile. Parents and carers should be supported to follow NHS guidance when preparing feeds, particularly the recommendation to use water that has been boiled and cooled to no less than 70°C before mixing with the powder, as this helps to kill any bacteria that may be present.

Although supply issues have improved, some families may still experience difficulties accessing their usual products. Our infographics to support parents and carers in identifying suitable alternatives and lowest cost options, can be found on our main website, here. Updated materials on formula pricing, including the lowest-cost options available to families can be found on our infant milk info website, here.

We at First Steps Nutrition Trust continue to advocate for stronger government action to ensure the safety and affordability of infant formula, particularly during contamination incidents and supply disruptions. Such policies must of course, also prioritise the protection, promotion and support of breastfeeding as the normal way to feed babies, and its significant benefits for infant and maternal health, as well as its role in supporting infant food security. We will share a more detailed policy briefing in due course.

For infant milk information for health workers, 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 news

News: BMJ Article Raises Concerns About Formula Sponsored Survey Circulated by Midwifery Journal

On 25 March 2026, The British Medical Journal published a news article after we raised concerns about an industry-led survey circulated to midwives and health visitors by the British Journal of Midwifery. The survey, sent out in February, was sponsored by SMA infant formula (owned by Nestlé) and included entry into a prize draw for £100 Amazon vouchers.

Dr Victoria Thomas, consultant paediatrician and co-chair of the Hospital Infant Feeding Network, said: “I do not think it is appropriate for a scientific journal to send out a survey such as this. It does constitute marketing, and I suspect the company is also trying to obtain additional marketing levers to use with professionals and consumers.”

While the survey states that breastfeeding is the best feeding option, all questions focused on formula feeding and infant gut health. One question asked respondents to rank SMA in comparison with four other formula brands, without the option to state that all are nutritionally equivalent. Dr Victoria Thomas said this was a “deeply misleading omission”, given NHS guidance that all infant formula sold in the UK is regulated to the same standards, regardless of brand or price.

Our senior nutritionist Katie was also quoted in the article: “This constitutes promotional marketing by the company to health professionals, a problematic practice that has been documented by researchers as a way for companies to create brand awareness, thereby influencing healthcare professionals to use and recommend their products.”

UK legislation and international guidance set clear limits on how infant formula companies can engage with health professionals, restricting this to factual and non-promotional information. These safeguards exist to protect breastfeeding and to help ensure that families receive clear, reliable advice that does not increase confusion or place unnecessary financial pressure on parents. Professional journals and organisations therefore play an important role in maintaining ethical standards in maternal and infant health.

The British Journal of Midwifery, which is published by the Mark Allen Group, has previously been criticised for accepting funding and sponsorship from infant formula companies in relation to professional events. Such arrangements create conflicts of interest, particularly where international guidance, including the World Health Organization International Code of Marketing of Breastmilk Substitutes, seeks to keep professional education separate from commercial influence. Clear boundaries are needed to support consistent, evidence based infant feeding practice.

Our advice: If you care about protecting infant feeding from commercialisation, we suggest you avoid this publisher, this journal and this survey.

We at First Steps Nutrition Trust act as secretariat for the Baby Feeding Law Group UK, which campaigns for stronger UK regulation of breastmilk substitute marketing in line with the Code and resolutions. Health professionals who want to ensure their practice aligns with the Code can find practical guidance in Unicef UK Baby Friendly’s ‘Guide to working within the International Code of Marketing of Breastmilk Substitutes’. In addition, comprehensive, independent information on all infant milks on the UK market can be accessed for free on our website, www.infantmilkinfo.org as an alternative to relying on company websites.

For more information about the BFLG-UK please visit our website Baby Feeding Law Group UK (bflg-uk.org) and sign up to our twitter (X) account @BflgUk. You can also email katie@firststepsnutrition.org

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Forthcoming

An update of First Steps’ Eating Well Healthy Start and Best Start Foods, a practical guide

On April 6th, the monetary allowance provided by the Healthy Start and Best Start Food Schemes increased by 10%.

Given these increases, and changes in public health recommendations in recent years, we have been working hard to update the current, 2022 version of Healthy Start and Best Start Foods – A practical guide – our guide to support beneficiaries of the schemes. The 2026 version will be available later this month on our website here: https://www.firststepsnutrition.org/eating-well-resources. We will announce its publication on our social media channels and will share in our May newsletter.

If anyone is interested in placing an order for hard copies of this resource, please contact admin@firststepsnutrition.org.

New ‘bite sized’ resources (posters, leaflets and recipe cards) are also under development for use in Family Hubs and food bank settings.

Watch this space!

The iHV Evidence Based Practice conference, Bournemouth, May 6th

The Institute of Health Visiting (iHV) will be hosting a full-day Evidence-based Practice Conference 2026, with the theme “From Evidence to Action: Getting it right from the start”, at Bournemouth International Centre on Wednesday 6 May 2026. Our Director, Vicky will be doing an oral presentation on Starting solids and the latest public health recommendations on shop bought baby foods. You can book your tickets here.

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The Unicef UK Baby Friendly Initiative virtual conference, virtual, November 18-19th

This annual conference brings together those involved in the care of babies, their parents and families to learn about the latest research and innovations in infant feeding and relationship building.

The 2026 conference is now open for bookings -find out more here: 2026 Virtual Conference - Baby Friendly Initiative. The early booking discount is available until July 31st.

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March 2026

Welcome to our first newsletter of spring!

In case you missed it, we are actively recruiting for up to three new trustees for our board. If you would like to be actively involved in setting the direction of First Steps and you have experience in: organisation/business management and growth; charity governance; accounting and financial management in the charitable sector; or fundraising, including from trusts and foundations, please do consider applying. You can find out more on our vacancies page.

Please see the contents of our March newsletter below.

NEWS

New report: SACN report on Nutrition and Maternal Weight Outcomes

Infant milk news

BFLG-UK news

BFLG-UK statement on the Governments’ joint response to the CMA recommendations, and an update on DHSC progress and implementation

Forthcoming

HR news

Welcoming Sara

News

New report: SACN report on Nutrition and Maternal Weight Outcomes

In February 2026, the Scientific Advisory Committee on Nutrition (SACN) published its first report on nutrition and maternal weight outcomes, reviewing the scientific basis of current UK dietary recommendations for women before pregnancy, during pregnancy and up to 24 months after delivery. This is the first of two publications from SACN on nutrition and maternal health, with a future position statement to follow on wider UK dietary recommendations for women of childbearing age. We at First Steps Nutrition Trust welcome this report and the renewed focus it brings to the importance of nutrition in pregnancy and early life, particularly for those most at risk of poor dietary outcomes.

Report overview

Around half of pregnant women in England are living with overweight or obesity (50.3%) at their first antenatal appointment, and overweight and obesity is increasing among women of childbearing age more broadly. National surveys show that between a third and two-thirds of women aged 16 to 54 years in England were living with overweight or obesity in 2022, with prevalence highest in the most deprived areas. At the same time, around 1 in 10 non-pregnant young women aged 16 to 24 were living with underweight, highlighting that poor nutritional status affects women across the weight spectrum.

The report is clear that the dietary patterns of most women of childbearing age fall short of UK recommendations. Survey data indicates that women, like the UK population overall, are not meeting recommendations for vegetables and fruit, fibre, oily fish, sugar, salt or saturated fat, and that energy intakes are likely to exceed requirements. There is currently no national dietary data set on pregnant or breastfeeding women in the UK, which SACN identifies as a significant gap.

The evidence reviewed by SACN found that improving dietary quality during and after pregnancy has modest but meaningful benefits for gestational weight gain (GWG) and postpartum weight. Lower glycaemic load dietary patterns, Mediterranean-style diets, and healthier eating patterns more broadly were associated with lower GWG. Dietary supplements, however, were not found to support healthier weight outcomes for most women. SACN also reiterates (in line with the 2025 NICE Maternal and Child Nutrition guidelines) that intentional weight loss during pregnancy is not recommended because of potential adverse effects on the baby.

Key Findings and Recommendations

Weight before pregnancy matters most: SACN confirms what we already knew; that a woman's weight at the start of pregnancy has a greater influence on health outcomes for her and her baby than how much weight she gains during pregnancy. The report emphasises the importance of supporting women to reach a healthy weight before pregnancy, and in between pregnancies.

No change to energy advice during pregnancy and breastfeeding: Women should consume an extra 200 kcal per day in the last three months of pregnancy, and around 330 kcal per day during the first six months of exclusive breastfeeding. SACN notes that women living with overweight or obesity may already be meeting their energy needs without eating more.
Breastfeeding remains a priority: Exclusive breastfeeding for the first six months is linked to lower maternal BMI in the longer term. SACN recommends that strategies to promote and support breastfeeding are strengthened, in line with the wider evidence on its benefits for mothers and babies.
Focus on diet quality, not supplements: SACN recommends that women follow existing UK dietary guidance and eat a healthy, balanced diet. The evidence does not support the use of dietary supplements to manage weight gain during pregnancy for most women.
Some groups need particular attention: The report highlights the need to focus on adolescent girls, older mothers, women from racially and ethnically diverse backgrounds, and those experiencing multiple disadvantage. There is a particular lack of evidence on adolescent girls, who are more likely to be living with underweight and whose energy needs in pregnancy are not well understood.
Better data is needed: SACN calls on government to collect nationally representative data on the nutrient intakes of pregnant and breastfeeding women, and to continue measuring and reporting maternal weight at the start of pregnancy. This is a significant gap that makes it harder to understand and respond to the needs of this group.

Looking ahead

This report is a timely and important contribution to the evidence base on maternal nutrition and weight. Its emphasis on improving diet quality before and during pregnancy, and on reaching the most marginalised groups, reflects a clear understanding that individual behaviour change alone is not enough.

The SACN report sits well alongside the Royal College of Physicians' recently published view on maternal health and obesity, which raises many of the same concerns. Both reports highlight the stark inequalities in maternal health outcomes and call for better support for women from the most deprived communities and those from racially and ethnically diverse backgrounds. Both also emphasise the importance of breastfeeding support. The RCP report adds to this by calling for the Healthy Start scheme to be expanded and for payments to keep pace with food price inflation, recognising that financial barriers must also be addressed. Together, these two reports make a strong case for sustained investment in maternal nutrition and for policies that tackle the wider factors shaping women’s diets.

Further resources

For practical advice on meeting nutritional needs during pregnancy and while breastfeeding, see our Eating Well resources, which can be downloaded for FREE or with a donation:

New DHSC guidance: The Healthy Child Programme

On February 6th, the Department for Health and Social Care published the Healthy Child Programme national framework for improving the health and wellbeing of babies and children and young people from birth and aged up to 19-25 years old in England. It sets out evidence-based approaches to prevention, early intervention and family support – supporting the government’s ambition of raising the healthiest ever generation of children. It comprises delivery guidance for public health nursing teams for and their provider organisations (divided in to part 1, principles, part 2 for health visiting (0-5s), and part 3 for school nursing (5-19s)), commissioning guidance and a high-impact area framework (again broken down in to sections, one of which is for health visiting and 0-5s) which translates the principles in to actionable priorities.

In relation to early years nutrition, the health visiting section of the high impact area framework contains the detail about what health visitors are meant to do to support women antenatally and thereafter with breastfeeding, infant feeding and healthy weight and nutrition. It refers to relevant SACN and NICE guidelines, the Unicef UK Baby Friendly Initiative, the International Code of Marketing of Breastmilk Substitutes and also our resources at First Steps Nutrition Trust for supporting eating well from pre-conception up to the age of 5 years.

The guidance does not introduce any new statutory duties; it is about providing long overdue clarity on what should be delivered and how to improve the quality and consistency of services provided under the health child programme across England in line with pre-existing evidence-based recommendations and guidance.

Infant Milk News

Updated: Infant milk costs and trends reports

At the end of February, we published updated costs and trends reports as an additional update to our usual biannual releases in May and October. We did this in response to sharp price increases following the recent formula milk recalls (see below). Parents and carers quickly felt the impact, with one reporting on social media that Cow & Gate rose from £9.20 to £11 in a single week. Our findings were reported on by The Sun, The Grocer and the BMJ. Beyond pricing, the recent recalls also disrupted availability (see below).

Since October 2025, prices have increased across several major brands, particularly those owned by Danone (Aptamil and Cow & Gate) and Nestlé (SMA), which were affected by the recall (see Graph 1). The average cost of branded powdered first infant formula now stands at £12.95 per 800g tin (6p higher than in October) compared with £6.99 for supermarket own-brand products. Notably, Aptamil First Infant Milk has risen back to £13.50, undoing its earlier price reduction and Cow & Gate has increased to £11 per 800g, its highest recorded price since our monitoring began in March 2021. Although only a small number of products have risen in price, Danone and Nestlé together account for around 85% of the market, making these price increases significant.

Graph 1. Unit cost of powdered, cows' milk-based first infant formula and the Healthy Start allowance, March 2021 to February 2026

Only four of the 12 standard 800g infant formulas available cost less than the current £8.50 weekly Healthy Start allowance for babies under one, a figure unchanged since May 2025 (see Table 1). Two of these are supermarket own-brand products, which are typically less widely available. Although the allowance will rise to £9.30 in April 2026, this will still not increase the number of full-size tins families can afford at current prices.

Table 1. Lowest cost standard size (800g) infant formula on the UK market in February 2026

Furthermore, larger 2 x 600g packs of Aptamil, Cow & Gate and SMA Pro First Infant Formula, previously seen as more cost-effective purchasing options, have increased by between 50p and £2.65 since October 2025, reducing the value of these bulk-buy options. For example, exclusively formula feeding a 10-week-old baby with two large packs of Cow & Gate First Infant Milk now costs £41.40 per week, up from £36 in October.

Our analysis found that prices for products marketed as specialised milks are rising placing significant financial pressure on families; both those with a baby with a diagnosed clinical need and those influenced by misleading marketing in a weakly regulated market. It’s important to remember that some formulas marketed as specialised milks lack evidence of effectiveness (i.e. comfort milks and hungry milks) while others are recommended in clinical guidelines (i.e. anti-reflux and lactose-free) but should only be used under medical supervision. Specialised formula should only be used following formal diagnosis and on the advice of a healthcare professional, with appropriate clinical supervision and ongoing review.

Prices of ready to feed starter pack of infant formula prices fell between October 2025 and February 2026, likely reflecting the recent Government recommendation that healthcare settings provide infant formula that is competitively priced on the retail market. However, and importantly, these lower upfront prices do not necessarily translate into lower long-term costs. Manufacturers may price starter packs competitively to encourage brand loyalty, while charging more for the equivalent powdered formula used longer term.

Pricing strategies continue to mislead parents into perceiving expensive formulas as superior. The gap between the cheapest and most expensive 800g tin has widened to £11.01 (from £8.51 in March 2021), with prices now ranging from £6.99 to £18. Despite this variation, by law, all infant formulas must meet the same nutritional composition standards, regardless of brand or price and parents can be reassured that it is safe to switch between first infant formula brands.

Adding further complexity for families, retail prices for identical products remain inconsistent across supermarkets, with the retailers offering the lowest prices changing over time.

What needs to happen next

Our findings highlight the financial strain and uncertainty facing families who rely on formula to feed their babies. High and variable pricing, combined with misleading marketing strategies, risks undermining informed decision-making and may contribute to unsafe feeding practices.

In its final market study report published in February 2025, the Competition and Markets Authority proposed that price caps could act as a backstop measure to prevent excessive pricing, although it stopped short of recommending immediate implementation. We therefore strongly urge the Government to assess urgently the risks, design and implementation of potential price controls, so they are ready to act if prices remain high or continue to rise.

Action on formula affordability must sit alongside measures to protect, promote and support breastfeeding. All families should be able to make informed infant feeding decisions, free from commercial influence, and all women should be supported to meet their breastfeeding goals.

Further resources

Below are our two updated infographics, which can be found here on our website. ‘Infant formula cost analysis’ summarises the price trends and our asks of policy makers. ‘Lowest cost infant formula’ shows just that, and is intended to inform parents using formula to feed their babies if they are struggling with the cost.

Update: UK formula milk recalls

As highlighted in our February newsletter, the Food Standards Agency (FSA) issued alerts earlier this year regarding several formula milk products that were contaminated, or potentially contaminated, with the toxin cereulide, which can cause rapid-onset symptoms including nausea, vomiting, diarrhoea and abdominal cramps.

Health care practitioners should continue to advise parents who use formula to feed their babies to check for affected batches and avoid using any recalled products. Comprehensive recall lists, including pack sizes and best-before dates, as well as guidance for professionals, are available here.

Practitioners should also reinforce that powdered infant formula is not sterile. Parents and carers should be encouraged to carefully follow NHS guidance when preparing feeds. A key part of this guidance is using water that has been boiled and then allowed to cool to no less than 70°C before mixing with the powder, as this helps to kill any bacteria that may be present.

Our February formula cost analysis (reported above) identified a significant impact on formula milk availability following the recall. Several supermarkets temporarily withdrew affected Danone (Aptamil and Cow & Gate) and Nestlé (SMA) products, restricting families’ options. At the height of disruption, the Grocer, reported out-of-stocks of 28.4% (98 of 335 products).

Although supply has since improved, many families experienced difficulties. In response, we developed an infographic to support parents and carers, struggling to access their usual formula, available here.

Infant formula remains a necessary and appropriate option for some infants. It is therefore essential that the UK Government takes all necessary steps to ensure product safety and protect the health of vulnerable babies. We are convening with peers to assess this evolving and complex situation and have reached out to the Food Standards Agency to clarify the actions being taken to protect infant health.

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

Baby Feeding Law Group news

BFLG-UK statement on the Governments’ joint response to the CMA recommendations, and an update on DHSC progress and implementation

As shared previously in our February newsletter, on 3 December 2025, the Government published its joint response to the Competition and Markets Authority (CMA) infant and follow-on formula market study. On 19 February 2026, we published our BFLG-UK statement on this joint response.

We welcome the government’s acknowledgement of the significant, longstanding issues within the formula market in the UK related to marketing, pricing and retail practices which undermine public health recommendations on infant feeding. The government response makes several notable, positive commitments but further actions will be needed in the short term to deliver significant positive impacts for families and babies, especially those on low incomes. From the 11 recommendations made by the CMA, the government accepted six “in principle”, committed to “further work” on three, and rejected two:

The BFLG-UK statement outlines the steps we welcome and support; steps where greater ambition and urgency is required by the government and what we feel needs to happen next:

We welcome and support:

1. The government commitment to supporting babies, new parents and carers to eat well.

2. The government focus on supporting more informed choices by parent (recommendations 1.1, 2.1).

3. The government’s commitment to clarify what constitutes advertising (recommendation 3.4).

4. The government’s commitment to ensure labelling complies with the law (recommendation 4.1).

Where greater ambition and urgency by the government is required:

1. Strengthening formula labelling and advertising rules (recommendations 3.1, 3.2 and 3.3)

2. Ensuring effective enforcement (recommendation 4.2)

3. Eliminating brand influence in health care settings (recommendation 1.2)

4. Monitoring and intervening to bring down the cost of infant formula (backstop recommendation)

What needs to happen next:

Timely implementation of the 6 CMA recommendations which have been accepted in principle. We have requested more information on the specific actions and timeframes to achieve the above, as well as the indicators which will be used to chart progress and impact. This will then determine when and whether further steps are required.

Clarification on the next steps to strengthen labelling and advertising rules, with a clear timeline for the 3 recommendations (3.1, 3.2 and 3.3) for which further work is required and how this further work will be conducted. The goal should be stronger regulations in line with ‘the Code’, which places restrictions on the advertising of all formula milks marketed for use up to 3 years of age, and their proper enforcement. This would put children’s wellbeing above commercial interests.

Active monitoring and reporting on infant formula prices and commitment to undertaking a formal assessment of the need for and feasibility of implementing more direct measures to improve formula affordability such as profit caps (see above).

We have communicated with the government (including the DHSC and devolved nations) our willingness to support, to ensure that every family has access to affordable products and services they need to ensure the best start in life for their child – and that they are protected from insidious marketing practices that skew feeding choices.

We have met with a representative from the DHSC, and they have shared that they are prioritising delivery of actions, especially those committed to in the government’s manifesto. The DHSC also shared how they are addressing the steps required to implement the government response in their perceived order of priority, including how they are working with and delegating responsibilities to the devolved nations (Food Standards Agency Northern Ireland, Food Standards Scotland and Public Health Wales) and other stakeholders involved in the actions required (for example, the NHS supply chain).

Considering our most recent infant formula costs and trends analyses which show increases (see above), we remain concerned that current actions are insufficient to ensure that infant formula is consistently affordable for parents and families. We therefore continue to advocate for the DHSC to urgently assess the risks, design and implementation of Government-led price controls while closely monitoring infant formula price changes, building on the proposals outlines in the final CMA market study report of February 2025.

Forthcoming

First Steps Nutrition Trust 2025 impact report

We’ve been busy writing our 2025 impact report and have created this infographic below which provides a snapshot of our top achievements of last year. The full report will be available next month. A huge thank you to our generous donors without which our work would not be possible. We are working hard to secure sustainable and more diverse income sources to secure the future of First Steps Nutrition, so please be in touch if you think you can help.

Imperial Ultra-Processed Food Policy Forum, hybrid, March 24th

Following up from 2024’s popular event, the team at Imperial College are hosting another one day UPF food policy forum, assessing the science and advancing regulatory and policy responses to ultra-processed foods. The event convenes world-leading scientists, politicians, policymakers and civil society representatives (including our Director, Vicky) at Imperial College London. Together, they will discuss the latest scientific evidence on UPFs and explore the scope for effective, evidence-based regulatory and policy responses to their growing dominance in people’s diets and their impacts on health.

This year’s Forum will focus on accelerating progress towards a more robust, science-based policy agenda. As governments worldwide intensify efforts to address the expanding role of UPFs in diets, high-quality research is increasingly central to shaping policies that are both effective and sustainable.

Momentum for action in the UK and internationally has continued since the 2024 Imperial event. A series of papers published in The Lancet in November 2025 marked a turning point, providing a strong framework for bridging science and policy (read more in our December newsletter).

The Ultra-processed Food Policy Forum will showcase policy approaches from across the globe, providing policymakers, researchers and civil society with comparative insights and practical lessons for future action. Vicky’s presentation will focus on early years nutrition.

Find out more and register to attend HERE.

An update of First Steps’ Eating Well Healthy Start and Best Start Foods, a practical guide

Next month will see a small but welcome 10% increase in the monetary allowance provided to Healthy Start beneficiaries. To ensure our Eating Well resource Healthy Start and Best Start Foods – A practical guide remains current we will be updating this resource to reflect this increase and other changes in public health recommendations and the wider context since 2022. We will also be sharing new ‘bite sized’ resources, likely including posters, leaflets and recipe cards for use in Family Hubs and food bank settings. Watch out for these new resources in our future newsletters.

The iHV Evidence Based Practice conference, Bournemouth, May 6th

HR News

Welcoming Sara

We’re excited to welcome recently qualified dietitian and MSc Nutrition graduate Sara Esser on to our team as our new Nutritionist. Sara brings with her several years of experience working in public health nutrition with the UCL Healthy Weight Policy Research team. Through her dietetic placements in NHS paediatric settings and her voluntary work supporting vulnerable families, she saw first‑hand the importance of addressing health inequalities to improve early years nutrition and long‑term health, which drew her to working for First Steps. She has particular interests in infant and young child nutrition, the regulation and marketing of breastmilk substitutes, and translating complex guidance into clear, practical information for families and practitioners.

February 2026

A belated happy new year. Please see the contents of our first newsletter of 2026 below.

NEWS

Updated: Eating Well in Pregnancy, a practical guide for supporting teenagers

Infant milk news

BFLG-UK news

Forthcoming

News

Updated: Eating Well in Healthy Pregnancy: A practical guide to support teenagers

This practical guide is all about supporting pregnant teenagers aged up to 19 (and their families) to shift the balance towards better food choices wherever possible and show 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 young 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. 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 2026 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 and talking to young women about weight in line with NICE guidelines
Additional signposting for young women on low incomes, as recommended by NICE
Updated content on Healthy Start and Best Start schemes
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
Added specific micronutrient requirements for teenagers who are pregnant.
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

To download a FREE PDF copy of this guide, or any of our other 12 Eating Well guides, visit our shop. Donations are welcome. This guide and other selected Eating Well guides are also available for sale as hard copies in our shop.

Updated: Eating Well: Vegan infants and under-5s

This practical guide has been created to equip parents and carers who wish to raise their babies and young children as vegan, with the knowledge and practical advice to do so in a way that will meet their nutritional needs. It is also relevant for feeding under-5s on dairy and egg-free diets, and for early years settings needing to cater for these dietary requirements for babies and young children in their care. It shows the sorts and amounts of foods and necessary supplements to meet the nutritional needs of under-5s on these special diets.

The resource contains:

a summary of the key principles of eating well for vegan infants and 1-4 year olds
some example meals and finger foods to show how the nutritional needs of vegan infants can be met
example breakfasts, snacks, savoury meals and desserts for 1-4 year olds, with recipes for the dishes shown in the photos, and
additional useful information for anyone supporting vegan under-5s.

We noticed when we updated it that it remains fairly unique, as there remains little other detailed expert advice for these specific age groups. The changes we have made in this 2025 update reflects the latest advice from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity on plant-based drinks and from the NHS on commercial baby foods. We have also made changes to ensure the most up to date information on the current retail offer for formula milks, plant-based drinks and supplements.

It is likely that parents who choose a vegan diet will be keen to breastfeed their children, and parents should be fully supported in this choice. There are no vegan infant formulas approved for sale in the UK. While soya formula was once recommended, this is judged unsuitable for use under 6 months of age and is no longer available. Plant-based formula milks can be purchased from overseas and at least one if now available in UK pharmacies, but these are either not in line with UK regulations or are intended for use under medical supervision by formula fed babies who are not able to drink standard infant formula due to allergy.

To download a FREE PDF copy of our guide ‘Eating Well: Vegan infants and under-5s’ or any of our other 12 Eating Well guides, visit our shop. Donations are welcome. This guide and other selected Eating Well guides are also available for sale as hard copies in our shop.

For more information on vegan diets in the early years, see our recent blog for the Maternity and Midwifery Forum: Veganuary 2026: Raising a vegan baby or toddler requires careful planning.

New: A Breastfeeding and Infant Feeding Vision for the UK

On 15 January 2026, a new and collective Vision for Breastfeeding and Infant Feeding in the UK was published through a process coordinated by Bremner and Co and commissioned by Impact on Urban Health through their Breastfeeding in Focus project. It was made possible through contributions and endorsement from the sector, including from us at First Steps. It was developed through a 3-phase process of engagement with breastfeeding organisations, practitioners, non-governmental organisations and academics across the UK, working together to articulate what all families should be able to expect from a supportive, equitable infant feeding system. The vision provides a shared foundation from which organisations can continue to collaborate, advocate and engage with policymakers with clarity and confidence.

The shared vision for the UK describes how the sector would like to:

Create supportive environments where breastfeeding is normalised and protected
Ensure all families have equitable access to trusted, independent infant feeding support, free from discrimination, misinformation and commercial influence
Deliver responsive, skilled support grounded in robust, evidence-based guidance
Strengthen dependable and resilient infant feeding support systems that reach every community
Secure a strong national commitment to high-quality breastfeeding and infant feeding support, through effective collaboration between government and organisations with recognised expertise.

You can read more about how the vision was developed in a Bremner & Co blog here and on the Impact on Urban Health website here.

New paper: An exploratory analysis of enablers of exclusive breastfeeding in England: Positive deviance in practice

This new paper explored enablers of exclusive breastfeeding in England and was published in the December 2025 issue of World Nutrition. Twelve mothers, six midwives and two advocates from London, the East and Southeast of England were interviewed. The core themes identified were the position of breastfeeding in society; the role of agency in breastfeeding outcomes and navigating a way forward. The significance of power emerged as a dominant overarching theme throughout the findings, and so the researchers mapped the findings according to Gaventa’s power analysis, to contextualise the findings through a power lens (see Figure 3 below). The researchers describe:

“Each theme demonstrates the importance of a different expression of power and how, utilised effectively and collaboratively, they could be instrumental in disrupting the current mechanisms of power over preventing England from reaching breastfeeding targets, including ineffectual governance and the breastmilk substitute industry. The power framework has therefore been adapted as a continuum, with increasing impact on power over, and at its strongest together.”

(See Figure 4 below).

*Figure 3: The findings of this research mapped to Gaventa’s power framework*

*Figure 4: A power continuum, based on the stylised idea of gaining momentum to displace an object. Power framework adapted from Gaventa*

Useful appendices to the article include a timeline of measures to support infant feeding practices in the UK (from 1981-2022) and a PESTLE (Political, Economic, Social, Technological, Legal and Environmental) analysis of factors affecting infant feeding practices in England. Recommendations are provided at the end of the article, by examining positive deviance, and aim to contribute to future policy and strategic planning in England to support reaching global and national EBF targets. You can read more in the full article here.

New: Department of Health and Social Care (DHSC) Partnerships Team spotlight on breastfeeding resources

The Partnerships Team from the Department of Health and Social Care (DHSC) send out a monthly Early Years newsletter. During December 2025, this newsletter showcased the DHSC Breastfeeding resources that are available.

The Best Start in Life website was officially launched in September 2025 (to replace the previous Childcare Choices website).The December 2025 Early Years newsletter indicated that existing resources are in the process of being updated, and in the New Year will be rebranded to align with the Best Start in Life.

The Breastfeeding resources that are available include:

Various breastfeeding guides, wallet cards, posters, social media creatives for both breastfeeding and pregnancy, and the 'easy read' leaflet created in collaboration with UNICEF. These can be downloaded and ordered here.

A comprehensive selection of knowledge and guidance for breastfeeding families, providing NHS-trusted advice on topics such as expressing breastmilk, breastfeeding in public, maintaining a breastfeeding-friendly diet, the many benefits of breastfeeding, returning to work while breastfeeding, and many more. These can be found here.

The easy-read 'A guide to help you start breastfeeding' leaflet, created in collaboration with UNICEF, provides mums and parents with key information about breastfeeding. This resource is designed to support audiences with low literacy levels or where English is not a first language. This can be downloaded here.

To sign up to receive the monthly newsletters, go to the Campaign Resource Centre. You will need to register an account, and this will enable you to: download and order resources (including posters, leaflets and digital assets); access campaign toolkits, brand guidelines and logos; and receive email updates on new campaigns and resources.

News: Baby food hit by problems for pouches

On 12 December 2025, the Grocer published Babyfood hit by problems for pouches, reporting that the “wet babyfood category” declined by about 15%, following the April 2025 BBC Panorama investigation, with criticised brands being worst affected.

The Truth about Baby Food Pouches documentary aired by the BBC, which our Director, Dr Vicky Sibson featured in, concluded that several baby food brands have made misleading health claims about their pouch products. The documentary provided an opportunity to shine a light on long-standing issues with commercial baby and toddler food marketing in the UK, using much of the ongoing technical and advocacy work of several organisations, including us at First Steps. The documentary also provided new momentum to leverage long overdue improvements in the commercial baby food retail offer.

This decline in the wet babyfood category is likely due to the exposé and media coverage, as well as the concurrent adjustments made to the NHS guidance to parents that they do not need to rely on shop-bought baby foods, which was a request we made to the DHSC’s chief nutritionist. In August 2025, the DHSC also published the Voluntary industry guidelines for Commercial baby food and drink , effectively putting the baby food industry on notice to improve product composition and marketing. Businesses have 18 months from publication of these guidelines in August 2025 (i.e., they have until the end of February 2027) to implement both the salt and sugar targets and the recommendations on labelling and marketing. We hope that during 2026, through collaborative work, we can achieve positive progress in the baby food space in the UK, to contribute to creating an enabling environment for all babies to have the best start in life.

New paper: Understanding parents’ experiences of using a portion guide for young children: A qualitative study

New qualitative research has explored parents’ experiences of using an age-appropriate portion size guide for children aged 1–4 years (specifically the HENRY ‘how big is a portion’ guide), providing timely insights for policy and practice. The research was published online in December 2025 and conducted by Mira Malmber and Rana Conway at University College London and Beckie Lang at HENRY.

The study is relevant to the Scientific Advisory Committee on Nutrition (SACN)’s 2023 report, Feeding young children aged 1 to 5 years, which highlighted that larger portions may contribute to higher energy intakes in young children, alongside National Child Measurement Programme data showing rising rates of overweight and obesity among reception-aged children. Despite the availability of several portion guidance tools in the UK, none are routinely provided to parents, and evidence on how families use them has been limited. SACN also highlighted the need to develop and communicate age-appropriate portion sizes for young children.

Interviews with 15 parents in England found that although guidance was welcomed, it had limited impact on portioning practices. Parents often found the guidance impractical or unrealistic, relying instead on their own experience and their child’s appetite and preferences. However, the guide was valued as an educational resource to support balanced diets and limit less healthy foods.

The research found that parents preferred picture-based, easy-to-access guidance delivered early in the complementary feeding period and from trusted sources, and noted that the FSNT eating well guides, are an example of good practice.

The authors conclude that portion guides alone are unlikely to change feeding behaviours and recommend more practical, holistic tools alongside greater investment in trusted early years services. We share this view and continue to advocate for parents and carers to have access to independent, evidence-based guidance through adequately resourced health visiting services and Best Start in Life Family Hubs, as set out in our joint position paper ‘Healthy Early Years Diets: Achieving the Best Start in Life’.

New policy paper: The Government’s Child Poverty Strategy

On 5 December 2025, the Government published its Child Poverty Strategy, called Our Children, Our Future: Tackling Child Poverty which was developed by the Child Poverty Taskforce. The strategy is considered a landmark commitment and key priority of the current government, aiming to lift 550,000 children out of poverty by 2030. The strategy acknowledges that the UK has higher child poverty rates than most European Union and Organisation of Economic Co-operation and Development (OECD) countries, with nearly one-third of children in the UK being ‘in relative low income’. The strategy describes how the government, working with partners, will work towards tackling the root causes and alleviating the symptoms of child poverty, to give children the best start in life across the UK.

The strategy consists of 6 chapters:

The scale of the challenge and the case for change
Reducing child poverty in partnership
Boosting family income
Driving down the costs of essentials
Strengthening local support for families
Hope for the future.

It is significant that the role of food and nutrition, including in the early years, in contributing to optimal health and development, is acknowledged in the strategy. Infant feeding is described in Chapter 4 (Driving down the cost of essentials), including the investments committed to supporting infant feeding services and breastfeeding support through the Family Hubs and Start for Life programme, as well as the National Breastfeeding helpline. The cost of infant formula is acknowledged in the strategy, and the government’s response to the Competition and Markets Authority (CMA) infant formula market study (see more on this below, in the section on BFLG-UK news) together with increasing value of Healthy Start vouchers are described as strategies to make it easier to access healthy, affordable food.

Other key components of the strategy (some of which had been announced previously but are now all consolidated in the strategy) include ending the two-child limit, expanding Free School Meals and implementation of School Food Standards and acknowledgement of the need to support children and families with No Recourse to Public Funds. The government had indicated that they will develop a monitoring and evaluation framework including annual reporting on the strategy.

For some helpful insights on the strategy, take a listen to a 10-minute podcast by Hannah Brinsden on the Food Foundation Pod Bites: Child poverty – are we failing?

For more information on supporting families, see our relevant resources:

New policy paper: Joint Government response to CMA formula market study

New inquiry report: First 1000 days, a renewed focus

On 22 January 2026, the cross-party Health and Social Care Committee published the Fifth Report of Session 2024–26 on the Inquiry on the First 1000 Days: a renewed focus. The First 1000 Days Inquiry report acknowledges the first 1000 days as a critical window of opportunity for child development and recognises that the UK has some of the worst health outcomes for young children in Europe, including rising obesity, uneven vaccination coverage and persistent inequalities. The First 1000 Days Inquiry aimed to understand why there continue to be challenges in achieving progress for early years interventions and care in the UK, despite effort and ongoing commitments from multiple governments. The report was developed following submissions of written evidence (including our consultation response in April 2025), presentations of oral evidence and committee meetings. The current report focuses on the Family Hubs and the Start for Life programme, health visiting, the workforce, vaccinations and service integration.

We are pleased to see recommendations on making Family Hubs universal and improving investment into health visiting. However, there are insufficient measures described to ensure comprehensive support for early years nutrition. It is concerning that infant and young child feeding and early years nutrition are not being comprehensively integrated into national reports and recommendations. There needs to be much better policy alignment and coherence if the government is to achieve its commitments to the best start in life and raising the healthiest generation ever.

The joint position from us at First Steps, the Obesity Health Alliance and others, on ‘Healthy Early Years Diets: Achieving the Best Start in Life’, updated in December 2025 and supported by over 100 organisations, describes our shared policy asks on health early years diets. The joint updated position statement presents a clear, achievable set of evidence-informed and cost-effective steps that will measurably improve the nutritional quality of diets in the early years. The joint position recommendations call for bolder government action, including stronger legislation to protect families from misleading commercial milk formula marketing, and introducing a mandatory regulatory framework governing the nutritional composition, marketing, and labelling of baby and toddler foods, among other actions.

Infant Milk News

News: Recent price rises in formula milk products

We have identified increases in the price of some formula milk products since the publication of our cost report in October 2025. We are currently investigating these changes and plan to publish an updated, comprehensive cost report as soon as possible, during February 2026.

Parents affected by these price rises can be reassured that it is safe to switch between first infant formula brands. By law, all infant formulas must meet the same nutritional composition standards, regardless of brand or price.

These cost increases are particularly concerning as they run counter to the CMA formula market study recommendations to reduce formula prices. Any increase in formula price will place additional pressure on families with infants and potentially increase the risk of unsafe formula feeding practices. This also confirms our concerns with the Government’s response to the CMA recommendations (see below), where we feel that stronger action is needed in the short term to deliver meaningful impact for families and babies. It is critical that the Government proceeds with timely implementation of the CMA recommendations it has accepted, and describes how and when they will determine whether more direct measures are needed to improve infant formula affordability (such as the backstop option that was recommended by the CMA, namely prices controls, which could be achieved through profit margin caps).

Product updates: Infatrini and Neocate LCP

Nutricia has updated the composition of Infatrini, a Food for Special Medical Purposes (FSMP) for the dietary management of disease-related malnutrition and growth failure in infants and young children. The revised formulation now includes 2’-Fucosyllactose (2’-FL) and added prebiotics (short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides). There is no good evidence that these additions provide benefits for infants when added to infant milks, and they are therefore considered unnecessary. The energy, macronutrient and micronutrient composition remains unchanged.

Neocate LCP, an amino acid-based FSMP suitable from birth for non-metabolic disorders, has been updated to a 420g tin with new packaging (previously 400g). The formulation is unchanged except for a switch in the source of Docosahexaenoic Acid, from Crypthecodinium cohnii oil to Schizochytrium sp. oil; both are microalgae-derived.

As a reminder, specialist infant milks marketed as FSMPs should only be used under medical supervision, as stated on product labels.

More information on milks marketed as FSMPs can be found in our reports: Specialised milk for infants who are premature, low birthweight or have faltering growth and Specialised milks for infants with allergies.

News: Nestlé and Danone Infant Formula and Follow-On Formula product recall

It has been confirmed that some batches of various Nestlé formula milks sold in the UK under the SMA and SMA Little Steps brands, as well as a Danone product sold under the Aptamil brand, have been contaminated with a toxin called cereulide. This toxin can cause food poisoning. The symptoms are nausea, vomiting and cramps very shortly after consumption.

Further details, including the affected batch numbers, are available in the food alerts issued by the Food Standards Agency since Friday 5 January 2026.

The alerts are as follows:

5th January: Nestlé recalls several SMA Infant Formula and Follow-On Formula as a precaution because of the possible presence of cereulide (toxin) | Food Standards Agency.

9th of January: Update 1 - Nestlé recalls several SMA Infant Formula and Follow-On Formula as a precaution because of the possible presence of cereulide (toxin) | Food Standards Agency.

24th of January Danone recalls Aptamil First Infant Formula because cereulide (toxin) has been found in this batch | Food Standards Agency

3rd of February: Update 1 - Nestlé recalls several SMA Infant Formula and Follow-On Formula as a precaution because of the possible presence of cereulide (toxin) | Food Standards Agency

3rd of February: Update 2: Nestlé recalls several SMA Infant Formula and Follow-On Formula because of the presence of cereulide (toxin) | Food Standards Agency

The recalls extend beyond the UK, affecting more than 60 countries, and have attracted national and international media attention. On 6 January, our Director, Vicky, spoke on BBC Radio at lunchtime, and our Senior Nutritionist, Katie, appeared on the ITV evening news. FSNT also contributed to an article in the Financial Times: Nestlé and Danone hit by backlash over contaminated baby formula.

The contamination has been traced to arachidonic acid (ARA) oil. Current UK legislation regulating infant formula (Commission Delegated Regulation (EU) 2016/127) mandates the addition of docosahexaenoic acid (DHA) to infant formula. The Codex Standard for Infant Formula, however, considers DHA to be an optional ingredient, but that if DHA is added to infant formula, then the same amount of ARA should also be added. This case highlights how microbial contamination of a single source ingredient can have global repercussions, particularly in the commercial infant formula industry, which operates within a profit-driven supply chain that pressures companies to source low-cost ingredients.

Advice for parents and carers using the affected formula milk products

It is vital that parents using any of the affected formula milk products check the batch numbers and stop using any that are listed as potentially contaminated (batch numbers that are not listed can continue to be used). If the baby is sick, the parent should contact their GP or call 111.
All parents and carers should be aware that it is perfectly possible and safe to switch brands of first infant formula as they are all nutritionally equivalent. There may be a period of adjustment as baby gets used to the new formula. Some babies may take a short time to adjust, and parents and carers may notice some temporary changes in their stools, as different ingredients are used in different brands. If a parent has any concerns they could contact their health visitor for advice, or their GP or 111.
Not all milk is suitable for feeding babies. Babies under one year of age should never be given condensed milk, evaporated milk, dried milk, goats’, sheeps’, cows’ milk or plants based milk drinks such as soya, rice or oat (as a drink) as outlined in NHS guidance on milk feeding babies under 1.
Home-made infant formula is not safe to use as it does not have an appropriate nutritional composition and therefore may not support proper growth and development, and the ingredients themselves, or the way in which they have been prepared, increases the risk of severe bacterial infection in infants.
The NHS recommends that non breastfed or mixed fed babies can be given infant formula up to 12 months of age and that follow-on formula is not necessary (and should never be given to babies under 6 months old).
Babies being fed one of the affected non-standard formulas (anti-reflux, comfort, lactose-free, or Alfamino) should consult their health professional for advice on a suitable alternative.

First Steps Nutrition Trust provides independent expert information about all formula milks on the UK market for parents and carers here: https://www.firststepsnutrition.org/parents-carers

Advice for health professionals

Health professionals can use our website www.infantmilkinfo.org to look up alternatives to the affected products to advise parents; see the tab ‘type of infant milk’ and look up lactose-free under infant formula, as well as comfort and anti-reflux. Information on alternatives to Alfamino are in the report “specialised milks for infants with allergies”.

Supporting all parents and carers who use infant formula

The recall comes shortly after the ByHeart powdered infant formula recall in the USA, which we reported on in our December newsletter. Together, these incidents reinforce the importance of reminding those using formula to feed their babies, that powdered infant formula is not sterile and that NHS guidance must be followed carefully when preparing feeds.

A key element of this guidance is ensuring that the water used to reconstitute the powder has been boiled and allowed to cool to no less than 70°C to kill any bacteria present in the powdered infant formula.

We also advise against using formula preparation devices, or at least checking the temperature of the hot shot as per NHS advice, as our research has shown they do not consistently heat water to 70°C and therefore may not effectively eliminate bacteria in powdered infant formula.

More information on safe formula preparation can be found here.

Infographics on safe formula preparation, suitable for sharing directly with families, are available here.

Policy recommendations

Intrinsic contamination of powdered infant formula has been documented repeatedly over decades, leading to numerous recalls and harm to infants. These incidents expose systemic failures in formula manufacturing, regulatory surveillance and communication of risk to parents and carers, reinforcing the need for stronger regulations to protect infant health.

On 2 February 2026, the European Food Safety Authority announced plans to update its scientific advice on cereulide, including setting a toxin threshold to trigger recalls. While welcome, this highlights the reactive nature of current safety systems.

Furthermore, the advertising and promotion of commercial milk formula suggest to parents that these products are inherently safe. This reinforces the urgent need for full implementation of the international Code and relevant World Health Assembly resolutions, which require clear warnings about the non-sterile nature of powdered formula milks.

We at First Steps are advocating for stronger independent oversight of formula manufacturers, improved monitoring of illness linked to formula feeding, and mandatory labelling to clearly state that powdered infant formula is not sterile and must be prepared according to NHS guidance. We also want to see the rules governing the addition of non-mandatory ingredients to formula milks to be revisited.

At the global level, the International Baby Food Action Network (IBFAN) is in Geneva this week urging Member States to adopt a new World Health Assembly resolution to reduce contamination risks for infants. Given the global nature of formula production and supply chains, such action would directly support and strengthen UK advocacy efforts.

Our Statement on Nestlé and Danone formula milk recalls, the first document on our First Steps Statements webpage provides latest information for parents and health workers, and we aim to keep this as up-to-date as possible, as new information becomes available.

New paper: Infant formula milk shows microbiological contaminants that are not removed using recommended preparation methods

New research from Queen’s University Belfast (published in October 2025) highlights concerns about the microbiological safety of powdered infant formula (PIF), particularly when prepared using at-home preparation machines (AHPMs). The study examined 21 UK PIF products prepared using NHS-recommended 70 °C water, boiled and cooled water, and AHPMs. All products were suitable from birth to six months and marketed for use with AHPMs.

Microbial contamination was detected in around one-third of products tested, with Bacillus species most commonly recovered, including Bacillus cereus, a known infant pathogen that produces cereulide toxin, associated with infant illness and the current recall of Nestlé and Danone infant formula milks products sold in the UK . Although contamination was observed across all preparation methods, significantly higher microbial levels were found in formula prepared using AHPMs, even when sterile water was used.

These findings align with our research conducted with colleagues at Swansea University, which shows that formula preparation devices frequently fail to deliver water at temperatures sufficient to reduce bacterial risk (>70 °C). The study also showed that rapid cooling of prepared formula may reduce the effectiveness of heat treatment, allowing surviving microbes to persist.

Together, these findings raise concerns about the safety of widely used formula preparation devices and highlight the need for further investigation by the Office for Product Safety and Standards, alongside clearer NHS guidance on their use in the interim.

We therefore continue to recommend avoiding formula preparation devices (like the Tommee Tippee Perfect prep) machine or at least checking the temperature of the hot shot as per NHS advice.
We now also suggest avoiding rapid cooling devices like the Nuby Rapid Cool, until further research shows that rapid cooling does not disrupt the effect of the hot water used for making up the formula, to kill any bacteria that may be present.

For resources to support families who use formula to feed their babies, see our Infant milks: Information for parents and carers webpage and our Formula choice and preparation infographic.

If you have any questions about accessing the site, please email us at admin@firststepsnutrition.org.

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

Baby Feeding Law Group news

New video: What are the solutions to the infant formula affordability crisis?

On 27 January 2026, Prof Amy Brown at Swansea University and colleagues shared a 3-minute summary video on YouTube summarising key messages from research looking at the impacts of and solutions to the infant formula milk affordability crisis. The research included interviews with 281 parents who were struggling to afford formula, and 158 professionals and volunteers who support parents. The research was led by Swansea University, together with partners at Cardiff Metropolitan University, The University of Hertfordshire, the Newcastle upon Tyne Hospitals NHS Trust, the Independent Food Aid Network, Leicester Mammas, and us at First Steps Nutrition Trust.

Findings from the research included that the cost of infant formula was having a devastating impact upon families, and parents reported feeling distressed, anxious, and heartbroken that it was so challenging to feed their infants. Poor affordability was found to exacerbate postnatal depression. Parents reported going into debt, skipping meals and not heating their homes to pay for infant formula. Some also reported unsafe practices such as watering down feeds and looking to Facebook marketplace to purchase infant formula, knowing that this could put their baby at risk, but not seeing an alternative. Many parents spoke of being angry at the high costs, much of which goes to marketing and profits of the infant formula companies. Solutions such as an emergency pathway led by councils or the NHS were suggested, however many parents just wanted formula to be cheaper. Any solution that didn’t reduce the cost allows companies to continue making high profits and passes the problem to the taxpayer.

The researchers made the following key recommendations to the Government:

Prioritise acting on the Competitions and Markets Authority’s 11 recommendations from their infant and follow-on formula market study
Regulate the price of infant formula
Ensure better support for breastfeeding

As secretariat for the Baby Feeding Law Group, we fully support these recommendations. Marketing and pricing are intertwined. Formula marketing needs to be reined in through strengthening UK laws in line with the Code and resolutions and enforcing them properly. Infant formula prices need to be reduced sustainably and in the long term through Government regulation. These actions will contribute to giving all babies the best start in life. The full research paper is currently under review and will be published shortly.

New policy paper: Joint Government response to CMA formula market study

On 3 December 2025, the Government published its joint response to the Competition and Markets Authority (CMA) infant and follow-on formula market study. The joint response was compiled by the UK, Scottish and Welsh governments (including the Department of Health and Social Care (DHSC), Public Health Scotland, Public Health Wales), Food Standards Scotland, and the Department of Health and Food Standards Agency in Northern Ireland.

It is significant that the government have formally acknowledged the longstanding issues with the formula market in the UK, relating to marketing, pricing and retail practices which undermine public health infant feeding recommendations. The government made several notable, positive commitments for which they should be praised. However, the current response relies on a non-legislative package of measures, and it our view that further actions will be needed in the short term to deliver meaningful impact for families and babies, especially those on low incomes.

The Government accepted (“in principle”) six of the CMA’s 11 recommendations, committed to “further work” on three and rejected two recommendations. The CMA had indicated that governments may wish to consider price controls for infant formula as a backstop option, if the CMA’s proposed package of measures does not achieve the desired market outcomes and if the impact on consumer outcomes is insufficient within a reasonable timeframe. Unfortunately, the government response does not mention this potential future option. We feel it is critical that an adequate timeframe is determined for when this be reviewed, and detail should be provided on how impacts will be monitored. If infant formula prices remain high in mid-2026 (and we have identified increases in the prices of some formula milk products, as described above in Infant milk news ), a formal assessment should be conducted on the need for and feasibility of implementing more direct measures to improve formula affordability (such as price controls through profit caps).

It is important that, for the six recommendations accepted in principle, these should be implemented in a timely manner, with further detail provided on the indicators to be used for monitoring impact and whether further steps are required. For the three recommendations requiring further work, there should be clarification on the next steps to strengthen labelling and advertising rules, and clear timelines for how this will be conducted. The goal should be stronger regulations in line with ‘the Code’, placing restrictions on advertising of all formula milks marketed for use up to 3 years, and proper enforcement. This would put children’s wellbeing above commercial interests. We will shortly be sharing a comprehensive BFLG-UK statement on the Government response to the CMA report, which will be available on the BFLG-UK website here.

A reminder: What YOU can do to challenge conflicts of interest (such as the upcoming formula-sponsored British Journal of Midwifery conference)

We have compiled a comprehensive list of suggestions for what healthcare professionals can do if they identify conflicts of interest, especially relating to challenging the inappropriate marketing of breastmilk substitutes or commercial milk formula targeting health professionals. See the suggestions provided on our First Steps Nutrition Trust website here.

The annual British Journal of Midwifery (BJM) conference is taking place on Tuesday 31 March 2026, with sponsors including Kendamil and Nutricia (Danone). We have previously written public letters to the conference organisers, have had commentaries published in the British Medical Journal, and we have directly emailed the conference organisers, but these have not resulted in any changes to the conference sponsorship policy. We encourage other individuals and organisations to send letters to the organisers and/or make public statements to create greater awareness of this problematic conflict of interest. The conference is organised by the Mark Allen publishing group and the names of contact people and their email addresses are available on the conference website here. Perhaps with continued pressure and advocacy, the organisers will change their policies in future, and/or fewer health professionals will attend and/or fewer speakers will agree to present at such conferences.

Forthcoming

Conference: iHV Evidence Based Practice conference Bournemouth May 6th

The Institute of Health Visiting (iHV) will be hosting a full-day Evidence-based Practice Conference 2026, with the theme “From Evidence to Action: Getting it right from the start”, at Bournemouth International Centre on Wednesday 6 May 2026. Our Director, Dr Vicky Sibson will be doing an oral presentation on Starting solids and the latest public health recommendations on shop bought baby foods. You can book your tickets here before 7 March 2026.

Updated resource: Eating Well Healthy Start and Best Start Foods: A practical guide

Our Eating Well resource Healthy Start and Best Start Foods – A practical guide was last updated in 2022. In light of the recent announcements to increase the value of the Healthy Start vouchers in April 2026, we will be updating this resource to reflect the increase in allowance. We will also be looking to develop posters, leaflet and recipe cards for use in Family Hubs and food bank settings and will share when these become available.

December 2025

Image by bearfotos via Freepik

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.

News

Updated: Eating Well for a Healthy Pregnancy
New: Eating well South Asian diets now available in hard copy
New series: Lancet series on Ultra-Processed Foods and Human Health
New review: UNICEF Ultra-processed Foods and Children, State of the Art review
New: National Childhood Measurement Programme Data, school year 2024/25
New joint policy position: Healthy Early Years Diets
New paper: Household food insecurity, nutrient intakes and BMI in New Zealand infants

Infant milk news

Updated: Specialised milks marketed for infants with allergies in the UK
Updated: Specialised milks for infants who are premature, low birth weight or have faltering growth
New: Study on the acceptability and feasibility of plain labelling infant formula in the NHS
New: Cow & Gate re-brand
An update on access to www.infantmilkinfo.org
News: Infant botulism outbreak linked to contaminated infant formula in the UK

BFLG-UK news

News: New allergy conference criticised over sponsorship links
Updated: Unicef UK Baby Friendly Initiative Guide on the International Code of Marketing of Breastmilk Substitutes for health workers

Forthcoming

An update of Eating Well Vegan infants and under 5s

HR Update

Another First Steps Nutrition Trust baby!

Happy reading!

News

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.

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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.

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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 in the 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.

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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”.

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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.

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New joint policy position: Healthy Early Years Diets

We have been working with peer members of the Obesity Health Alliance and members of the Baby Feeding Law Group UK to 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.

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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.

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Infant milk news

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 and April newsletters).

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.

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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.

This updated report can be found on the www.infantmilkinfo.org website here.

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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.

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New: Cow & Gate re-brand

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.

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An update on access to infantmilkinfo.org

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.

If you have any questions about accessing the site, please email us at admin@firststepsnutrition.org.

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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.

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

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 and 2025, 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.

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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.

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

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Forthcoming

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.

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HR Update

Another First Steps Nutrition Trust baby!

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 21^st 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.

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November 2025

Image by bedneyimages via Freepik

Welcome to the November edition of our newsletter – contents below.

News

Updated: Eating Well New Mums
New paper: Unveiling implicit and explicit packaging design features on commercial baby foods in the UK: a content analysis
New paper: Exploration of food provision challenges across English nurseries: results from a nationally representative cross-sectional study
New resource: Updated WHO model chapter for textbooks on Infant and Young Child Feeding published (2nd edition, 2025)

Infant milk news

Updated: Infant milk cost reports and infographics
Latest in trends in the cost of infant formula
New paper: Effects of Infant Formula Type on Early Childhood Growth Outcomes: A Retrospective Cohort Study

BFLG-UK news

Update: Still no government response to recommendations made by February 2025 CMA report on the infant and follow-on formula market in the UK
New paper: The imprints of sponsorship: The case of UNITAR’s Danone-sponsored Breastfeeding Education Initiative
New paper: Conflicts of Interest in Infant and Young Child Feeding: A Review of Australian Health Professional Associations' Guidance to Members on the International Code of Marketing of Breast-Milk Substitutes
New resource: Unmasking Influence: Full documentary now publicly available

Forthcoming

Food Active Conference: 11 November, online
Lancet UPF series launch: 19 November, in-person and online
Food, Pregnancy and Me webinar: 1 December, online

HR Update

Goodbye to Jasmine

Happy reading!

News

Updated: Eating for Well New Mums

We have updated our Eating Well for New Mums resource, which was last updated in 2020. The guide summarises the importance of eating well for all new mums and answers some FAQ new breastfeeding mums might have about eating and drinking. It provides ideas for snacks and drinks that provide a range of important nutrients and complements the other resources we have produced which give practical ideas for eating well in pregnancy and for the whole family.

Most of the changes we made simply ensure the guide takes in to account the changing, challenging context in which new mums are trying to eat well and changes to services and support like the Healthy Start scheme. Edits have been made to advice around plant milks and supplements, in line with latest SACN recommendations and NICE guidelines.

If you would like to learn more or access the full guide, the updated Eating Well for New Mums resource can be downloaded for free or by donation here.

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New paper: Unveiling implicit and explicit packaging design features on commercial baby foods in the UK: a content analysis

This paper by Tang Tang and colleagues at the University of Leeds and Dailan University of Technology, China, published in the journal Design for Health, investigated how the visual design of commercial baby food packaging in the UK contributes to their misleading promotion. The authors assessed 35 selected products marketed for children under 36 months of age in the UK, which they described as exemplars across product categories, including those that were least and most compliant with the WHO Europe Nutrient and Promotion Profile Model.

The researchers found that packaging design elements such as typography (see Table 4), colour, schematic elements, images and layout (see Table 1), emphasise naturalness, healthfulness and visual appeal whilst leaving out or downplaying key information, such as the sugar content.

“Packaging reinforces the potential to mislead consumers”. This is important because of the power in visually appealing packaging to inform quick, intuitive, emotionally driven decision-making based on convenience and perceived benefits, rather than analytical decision-making based on scrutiny of nutrition information. Implicit design features and explicit claims like ‘no added sugar’, ‘natural’, or ‘no artificial flavours or colours’ together contradict product composition, which is typically less healthy than portrayed.

The authors suggest that the findings could inform more ethical and responsible packaging. In relation to this suggestion, it is important to note that packaging design and features are not covered by current (outdated) UK baby food regulations or the voluntary guidance published by Government in August 2025. The NPPM recommends sugar warning labels on high sugar products, but its other recommendations do not address packaging design, see figure 1. However, adherence to the NPPM recommendations, e.g. labelling not displaying any health and nutrition claims, would leave less information to be exploited by packaging design.

We agree that packaging could be improved to minimise misleading marketing of commercial baby and toddler foods and enable more informed decision making by parents, and this paper provides important insight as to how that may be done. There is also an interesting example set in the guidance notes to the infant formula and follow on formula regulations, which makes stipulations about typography, placement and label layouts, see here. While the paper highlights how packaging design could support improved marketing, in our view it remains vital to ensure that future innovation in this space ensures that commercial products are not positioned as superior to healthy home prepared foods, which SACN and the NHS state are preferable to support optimal infant and young child feeding.

For practical, pictorial guidance on feeding babies under 12 months and young children between the ages of 1 and 5 years, without using commercial baby and toddler foods, see our FREE eating well guides here.

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New paper: Exploration of food provision challenges across English nurseries: results from a nationally representative cross-sectional study

This paper by Emily Warren and colleagues at the London School of Hygiene and Tropical Medicine and published in the Journal of Family and Child Health, reports on the results of an analysis of a nationally representative cross-sectional survey of food provision and practices in 302 nurseries in England between October and November 2021.

More than 90% of nurseries reported experiencing at least one challenge in providing healthy food - a stipulation of the Early Years Foundation Stage Framework. The most common challenges were the cost of healthy food, and the lack of time, facilities, and trained staff for preparation. Less than half reported challenges in information and guidance. 87% of nurseries reported unmet training needs, with indirect and direct costs being the barrier. Areas of training that respondents reported would be useful included parent engagement and children’s food and nutrition requirements. Nurseries that provide food have been financially impacted by the introduction of the new 30-hour free childcare policy applicable from 9 months of age and have increase their fees either for childcare or meals. It is important to note that 24% of the nurseries required all children to bring packed lunches and 42% allowed packed lunches if this was the families preference.

These challenges to healthy food provision are concerning because most children attend childcare from a young age and in full-day care, children typically receive around 90% of their daily energy and nutrient intake from meals and snacks provided by the setting.

The study highlights that nurseries need more funding to be able to provide healthy food and that the impact on nurseries of the new 30-hour free childcare policy needs review. The authors also acknowledge that similar research needs to be undertaken in other early years settings, including childminders.

First Steps Nutrition Trust is a member of the Early Years Food Coalition led by Bremner and Co, supporting advocacy with Government to improve healthy food provision in early years settings.

Many of our eating well resources are relevant and suitable for use in early years settings, including “Eating Well: Packed lunches for 1-under 5-year-olds”. All our resources can be downloaded for free or by donation here and hard copies of some titles (including packed lunches) are also available for purchase.

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New resource: Updated WHO model chapter for textbooks on Infant and Young Child Feeding published (2^nd edition, 2025)

In 2009, the WHO first published a model chapter for textbooks for medical students and allied health professionals on Infant and Young Child Feeding (IYCF). This model chapter has now been updated by the WHO’s Department of Nutrition and Food Safety and the PDF document is available here. The model chapter aims to brings together essential knowledge about IYCF that health professionals should acquire as part of their basic education.

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Infant milk news

Updated infant milk cost reports and infographics

Twice a year, we carry out a review of the cost of infant milks. The purpose is to share information on prices to guide health worker conversations with families who use formula to feed their babies and are looking to cut costs. The important point is that all first infant formulas are nutritionally equivalent despite large price differentials suggesting some may be better than others (noting though that none provide the health benefits of breastfeeding). Since the cost-of-living crisis, we have also been following the trends in prices, see more below.

Our recent review reveals the following:

The prices for 9 out of the 12 infant formulas available on the market have not lowered in price, despite the Competition and Market Authority’s findings and recommendations published in February this year.

The average cost of branded infant formula is currently £12.89 for an 800g tin, only 10p lower than in May 2025. This compares to £6.99 for supermarket own-brand infant formula.

Since March 2021, the difference between the least and most expensive products has increased from £8.51 to £11.01, with a range of £6.99 to £18/tin. This despite all infant formulas being nutritionally equivalent, by law.

Only 4 of the twelve 800 g tins of infant formulas cost less than the £8.50 weekly Healthy Start allowance for a baby under one.

As usual, current pricing strategies mean that the least expensive way to buy infant formula is in powdered format. Aldi Mamia and Lidl Lupilu remain the least expensive infant formula powders in standard size formats (800g), both costing £6.99 and 11p per 100ml of made-up formula. These supermarket own-brand products are less widely available than branded formulas in stores and online.

This means that there are five products affordable with the Healthy Start allowance that provides £8.50 a week for a baby up to aged one year. However, Cow & Gate First Infant Milk from Savers is just 700g rather than 800g.

Where available, and feasible given the up-front cost, ‘big packs’ provide a cheaper way of buying branded products. For example, 2 x 600g packs of Cow & Gate First Infant Milk, SMA Pro First Infant 1 Milk per 100ml are 4p cheaper per 100ml than standard size formats of the same product, and Aptamil First Infant Milk per 100ml is 3p cheaper per 100ml than standard size formats of the same product.

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. Many continue to believe that switching to follow-on formula after six months might save money—especially since UK regulations allow promotional offers on follow-on formula. However, there are no cost savings to be made from switching from first infant formula to follow-on formula. An examination of promotions for follow-on formula revealed that only one of the May 2025 promotions was still valid at the end of September/start of October. Promotions are not a reliable foundation for families on a budget when making feeding decisions, leaving them exposed to price increases once promotions end.

See a summary of the above information in our infographic here.

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Latest trends in the cost of infant formulas

Our routine price monitoring (see Graph 1) shows that the cost of infant formula began to rise rapidly in early 2021, preceding general food price rises. Between March 2021 and April 2023, the unit price of the 12 infant formulas available at the time rose by an average of 22%.

Since May 2025, prices for 9 out of the 12 infant formulas available on the market have remained static. The price of Aptamil first infant milk has come down by 70p, from £13.50 to £12.80. The price of Bonya first infant milk by Kendamil has come down by 95p, from £8.45 to £7.50. Whereas the cost of SMA Little Steps first infant formula has increased from £7.95 to £8.49, after dropping from £9.75 to £7.95 between October 2024 and May 2025.

Graph 1 Unit cost of powdered, cows' milk-based first infant formula and the Healthy Start allowance March 2021 to October 2025.

In short, the infant formula retail offer remains dominated by expensive products, prices remain higher now than before the cost-of-living crisis and most are not affordable with the Healthy Start allowance.

See a summary of the above information as well as our policy asks in our infographic here.

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New paper: Effects of Infant Formula Type on Early Childhood Growth Outcomes: A Retrospective Cohort Study

This paper by Uzma Rani and colleagues at the University of Iowa and published in the journal Nutrients, examined the effect of specialised infant formula intakes (mostly reduced lactose or hydrolysed formula) on growth outcomes for babies in the US, compared to babies fed standard formula or breastfed, through a retrospective cohort study. The authors obtained data on breastfeeding status and infant formula use (whether standard or non-standard), from over 5000 full-term babies, at 2 months, and followed them up to assess growth at 1 and 2 years of age. Just over a third of babies were exclusively breastfed at 2 months, over 40% were fed with standard formula, and nearly a quarter were given a specialised formula. The assumption was feeding practices at 2 months may be a good indicator of ongoing feeding practices as the baby aged, although the authors acknowledge a single point of measurement for exposure was a limitation of the study.

The study found that at 1 year of age, babies who were fed non-standard formulas had higher weight-for-age, BMI, and weight-for-length z-scores than those fed standard infant formula, although after controlling for other covariates, weight-for-age and BMI z-scores remained significantly higher in the non-standard formula infants. At 2 years, only their weight for age z-score remained higher than those fed standard infant formula. At both 1 and 2 years of age, babies fed standard or non-standard infant formula had higher weight-for-age, BMI, weight-for-length, and length-for-age z-scores compared with those who were exclusively breastfed.

Specialised formulas often contain maltodextrins and/or sucrose in place of lactose which the authors highlight to have a higher glycaemic load than lactose, which could speed up weight gain. (It is important to note that maltodextrins are also implicated in contributing to tooth decay, although this was not mentioned in this study). They also state that hydrolysed formulas may alter metabolic responses due to faster absorption rates compared to intact proteins. Specialised formula is intended for use by formula fed infants for whom a standard infant formula is not suitable for medical reasons. However, the authors highlight that specialised formula is often overused, especially in instances when there is no clinical need.

The authors recommend future research that investigates the potential long-term health impacts of offering non-standard infant formula, such as obesity risk, as well as the role of marketing in product choice for infants without medical indications. They highlight the importance of this research informing formula regulations, which in the US (as in the EU and UK) require only evidence of adequate infant growth over a short period of time.

We at First Steps Nutrition Trust have been working to expose the issues surrounding the regulation and marketing of specialised infant milks in the UK for more than a decade, as well as providing independent information on these products to support their appropriate use. See this editorial published in 2024 “Specialised Infant Formulas: Overused, Overpriced and Obesogenic”. We are in the process of updating our report “Specialised milks for infants with allergies in the UK” for sharing in our December newsletter.

To support health workers conversations with families who use formula to feed their babies about which product to choose, see our website here, along with our infographics here.

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

Update: Still no government response to recommendations made by February 2025 CMA report on the infant and follow-on formula market in the UK

Our most recent regular monitoring data on the cost of infant formula in the UK (see above) has once again illustrated that there has been no meaningful reduction in the cost of infant formula to UK families. In light of this, on 20 October 2025, we shared a press release, Formula company greed remains unchecked as Government delays its response to watchdog recommendations and we coordinated a joint letter to the UK Health Ministers, urging them to publish the DHSC’s response to the Competition and Markets Authority (CMA) recommendations and initiate long-overdue action to improve the accountability of commercial milk formula companies. Media coverage of our press release included pieces in the British Medical Journal (Infant formula: Government is criticised for “inexcusable” delay in toughening marketing rules), the Telegraph (Doctors accuse baby formula makers of ‘unchecked greed’) and The Daily Mail (Parents face crippling costs to feed their babies as Government fails to check 'greedy' formula firms, experts warn) on 20 October, as well as a segment on ITV news on 28 October 2025, about “risks to babies as struggling parents resort to watering down their formula milk”.

It is therefore disappointing that the DHSC responded to our letter by stating that the government response will be published in “due course” with no indication of when this might be.

Follow us on social media where we will provide updates of any progress between now and our December newsletter.

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New paper: The imprints of sponsorship: The case of UNITAR’s Danone-sponsored Breastfeeding Education Initiative

On 30 September 2025, Laura Raquel Piaggio, from the SANAR (Sociedad Argentina de Nutrición y Alimentos Reales / Argentine Society of Nutrition and Real Foods) Foundation, Argentina, and colleagues published this paper in the journal World Nutrition, exposing a significant conflict of interest in the presentation of a United Nations breastfeeding training programme. The online course (aimed at the general public, health professionals, and policymakers) was called the Breastfeeding Education Initiative (BFEI) and was launched in 2023 by the United Nations Institute for Training and Research (UNITAR). It also included regional training, government collaboration and the establishment of a panel of experts from various countries and disciplines. Unfortunately, the BFEI programme was developed through a partnership between UNITAR and Danone (one of the biggest manufacturers of commercial milk formula globally), presenting a clear conflict of interest. Piaggio and colleagues documented how this commercial influence was discovered and the impact it had on the technical content developed and shared as part of the programme, including the influence on the educational programme’s content (such as the omission of sufficient information on the Code and marketing practices by CMF companies). The authors report that in June 2025, the entities supporting the initiative were no longer disclosed on the website, and in September 2025, the website shared a message indicating that the BFEI project was concluded and the course and website were no longer available. An announcement on the UNITAR website indicates that the courses and webinar series were “successfully concluded” at the end of December 2024. This case study serves as an example of why conflicts of interest with the formula industry must be avoided.

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New paper: Conflicts of Interest in Infant and Young Child Feeding: A Review of Australian Health Professional Associations' Guidance to Members on the International Code of Marketing of Breast-Milk Substitutes

On 31 October 2025, Naomi Hull and colleagues in Australia published this paper in the journal Maternal and Child Nutrition, describing a systematic methodology to assess the extent to which the codes and standards of health professional associations (HPAs) require compliance with the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions (“the Code”). The Infant Feeding Conflict of Interest Assessment Tool was developed using content from most recent global guidance on the Code and on preventing conflicts of interest in infant and young child feeding. The tool assesses documents by applying a simple scoring system to 8 critical elements of the Code and WHO guidance, and a total score and percentage can be calculated to provide an evaluation of the level of compliance of each document or standard. Hull and colleagues tested this tool and scoring mechanism with 19 HPAs in Australia to present the first ever such evaluation of national HPAs in one country. The authors state that the tool now needs further testing and development in a range of other country settings, and validation against surveys of changes in HPA adherence and health workers attitudes and awareness of medical marketing of commercial milk formulas.

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New resource: Unmasking Influence: Full documentary now publicly available

Unmasking Influence: How commercial actors influence policy and public health is a documentary about how commercial actors influence policy and public health, produced by Dr May van Schalkwyk and Professor Mark Petticrew of the commercial determinants research group at the London School of Hygiene & Tropical Medicine. The documentary shares stories and experiences of several researchers, health professionals and activists (including Prof Chris van Tulleken and Patti Rundall, OBE), using examples from different commercial determinants of health (including alcohol, tobacco, food, gambling, and others).

There have been various screenings of the documentary, but as of 3 November 2025, the full film (48 minutes) is now available to watch on the LSHTM Vimeo channel here.

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Forthcoming

Food Active 2025 Conference: 11 November 2025, online

The Food Active 2025 Conference “A Decade of Action: The Healthy Weight Declaration after 10 Years” takes place on Tuesday 11 November, from 9:30 am to 1:00 pm. 2025 marks ten years since the launch of Food Active’s Healthy Weight Declaration (HWD); established as a mechanism to support local government consider whole systems working to promote healthy weight. The conference will reflect on the declaration’s implementation, evolution, and impact on local policy and population health. Delegates will explore whole-systems approaches to promoting healthy weight, share best practice, and discuss how the HWD supports partnership working. The conference will also address the growing concerns associated with the commercial determinants of health and how the declaration helps local leaders respond to commercial influences and their impact on public health.

The conference will bring together colleagues, including, national partners, local authority officers, system leaders, NHS partners and ICS colleagues, academics, VCFSE organisations and more.

Register to attend here.

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Launch of the Lancet Series on Ultra-processed Foods and Human Health: 19 November 2025 in-person (Royal College of Physicians, London) and online

Photo credit: Peter Bond on Upsplash

On Wednesday 19 November 2025, from 6:30pm, the landmark three-paper Lancet Series on ultra-processed foods (UPFs) and Human Health will be launched at an event at the Royal College of Physicians in London, as well as online. Speakers include authors of the 3 papers and responses from experts, including the WHO and UNICEF.

Speakers will discuss the scientific, policy, and political dimensions of the global UPF challenge, and there will be a Call to Action and Launch of the Ultra-processed Food Action Network.

We (Vicky, Katie and Tami) will be at the event in person so please come and say hello if you are there too. While the in-person even has now reached capacity, you can register to add your name to a waiting list to attend in person here. Register to attend online here.

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Food, Pregnancy and Me webinar: 1 December 2025, online

This webinar will take place between 10 and 11.30am on Monday 1December 2025 and will give an overview of the School for Public Health Research (NIHR) project “Food, pregnancy and me”. The project aimed to identify the prevalence of food insecurity in pregnancy in two maternity services in England (Gateshead and Coventry), look at how food insecurity was associated with pregnancy outcomes in these settings, explore pregnant and postnatal experiences and support needs, and co-develop policy recommendations to prevent or mitigate food insecurity in pregnancy. Register to attend online here.

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HR Update

Goodbye Jasmine

We’re sad to say goodbye to our Nutrition Officer Jasmine who joined us this time last year to provide maternity cover for Rachel. She has done so much in her time at First Steps Nutrition Trust, including taking our social media communications to a new level and being instrumental in supporting our work on commercial baby foods. In exciting news, she is now off to have a baby too! We hope to share happy news about her baby’s safe arrival in due course.

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October 2025

A field with a harvest of pumpkins and a wheelbarrow full of picked pumpkins

Image by rawpixel.com via Freepik

Welcome to the October edition of our newsletter – contents below.

News

New: Commercial baby food and drink: voluntary industry guidelines
New data: Eating habits of children aged 16 to 18 months in England
New infographic: Plant-based drinks
New infographic: Can food insecure women breastfeed?
New report: UNICEF Feeding Profit
New paper: Ultra-processed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial
New paper: How Does Household Food Insecurity Impact Complementary Feeding, in High Income Countries, in a Cost-of-Living Crisis? A Systematic Scoping Review
New paper: How labelling of commercial infant food impacts parents’ beliefs about sugar content and related purchasing and feeding decisions: a scoping review
New paper: Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status
New paper: “You Want to Eat Healthy, Especially When You're Pregnant. But Sometimes, It's Just Not Possible”: Perceptions of Facilitators and Barriers to Healthy Food and Diet Practices During Pre-Conception and Pregnancy
New editorial: Food Allergy Prevention: Is Earlier Complementary Food Introduction Really the Optimal Approach?

Infant milk news

Updated recommendations: Cold water sterilising
A reminder: Formula preparation devices
New paper: Maternal Recognition of Formula Food Brand Logos and Its Association with Breastfeeding

BFLG-UK news

New paper: Breastmilk substitute marketing practices in four countries: an analysis using a community-based approach
New paper: Profits Before Health? New Zealand Government Rejection of Stricter Infant Formula Marketing Standards and the Lobbying Behind It
A reminder: What YOU can do to challenge conflicts of interest

Forthcoming

All Party Parliamentary Group on Infant Feeding and Inequalities, 28 October, hybrid
UNICEF UK Baby Friendly Initiative Conference, 12-13 November Telford

HR Update

A warm welcome to our new team member

Happy reading!

News

New: Commercial baby food and drink: voluntary industry guidelines

On 22 August the Department of Health and Social Care finally published voluntary industry guidelines on commercial baby food and drink, five years after they first consulted on them, and six years after publication of their evidence review on infant and baby food and drink. We submitted consultation responses on the earlier drafts in 2020 and 2024. Read our Director’s statement here.

The guidelines are applicable to all foods and drinks marketed for children under 36 months, except commercial milk formulas.

On nutrition, they focus on sugar and salt. They set out recommendations on added sugars (allowed or not allowed), total sugar (expressed as max % fruit content or max g fruit/100g product or as a max % of energy per 100g), added salt (not allowed) and total sodium (mg/kcal) by product category (baby meals; baby finger foods marketed for use under 12 months; baby finger foods and snacks marketed for use from 12 months of age; drinks).

They also advise food producers to consider other aspects of composition:

producing more vegetable and savoury foods than fruit-based and sweet foods
using more bitter and less sweet vegetables as ingredients
refraining from masking the flavour of vegetables
producing more single-flavour fruit and vegetable foods
producing fewer highly blended foods to help enable texture progression
reducing the total sugar and free sugar contents of foods wherever possible
appropriate portion sizes, particularly for finger foods and products aimed at children aged up to 12 months
avoiding producing sweet desserts

On marketing and labelling, the guidelines ‘strongly encourage’ food producers to:

label products in line with scientific and government advice to introduce solid foods at around 6 months of age
provide honest labelling so that product names are not misleading and are aligned with the quantity of the primary ingredients
restrict inappropriate on-pack marketing and promotional statements that make ‘implied health claims’ about health or nutritional benefits that are not based on scientific evidence
have clear feeding instructions (for example ‘use a spoon’ or ‘do not suck’) on the front of products packaged in pouches with a nozzle
stop labelling and marketing snacks or food products that can be eaten between meals as suitable for children aged 12 months and under

A lot of the above is positive and welcome, but some concerning details from our perspective include the following:

Added sugars are allowed in finger foods and snacks marketed for use from 12 months.
Maltodextrins are not counted as added sugars so are allowed (see below).
No total sugar limits are given for fruit and vegetable foods but at the same time there is also no recommendation to alert parents to their high sugar content, e.g. high sugar warning labels.
Less stringent salt limits than WHO recommendations (see below).
Growing up milks and drinks marketed for use from 12-36 months are not counted as drinks and are exempt from these guidelines despite containing lots of sugar and widespread misleading marketing and labelling.
Regulated health and nutrition claims such as ‘no added sugar’ are permitted.

The guidelines are not as comprehensive or as stringent as the WHO Europe Nutrient Profile and Promotion Model (NPPM), which sets stricter sugar and salt restrictions, and levels for other nutrients plus a longer list of recommendations to improve labelling and marketing, including banning all health and nutrition claims and requiring a high sugar warning on products which exceed acceptable sugar limits. For a list of all the NPPM recommendations, see pages 6 and 7 in the WHO Europe document: Nutrient and promotion profile model: supporting appropriate promotion of food products for infants and young children 6–36 months in the WHO European Region.

Action to improve the nutritional quality and appropriateness of the commercial baby and toddler food offer is long overdue, and these products are widely and frequently used by families with children under 3 years of age in all socio-economic groups. So, IF adhered to, these guidelines will be positive, however voluntary measures have been shown to have limited effect. Stronger mandatory regulations are therefore still needed to replace the current regulations which date from 2003. There is agreement across the sector that these should be informed by the NPPM and UK public health recommendations. We are also advocating that they should take in to account emerging research, including on ingredient markers of ultra-processed foods such as maltodextrins and on texture.

The news report below from the I-Paper draws on our 2023 report “Ultra-processed Foods in the diets of infants and young children in the UK” and our 2024 briefing paper "Drinks for young children marketed as 'growing up' and 'toddler' milks and drinks" and highlights additives of concern.

This report comes after new data from colleagues at Leeds University confirming that more than a third of commercial baby and toddler foods can be classified as ultra-processed, with the proportion in certain product categories like baby snacks and cereals much higher. Read more in this news report in the Independent: “Ultra-processed baby foods ‘set children up for lifetime of obesity,’ experts warn”.

A reminder given all of the above, the NHS now makes clear that families should not rely on shop bought baby foods and home-prepared foods are often healthier and cheaper. Read about this change in public facing advice in our July newsletter.

For practical, pictorial guidance on feeding babies under 12 months and young children between the ages of 1 and 5 years, without using commercial baby and toddler foods, see our FREE eating well guides here.

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New data: Eating habits of children aged 16 to 18 months in England

On 22 August, the Department of Health and Social Care published a summary of the main findings of a nationally representative survey of primary caregivers of children aged 16 to 18 months, conducted in 2023 in England. This is important data because there is no other nationally representative data collection on the diet and nutrition of young children aged between 11 and 18 months and their influencing factors. The data set covers:

Caring arrangements and meal provision
Food and drinks at 16 to 18 months
Eating and feeding behaviours at 16 to 18 months
Healthy Start scheme
Food security
Feeding from birth
Dental hygiene

Image credit: First Steps Nutrition Trust, UPF report

Some points we found striking:

21% of 16-18 month olds were given commercial baby/toddler finger foods/snacks daily, and 84% at least once a week.
23% of 16-18 month olds were being given breastmilk at least once a day, 16% of caregivers said breastmilk was their child’s main milk drink.
18% said plant-based alternatives were their child’s main ‘milk’ drinks, but this included 2% who drank plant-based toddler or growing-up drinks.
Only 53% of 16-18 month olds gave their child vitamin drops.
18% of 16-18 month olds were being given a formula milk at least once a day, and 7% had these as their main milk drink.
52% of 16-18 month olds drank squash, 21% drinking this at least once a day.
Only 28% of 16-18 month olds usually used an open cup or free-flowing cup, with 27% using a cup or beaker with a valve and 24% still using a bottle.
20% of primary caregivers reported being currently eligible for the Healthy Start scheme but only 74% of those had registered for the scheme.
25-33% of caregivers reported experiencing food insecurity, e.g. worrying about food running out and not being able to afford balanced meals.
Of all primary caregivers surveyed, 10% had used growing-up milk and 9% had used prescribed specialist formula.
33% of 16-18 month olds were given solid food before 6 months.
65% of caregivers said they were yet to take their child to the dentist.

Nb. Across the topics covered by the survey, there were some differences between subgroups. Caregivers who were more affluent (as shown by having higher household incomes or living in less deprived areas) were more likely to align with UK guidance, compared with caregivers with lower household incomes or those living in more deprived areas.

The conclusion states that the report highlights some areas of concern in the eating habits of children aged 16 to 18 months, including:

Sugary foods as a regular part of children’s diets
Salt added to food for young children
Frequent use of purchased snacks and ‘treats’ (such as sweets, crisps, chocolates and ice cream)
Use of drinks other than breast milk, water or milk
Use of formula milks (including infant formula and follow-on formula) after 12 months of age, and growing-up or toddler milks

It acknowledges that further support and guidance are needed for families with young children, particularly about healthy snacks and drinks, and advice on feeding from birth including breastfeeding.

It fails to acknowledge that these findings also highlight the need to improve the food environment to better enable parents to follow public health recommendations, e.g. strengthening and enforcing regulations on the marketing of commercial milk formulas, especially follow-on formula and growing up milks and drinks. UNICEF’s latest report ‘Feeding Profits’ makes a comprehensive set of recommendations for improving the food environment, including for babies and toddlers. See below.

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New infographic: Plant-based drinks

To summarise the latest recommendations on plant-based milk alternatives for young children from the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity (CoT), we have produced the following infographic. Read more about the recommendations in our August newsletter.

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New infographic: Can food insecure women breastfeed?

To summarise our frequently asked questions (FAQ) on this topic which we shared with you in our May newsletter, we have produced the following infographic. Its purpose is to address widespread misconceptions about the links between maternal diet, stress and breastfeeding. The full FAQ is available on our infantmilkinfo.org website here.

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New report: UNICEF - Feeding Profit: How food environments are failing children

On 10 September 2025, UNICEF published its Child Nutrition Report 2025, Feeding Profit: How food environments are failing children. The documents include a 16-page Report brief (available in English, Arabic, French, Portuguese, Russian and Spanish), 114-page Full report and 40-page Data tables document. There was much media coverage of this report’s publication, including by the BBC, the Guardian, the Independent, and the Times among others.

The key message being reiterated by this report, is that, for the first time ever, among school-aged children and adolescents globally, overweight has exceeded underweight as the dominant form of malnutrition. This same pattern is seen in the UK:

in children under five, stunting in the UK is reported at 4% in 2024, compared to overweight at 8%. This compares to global averages of 23% for stunting and 5% for overweight in children under 5.
among school-aged children (5-19 years), as of 2022, modelled estimates for underweight in the UK are reported to be 2% while overweight is 30%. This compares to global averages of 10% for underweight and 20% for overweight.

The report provides a number of helpful definitions, latest data on the status, trends and inequities in overweight and obesity among children and adolescents worldwide and through regional profiles (in the Data tables and Annex 1) and an analysis of the drivers of unhealthy food environments.

Four key drivers of unhealthy food environments are described:

Inexpensive ultra-processed foods and beverages are flooding retail markets and infiltrating schools
Children are highly exposed to the marketing of ultra-processed foods and beverages at home, school and play, particularly digital marketing
The unethical practices of the ultra-processed food and beverage industry undermine government action and exploit children, even in times of crisis
Inadequate legal measures and policies enable the ultra-processed food and beverage industry to manipulate children’s food environments

Based on the analysis provided and using recent examples of countries that have made progress, the report presents eight recommendations to transform children’s food environments:

Implement the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions to protect and promote breastfeeding and appropriate complementary feeding.
Implement comprehensive, mandatory measures to transform food environments (school food environments, food marketing restrictions, food labelling, taxes on unhealthy foods and beverages and food reformulation).
Implement comprehensive policies to improve the availability and affordability of locally produced nutritious foods for children and adolescents.
Establish robust safeguards to protect public policy processes from interference by the ultra-processed food industry.
Implement social and behaviour change initiatives that empower families and communities to claim their right to a healthy food environment.
Strengthen social protection programs to address income poverty and increase children’s access to nutritious and healthy diets.
Engage young people in public policymaking on food justice by fostering youth-led advocacy.
Strengthen global and national data and surveillance systems to monitor food environments, diets, and overweight among children and adolescents.

Priority regulatory actions to create healthy food environments for children (page 17, full report) are also provided, based on content from the UNICEF Nutrition Strategy 2030 and the WHO Acceleration Plan to Stop Obesity. These include breastfeeding, first foods and foods in pre-schools and schools, as well as food marketing, labelling, subsidies, taxes and reformulation.

Our advocacy and policy influencing work in the UK aligns with several of the above recommendations.

There are also specific recommendations for various stakeholders to ensure commitment and accountability for action (Pg 6-7 of Full report), including to Governments who are acknowledged as bearing the primary responsibility for protecting children’s right to food and nutrition, but need to be supported through unified and comprehensive action from multiple stakeholders, including:

Civil society and the media
Development and humanitarian organizations
Donors and other financial partners
Academic and research organizations
Food and beverage industry actors

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New paper: Ultra-processed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial

This paper by Sam Dicken and colleagues from a wide range of global institutions, reports on the results of a 2 by 2 randomised, controlled, cross-over trial among 55 overweight adults (BMI ≥25 and <40kg/m2) in England, whose habitual UPF intake was ≥50% kcal day. It assessed outcomes of two, 8 week-long ad libitum diets (separated by a six-week period), one minimally processed (MP) and one ultra-processed (UPF); i.e. each person ate 8 weeks of the MP diet then 8 weeks of the UPF diet, or vice versa (as shown). Both diets met with the recommendations of the UK Eat Well guide in terms of the nutrition and balance of different food groups they provided. All foods/drinks were delivered to participants at their homes. The primary outcome was within-participant difference in percent weight change (%WC) between diets, from baseline to week 8. Secondary outcomes were change in anthropometry, body composition, cardiometabolic markers and appetite.

The main finding was that both the MP and the UPF diets led to weight loss: MPF (%WC, −2.06 (95% CI −2.99, −1.13) and UPF (%WC, −1.05 (95% CI −1.98, −0.13)). The weight loss on the UPF diet was unexpected given the results of previous trials, but the weight loss on the MP diet was significantly more than on the UPF diet: %WC on MPF (change in %WC, −1.01 (95% CI, −1.87, −0.14), P = 0.024; Cohen’s d, −0.48 (95% CI, −0.91, −0.06)).

Weight and BMI were significantly lower at 8 weeks from baseline on both diets. There were some positive changes in body composition on the MPF but not the UPF diet, including lower fat mass. Changes in blood pressure and heart rate did not differ significantly between diets. The clinical markers showed a mixed picture, with some better on the MP diet and some better on the UPF diet. Some but not all measures of subjective appetite measures were better on the MP than the UPF diet.

The potential mechanisms behind the results were the greater energy density, flavour and taste ratings and potentially appeal of the UPF than the MP diet, noting it was delivered in its original packaging including health and nutrition claims. These differences mean that energy intake could have been greater on the UPF diet.

The authors conclude that dietary guidance needs to include the extent of food processing in addition to existing food and nutrient based recommendations.

How is this relevant to the early years? In this pre-recorded PowerPoint presentation from April 2025, our Director Vicky outlines the latest evidence on UPF consumption and childhood adiposity. UPFs dominate UK diets from infancy and through the early years. One study by Rana Conway and colleagues at UCL found that UPFs accounted for 47% total energy intakes in a cohort of UK twins at 21 months (in 2009/2010) and 59% by the time they were 7-year-olds (in 2014/2015). Daniela Neri and colleagues analysed UK National Diet and Nutrition Survey data and found that UPFs contributed 61% of total mean energy intake in 2–5-year-olds (in 2008-2014). At the same time obesity levels in children aged 4-5 years are more or less stable and high. Latest National Childhood Measurement Programme data report a prevalence of overweight and obesity at 22% at 4/5 years of age in England in 2023/2024. As summarised in the presentation, a growing number of studies show associations between UPF consumption and adiposity in young children.

So, whilst this study by Sam Dicken and colleagues was among overweight adults, it seems reasonable to assume generalisability to children. This would support a recommendation that dietary guidelines for children need to include food processing as well as nutrient and food based recommendations. This was the top recommendation of our 2023 UPF report, which you can read here.

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New paper: How Does Household Food Insecurity Impact Complementary Feeding, in High Income Countries, in a Cost-of-Living Crisis? A Systematic Scoping Review

This paper by Grace Hollinrake and colleagues at Swansea University sought to review available evidence on the effect of household food insecurity on complementary feeding practices in high income countries. Their search yielded only five articles (two qualitative and three quantitative) from studies in Australia, New Zealand and the USA, showing that this is a new area of research, but also quite neglected. They report that the studies revealed that coping strategies to prevent hunger and food waste negatively affected some aspects of complementary feeding; children were encouraged to finish their food, foods that might not be accepted were not offered and the variety of foods given was reduced. These are at odds with advice to feed responsively, to give a wide variety of foods and to offer repeatedly and accept frequent rejection. This is concerning because what and how young children are fed impacts on their health and development and shapes their food preferences and eating styles in the short and long term.

Other interesting findings from the studies were: that food banks were used by some families but that this reduced the variety of foods; that high satiety foods were preferred to make more filling meals and also products with high sugar content; that food insecure families were more likely to give their babies baby food pouches (which typically are high in sugar) and less likely to practice baby-led weaning; but also that that some parents emphasised providing home-cooked meals.

Image credit: First Steps Nutrition Trust, UPF report

The authors conclude that diet and feeding practices could be negatively affected by household food insecurity. Diet quality and variety may reduce, baby food pouches may be more likely to be used, and persuasive feeding practices could be used to avoid food waste and child hunger. However, more research is needed to inform UK policy and practice to support families with young children experiencing the current cost of living crisis.

The paper indicates the importance that health workers supporting families with complementary feeding are aware of the challenges food insecurity poses to them applying public health recommendations for infant and young child feeding, and to tailor their advice and give additional support accordingly. This approach is recommended in the NICE guidelines on Maternal and Child Nutrition (NG 247), which also recommends discussing: the cost of healthy food and where to get support, including government and local schemes that offer advice and help to buy healthy food and milk (including Healthy Start, depending on eligibility) and income support schemes.

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New paper: How labelling of commercial infant food impacts parents’ beliefs about sugar content and related purchasing and feeding decisions: a scoping review

This paper by Rana Conway and colleagues at University College London was commissioned by the DHSC and is meant to inform policy. It reviewed available literature on parental feeding beliefs and decisions for children under 3, from high income countries and regions similar to the UK. They found 15 unique studies, seven quantitative, seven qualitative and one mixed methods. Specific review questions were 1. What is known about how primary caregivers understand terms used on commercial infant foods to describe sugar? and 2. What is known about how primary caregivers might use sugar warning labels on commercial infant foods?

They found little research to answer their specific questions, but key findings included the following:

Simply labelling products as suitable for babies elicited a trust that they were healthy, including not having a high sugar content.
Strategies to raise awareness of sugar content (sugar warning labels, counter marketing videos and provision of information sheets) were only tested in three studies. They show some indications of success in shaping intentions to serve, product choices and attitudes towards high sugar products.
One study looked at parents’ ideas of strategies to promote avoidance of sugar sweetened drinks, and these included illustrations of sugar content and messages on the negative effects of sugar on children’s health might change feeding behaviours.
Marketing claims are commonplace, effective and misleading: in 11 of the 15 studies, parents described the claims ‘no added sugar’, ‘less sugar’ and ‘only natural sugar’ on product labels as appealing, and many understood these all to mean low sugar. [This is highly problematic because in the UK these are regulated claims and are widely used despite being misleading].
Parents are unaware of the high sugar content in many baby foods, find the on-pack messaging confusing and deceptive and want clearer information on sugar content. Parents support regulation on the content and marketing of commercial infant foods.

The authors rightly highlight that while UK legislation limits the amount of certain nutrients in commercial infant foods, for most products there is no limit on the total sugar content. They highlight the WHO Nutrient Profile and Promotion Model as a tool that could be used to set limits. They also share that a survey by Action on Sugar has shown that UK parents would support government action to ensure all foods and drinks on the baby aisle are nutritionally appropriate and in line with NHS recommendations.

The authors also acknowledge that the NPPM recommends a high sugar warning where certain limits are exceeded, and that the logic of the high sugar warning is to push industry to reformulate (so they can market their products without a warning) or diversify product offerings to include more less sweet options, as well as to aid parent’s decision making. However, the review only found one study on sugar warning labels to include and while it found positive results that the warning averted choices in favour of products without the warning, the authors state concern about what alternative foods parents might select if sugar warning labels were added to commercial infant foods and suggested further research is needed on benefits and harms of their use.

The authors conclude that parents’ understanding of the terms such as added sugar was unclear as was the impact of introducing sugar warning labels. Nonetheless, parents’ find the current labelling of commercial infant food misleading and desire clearer labelling to support informed purchasing and feeding decisions. They highlight that current lack of regulation makes parents vulnerable to making underinformed choices for their children and that the results support calls for legislation to make commercial infant food labelling clearer to reduce free sugar intakes. However, they recommend more research on sugar warning labels.

It should be noted that the conclusion of this scoping review compares to a more favourable position on sugar warning labels from a mixed methods study conducted by the same study team published in May this year, and summarised in our June newsletter. This study concluded that: “Results suggest that the mandatory use of minimum age guidance and sugar warning labels on commercial infant foods could provide parents with agency and shift feeding behaviours toward closer alignment with recommendations. Importantly, the impact of these label changes appears socioeconomically equitable, and they are supported by parents”.

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New paper: Baby food pouches and Baby-led Weaning: Associations with energy intake, eating behaviour and infant weight status

This new paper written by Alice Cox and colleagues in New Zealand explored the associations between baby food pouch intake, baby-led weaning and energy intake, eating behaviour and BMI for infants aged 7-10 months. Data from over 600 infants were included in the study, where the researchers assessed baby pouch use frequency, baby-led weaning status, diets and feeding behaviour, and BMI z-scores.

Image credit: First Steps Nutrition Trust, UPF report

Around 30% of the participants reported ‘frequent pouch use’, once a day or more. Less frequent pouch users offered their infants pouches up to 2-4 times a week. At 6 months, most infants in the study were spoon feeding (76%), 10% with partial baby-led weaning and 13% full baby-led weaning. Whereas by 7-10 months, around half were still spoon feeding, a quarter partial baby-led weaning, and a quarter were full baby-led weaning. There were no differences in energy intakes or BMI z-scores between those with frequent or infrequent pouch use or related to baby-led weaning status. The study found an association between food responsiveness and frequent pouch use. The food responsiveness scale measured desire to eat regardless of hunger ques (such as, “Even if my child is full up s/he finds room to eat his/her favourite food”). Therefore, children who consumed pouches frequently were more likely to eat even when they weren’t hungry. Full or partial baby-led weaning was associated with reduced restrictive/selective eating at both 6 months and 7-10 months. For example, children who showed signs of restrictive/selective eating were likely to avoid foods of certain textures or temperatures.

The authors highlight that families may offer pouches more regularly early on if their infant shows signs of fussy eating behaviour. On the other hand, if infants are not exposed to appropriate textures early on in the complementary feeding period, they may reject certain textures later on, which could contribute to fussy eating behaviour.

This study is important for a number of reasons. Research into the texture of baby foods is limited, yet dietary texture progression is important for young children. The study highlights that eating directly from pouches means that infants are unable to learn about the food’s sensory properties, such as texture and feel. And that relying too much on pouches could lead to a delay in age-appropriate texture progression to lumpy, chewable foods. The NHS recommends that parents should move babies on from puréed or blended foods to mashed, lumpy or finger foods as soon as they can manage them. This is because it helps them learn how to chew, move solid food around their mouth, and swallow. It is important to remember that some babies take longer to get used to new textures, whereas others like to start with mashed, lumpy or finger foods. Additionally, appropriately timed texture introduction is thought to be important for food acceptance as children get older.

We first raised concerns about the use of baby food pouches in our report published in 2017 on Baby Food in the UK. Since then, pouches have gained in popularity and various issues with their use have been exposed. Earlier this year, BBC Panorama published its programme ‘The Truth About Baby Food Pouches’, which exposed issues with high sugar levels and a lack of certain micronutrients, such as iron. Alongside this, researchers from the University of Leeds published research that found pouches make up nearly 40% of the baby food market and that fruit-based pouches had enough sugars to warrant a high sugar warning level according to the WHO Nutrient Profiling and Promotion model. These findings are reflected in a narrative review of over 30 research papers that we published with the University of Glasgow in July this year. We found that over 50% of products on the baby food market were classified as puréed, of which many are pouches, and that the median sugar content of purées was over 10g of sugar per 100g.

Recently, the Department of Health and Social Care published voluntary industry guidelines for commercial baby foods; read more about this above.

Parents must be given more support to feed their children diets based on nutritious, minimally processed foods, as this will give them the best start in life. As above, the timely introduction of varied tastes and textures during complementary feeding can help to influence children’s long-term preferences.

See our eating well resources for practical, pictorial guides for feeding young children here.

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New paper: “You Want to Eat Healthy, Especially When You're Pregnant. But Sometimes, It's Just Not Possible”: Perceptions of Facilitators and Barriers to Healthy Food and Diet Practices During Pre-Conception and Pregnancy

This paper by Jane McClinchy et al (published on 7 September 2025) is a write up of research commissioned by the Food Foundation for their 2023 report “Preconception, Pregnancy and Healthy Weight in Childhood”. This qualitative study used focus group discussions with UK women trying to conceive, pregnant or with a baby under 6 months of age, to explore faciliators and barriers to eating well in pregnancy and how these could be addressed or used to improve dietary practices.

Challenges to eating well in pregnancy included: ‘mothers’ load’, i.e. tiredness and busyness when women have jobs and other children to care for; pregnancy side effects including nausea, cravings and heartburn; accessibility, availability and cost of healthy foods and marketing of unhealthy foods; and lack of individualised advice with too great an emphasis on what to avoid and what supplements to take and too little information and advice on healthy meals and snacks.

Facilitators to eating well in pregnancy included: meal planning and cooking skills; and partner and family support with meal preparation.

Changes recommended to support eating well in pregnancy included: access to professional advice and support like cooking classes; co-creation of healthy eating resources with pre-pregnant and pregnant women available for all.

This insightful paper shares important knowledge relevant to all those with a role in supporting women to eat well for and during pregnancy. To support practice, our Eating Well pregnancy guides provide lots of ideas of simple, cost effective snacks and meals to meet the nutritional needs of pregnant women and pregnant teenagers, as well as tips and hints for managing on a budget. They can be accessed for free here.

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New editorial: Food Allergy Prevention: Is Earlier Complementary Food Introduction Really the Optimal Approach?

This editorial by Catherine Breen and colleagues outlines the tensions that exist between allergy research seeking to explore the preventive effects of introduction of common allergenic foods (especially egg and peanut) before 6 months of age, with public health recommendations to exclusively breastfeed to around 6 months to protect infants and mothers from a wide range of negative health outcomes. The authors recommend that trial designs seek to test simpler interventions, focused on one of timing of: introduction of allergens (alone or alongside other complementary foods), form/dose of allergen or frequency of allergen, rather than mixing up these exposures. They highlight that there are no published or registered clinical trials which focus on testing timing of allergenic food introduction alone, without changing intensity of allergenic food consumption and/or timing of complementary feeding. The authors suggest allergy prevention research could focus on working within, rather than against, government infant feeding guidelines. More specifically, they recommend research to establish whether the optimal approach to food allergy prevention might actually involve allergenic food introduction that is consistent with current public health guidance; i.e. introduction of common allergenic foods at around 6 months with regular exposure through the complementary feeding period. This is because available data indicate poor compliance with these current recommendations.

Lastly, they urge caution in light of the vested interest of the formula industry in research that focuses on shortening the duration of exclusive breastfeeding, and the possible harms to infant health that may arise as a result of commercial exploitation.

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Infant milk news

Updated recommendations: Cold water sterilising

We have had a number of queries about cold water sterilising because of inconsistency in the advice on different NHS webpages and also with that given by Milton on their product labels and website.

After consulting and connecting relevant organisations, we hope that the advice will become more consistent. The important point to note is that following cold water sterilisation, baby feeding equipment should be rinsed with cooled boiled water.

Image credit: www.nhs.uk

This NHS page ‘How to make up baby formula’ states (Step 5): If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle (not tap water).

The NHS and Start for Life webpages simply advise families to follow the manufacturer’s instructions.

See Milton’s FAQ “Why do I now need to rinse after using Milton Sterilising products?”

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A reminder: Formula preparation devices

We would like to clarify guidance on using formula preparation machines following a flurry of queries related to the Baby Brezza Formula Pro machines and the release of the new Tommee Tippee Perfect Prep Pro machine.

Research from Swansea University that we here at First Steps Nutrition Trust collaborated on, suggests that 50% of families are using formula preparation machines. These machines are marketed as being convenient methods of preparing formula feeds from powdered formula, for consumption within minutes. However, formula preparation machines regularly dispense water below the recommended minimum of 70ºC (either by design, as is the case for the Baby Brezza or not, as our study showed for the Tommee Tippee Perfect Prep). This is problematic because the water needs to be at least 70ºC to kill any bacteria that may be present in the powdered infant formula, which is not sterile. Using hotter water is possible; the nutrients in the formula will not be affected although the taste may change. If there is probiotic bacteria in the powdered infant formula these will be killed. However, probiotics have no proven benefits for infants when added to infant formula and the priority when reconstituting powdered infant formula should always be optimising microbiological safety rather than maintaining any live bacteria.

After this study was published, the NHS Better Health Start for Life website has added this recommendation:

You can find more detail about making up infant milks safely, and some helpful infographics on safe formula preparation to share with families who use formula to feed their babies here: Making infant milk safely — First Steps Nutrition Trust

For our FAQs on infant milk safety, head to our Infant Milk Info site here.

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New paper: Maternal Recognition of Formula Food Brand Logos and Its Association with Breastfeeding

Research by Selen Pervane and Betul Ulukol at Ankara University in Turkey, found that over 60% of over 400 mums recognised infant formula logos. The study recruited women who were pregnant for the first time, and mums with infants under 6 months of age. Participants were shown formula brand logos with the names removed, and were asked whether they recognised the logo, whether it was associated with infant formula, and where they recognised it from. Over half of mothers who had never used formula to feed their babies also recognised the logos. Around 30% of the women reported seeing the logos on TV or from the internet, suggesting that digital advertisements are a key exposure. The rate of formula usage was 51% among mothers who recognised the logos, compared with 27% among those who did not recognise the logos.

These findings are concerning because they show how pervasive formula marketing strategies clearly influence the feeding decisions of parents and carers, as also outlined by the WHO in this report from 2022. They also show how digital marketing is key. These findings support the need to implement the Code to better protect breastfeeding, noting that this is also the top recommendation of UNICEF’s latest report ‘Feeding Profits’ which we write about above.

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

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Baby Feeding Law Group UK News

New paper: Breastmilk substitute marketing practices in four countries: an analysis using a community-based approach

On 31 July 2025, a four-country paper (including the UK, US, Australia and Canada) on monitoring of Code violations was published in the journal, Archives of Public Health. The purpose of this quantitative study was to collect data on the breadth and scope of violations of the Code in four industrialized countries (U.S., Canada, Australia and the UK) that either do not abide by the Code or only partially abide by it, or that do not adequately enforce Code-related policies or laws. The researchers used a community-based approach by inviting volunteers in the four countries to participate by downloading a “scavenger hunt” mobile application (called GooseChase Adventures). Participants were required to fulfil 30 “missions” listed within the application, which incorporated tasks to find products that were marketed in a way that violated the Code. Missions were completed through uploading photographic evidence of examples of Code violations to the appropriate category of examples. Enrolment and data collection took place between July 2023 to July 2024.

The target sample size was 1,000 people per country, but over the course of the year only 1,261 individuals expressed interest in participating and only 138 completed the demographic survey, finished enrolment, created a profile on the module app, submitted verified Code violations and were therefore included in the sample. The sample was all female and predominantly made of individuals from the US (n=99; 71.7%) with only 20 participants from the UK (14.5%), 14 from Australia (10.1%) and just 5 from Canada (3.6%). Most participants (n=122; 88.4%) were lactation support professionals. A total of 700 violations were submitted, and the most frequently reported Code violations were Facebook adverts for BMS. The researchers concluded that Code violations are prevalent across the four countries (noting that 71.7% of the findings come from the US), and the public remain exposed to misleading marketing of breastmilk substitutes. The author’s recommended that countries should legislate the Code into law and commit to its implementation, noting that this is also the top recommendation of UNICEF’s latest report ‘Feeding Profits’ which we write about above.

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New paper: Profits Before Health? New Zealand Government Rejection of Stricter Infant Formula Marketing Standards and the Lobbying Behind It

On 6 August 2025, a Perspective Article was published in the Maternal and Child Nutrition journal, written by Naomi Hull and colleagues in Australia. This paper provides a timely country case study of how transnational dairy and baby food corporations lobbied the New Zealand (NZ) government, exerting strong political influence and using economic arguments, to reject updated infant formula standards, despite strong evidence for policy designed to protect infant health and despite support across Australia for reform. The researchers sourced data through NZ Official Information Act requests, which included communications between commercial milk formula (CMF) industry lobbyists and the government representatives including the Prime Minister and cabinet ministers of the NZ Government. The Food Standards Australia New Zealand (FSANZ) is the government body responsible for setting joint food standards for Australia and NZ and these standards (specifically 2.9.1) regulate the composition, labelling and sale of infant formula products. In 2012, the FSANZ started a process to review regulatory requirements for infant formula, which included seven rounds of public consultation. Two CMF companies provided strong opposition to recommendations to restrict sales of specialised formulas and claims on infant formula packaging, indicating that this would have economic implications through reduced exports to China. In 2024, the NZ government announced its decision to opt out of the proposed new standard, despite evidence that the revised standard's benefits to infant health outweighed industry impact.

Neither Australia nor NZ have effective regulations to legislate the Code. This case study illustrates weaknesses in NZ's political transparency laws, where no mandatory lobbying registers and reporting requirements exist. It also demonstrates how the CMF industry has a notable level of access to and influence over politicians.

The researchers provide strong statements in the conclusions, that

“Ensuring that infant feeding decisions are not influenced by commercial marketing is crucial to population health.
Governments must withstand corporate pressures to expand trade and instead prioritise the health and safe nutrition of this most vulnerable group.”

The researchers further conclude that “it is crucial for governments to make policy decisions without the influence of the baby food industry and provide a strong argument for better regulation of corporate lobbying”.

This article provides a timely and critical lesson for the UK government. Industry responses to the work of the Competition and Markets Authority on infant formula and follow-on formula (here and here) include inadequate attempts to challenge the evidence supporting some public health recommendations on infant and young child feeding in the UK. We shared this paper with contacts in the DHSC and hope that they have taken on board the lessons of what has happened in NZ as they finalise their response to the CMA’s recommendations.

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A reminder: What YOU can do to challenge conflicts of interest

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Forthcoming

All Party Parliamentary Group on Infant Feeding and Inequalities, 28 October, hybrid

The next meeting of the All-Party Parliamentary Group on Infant Feeding and Inequalities will take place on Tuesday 28 October, in a hybrid format (in-person at Portcullis House, and online via Microsoft Teams) at 13:00. There will be an external speaker, in addition to an update on the work of the APPG. The invitation will be shared by Jess Brown-Fuller’s team in the coming weeks. If you would like to be added to the APPG IFI mailing list, please send an email request to Jess: jess.brownfuller.mp@parliament.uk and Jess’s parliamentary assistant, Edmund Leagrave: edmund.legrave@parliament.uk

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Unicef UK Baby Friendly Initiative Conference, 12 - 13 November, Telford

This year’s annual UNICEF UK BFI conference is in person at the Telford International Conference Centre. From confronting corporate power, the latest research on the microbiome, and updates on the Infant Feeding Survey, the programme features a diverse range of talks by renowned professionals and researchers. Information on the programme and speakers can be found here and you can book your tickets here. See you there!

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HR Update

We're delighted to have Tami Mann join our team as Nutrition Intern for Social Media and Communications. Tami is currently pursuing an MSc in Nutrition for Global Public Health at the London School of Hygiene and Tropical Medicine. Welcome Tami!

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August 2025

Image by Balash Mirzabey on Freepik

Welcome to the August edition of our newsletter – contents below.

Can you support us with a donation?

As you know, First Steps Nutrition Trust is a registered charity, funded by a small number of generous individuals and grants. We don’t receive government funding and only accept funds from conflict-of-interest free sources. If you are consistently finding value in this newsletter, please consider making a donation towards our work. You can do this here on our PayPal page and don’t need a PayPal account.

Thank you!

News

World Breastfeeding Week, 1 – 7 August
New Government policy papers: A round up of the new Government policy papers relevant to early years nutrition
New SACN recommendations: Plant-based drinks
New ‘shoddy’ award: Which? award for Kiddilicious
New advertising policy: Knowsley bans ads for formula milks
New papers: A Future Healthcare Journal special issue on Commercial Determinants and Conflicts of Interest in Public Health and Policy
New warning: FSA advice on ‘slushies’

Infant milk news

New recipe and branding: Nanny Care

BFLG-UK news

New report: Current formula marketing practices in the UK: Why stronger rules are needed

Forthcoming

Unicef UK Baby Friendly Initiative Conference, 12 – 13 November, Telford

Happy reading!

News

World Breastfeeding Week, 1 – 7 August

Today (7 August) is the last day of World Breastfeeding Week. This year’s global theme was Prioritise Breastfeeding: Create sustainable support systems. This theme focused on environment and climate change, by highlighting the roles of all stakeholders, especially trained healthcare professionals, in supporting breastfeeding to create a sustainable environment while simultaneously reducing the climate-related impacts of formula feeding. The consistent, evidence-based support that breastfeeding mothers need should start during the antenatal period, with health workers providing clear, reassuring and skilled guidance. Continued breastfeeding support is needed at the time of delivery, during hospital stays and especially after discharge. Mothers need support to manage any breastfeeding challenges and then continued policy and practical support to balance breastfeeding with return to work, especially in the current context of widespread unethical marketing by the commercial formula industry.

Two of our practical guides could be useful to new mums and can be downloaded for free here.

"Eating well for new mums," offers easy, nutritious, cost-effective snack ideas and provides information about diet and breastfeeding to inform and support breastfeeding mothers. It also answers FAQs that new breastfeeding mums might have about eating and drinking well and provides information to dispel common myths and misconceptions.
Our resource ‘Breastmilk and breastfeeding: A simple guide’ contains information about breastmilk and why breastfeeding matters for babies, mums and the world we live in.

Here, at First Steps Nutrition Trust, we have been advocating for breastfeeding support - as the normal way to feed babies and young children - since our inception 14 years ago, and long may we continue to do so!

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New Government policy papers for England: A round up of the new papers relevant to early years nutrition

There has been a flurry of new policy papers released by the Government in July, with implications for early years nutrition in England:

3 July (with corrections on 15 July), from DHSC: Policy paper: 10 Year Health Plan for England: fit for the future
7 July, from DFE: Policy Paper: Giving Every Child the Best Start in Life
15 July, from DEFRA: Policy Paper: A UK Government Food Strategy for England

Here are our reflections on the plans and their relevance to early years nutrition, in their order of release.

The 10-year Health Plan for England from the Department of Health and Social Care (DHSC), aims to transform the NHS into a more efficient and responsive health service. It is the plan to deliver on the Government’s Health Mission. It emphasises three major shifts:

shifting care to the community (e.g. Community/Neighbourhood Health Centres will provide 24/7 access to healthcare services),
moving from analogue to digital services (e.g. Digital single patient records will be created),
and focusing on prevention rather than just treatment (Giving people “power to make the healthy choice”).

Image credit: NHS

Unfortunately, the plan includes little explicit content on babies, young children and nutrition and feeding, although it is light on detail generally, given its vast scope. Here are our reflections in relation to what we fed in to the consultation in December 2024:

There is one mention of breastfeeding in a personal quote, which is unfortunately negative. The Breastfeeding Network write about the conspicuous absence of breastfeeding in this blog. However, breastfeeding support via health visitors is mentioned in the Best Start in Life strategy (see below), so we assume it is implicit. That said, the details will be vital, and we would like to see a clear commitment to peer support services as well as support through health professionals.

Health visiting gets a mention in Chapter 2 “From Hospital to Community”, where the need to “get prevention right… in the critical 1,001 days” is acknowledged. The focus here is on vaccinations and holistic support for children’s broader development. The Institute of Health Visiting present a ‘glass half full’ (hopeful) interpretation of the implications for health visiting, including plugging gaps in the workforce here (a separate workforce plan is pending).

Image credit: NHS

Chapter 4 on “Sickness to Prevention” has a section on ‘ending the obesity epidemic’. It states “Food choices are partly an individual choice, but they are also influenced by our environment. This is particularly true for children, who have little choice in the food they eat and are less able than adults to resist food advertising or product placement”. However, it mostly focuses on interventions at school age. There’s a mention of the potential to extend the soft drinks industry levy to milk-based drinks, but we’ve been told by the DHSC that unnecessary growing up and toddler milks are not considered in scope. One positive is a promised increase in the Healthy Start allowance from 2026 “to support the poorest families and tackle child poverty”, though this is meagre at 10 percent (“pregnant women and children aged one or older but under 4 will each receive £4.65 per week (up from £4.25). Children under one year old will receive £9.30 every week (up from £8.50)”). There is no mention of efforts to increase coverage of the scheme.

There are also no mentions of any planned actions on formula marketing, baby foods composition and marketing, or early years settings food provision, although the latter is more relevant to the Department for Education (DFE)-led Best Start in Life strategy (see below).

Sadly, without meaningful and holistic attention to diets in the early years (i.e. preconception, pregnancy, infancy and early childhood) there will be no sustainable reduction in obesity.

In terms of how the plan will be delivered, partnerships are embraced: “Instead of going it alone, the Plan sets out how the NHS will create new collaborations with commercial partners, universities, councils and mayors…”. Of concern is a big emphasis on partnerships with industry, including multinationals with a track record undermining heathy early years diets. E.g., page 58 shares that “Danone has committed to never introducing a high fat, salt or sugar product targeted at children… It will be by working with these partners that we will make all our efforts more than the sum of their parts”.

To sum up, from an early years nutrition perspective there is little detail in this NHS 10-year plan to indicate that the Government understand the extent and scope of actions required to improve early years diets, and the necessary safeguards against conflicts of interest. However, the Best Start in Life Strategy and the Food Strategy also include early years content, and taking a holistic view of evolving Government policy provides optimism.

The Best Start in Life strategy is a policy paper from the Department for Education (DfE), and its scope covers ‘family services’ and early education and care. It is situated as supporting the Government’s Opportunity Mission.

Published four days after the NHS 10-year plan, it references and builds on elements within that plan making them relevant to the early years and cites the importance of the pending Child Poverty Strategy:

“The reforms set out in this strategy go hand in hand with the move to a Neighbourhood Health Service set out in the Government’s 10 Year Health Plan, and the three radical shifts – hospital to community, analogue to digital and sickness to prevention. Supporting families with young children to thrive will also be integral to the Child Poverty Strategy due to be published late this year…We have also launched a review of the parental leave and pay system…”.

The strategy seeks to holistically address the needs of babies and young children regarding their learning, health and development, acknowledging the need to support families and provide high-quality early education and childcare.

Early years feeding and food provision should be implicit within, and there are a few explicit mentions: breastfeeding support from health visitors in ‘Best Start in Life Family Hubs’, reference to the Government commitment to increase the Healthy Start allowance, and the recent welcome commitment to provide free early years meals to families on universal credit where their child attends a state-funded school nursery.

The headline goal of the strategy is for 75 percent of 5-year-olds in England to have a good level of development by 2028, through:

Expanding and strengthening family services, providing high quality support to parents and children from pregnancy to age 5
More accessible and affordable education and childcare
Improving the quality of education and care that children receive in early years settings, from childminders and in reception classes

This work will be supported by the appointment of a new Best Start in Life Champion to help drive delivery across government.

Focusing on 1 - improving family services (as this is directly relevant to early years nutrition). This will involve:

Creating a new ‘Best Start Family Service’, based on ‘Best Start Family Hubs’ in every local authority. These will provide a ‘new evidenced-informed core offer for parents’ and a new national Best Start digital service ‘bringing together the trusted advice and guidance all parents need in one place and linking families to their local services’ and providing a digital alternative to the red book. They will host professionals working across all local teams, including health and education, and will work with nurseries, childminders, schools, health services, libraries and local voluntary and community groups.
Strengthening health services: improving maternity care (focusing on safety and preventable deaths), strengthening health visiting services (focusing on health and development reviews), increasing access to vaccinations, and reducing tooth decay in children (including supervised tooth brushing for pre-school children in deprived areas). 
Backed by local Best Start Plans, coproduced by local authorities and communities.

The strategy outlines how the elements under point 1. support the 10-year health plan shift from hospital to community and highlight the commitment in that plan to support healthy eating in the early years among the poorest families by increasing the Healthy Start allowance and increasing access to free early years meals.

There is a lot of scope in the above to meaningfully support healthy eating in the early years (including breastfeeding and complementary feeding), and we hope that due attention to nutrition will be given alongside other aspects of childcare and development.

2 - increasing the accessibility and affordability of early education and childcare - is relevant to early years nutrition as it will mean more babies in childcare from the age of 9 months. This makes application of the new DFE nutrition guidance for early years settings even more important, as well as considering how best to address the challenges working families express in finding time for home preparation of meals and eating together.

3 - improving the quality of early education and childcare - appears to be focused on the quality of education. We hope that consideration is given to the quality of the food and feeding practices under this agenda, to support healthy early years diets.

First Steps Nutrition Trust is a part of the Early Years Food Coalition, led by Bremner and Co with funding and support from Impact on Urban Health. We will be working with them to push for our shared calls on food provision in early years settings, including extension of free early years meals to private, voluntary and independent settings and sufficient funding for application of the DFE nutrition guidance

To sum up, from an early years nutrition perspective, building on the 10-year health plan, the Best Start in Life Strategy shows potential to improve infant and young child feeding support for families, and to improve food provision in early years settings, but details need to be worked up to be sure.

The UK government food strategy for England is a policy paper from the Department of Environment, Food & Rural Affairs (DEFRA), published on 15 July after the 10-year health plan and the Best Start in Life Strategy. Its subtitle is encouraging “Towards a Good Food Cycle: a UK government food strategy for England, considering the wider UK food system”. The ‘good food cycle’ (the alternative to the junk food cycle) connects production, access, health, resilience and growth. The ministerial foreword even mentions children:

“…this government is bringing together the entire food system to build a future where good food is accessible to everyone, not just a privileged few. A future where every child, every family, and every community can access healthy, affordable, and proudly British food”.

It acknowledges that rising obesity, food insecurity, and environmental degradation are not inevitable, and that working families in particular are struggling to eat well.

It sets out how the Government aims to create a healthier, more affordable, sustainable, resilient food system, while growing the economy, protecting the environment, and celebrating the best of British food and culture. There is welcome emphasis in the vision on children. The strategy supports delivery of the Plan for Change and the national missions.

It includes the following content:

The context and key challenges facing the food system
The Government’s high-level vision for the UK food system
The 10 priority outcomes that will make the vision a reality
Next steps on how the outcomes will be delivered

10 Priority Outcomes for the National Food Strategy

An improved food environment that supports healthier and more environmentally sustainable food sales.
Access for all to safe, affordable, healthy, convenient and appealing food options
Conditions for the food sector to thrive and grow sustainably, including investment in innovation, and productivity, and fairer, more transparent supply chains
Food sector attracts talent and develops skilled workforce in every region
Food supply is environmentally sustainable, with high animal welfare standards, and waste is reduced
Trade supports environmentally sustainable growth, upholds British standards and expands export opportunities
Resilient domestic production for a secure supply of healthy food
Greater preparedness for supply chain shocks, disruption and impacts of chronic risks
Celebrated and valued UK, regional and local food cultures
People are more connected to their local food systems and have the confidence knowledge and skills to cook and eat healthily

Annex A to the strategy maps existing policies on to outcomes and lists several that are directly relevant to early years nutrition, such as Healthy Start and the Nursery Milk Scheme which are linked to outcome 2. Annex B to the strategy provides a brief description and rationale for each outcome and describes interactions with other outcomes.

There are lots of opportunities under the outcomes to better support healthy early years diets e.g. under outcome 1, it is acknowledged that our food environment is dominated by unhealthy foods that are actively marketed, and how ‘interventions to restrict advertising’ could help. Government action to strengthen (and independently enforce) regulations on the marketing of commercial milk formulas (CMF) and baby and toddler foods, and improve the composition of baby and toddler foods, would be directly relevant to this outcome. Under outcome 2, policies to enable breastfeeding ought to get a mention here if this is a food strategy for all, with the potential to reference breastfeeding support provided via health visitors (and hopefully peer supporters too) and in Best Start in Life Family Hubs. Government action to strengthen regulations on CMF marketing would also be relevant to this outcome. The high cost of infant formula is also relevant here, and our opinion at First Steps Nutrition Trust is that this requires Government regulation in the form of price controls.

The ministerial foreword states that: “The transformation ahead will be led by the people who know the system best - our world-class farmers, fishers, producers, and workers. We will continue to listen, learn and act through the Citizen Advisory Council, the Food Strategy Advisory Board, and our work with UK Hospitality, National Farmers Union, British Retail Consortium, and Food and Drink Federation, reflecting our deep engagement across the sector”. We, like others, remain concerned about the extent of industry involvement and the potential negative implications of the inherent conflict of interest for public health.

We are encouraged by recognition within the strategy of the need to tackle marketing, and support Sustain’s view that “[the food strategy] ambitions can only be met if embedded by law and regulation” (read this blog).

Within the strategy we are told that “the next key milestone will be development of metrics, indicators and implementation plans for the food strategy outcomes. As we do this, we will continue to listen to and engage stakeholders across the food system”.

To sum up, from an early years nutrition perspective it is encouraging to see a focus on children and pre-existing policies relevant to the early years are considered in this evolving food strategy. However, there is a need to systematically consider how to address the nutrition needs and vulnerabilities of pregnant women, infants and young children. We welcome the commitment to listen to stakeholders and will continue to engage.

This Venn diagram illustrates linkages between the three plans in terms of the priorities and policies mentioned within. It also outlines where, in our view, policies need clarifying and strengthening and what is conspicuously absent. Lastly, it lists some of the significant forthcoming policy opportunities which will hopefully unlock more commitments to support babies, young children and their families to eat well.

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New SACN recommendations: Plant-based drinks

On 16 July, the Scientific Advisory Committee on Nutrition (SACN) published “SACN and COT [Committee on Toxicity] assessment of the health benefits and risks of consuming plant-based drinks”. This follows consultation between July and September last year, which we fed in to (see here). We are pleased to see much of our feedback was taken on board, especially that there are specific recommendations for 1 to <5 year olds, and that plant-based drinks marketed specifically for young children (labelled for use from 12-36 months+) are separated out.

Key points from the report are as follows:

Background

Around 10% of people in the National Diet and Nutrition Survey 2019 to 2023 reported that they consumed plant-based drinks [for 1.5-3 year olds, this was 9%, but among 1.5-10 year olds 92% ate meat and fish and did not have any dietary restrictions and only 2% ate mainly vegetarian or vegan diets; i.e. a small proportion of young children consume plant-based drinks, and most of these eat animal source foods]
Oat drinks are the most popular plant-based drink, followed by soya and almond drinks.

Cows’ milk is an important contributor to intakes of calcium and other micronutrients and for 1-5s, is a major contributor to energy, protein and saturated fat intakes. Cows’ milk is not essential for young children but if it is not part of their diet, other foods and drinks are needed to replace the nutrients that it provides.

The nutrient content of plant-based drinks varies considerably, and they tend to contain free sugars (sugars added as an ingredient or present as a result of the manufacturing process) and vary in the type and amount of micronutrient fortification. Organic plant-based drinks are not fortified at all.

Conclusions

No almond, oat or soya drink currently available in the UK is nutritionally equivalent to cows’ milk.
Risks of consuming plant-based drinks over cows’ milk are: higher intakes of free sugars, inadequate intakes of certain micronutrients and lower intakes of protein (for almond and oat drinks) (the latter more of a concern for children following vegan diets).
The only clear, potential toxicological concern relates to isoflavones among children aged 1-to-5 years who are high consumers of soya (e.g. because they are vegan). This is because children are more highly exposed on a body weight basis than adults because of their smaller body size.

Recommendations

For 1-<5-year-olds:

Whole or semi-skimmed cows’ milk are preferable to plant-based drinks for children aged 1 to 5 years who consume animal products
Fortified and unsweetened (without free sugars or non-sugar sweeteners*) almond, oat and soya drinks are an acceptable alternative to cows’ milk [where cows’ milk is not an option]
Unfortified or sweetened (with free sugars or non-sugar sweeteners) plant-based drinks are not an acceptable alternative to cows’ milk [this includes any organic plant drink]
There is no need for drinks specifically marketed for children aged 1 to 3 years, including plant-based ‘growing up’ and other ‘toddler’ drinks
Young children should ideally be breastfed into the second year of life or beyond

For 1-<5-year-olds following a vegan diet:

Fortified and unsweetened (without free sugars or non-sugar sweeteners*) almond, oat and soya drinks are preferable to water in meals and snacks where other children would usually consume cows’ milk; soya drinks are preferable because of higher protein levels
Offer a variety of suitable alternatives to animal-based food and drinks, rather than mainly consuming soya products, to avoid high intakes of isoflavones

*Nb. how SACN and COT define ‘unsweetened’ – no added sugars, no free sugars and no non-sugar sweeteners. This is important as most oat drinks contain free sugars.

Recommendations are also made for government and industry, including that government considers options to help consumers make informed choices about the suitability of plant-based drinks compared with cows’ milk and industry improves the nutritional content of plant-based drinks (addressing sugar content and fortification: Plant-based drinks should be fortified with vitamin A, riboflavin, vitamin B12, calcium and iodine at levels comparable with those found in semi-skimmed cows’ milk, and also vitamin D, which is already common practice).

The recommendations broadly align with our existing position on plant-based drinks (see this 2021 briefing) and the advice in our Eating Well guide for vegan infants and under 5s, in that we recommend unsweetened, calcium-fortified soya drinks in place of cows’ milk, taking care to provide alternative protein sources in the diet as a whole. We also caution against the use of oat drinks that contain free sugars. We remain concerned that nut-based drinks are low in energy and protein compared to other options but note that most children consume excess calories and protein. Lastly, we recommend unsweetened, calcium-fortified pea drinks as an alternative to soya drinks, and these are a category that SACN and COT did not investigate. We will revisit our evaluation of nut and pea-based products in due course.

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New 'shoddy' award: Which? award for Kiddilicious

Image credit: which.co.uk

Which? is naming and shaming companies behind the year’s biggest consumer letdowns in their third annual Shoddy Awards. Kiddylicious has been called out for their ‘Suspect Snacks’, due to misleading marketing claims on those aimed at children from 6 months to five years. Their claims create a health halo effect and lead parents and carers into believing they are making good choices. Many products carry ‘allergen-free’ and ‘no-added sugar’ messages, despite being high in sugar. Which? says that “many are more akin to sweets which are damaging teeth, with several classified as confectionery under World Health Organization guidelines”. These issues are not unique to Kiddylicious, as demonstrated by research carried out by the University of Leeds earlier this year, where 55% of snacks were found to contain sugars. Our summary of this research can be found in our May newsletter.

There has been a lot of research in this area. Our 2018 report on fruit-based baby snacks can be found here as well as our 2023 report examining the extent to which baby foods including snacks are ultra-processed which can be found here.

Which? highlights that offering snacks to babies under 1 risks displacing breast or formula milk. The NHS states that babies under 12 months do not need snacks, and that breast milk or infant formula should be given when they are hungry between meals. The NHS states that home prepared snacks are preferred, and if you’re using shop-bought baby foods, use them only occasionally, not every day. Avoid biscuits, rusks, biscotti and melty snacks, and choose ones with the least sugar and avoid the ones with sweet fruit or sweet vegetables.

Worryingly, recent research by Alexandra Rhodes from UCL and colleagues explored the drivers of using (ultra) processed baby snack foods (see here). The authors found that families were using snacks not only for hunger, but also for distraction, entertainment, as treats and out of habit, confirming earlier research by Anna Isaaca and colleagues (see here). They also highlighted that parents were swayed to purchase snacks by on-pack health and nutrition claims (like ‘no additives’, ‘contains fruit/vegetables’, ‘natural ingredients’ and ‘no added sugar’). A fuller summary of this research can be found in our June newsletter.

For nutritious, cost effective and simple alternatives to shop-bought baby and toddler snacks, our FREE, ‘Eating well: snacks for 1-to-under-5-year olds’ resource has plenty of ideas. Download it here.

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New advertising policy: Knowsley bans ads for formula milks

We are pleased to hear that Knowsley Council in Merseyside is the second council to sign off a comprehensive healthier food and advertising policy, as covered by the BBC here. This includes stronger restrictions on formula milk advertisements and advertisements of pre-packaged meals and snacks for babies and children up to three years old. Knowsley Council highlights that “formula milk is often marketed in such a way that it suggests its benefits outweigh breastfeeding or using cows’ milk after the age of one”. All first infant formulas can support a baby’s growth and development, but they do not have the same health benefits as breastfeeding. As a breastfeeding friendly council, Knowsley has acknowledged that misleading marketing messages from infant formula companies undermine public health messages related to breastfeeding, as well as safe and appropriate formula feeding. Our recent report on current formula marketing practices in the UK highlights many of these issues (see more on this in BFLG-UK news below).

Hounslow Council was the first council to sign off a policy like this in November 2024, acting on the World Health Organization’s (WHO) calls to restrict the inappropriate marketing of commercial baby food, through use of the WHO Nutrient Profile and Promotion Model and the WHO Code.

The first years of life are the most critical time for establishing healthy food preferences, dietary patterns and growth trajectories. Strengthening local food advertising policy can help to protect babies and young children’s health. This is especially true in the context of an absence of meaningful regulations for baby food nutrition composition and marketing, alongside formula marketing that undermines informed decision-making by parents on what and how they feed their babies and young children.

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New papers: A Future Healthcare Journal special issue on Commercial Determinants and Conflicts of Interest in Public Health and Policy

The June 2025, Volume 12, Issue 2 of the Royal College of Physicians’ Future Healthcare Journal special issue on Commercial Determinants and Conflicts of Interest in Public Health and Policy highlights the major and increasing influence of the tobacco, alcohol, food (including baby food) and gambling industries on the NHS and public health in the UK. The two Editorials and 12 Discussion pieces (including two articles from the perspective of young people) provide a clear, evidence-based and up-to-date warning that preventable illness and widening health inequalities in the UK are being driven by profit-driven actions of global corporations which focus on selling products that are harmful to health. The articles highlight how industries such as tobacco, alcohol, food, pharmaceuticals, and gambling foster conflicts of interest with key stakeholders—including scientists, clinicians, academics, regulators, and charities. The special issue urges decision-makers to acknowledge and address the systemic harm these profit-driven industries inflict on public health.

Of particular interest are two articles relating to infant and young child feeding:

Helfer B, Henke-Ciążyńska K, Boyle RJ: Commercial influences on infant and young child feeding summarised in this which describes the three key domains of commercial milk formula industry influence and their negative consequences

Waterston T, Cattaneo A, Bando N, Errico J, Boyle R, Brennan S, Lake L, Mialon M, Grummer-Strawn L; HASFF (Health Advocates for Sponsorship- Free Feeding): The urgent need to end sponsorship of healthcare professional associations by the commercial milk formula industry.

This article describes how the Health Advocates for Sponsorship-Free Feeding (HASFF) working group, convened by the World Health Organization, developed a range of tools and resources to support and encourage other HCPAs to end sponsorship from the CMF industry as a practical solution to address some of the challenges.

Two articles relate to (ultra processed and / or junk) food in general:

Bethell LJN: The soft power forcefield that protects the junk food industry.
- Lord Bethell explains how the “junk food industry” plays an intrinsic role in creating the personal identity of people in the UK, contributing to the cultures of the country and relationship-building. He further describes how the industry works hard to promote this connection, using established techniques drawn from the political playbook (e.g., resistance to foreign competition, nostalgia marketing, product placement in national media, sponsorship of national events, etc.)
van Tulleken C: Ultra-processed foods and public health: Evidence of harm and of conflicts of interest in the food industry to evade regulation.
- Prof van Tulleken describes that, despite the global pandemic of diet-related disease being increasingly recognised as commerciogenic (i.e., driven by financial incentives in the food system which drive the marketing and consumption of harmful food, including UPF), the UK policy response remains compromised by widespread conflicts of interest.

Authors of all articles in the issue provide many and varied evidence-based solutions to the challenge of commercial influence of public health policy. There is a clear common thread: all solutions involve ending the conflicts of interest between those who create policy and those with a financial interest in the subject of the policy, which is a matter that we actively advocate for at First Steps Nutrition Trust.

We have compiled a comprehensive list of suggestions for what healthcare professionals can do if they identify conflicts of interest, especially relating to challenging the inappropriate marketing of breastmilk substitutes or commercial milk formula targeting health professionals. See the suggestions provided on the First Steps Nutrition Trust website here. Please feel free to reach out to us if you have any questions or concerns: vicky@firststepsnutrition.org or katie@firststepsnutrition.org

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New warning: FSA advice on ‘slushies’

Image credit (FSA poster)

The Food Standards Agency (FSA) has updated its guidance for the consumption of slush ice drinks (‘slushies’). Previous guidance recommended that “slush ice drinks containing glycerol should not be sold to children aged 4 or below”. The guidance on slush ice drinks containing glycerol (updated on 16 July 2025) has increased the age limit, stating “slush ice drinks that contain glycerol shouldn’t be consumed by children under 7, and no refills for under 10” (i.e., children between 7-10 should have a maximum of one 350ml slushie per day).

This is updated guidance is because ‘slushies’ can contain the ingredient glycerol (E422) as a substitute for sugar, and this additive is used at a level required to create the ‘slush’ effect. Glycerol can cause adverse effects like headaches and sickness in young children and in high quantities or severe cases, even more serious side effects. More information is available here and here.

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Infant milk news

New recipe and branding: Nanny Care

Nanny Care has changed its branding and recipe as of May 2025.

The nutritional composition changes include the following:

The addition of 2’-FL, a permissible but not mandatory or necessary ingredient
Switching its fish oil-based DHA for a plant-based DHA
A small increase in calcium
A small decrease in vitamin C

For detailed nutritional composition information designed for use by healthcare professionals, you can visit our Infant Milk Info site here. This has information for both the old and new tins.

It is vital to note that the old and new products both comply with the nutrition composition requirements for infant formula, and that all infant formula are nutritionally sufficient for non-breastfed and partially breastfed babies. Infant formula can support adequate growth and development but does not impart the health benefits of breastfeeding.

The new tins are smaller, at 800g rather than 900g, and Nannycare has confirmed that the prices will remain the same. Therefore, the cost per feed will increase slightly. For conversations with families about the cost of infant formula, our infographic on the ‘Lowest Cost Infant Formula’ may be of use.

As we have highlighted in our recent report on Current formula marketing in the UK (covered in BFLG-UK news below), we are disappointed to see that Nannycare’s new labelling is less compliant with the law than its previous branding. The labels of the first infant milk and the follow-on milk remain similar. Additionally, the labels include more claims (and also intangible and non-verifiable messages). This indicates that current enforcement mechanisms do not work and that stronger, enforced regulations are needed to level the playing field for businesses and protect infant health.

Our research paper published earlier this year highlights how infant formula and follow-on formula labels from many companies routinely fail to comply with existing labelling regulations: only half of the 57 labels sampled complied with UK Law and even less with the Code.

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Baby Feeding Law Group UK News

New report: Current formula marketing practices in the UK: Why stronger rules are needed

On 17 July 2025, First Steps Nutrition Trust published a comprehensive report documenting the pervasive and evolving marketing practices by commercial milk formula manufacturers and retailers in the UK to show why stronger, enforced regulations are needed to protect all babies and families in the UK. We summarised the report in a 3 page brief, pictured above.

While we are waiting on the government response to the Competition and Markets Authority’s recommendations on the formula market, we are observing in real-time how the CMF manufacturers, with well-resourced marketing teams can be agile and responsive to any messaging that may criticise their products and their marketing practices, adapting their marketing strategies as a way of reassuring consumers. This approach is unhelpful to parents and caregivers, and clearly not aligned with the recommendations from the CMA's market study. The marketing examples are presented according to the various CMA recommendations (acknowledging that some examples of inappropriate marketing are relevant to more than one of the CMA's recommendations) and include a range of manufacturers, brands and practices, all of which are current (from June and July 2025).

I news featured our report in this ‘big read’ by Emma Morgan, published on Sunday 27 July.

Some extracts:
"Politicians and campaign groups are urging the Government to take action to restrict the marketing practices of baby formula companies, accusing them of “doubling down” on advertising that “hinders parents making informed choices”.

"Patti Rundall, who has been campaigning for safe infant feeding since 1980 and is the policy director of Baby Milk Action told The i Paper that no matter how subtle, marketing messages “really matter. We think it’s small, but it penetrates. If parents don’t have all the other information that tells them why this is nonsense, then they’re going to believe it".

“Too many families are currently being let down by the infant formula industry while the Government stands by and watches,” Jess Brown-Fuller MP said. “It’s immoral... Now it’s time for Wes Streeting to act. Accept the CMA’s recommendations. Implement them fully. And show that building the ‘healthiest generation ever’ starts with making sure every child, regardless of background, has a fair start in life.”

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Forthcoming

Unicef UK Baby Friendly Initiative Conference, 12 - 13 November, Telford

This year’s annual Unicef UK BFI conference is in person at the Telford International conference centre. From confronting corporate power, the latest research on the microbiome, and updates on the Infant Feeding Survey, the programme features a diverse range of talks by renowned professionals and researchers. Information on the programme and speakers can be found here and you can book your tickets here. See you there!

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July 2025

Image by Wirestock on Freepik

Welcome to the July edition of our newsletter – contents below.

Can you support us with a donation?

Thank you!

News

Updated NHS advice: Only use shop bought baby foods occasionally
New paper: Commercial Baby Foods: Nutrition, Marketing and Motivations for Use - A Narrative Review
New paper: “Snack foods for babies: What is driving the increasing use of processed baby snack foods in the UK?”
New paper: “Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years - summary of new NICE guidance”
New National Diet and Nutrition Survey data 2009-2013: Focus on 1.5-3 year olds
New report: The Grocer focus on infant and childcare
New paper: “Association of low-calorie sweetened product consumption and intakes of free sugar and ultra-processed foods in UK children: a national study from 2008 to 2019”
New: Start for Life Early Years newsletter
New: Scotland’s new Breastfeeding and Infant Feeding Strategic Framework (2025-2030)

Infant milk news

New: Infant formula cost data by retailer, from the Food Foundation
New infographic: Rice-based formula

BFLG-UK news

WBTi UK 2024 report parliamentary launch
Infant Feeding Adjournment debate

Forthcoming

Webinar: Findings of the study: Maternal wellbeing, infant feeding and return to paid work. 16 July, 1pm, online
World Breastfeeding Week, 1 - 7 August
Unicef UK Baby Friendly Initiative Conference, 12 - 13 November, Telford

Happy reading!

News

Updated NHS advice: Only use shop bought baby foods occasionally

Early in June we noticed that the Department of Health and Social Care (DHSC) have finally updated their advice for parents (i.e. the Better Health Start for Life webpages) on what to feed babies and young children to systematically make explicit that shop-bought baby and toddler foods should be avoided or minimised, and that healthy home-prepared foods are a better choice. This comes after a specific request we made to the chief nutritionist in May this year, and the sharing of suggested wording for each relevant webpage. We first asked for public facing advice to explicitly discourage the use of commercial baby/toddler foods in 2018 (see our baby food puree report) and then again in 2023 (see our UPF report). These changes are overdue given the position of the Scientific Advisory Committee on Nutrition (SACN) in their July 2023 guidance on feeding young children aged 1 to 5 years:

“Commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements”. (page 27)
“Home-prepared foods are generally recommended to help introduce infants and young children to a range of appropriate flavours and textures”. (page 37) (nb. this also appeared in the PHE 2019 commercial infant foods evidence review)

Key messages on shop-bought baby food pouches, jars, trays, pots and snacks include:

If you’re using them:
- Don’t do so every day (even as a snack) / only use occasionally. Swap them for simple mashed or finger foods
- Wait until 6 months even if the labels say use from 4 months
- And if your baby is under 12 months, don’t give them snacks at all
- And if you use pouches, don’t let baby suck from them as this increases risk of tooth decay
- Move on from purees/blended foods asap
- Avoid the biscuits, rusks, biscotti and melty snacks
- Choose the ones with the least sugar / avoid the ones with fruit and sweet veg
Preparing food at home is often healthier and cheaper than shop-bought food

Image from NHS Start For Life

“Restrict shop-bought baby food, government tells parents”, BBC news, 10 June.

“Don’t rely on shop-bought babyfood, government advises parents
This is the first time the NHS website has published advice on commercial babyfood”, The Grocer, 10 June.

“Do not rely on ready-made baby food, NHS tells parents”, The Times, 10 June.

Image credit: The Times

While the changes made are very much welcomed, we have made further suggestions for clarifying 1. The content on snacks and finger foods - to make clear that shop-bought “finger foods” are snacks, 2. The content on growing up and toddler milks - to make clear that they are not needed and may contain a lot of sugar, and 3. To make clear that the advice to choose lower sugar options includes those that are labelled ‘no added sugars’ and ‘contains naturally occurring sugars’. These suggestions draw on the findings of the paper by Rana Conway and colleagues summarised in last month’s newsletter, see here.

Lastly, our FREE, practical guide “Eating well: The First Year” is our most popular guide and provides all the information families need on preparing foods for babies at home. It uses lots of visuals to provide simple guidance on HOW to introduce solids and feed babies between the ages of 6 and 12 months and lots of ideas on WHAT too. You can download it for free or purchase a hard copy here.

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New paper: Commercial Baby Foods: Nutrition, Marketing and Motivations for Use - A Narrative Review

A new research paper by our nutrition officer Jasmine and colleagues at First Steps Nutrition Trust and the University of Glasgow was published on 2 July in Maternal and Child Nutrition. It summarises research on commercial baby foods published since 2019, when Public Health England (PHE) highlighted the need for action in its evidence review on commercial baby foods.

For context, in 2019, PHE found that young children were consuming diets that included too many snacks and were too high in salt and sugar. Additionally, they highlighted that appropriate home-prepared foods are preferred to commercial baby foods, which a lot of the time do not align with government advice on infant and child feeding or promote healthy diets. Their recommendations focused on

Improving commercial baby food nutrient composition by reducing sugar, particularly in snacks
Emphasising the need to limit misleading marketing practices, especially those contradicting public health recommendations for complementary feeding, and to reduce the use of nutrition claims and ‘health halo’ statements

The authors highlight the necessity to review newer emerging studies and assess progress following PHE's recommendations. The market is dynamic, and scrutiny of the nutritional composition and marketing strategies is necessary to ensure that recommendations are in line with the current retail offer.

In this review, 31 studies from the UK, Europe, Australia and New Zealand were separated into three topics and reviewed. The topics looked at were (1) Nutritional Composition, Flavour Profile and Texture, (2) Marketing and Labelling, and (3) Parental Choice and Preferences. The paper found that out of all products sampled, 56% were puréed and 18% were snacks. The median sugar content per 100 g was 10.4 g in purées, 20.3g in snacks, and 14.7g in cereals. Concerningly, nearly half of all products contained added or free sugars, and 62% when looking at snacks alone. Six out of nine studies had ‘no added sugar’ claims, and eight studies reported finding claims related to health or nutrition. All studies reported that health/development/nutrition were motivations to purchase commercial baby foods, and 75% mentioned ‘baby's enjoyment’, ‘convenience/time’, and ‘safety’.

In summary:

Commercial baby foods are often nutritionally inadequate and/or high in sugar.
Snack foods and squeeze pouches are readily available, often sweet, and lack textural variety.
Marketing claims are often misleading and exploit parents/carers' fears to motivate use.
Existing guidelines are not being utilised by baby food manufacturers.
Policies, regulations, and advice on CBF must be strengthened to improve complementary feeding practices and reduce the prevalence of poor health outcomes.

These findings are concerning as commercial baby foods can contribute to poor diets, which could impact long‐term taste preferences in infants and young children. Additionally, low‐quality diets for children under two are associated with an increased risk of obesity in later life and, in turn, type 2 diabetes, cardiovascular disease, and some types of cancer.

High‐quality guidelines already exist, such as the WHO's Nutrient Profile and Promotion Model, but these are not being utilised.

The wider policy recommendations from this narrative review are to:

Strengthen regulations in the UK and ensure that they are mandatory.
Ensure independent monitoring and enforcement of regulations.
Clarify NHS complementary feeding advice to include explicit guidance on commercial baby foods.

As we outline in our first news article, we are pleased that the NHS has recently updated its complementary feeding advice with guidance on commercial baby foods; however, these other steps remain necessary to enable parents/carers to make informed decisions about what foods to choose when feeding their infants and young children, in line with public health recommendations. Mandatory guidelines are essential as voluntary ones historically are ineffective. Improved diets in the infants would help to reduce the prevalence of obesity and non‐communicable diseases, therefore allowing children to grow up into healthy adults.

To coincide with the BBC Panorama documentary ‘The Truth on Baby Food Pouches’ which aired on 28 April, we wrote this briefing on commercial baby and toddler foods. It outlines our policy asks of the Government, which are in line with the recommendations of this research.

If you would like to see stronger, mandatory and properly enforced regulations, please consider writing to your MP. It takes less than 2 minutes to do this using Sustain’s template letter, which can be found here. The more people that write, the greater the chance of action.

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New paper: “Snack foods for babies: What is driving the increasing use of processed baby snack foods in the UK?”

A new study by Alexandra Rhodes from UCL and colleagues explored the drivers of using (ultra) processed baby snack foods. As we know, many commercial baby food age labels do not align with public health recommendations (e.g. snacks labelled ‘7 months +’ when snacks should not be given before 12 months), products are often high in free sugars and have soft and melty textures which do not aide development. The authors state that “snacking deserves attention given its contribution to overall diet quality and the importance of the early years for establishing future dietary behaviours”.

In this mixed methods study, in 2022, over 1,000 parents and carers of children aged 6-23 months took part in a nationally representative online survey. Additionally, 22 parents/carers living in London took part in focus group discussions.

Parents/carers were asked what age they first gave processed snack foods to their babies. A worrying 29.6% introduced these when their babies were under 6 months of age, and nearly 64.3% between 6 and 11 months. This suggests that processed snack foods are often some of the first foods that babies consume. While use between meals was most common, 50.6% were offering these products as a part of meals.

A large majority, 72%, of parents and carers were unaware that snacks should not be introduced before 12 months of age, and only 13.5% were aware of the public health recommendations to introduce healthy snacks after 12 months of age.

The focus group discussions yielded findings in 8 themes:

Giving baby foods is normalised and pervasive. They are given regularly, often daily basis especially out of home. Parents believed these products to be strictly regulated, and their positioning on the baby food aisle implies they are a good and safe choice. Labelling and a texture which is safe against choking determine age of introduction.
Snacks are not just for hunger, but also for distraction, entertainment, as treats and out of habit.
Baby snacks are more convenient than healthy snacks, especially out of the home, because of long shelf lives, resealable bags and less mess.
Baby snacks are chosen on the basis of what is believed to be best for baby/toddler, in terms of nutrition (less sugar, salt and additives than other snacks), development (self feeding) and safety (not a choking risk).
Brand communications (especially on social media) support baby snack choice, giving an image of being baby experts, especially when coupled with endorsement by a health or nutrition professional.
On pack health and nutrition claims (like ‘no additives’, ‘contains fruit/vegetables’, ‘natural ingredients’ and ‘no added sugar’), colours and images, and age labels also informed parents snack choices.
Peer group influence in real life and on social media influenced product choice, as well as toddler’s preferences.
Price promotions influence purchase, especially as these products are expensive.

Survey data indicate that the two most common reasons parents choose products relates to a belief that they are good for their child’s health or development. This is despite existing evidence which shows these products are less healthy than they claim to be.

Image credit: First Steps Nutrition Trust

Some extracts from discussion are as follows:

“The high trust in brands coupled with a belief that the baby food market is tightly regulated may suggest parents are being misled about the composition of products. The spurious nature of the ‘health halo’ surrounding baby snack foods has been highlighted before, … parents making choices regarding baby snack foods based on misleading information”.

The use of baby snacks for reasons other than hunger is a particular concern because “using food to soothe distressed babies has been shown to predict obesogenic eating behaviours and higher BMI in later childhood”.

“The textures and flavours of these products are more akin to processed snack foods than real foods and as such the normalisation of processed baby snacks may have problematic consequences for future taste preferences and eating habits”.

“The legitimisation of baby snack foods as an appropriate element of a baby’s diet is being driven by baby food manufacturers. By promoting these ‘finger foods’ as weaning foods and offering parents advice on weaning and recipe ideas the manufacturers are presenting themselves as baby feeding experts”.

To conclude, the study confirms that UK parents believe that processed baby snacks are a normal and healthy part of their children’s diets and that they offer benefits to their growth and development. This is primarily driven by brand communications and on-pack claims. The authors highlight that it is important to raise awareness of the health risks of using snacks for reasons other than satiating hunger, that brands should align their advice with public health recommendations and that products should not be presented as ‘nutritionist approved’. They call for greater transparency in communications and marketing, and stronger regulation, to help parents make more informed and healthier choices for their babies and toddlers. “Interventions targeting both individual behaviours and broader systemic influences are needed”.

As above, the public facing advice on commercial baby foods on NHS Better Health Start for Life was recently updated, reiterating babies under 12 months should not be given snacks and including new advice to avoid shop-bought biscuits, rusks, biscotti and melty snacks. This is very positive, though it may be that clearer messages on shop bought ‘finger foods’ are needed, so that parents are clear that these are also snacks and to be avoided. In addition, as the study authors suggest, new advice may also be needed on not using foods like shop-bought snacks for non-nutritive reasons like distraction, soothing and calming.

See our news piece above on our own baby foods paper, for more information on our policy asks and information about an e-action to call on your MP to support stronger regulations.

For FREE practical advice on feeding in the first year of life (avoiding snacks), and on healthy snacks for young children from the age of one, see our eating well guides:

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New paper: “Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years - summary of new NICE guidance”

This article published in the British Medical Journal (BMJ) on 26 June 2025, summarises select recommendations from the new National Institute for Health and Care Excellence (NICE) guideline on maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years, published in January this year. This guideline replaces the old NICE guideline on maternal and child nutrition (PH11) and the recommendations on weight management during pregnancy from the NICE guideline on weight management before, during, and after pregnancy (PH27).

The guideline is based on existing UK government advice (i.e. it was not within scope of the guideline development to amend pre-existing government advice), and it aims to improve the uptake of this advice in practice. It is aimed at all healthcare workers (including midwives, health visitors, general practitioners, and paediatricians) who work with pregnant women and parents/carers of babies and young children, and is also relevant to others such as commissioners and those working in early years education and care.

The BMJ article covers the recommendations on: folic acid supplementation in pregnancy; vitamin supplementation in pregnancy and while breastfeeding; micronutrient supplementation in infancy and childhood; healthy eating and weight management in pregnancy; infant feeding; complementary feeding, and healthy eating from 1 to 5 years. Each section outlines the core recommendations, gives information on the source and strength of the evidence behind them and is illustrated by useful infographics (which we unfortunately can’t share here due to copyright).

Emphasised throughout is the need to use non-commercial information sources, making our Eating Well guides and infant feeding resources (including our www.infantmilkinfo.org website for health workers) relevant.

If you have a BMJ subscription, read the article here.

Access the NICE Maternal and Child Nutrition guidelines here.

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New National Diet and Nutrition Survey (NDNS) data 2019-2023: Focus on 1.5-3 year olds

The NDNS provides evidence on the diet and nutrition of the UK population to help identify and address nutritional issues in the population, and monitor progress towards public health nutrition objectives. It is designed to assess the diet, nutrient intake and nutritional status of the general UK population. Participants aged 18 months and over living in private households are selected each year from all 4 UK countries and the sample is nationally representative. The results are presented for 7 standard NDNS age groups, the youngest of which is 1.5 to 3 years. This report provides a summary of key findings for the population as a whole, with mention of specific results by age group. In this newsletter piece, we pick out findings for the age group 1.5 to 3 years and contextualise them in the wider findings.

To start, it may be useful to note that among 1.5-10 year olds, data from 2023 indicate that 92% eat meat and fish and do not have any dietary restrictions. Only 2% are vegetarian, 2% eat mainly vegetarian or vegan diets, 1% are pescatarian and 3% reported a religious restriction. 0% were vegan. And for the same age group and year, 77% are highly food secure, 11% marginally food secure and 11% low/very low food security.

Selected foods and drinks

Fruit and vegetables
While most participants did not meet the UK government recommendation to eat at least 5 X 80g portions of a variety of fruit and vegetables each day, consumption by young children is reasonable. Mean daily intakes are 227±107g, which is 5.7±2.7 based on 40g portions, or 4.5±2.7 based on 50g portions (noting there is no agreed portion size for children). This comprises more fruit than veg (and so more sugar) but only a small proportion is dried or processed.

Red and processed meat
The UK government recommends that people who eat more than 90g of red or processed meat a day should cut down to 70g. In 2019 to 2023, average consumption of red and processed meat was below 70g per day in all age and sex groups. Young children aged 1.5-3 years consumed a mean daily intake of 27±17g red and processed meat, 18±17g white meat, and a total of 47±28g. In our portion size guide, we recommend around 40g for meat for 1-to-under 5 year olds, and red and processed meat should be consumed sparingly. With that in mind these amounts could be viewed to be on the the high side from the perspective that they suggest a large portion size of meat being consumed daily, when more plant-source foods could be an option.

Drinks
The highest average consumption of sugar-sweetened soft drinks was by children aged 11 to 18 years (124mls (131g)/day). Average consumption by younger children (4 to 10 years) was under half this amount (54mls (60g)/day). However, the youngest children aged 1.5-3 years still consumed 40±149g/day. Considering only consumers (the other figures are population averages), this average is much higher at 181±83g/day.

Figures for soft drinks with no added sugar are even higher, at 169±271g/day for 1.5-3 year olds, or among the 54% consumers 313±198g/day. This is higher than teenagers (11-18 year olds: 153±235g/day, 53% consumers 287±202g/day). A proportion of these drinks will contain non-sugar sweeteners, which are meant to be avoided by young children.

Levels of fruit juices and smoothie consumption are also concerning given their high free sugar contents, at 43±86g/day for 1.5-3 year olds, or among the 37% consumers 117±83g/day.

These figures are concerning because young children should be drinking water or milk. Sugary drinks drive excess energy intake, weight gain and dental decay, and sweetened drinks can cause dental erosion if they contain acids, and encourage sweet preference.

Other
Other interesting findings from the report with respect to 1-5-3 year olds include that 3% still consume a formula milk (unnecessarily), 14% consume commercial baby and toddler foods and 9% consume plant-based milk alternatives. Free sugar levels in toddler and growing up milks and commercial baby foods are a concern and avoidable. Plant-based milk alternatives are not nutritionally equivalent to cows’ milk and need to be chosen with care for young children.

Energy and nutrient intakes
The Estimated Average Requirement (EAR) for energy is the amount of calories that will meet the needs of about half the general population. The EAR varies by age and sex. Average energy intakes were below the EAR (likely due to underreporting), with the exception of 1.5 to 3 year olds.

Saturated fats
The UK government recommends that, from the age of 2 years, no more than 10% of energy comes from saturated fats. For 2019 to 2023, average intakes exceeded the recommendation, including for 1.5 to 3 year olds, for whom saturated fats provided 13.5±3.1% of energy, compared to 12.6% for adults.

Free sugars
The UK government recommends that, from the age of 1 year, no more than 5% of energy comes from free sugars. Average intakes were 8.1±4.4% for 1.5 to 3 year olds, compared to 10% for adults. Top food sources for 1.5 to 3 year olds (showing food types which could benefit from reformulation and/or where we need consumption to be reduced / parents need to be enabled to access less sugary options) were: fruit and veg juice and smoothies (12%), breakfast cereals (9%), yoghurts, fromage frais and dairy desserts (9%), biscuits (8%), buns/cakes/pastries/fruit pies (8%) and sugars/preserves/sweet spreads (8%).

Fibre
Most people do not meet UK government fibre recommendations (at least 30g per day for adults and 15-25g per day for children depending on their age, 15g for 1.5-3 year olds). 78% of 1.5-3 year olds and 86% of 4-10 year olds did not meet the recommendation for their age group; 1.5-3 year olds consumed 12.5±3.7g fibre on average.

Nutritional status
While 10% of 4-10 year olds had low vitamin D status, there was no new data for 1.5-3 year olds and no new data for folate or iodine (which are more of a concern for other age groups anyway).

Dietary inequalities
Participants in higher income households in 2019 to 2023 were closer to meeting some dietary recommendations. However, where diets failed to meet recommendations, this was consistent across the range of incomes.

There was a slight increase in intake of fruit and vegetables with increasing income for all age and sex groups. Fibre intake also increased, on average, with increasing income across all age and sex groups.

There was little variation in energy (calorie) intakes by income for most population groups. This was largely also the case for percentage energy from free sugars. Looking at equivalised index of multiple deprivation (EIMD) for England, for all age groups, mean free sugars intake exceeded the recommendation of no more than 5% of energy across quintiles. However, in all age groups, mean intake of free sugars as a percentage of energy was highest in the most deprived EIMD quintile.

There was a downward trend in quantities of sugar-sweetened soft drinks being consumed with increasing income among 1.5-3 year olds, whereas for most age and sex groups, the percentage of consumers of buns, cakes and pastries increased with increasing household income and the largest increases were seen among 1.5-3-year-olds.

Folate status (RBC folate concentration) of women of childbearing age (16 to 49 years) tended to increase with increasing income. No association was seen for other population groups.

Food and drinks from the out of home sector
Almost three-quarters (72%) of participants reported buying food or drink out of home (e.g. cafes, pubs, takeaways) in the last 7 days, with most making purchases 1 to 2 times a week. 61% purchased for 1.5-3 year olds; 39% purchasing drinks, 32% lunch, 31% snacks, and 24% dinner, at least once, mostly from cafes/delis (15%), fast food/takeaways (15%), canteens at work or place of study (13%) and restaurants/pubs (11%). A total of 7% of eating events were out of home, though these contributed 18% to energy and 19% to free sugars. This indicates that what is available out of home for young children is not nutritionally balanced and contributes disproportionately to energy and free sugar intakes.

Summary
To summarise, this latest NDNS data show that average diets for young children aged 1.5-3 years are sub optimal with some inequalities; overall they consume too much energy, from excess free sugars (from foods and drinks that are too sweet and often discretionary) and diets containing too much saturated fat and too little fibre. Foods and drinks purchased out of home contribute disproportionately to energy and free sugar intakes. Levels of consumption of unnecessary artificially sweetened drinks are also likely to be high.

Policy actions to improve the wider food environment, such as this week’s announcement of mandatory health targets for supermarkets have the potential to support improvements in young children’s diets. However, much more needs to be done to enable families -especially those on the lowest incomes - to feed their children nutritious diets based on minimally processed foods, starting from infancy. This includes strengthening the Healthy Start scheme, strengthening and enforcing regulations on composition and marketing of commercial baby foods and marketing of formula milks, ensuring support for parents through a properly resourced health visiting service, and more. A summary of our policy asks healthy early years diets can be found here.

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New report: Grocer focus on infant and childcare

Last month, the Grocer published its regular market report on baby products including formula milks and baby foods. Its title ‘Have the big baby brands lost their way?’ reflects the scrutiny that the sector has been under in the media in recent months – largely due to the CMA’s Infant and Follow on Market study and the BBC’s Panorama, ‘The Truth about Baby Food Pouches’.

Image credits above and below: The Grocer

Using Kantar data from January 2024, the report looks at retail sales value of different product categories. It reports that the ‘baby milk’ (i.e., infant and follow on formulas and growing up milks) category is up 3.7%, baby foods 3.5%, but baby ‘finger foods’ (i.e., snacks) a massive 11% (read more about why this is problematic in our newsletter piece above.

When analysing brand data from March 2024, the Grocer shares that Organix and Kiddilicious have seen the value of retail sales grow 9.2% and 8.4% respectively, while Ella’s Kitchen, Heinz and Hipp have all seen a decline.

This data suggests some changes in brand loyalty that could be influenced by the types of products they are selling and their brand communications, e.g. where brands are marketing baby snacks which parents/carers still believe are healthy options for young babies (read our newsletter piece above).

We continue to call for stronger, mandatory and properly enforced regulations on commercial baby foods and for the Government to accept the Competition and Market Authority (CMA)’s 11 recommendations to improve the baby formula industry. Our position on baby foods can be found here, and on the CMA’s formula market recommendations can be found here.

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New paper: “Association of low-calorie sweetened product consumption and intakes of free sugar and ultra-processed foods in UK children: a national study from 2008 to 2019”.

Seesen and colleagues published this insightful paper in the European Journal of Nutrition on 26 June.

This study examined the trends and associations between the consumption of LCS (low-and no-calorie sweetened) foods and drinks and intakes of sugar, total energy, water, and ultra-processed food (UPFs) in UK children aged 4–18 years, using nationally representative dietary survey data (from the NDNS) collected between 2008 and 2019.

The context is that efforts to reduce free sugar intakes have promoted the consumption of LCS, including in children; both directly (e.g. through advising healthier food swaps from high sugar to low sugar products with LCS) and indirectly (e.g. through the soft drinks industry levy leading to greater sales of LCS soft drinks). There is a mixed evidence base on LCS and health, which includes evidence of harm (see our May newsletter piece on the latest SACN position on non-sugar sweeteners), but at the same time little is known about how LCS consumption is associated with children’s diet quality more broadly.

In this study, children (median age 10 years old in 2008-09) were assigned a group based on their LCS consumption as analysed from 4 day diet recall data – no LCS, low, mid and high LCS consumption.

Results included:

A large proportion of children consumed LCS products in 2008–2009 – 70.4%, mean 256.5g/d - and this level of consumption did not change over time.
Children in the high LCS product consumption group had lower intakes of water and other drinks compared with non-consumers. Also, though water intakes increased over time for all children, the increase was less for high LCS consumers. These findings suggest that LCS drinks displace water.
High LCS children also had lower sugar intakes in 2008–2009 compared with non-consumers, but this difference was less after 11 years. Also, whether no, low or high LCS, all children were consuming too much free sugars, and although intakes have decreased over time (and more for no/low LCS), they are still far above the recommended maximum of 5% Total Dietary Energy Intake from free sugars recommended by SACN).
There was a greater decline in the total energy intake among children with the highest LCS product consumption compared with non-consumers.
All LCS consumption groups had similar declines in the consumption of UPF over the study period, except for the high-LCS group whose decline was less pronounced.

The authors highlight that the diminishing difference in free-sugar intake between the high LCS and no LCS groups by 2018–2019 raises the question of whether the promotion of LCS as alternatives to sugar-sweetened products is an effective public health strategy to reduce free sugar intake in children and improve overall dietary patterns. They also highlight that LCS products may be key components of an UPF dietary pattern and state “Health policies aimed at improving children’s diets [need] to sufficiently consider the evidence and debate on the health risks and benefits of LCS products”. They share a view that the substitution of sugar sweetened drinks with those containing LCS may present a missed opportunity to increase water consumption in children. Lastly, they stress the need for more comprehensive consideration of dietary patterns, beyond individual nutrients.

It is timely that in April, SACN published a statement on the WHO guideline on non-sugar sweeteners, and recommended that their intake be minimised (see our May newsletter). More specifically,

For younger children, SACN recommends:
- not giving them drinks sweetened with sugar or non-sugar sweeteners
- giving them unsweetened food (not sweetened with either sugar or non-sugar sweeteners)
For older children and adults, SACN recommends:
- swapping sugars for non-sugar sweeteners may help reduce sugar intake from foods and drinks (and so reduce energy intake), at least in the short term - the long-term goal is to limit both sugar and non-sugar sweeteners intake

A key question remains HOW these changes can be enabled given the pervasiveness of non-sugar sweeteners in our food supply. Watch this space for an update of our 2019 report on sweeteners in the diets of young children in the UK, including updated policy recommendations.

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New: Start for Life Early Years newsletter

On 27 June 2025, the Partnerships Team from the Department of Health and Social Care (DHSC) launched a new Start for Life Early Years newsletter. This monthly newsletter will highlight a topic or campaign within the early years, and share the free resources available from the DHSC Campaign Resource Centre and beyond. This service aims to provide partners with campaign tips, communications messaging, statistics and case studies to support their work.

The first, June 2025, newsletter featured the Better Health Start for Life campaign including the following topics: Breastfeeding, Introducing Solid Foods, Parent-Infant Relationships, Top Tips for Teeth and more. Examples of resources available are: A4 and A3 posters, leaflets, digital screens, editorial content, guides, social media toolkits and much more.

To sign up to receive these newsletters, you will need to create an account on the Campaign Resource Centre and can then elect to sign up to receive emails, and choose which topics are relevant to you.

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New: Scotland’s new Breastfeeding and Infant Feeding Strategic Framework (2025-2030)

On 9 June 2025, the Children and Families Directorate of the Scottish Government published Scotland’s Breastfeeding and Infant Feeding Strategic Framework (2025-2030) including a Road Map and Delivery Plan. This comprehensive document describes the national actions on how pregnant women, mothers and new parents in Scotland will be supported on their infant feeding journeys, as well as how Scotland plans to continue to reduce breastfeeding inequalities and improve experiences, all informed by evidence of what works in Scotland. The strategic framework outlines Scotland’s commitment to improving breastfeeding and infant feeding practices from 2025 to 2030, through evidence-based actions and policies, emphasising the importance of support for diverse families. The strategic framework includes a vision and 6 strategic goals with corresponding objectives, outcomes and measures for each goal.

This is a valuable resource with up-to-date information and content on breastfeeding and infant feeding support. While this strategic framework has been specifically developed for Scotland, it contains content and resources that can be applied to other contexts as well.

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Infant milk news

New: Infant formula cost data by retailer, from the Food Foundation

The Food Foundation has published its new infant formula cost data ahead of the overdue Government response to the Competition and Markets Authority (CMA) Infant and Follow-on Formula Market Study and recommendations. The data shows that first infant formula prices remain high, and the most expensive brand is still twice the price of the cheapest formula.

There were some positive reductions in the cost of first infant formula:

Cow and Gate and Aptamil 1 prices were reduced in Tesco’s, Sainsbury’s and ASDA, in April to May 2025.

Aldi pledged to freeze the price of its Mamia First Infant Formula for the remainder of 2025 since June.

However, they show that SMA Little Steps increased in some retailers and reduced in others.

In November 2024, Ocado reduced the price of SMA Little Steps from £9.75 to £7.95, bringing the price in line with other major retailers at the time.

In May to June 2025 both ASDA and Morrison’s increased the price of Little Steps from £7.95 to £8.40 and £8.43 respectively.

All seven other major retailers sampled sell the Little Steps 800g tin for £7.99.

Image credit: The Food Foundation

Table 1: First Infant Milk Formula 800g tin prices, June 2025 Ranking cheapest (green) and most expensive (orange) retailers for each brand, and price changes since October 2024 (in brackets and coloured text)

Reflecting The Food Foundation’s findings, our latest  infant formula cost trend analysis in May showed that prices have remained high and static. Despite already being the cheapest on the market, Aldi (Mamia) and Lidl (Lupilu) brought the price of both their own-brand products down a further 10p, to £6.99 a tin, while Boots brought down the cost of SMA Little Steps from £9.75 to £7.95 to align with the price at most other retailers.

While the average cost of branded infant formula is currently £13.49/tin, the range is £7.95 to £18.00. This compares to £6.99 for supermarket own-brand infant formula. 

There are just four first infant formula (including Aldi and Lidl own-brand products) that are affordable under the Healthy Start scheme that provides £8.50 per week to eligible families with children under the age of one.

The Food Foundation, like us, is calling on the Government to accept all 11 of the recommendations made by the CMA, and to increase the value of the Healthy Start scheme weekly payments in line with inflation and ensure the value continues to be index-linked and expand eligibility so more families benefit from the support. This would increase infant formula accessibility as well as supporting breastfeeding. Our view is that the Government should also consider price controls, especially profit margin caps, to improve infant formula affordability, bringing infant formula prices down in the short term and sustainably.

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New Infographic: Rice-based formulas

After an increasing number of queries about rice-based formula milks (including ‘Sprout’ vegan formula from Australia, and ‘Arize’, a new FSMP on the UK market), we have created this new infographic:

Two key points:

'Arize' is plant-based but not vegan. As it is an FSMP, it should only be used under medical supervision and is intended for infants with diagnosed cows’ milk allergy.
‘Sprout’ does NOT meet UK/European regulations for infant formula composition in a number of ways, which means we would not endorse its use.

You can find out more about both products in our FAQ ‘what rice-based formula milks are available and are they recommended?’ here.

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

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Baby Feeding Law Group UK News

WBTi UK 2024 report parliamentary launch

On 24 June 2025, the World Breastfeeding Trends Initiative UK 2024 report was launched in parliament, by a well-attended event hosted by Jess Brown-Fuller, MP. The evening was chaired by journalist Kate Quilton and included presentations by Helen Gray (from the WBTi UK Steering Group), Prof Nigel Rollins (Queens University, Belfast and previously with the WHO Department of Maternal, Newborn, Child and Adolescent Health and Ageing) and Prof Amy Brown (Professor of Maternal and Child Health at Swansea University).

The event included critical discussions of the current challenges surrounding breastfeeding and infant feeding families in the UK are experiencing, together with recommendations that could help support families. The many gaps include a lack of an integrated infant feeding strategy, insufficient and wholly inadequately funded breastfeeding support together with weak regulations which currently allow rampant marketing of formula milks, and excessively high prices and profiteering by formula companies.

Image credit: from WBTi UK

The clear call to action from the event was for the UK and all devolved governments fully implement the recent recommendations from the Competition and Markets Authority (CMA) infant formula and follow-on formula market study.

The British Medical Journal (BMJ) published a news piece about the WBTi UK parliamentary launch, Formula milk: Overpriced and misleading products are risking child health, say campaigners. This BMJ piece reiterates the need for government action to protect families against the current high prices and misleading marketing of infant formula products that are exploiting parents and risking children’s health, due to weak regulations.

We eagerly await the formal government response to the CMA report.

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Infant Feeding Adjournment debate

On Tuesday 1 July 2025, Jess Brown-Fuller, MP, led an Adjournment debate on Infant feeding in the House of Commons. The link to the video of the debate is available here and the transcript is here. The speech covered many important issues over a short space of time, using a combination of evidence, reports, statistics together with local examples, personal stories and lived experience. A total of 7 different MPs (from across different political parties and including 5 men) spoke through interventions, providing constructive, relevant and timely messaging that complemented Jess’s speech. The response from Ashley Dalton, as the Parliamentary Under-Secretary of State for Public Health and Prevention, was quite comprehensive in acknowledging the issues, while repeating familiar messages from the Department of Health and Social Care. Minister Dalton confirmed that the NHS 10-year Plan will be launched on Thursday 3 July 2025, and we eagerly await this, and any commitments to protecting and improving the diets of babies and young children.

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Forthcoming

Webinar: Findings of the study: Maternal wellbeing, infant feeding and return to paid work. 16 July, 1pm, online

Professor Sarah Jewell and colleagues are hosting a special online event launching the findings of their “Maternal Wellbeing, Infant Feeding and Return to Paid Work” study funded by the Nuffield Foundation. This one-hour webinar will share key insights from the study, introduce their toolkits for parents and employers, and offer a space for interactive discussion about how workplaces can better support mothers returning to paid work while breastfeeding.

Find out more and register here.

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World Breastfeeding Week, 1 - 7 August

Each year, the World Alliance for Breastfeeding Action creates a theme and resources for World Breastfeeding Week (WBW), which takes place from 1-7 August. For WBW 2025, the global theme is Prioritise Breastfeeding: Create sustainable support systems. This theme focuses on environment and climate change, by highlighting our roles in supporting breastfeeding to create a sustainable environment while simultaneously reducing the climate-related impacts of formula feeding. This can include highlighting that breastfeeding is a natural, renewable food that is environmentally safe, produced and delivered without pollution, packaging or waste and is a sustainable way of feeding infants that is good for the planet and its people. We can also create awareness around the carbon and water footprints associated with consumption of commercial milk formula, as can be measured through the Green Feeding Climate Action Tool.

The WBW 2025 website contains a wealth of resources, including the following (which are available in multiple languages):

The official Logo
A Poster, summarising the objectives and key actions
A Social media kit 2025

The WBW 2025 website contains links to various WBW social media accounts that can be followed, including Facebook, X/Twitter, Instagram and a YouTube channel.

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Unicef UK Baby Friendly Initiative Conference, 12 – 13 November, Telford

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June 2025

Image by Bearfotos on Freepik

Welcome to the June edition of our newsletter – contents below.

Can you support us with a donation?

Thank you!

News

New report: ‘The Whole Truth’ by the Soil Association
New report: ‘Boosting early years nutrition to support a healthy childhood’ by the Food Foundation
Update: Development of the National Food Strategy
New report: ‘Meat Facts’ by the Food Foundation
New paper: Packed Lunch Provision and Consumption in Early Years Settings in Sheffield: A Cross-Sectional Study
New guidance: Early Years Foundation Stage nutrition guidance: Guidance for group and school-based providers and childminders in England
New paper: Estimating the Impact on Parents’ Infant Feeding Choices of Increasing Age Guidance and Adding Sugar Warning Labels to Commercial Infant Foods: A Mixed-Methods Study

Infant milk news

Updated: Costs of infant formula, follow-on formula and milks marketed as foods for special medical purposes available over the counter in the UK, and infant formula trends analysis
Updated: Infant milk costs infographics
Infant formula costs in the news

BFLG-UK news

New World Health Assembly resolution: Regulating the digital marketing of breastmilk substitutes

Forthcoming

Webinar: Evaluation of the Healthy Start Scheme, 24 June
Webinar: www.infantmilkinfo.org, 25 June

Happy reading!

News

New report: ‘The Whole Truth’ by the Soil Association

The Soil Association published this new report on 19 May to mark the launch of their new campaign calling on Government to ‘tell the whole truth’ about ultra-processed foods. More specifically, they call on Government to “resist the influence of the ultra-processed food industry and make minimally processed food accessible to all” as part of its new national Food Strategy (see more on this below). This call is based on the shocking findings of their investigation into UPF industry lobbying and its impact on health policy, which was covered in the Guardian. In short, the DHSC had planned to encourage retailers to shift the balance of price promotions towards “minimally processed foods” - which includes fruit, vegetables, beans, whole grains like rice and pasta, and unprocessed meat. But industry lobbyists, representing the UK's biggest UPF companies, demanded this advice was removed from the guidance issued to retailers, despite overwhelming scientific evidence that minimally processed and whole foods are crucial for a healthy diet. This video provides a summary of the investigation and its findings.

Around two thirds of the average child’s energy intake between the ages of 2 and 5 is from UPFs, so many children are not exposed to the varying tastes and textures from whole, minimally processed foods. The Soil Association calls for the food system to be ‘re-wired’ so that healthy food is prioritised. It discusses how UK public health messaging lacks guidance on UPFs, whilst a growing number of countries promote non-ultra processed foods. For example, despite NHS Professionals recommending that its employees eat “natural, unprocessed or minimally processed food that is as close to its original form as possible” this advice has not been extended to the public by the NHS. Other recommendations include strengthening the Healthy Start scheme and fiscal measures for the Soft Drinks Industry Levy to support increasing whole and minimally processed food consumption.

UPFs dominate the diets of babies and young children, with short- and long-term negative health implications, including on weight status (see our pre-recorded key note lecture outlining the evidence on this here). The Government must act now to re-balance early years’ diets towards minimally processed and whole foods. For more information, our 2023 policy report highlights our stance on UPFs and recommendations to Government, which are coherent with those of the Soil Association.

To support ‘the Whole Truth’ campaign, sign and share this petition.

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***New report: ‘*Boosting early years nutrition to support a healthy childhood’ by the Food Foundation**

The Food Foundation launched this last report in their three-part series on early years nutrition, in parliament on the 14 May. It looks at diets and health of 1- to 5-year-olds, with a focus on commercial baby and toddler foods and food provision in early years settings. It highlights challenges and barriers to providing nutritious diets at home and in settings, drawing on existing research and reports (including those from First Steps Nutrition Trust) and case studies and new research and insights. These inform policy recommendations and a call to action, summarised below.

Section 1 highlights how average early years’ diets are poor across the board (too high in sugar, saturated fat and salt, too low in fibre, iron and zinc), with significant dietary and health outcome inequalities meaning children in the poorest families have higher levels of overweight, obesity and dental decay.

Section 2 outlines some of the key factors which shape access to heathy and affordable food in the early years, being led by the views of surveyed parents. Affordability and high prices of healthy foods are a key concern, and the report highlights issues with ‘free early years meals’ as well as the Healthy Start scheme, with new analysis of the latter by Imperial College as shown.

Another concern is the ubiquity and strong appeal of less healthy foods in retail settings, including commercial baby and toddler foods and discretionary growing up and toddler milks.

The last set of concerns are issues with food in childcare settings, including packed lunches which lack necessary nutrition and include lots of packaged foods, and the barriers settings experience trying to provide nutritious meals and snacks.

Section 3 outlines four recommendations to give all children the best start in life:

1. Strengthen existing nutritional safety nets (i.e., Early Years Free Meals and Healthy Start) so that they effectively support families on a low income
2. Strengthen standards on the marketing and nutritional quality of commercial milk formula and foods
3. Support early years settings to deliver nutritious food for all young children
4. Improve the incentives in the wider food system, to help deliver better nutrition for all ages

The concluding call to action is “for the government to ensure that health and nutrition policies take a life-course approach and include attention to the specific needs of the under 5s”.

The recommendations above should be considered in the context of the summary of all of the policy recommendations made across the three reports in this series, which are available here, with a powerful foreword by the Food Foundation's Food Ambassador, mother and grandmother, Kathleen Kerridge.

The Food Foundation has incorporated First Steps Nutrition Trust reports and analyses into this work and our Director, Vicky, advised on all three reports. We strongly endorse the Food Foundation’s recommendations, which have been influenced by our own.

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Update: Development of the National Food Strategy

Late last year DEFRA announced its intention to create a National Food Strategy, and to do so with cross government input and in consultation with key stakeholders. This blog by Glen Tarman, Director of Policy and Advocacy at Sustain, provides a great summary of the process so far, concerns and next steps: Where are we now with the development of the UK Food Strategy, and what comes next? | Sustain.

We at First Steps Nutrition Trust have been engaging with the process and attended a stakeholder workshop in London in May. We share the concerns outlined by Greg and have been working hard to call for the National Food Strategy to take a life cycle approach and ensure focused attention to the early years, especially babies, but also pregnant women and young children. We have done a lot of work in the space in the past, and are urging DEFRA officials to take this into account. Read more in our briefings below.

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New report: ‘Meat Facts’ by the Food Foundation

This new report by Rebecca Tobi and colleagues at the Food Foundation, explores questions around how much meat we should be eating and what type, to avert the dual public health and environmental crisis that will arise from our current meat consumption habits in the UK.

The report reveals that the UK eats twice as much meat as the global average, a third of the meat children consume is from processed meats, such as sausages and chicken goujons, and nearly 10 percent is from meat on pizzas. The figures on processed meats are concerning, as there is strong evidence that links processed meat overconsumption and increased risk of developing chronic diseases, including bowel cancer. However, globally, evidence suggests that animal-based foods can support normal growth in children in low and middle-income countries, and meat can form part of a healthy and balanced diet.

The Food Foundation recommends that the Government should implement limits or remove processed meats from settings such as schools, where processed meat is regularly served. Wider recommendations for policy makers include support for increased fruit, vegetable, beans and pulse consumption via an improved horticultural sector, and introduction of mandatory reporting for large food businesses on animal vs plant protein sales.

These findings reflect those in a report published by Eating Better in 2023, called ‘It’s time to act on processed meat’, highlighting the health and environmental concerns related to eating processed meat. Our accompanying blog post explored concerns for processed meats in the diets of babies and young children. Processed meat does not offer the same health benefits as minimally processed meat, which can be an important source of iron, protein, zinc and vitamin C. High salt content in processed meat is of particular concern due to increased risk of high blood pressure later in life.

We support the Food Foundation and Eating Better’s calls for a reduction in processed meat consumption in the UK, particularly in the diets of babies and young children.

For inspiration and practical guidance on how to provide babies and young children diets based on minimally processed foods, see our 'Eating Well' resources. For plant-based recipes suitable for vegans and all infants and young children, see ‘Eating Well: Vegan Infants and Under 5s’.

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New paper: Packed Lunch Provision and Consumption in Early Years Settings in Sheffield: A Cross-Sectional Study

This paper by Jo Pearce and Claire Wall from Sheffield Hallam University examined packed lunches of 3–4-year-olds in early years settings. The observational research looked at nutrient composition, food type, cost and level of processing for 185 packed lunches eaten by 67 children over 5 days in 8 separate early years settings in Sheffield.

The analysis found that although more than 75% of packed lunches contained fruit, just under 40% contained vegetables. What is more, 40% of lunches contained pre-packaged foods and over 65% of overall energy intake was from ultra processed foods. A concerning 65% of packed lunches in more deprived areas contained chocolate or confectionery. Many lunches offered excess energy, fat, saturated fat, free sugars and sodium. In areas with higher deprivation, lunches contained more free sugars, less fibre and vitamin C. The cost analysis found that lunches cost an average of £1.26, with no differences between area deprivation, and that healthier lunches were cheaper. Children left around 20% of the food provided by their packed lunch, i.e. it seems the provided portion sizes were larger than needed.

This research reflects findings from the ‘Nourishing our Futures’ conference report that found parents in Essex provided lunches often contained more processed foods than those provided in early years settings.

These findings are concerning for many reasons, including that most 3-4 year olds attend settings, that levels of overweight/obesity and dental decay are high from these young ages, and that the Department of Education has recently clarified that settings cannot charge for food and yet the sector is seriously underfunded (read more on this here).

The Department of Education has just published new guidance: Early Years Foundation Stage nutrition guidance: Guidance for group and school-based providers and childminders in England (see below). For additional practical guidance on eating well in infancy and between 1 and under 5 years of age suitable for use in early years settings, see our 'Eating Well' resources. Our ‘Packed lunches for 1-to-under-5-year olds’ resource may be particularly useful for settings to share with parents.

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New guidance: Early Years Foundation Stage nutrition guidance: Guidance for group and school-based providers and childminders in England

In April, the Department for Education published this new guidance, with a new requirement in the Early Years Foundation Stage (EYFS) statutory framework that early years providers ‘should’ have regard to the new nutrition guidance from September 2025. It supports the pre-existing requirement: “Where children are provided with meals, snacks and drinks, these must be healthy, balanced and nutritious”. On the 30^th of May, the guidance was updated to read “providers must take this guidance into account and follow it unless there is good reason not to”.

We at First Steps Nutrition Trust provided feedback on the draft version of this guidance, through our participation in the Bremner and co-led working group focused on food provision in early years settings. We are pleased to see many of our suggestions accepted.

The guidance is applicable to all early years settings providing care for 0–5-year-olds, and is split into sections on the first year, then 1-5s. It covers food allergies and intolerances, cost-effective healthy food, and planning food activities with children. Of note (with thanks to Dayna Brackley of Bremner and Co), there is welcome content:

On food texture, and the importance of offering appropriately textured food to support babies’ development
On foods/drinks to provide, limit and avoid
Which aligns with School Food Standards
Including example meals and snacks, instead of more prescriptive model menus as advised in the past
Encouraging settings to create food and nutrition policies
Covering meeting the needs of all children, including those with special educational needs, religious or cultural dietary requirements as well as allergies
Including clear and explicit advice on formula in line with latest government guidance, including that formula is not needed after 1
Signposting to Health Start and Free School Meals
Acknowledging that packed lunches are common (as recent work done in Sheffield and Essex indicates, see above), encouraging settings to support healthy choices.

The guidance cross references other government information sources.
It may be useful to note that our 'Eating Well' resources are widely used by settings and are available free to access here.

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New paper: Estimating the Impact on Parents’ Infant Feeding Choices of Increasing Age Guidance and Adding Sugar Warning Labels to Commercial Infant Foods: A Mixed-Methods Study

This paper by Rana Conway and colleagues at UCL investigated the impact of increasing age guidance on commercial baby foods and adding sugar warnings, on UK parents’ product choices. As we know, many commercial baby food age labels do not align with public health recommendations (e.g. pouches labelled ‘4 months +’ and snacks labelled ‘7 months +’, when first foods should not be introduced until around 6 months and snacks should not be given before 12 months) and products are often high in free sugars. It has also been shown previously that parents believe that there are strict regulations which means they can trust products in the baby food aisle are healthy and appropriate.

In this study, over 1,000 parents and carers of children aged 6-23 months took part in an online survey. Additionally, 22 participants took part in focus group discussions.

When asked to imagine they were buying for a 5-month-old baby, similar numbers of participants selected products labelled ‘6 months+’ as they did for ‘4 months+’, but fewer chose snacks labelled ’12 months+’ compared with ‘6 months+’. Nearly 30% fewer participants chose commercial baby food desserts containing sugar warning labels than desserts without. There were no differences by income, occupation, or education.

Participants thought that the age labels on products and their wide availability meant they were recommended. Parents felt labels were misleading and wanted age guidance on labels to align with government recommendations.

Both survey and focus group participants trusted that commercial baby foods were low in sugar, and that those with younger age labels would have especially low levels. There was also a widespread belief that natural sugars were not unhealthy. Focus group interviewees strongly supported the introduction of sugar warning labels.

Only 13.5% of survey respondents were aware of the public health recommendation that snacks should only be introduced after 12 months of age, and there was widespread confusion of what constitutes a snack. Melty textures and utility for self-feeding made interviewees feel that snacks were suitable for young babies, and providing infants under 12 months with multiple daily snacks was the norm. Participants were confused by inconsistent messaging, particularly that commercial baby foods are labelled as ‘finger foods’ rather than ‘snacks’, when the NHS advises that finger foods should be given from early on in complementary feeding whereas snacks should not be given from 12 months.

Image credit: First Steps Nutrition Trust

These findings highlight how parents’ misplaced trust in the baby food industry and unchecked misleading marketing, is leading them to choose commercial baby food products which are not age appropriate and which are high in free sugars. But importantly, it also shows that there are acceptable solutions which could change behaviours for the better, across socio-economic groups:

Ensuring minimum age guidance of 6 months + on commercial baby foods and 12 months + on commercial baby snacks could shift feeding behaviours toward closer alignment with government feeding advice.
Adding front of pack sugar warning labels and removing “contains natural sugar” could support a reduction in sugar intake.

The authors highlight how sugar warning labels are recommended in the WHO Europe Nutrient and Promotion Profile Model (which we advocate is used as a basis of updated UK baby food regulations), alongside removal of claims and health halo statements such as ‘no added sugar’. They state that sugar warning labels have been shown to discourage consumption of high sugar foods in South America, and that meta analyses show that warning labels are more effective than traffic light labels in discouraging unhealthy purchasing behaviour.

Additionally, the findings highlight the need:

to find ways to effectively communicate to parents about free sugars, and to address perceptions that natural sugars are not unhealthy
for an update of NHS webpages to provide clear, consistent and systematic advice regarding home prepared vs commercial baby and toddler foods. The authors call for “clear and consistent messaging … regarding the importance of early and repeated exposure to healthy, unprocessed foods... to encourage preference for these foods”.

To coincide with the BBC Panorama documentary ‘The Truth on Baby Food Pouches’ which aired on 28 April, we wrote this briefing on commercial baby and toddler foods. It outlines our policy asks of the Government, which are in line with the recommendations of this research.

If you would like to see stronger, mandatory and properly enforced regulations, please consider writing to your MP. It takes less than 2 minutes to do this using Sustain’s template letter, which can be found here. The more people that write, the greater the chance of action.

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Infant milk news

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

Twice a year, we carry out a review of the cost of infant milks. Our recent review reveals the following:

The cost difference between the most and least expensive cows’ milk-based first infant formula is £11.01 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.

As usual, current pricing strategies mean that the least expensive way to buy infant formula is in powdered format. Aldi Mamia and Lidl Lupilu remain the least expensive infant formula powders in standard size formats (800g), both costing £6.99 and 11p per 100ml of made-up formula.

There are five products affordable with the Healthy Start allowance that provides £8.50 a week for a baby up to aged one year. However, Cow & Gate First Infant Milk from Savers is just 700g rather than 800g.

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.

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. Many continue to believe that switching to follow-on formula after six months might save money—especially since UK regulations allow promotional offers on follow-on formula. However, our cost analysis continues to show that this not be the case and, in some cases, powdered follow-on formula may be more expensive than the same brand's infant formula when prepared. Additionally, our review of promotions found that offers on follow-on formulas in October 2024 were no longer available by May 2025. 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.

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Latest trends in the cost of infant formulas

Our latest infant formula cost trend analysis shows that prices have remained high and static. Despite already being the cheapest on the market, Aldi (Mamia) and Lidl (Lupilu) brought the price of both their own-brand products down a further 10p, to £6.99 a tin, while Boots brought down the cost of SMA Little Steps from £9.75 to £7.95 to align with the price at most other retailers. While the average cost of branded infant formula is currently £13.49/tin, the range is £7.95 to £18.00. This compares to £6.99 for supermarket own-brand infant formula.

In short, the infant formula retail offer remains dominated by expensive products, and prices remain higher now than before the cost-of-living crisis. The average unit price for infant formula in March 2021 was £11.10 compared to £11.99 in May 2025, and the difference between the least and most expensive products – despite being nutritionally comparable - has increased from £8.51 to £11.01. The few lower price options may not be accessible to many families on low incomes, as there are fewer Aldi and Lidl branches than for other supermarkets and it’s not possible to shop online at Lidl.

We call on the DHSC to accept and act on all 11 recommendations of the Competition and Markets Authority, and reiterate that further government action may be needed in the short term to ensure infant formula is accessible and affordable to families that need it, while protecting and supporting breastfeeding:

• To increase infant formula accessibility as well as supporting breastfeeding
➢ Improve the Healthy Start scheme.

• To improve infant formula affordability, bringing infant formula prices down in the short term and sustainably
➢ Consider price controls, especially profit margin caps.

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Updated: Infant milk costs infographics

To support parents and carers who use formula to feed their babies and are concerned about the cost of infant formula, we have updated our infant milk cost infographic as shown. Nb. We have chosen to make explicit in this latest version that infant formula does not have the same health benefits of breastfeeding in light of the findings of Athanasiadou and colleagues reported on in our May newsletter, that many women erroneously believe that breastfeeding and formula feeding provide a baby with the same health benefits.

Our infant formula cost trend analysis and policy asks are also available as an infographic as shown.

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Infant formula costs in the news

Our infant formula cost data analysis and asks of Government were reported on by the Guardian and the Sun newspapers on 29 May, and Jess Brown-Fuller MP (chair of the All Party Parliamentary Group on Infant Feeding) also spoke about the issue on LBC radio, calling on the Government to accept and implement all of the Competition and Markets Authority’s recommendations. These reports were followed by news reports in the Sun and the Grocer on 2 June that Aldi will freeze the price of Mamia at £6.99 until the end of the year.

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

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Baby Feeding Law Group UK News

Image credit: WHO World Health Assembly

New World Health Assembly resolution: Regulating the digital marketing of breastmilk substitutes

On 26 May 2025, the 78^th World Health Assembly adopted the resolution for Regulating the digital marketing of breast-milk substitutes, including formula milk and baby foods. This resolution represents an extension of the provisions of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent WHA resolutions, aimed to protect parents, caregivers and families from misleading marketing by the commercial milk formula industry. This new resolution draws on various WHO guidance documents including the 2023 Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes. You can read more on the activities at the 78^th WHA here: Baby Milk Action blog and WHA news update (27 May 2025).

A side event was held at the WHA on 21 May, on “Monitoring Digital Marketing of Breast-milk Substitutes: Open Data & Global Accountability” and was hosted by Colansa (Comunidad de Práctica Latinoamérica y Caribe Nutrición y Saludand - Community of Practice for Nutrition and Health in Latin America and the Caribbean) and co-organised by IBFAN, Save the Children, ALSANNA (La Alianza Global para la Alimentación Saludable de Niñas, Niños y Adolescentes - The Global Alliance for Healthy Eating for Children and Adolescents), the World Obesity Federation (WOF), Fundação Oswaldo Cruz (Fiocruz), the International Lactation Consultant Association (ILCA) and IDEC (Brazilian Institute of Consumer Protection), with the support of the Brazilian Ministry of Health, UNICEF and the Global Health Advocacy Incubator (GHAI). The full recording of the side event, including talks by representatives of the WHO, Alive & Thrive, country delegates and more, is available here.

It is now the responsibility of countries and governments to update national legislation to incorporate the provisions of all WHA resolutions relating to the Code, and to invest in effective systems for routine monitoring and enforcement of national legislation.

In the UK, national legislation currently scores just 40 out of 100 in the 2024 International Code status report of national implementation of the Code, and violations of national legislation and the Code persist. It is therefore timely, relevant and essential for the UK government to strengthen existing legislation to align with the Code and all subsequent WHA resolutions and ensure sufficient monitoring and enforcement mechanisms.

An important first step would be for the government to fully implement the 11 recommendations made in the Competition and Markets Authority’s market study into infant and follow-on formula in the UK. We eagerly await the government response to the final CMA report and will continue to advocate for stronger marketing restrictions on commercial milk formula and associated products.

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Forthcoming

Webinar: Evaluation of the Healthy Start Scheme, 24 June

The Glasgow university led Maternal and Child Health Network (MatCHNet) are hosting a webinar by Christina Vogel of City St George’s University of London on their Evaluation of the Healthy Start Scheme. This will be online on Tuesday 24 June at 12.20pm. Sign up here.

Webinar: www.infantmilkinfo.org, 25 June

We will be delivering our second webinar on Wednesday 25 June from 1:30 – 2:30pm, to introduce healthcare professionals with an interest in infant milk feeding to our website dedicated to infant milk: www.infantmilkinfo.org. 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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May 2025

Image by pvproductions on Freepik

Welcome to the May edition of our newsletter – contents below.

Can you support us with a donation?

As you may know, First Steps Nutrition Trust is a registered charity, funded by a small number of generous individuals and grants. We don’t receive government funding and only accept funds from conflict-of-interest free sources. If you are consistently finding value in this newsletter, please consider supporting our work with a donation. You can do this here on our PayPal page and don’t need a PayPal account.

Thank you.

News

Commercial baby foods in the news: Panorama’s ‘The Truth About Baby Food Pouches’, new research from University of Leeds and First Steps Nutrition Trust recommendations
New SACN statement: The WHO guideline on non-sugar sweeteners
SACN evidence update: Processed foods and health
New obesity data: Changes in BMI category of children between the first and final years of primary school, 2023 to 2024
New briefing: Strengthening the Healthy Start Scheme to protect children’s health by the Food Foundation and First Steps Nutrition Trust
New report: Corporate Lobbying: The Dark Side of the Plate by the Food Foundation
New report: Infant and young child feeding in emergencies on the island of Ireland: a guidance document for creating an all-island preparedness plan
House of Lords Debate: Report from the Food, Diet and Obesity Committee: 'Recipe for health: a plan to fix our broken food system'

Infant milk news

New paper: Cross‐Sectional Associations Between Exposure to Commercial Milk Formula Marketing, Beliefs About Its Use, and Socioeconomic Position Among Pregnant Women and Mothers in the UK
New FAQ: Can food insecure women breastfeed?

BFLG-UK news

New briefing: Marketing restrictions for follow-on formula and growing-up milks: Global examples and guidance

Forthcoming

World Health Assembly 78 (19-27 May 2025) and digital marketing resolution
Webinar: Evaluation of the Healthy Start Scheme, Tuesday 24 June

Happy reading!

News

Commercial baby foods in the news: Panorama’s ‘The Truth About Baby Food Pouches’, new research from the University of Leeds and First Steps Nutrition Trust recommendations

On Monday 28 April, the BBC aired a new documentary on baby food pouches, which we and many peers have been feeding into for nearly a year. The programme can be watched in the UK using BBC i-Player, at this link.

The programme featured new data from the BBC’s lab-testing of selected pouches from the six leading brands (Aldi's Mamia, Heinz, Little Freddie's, Ella's Kitchen, Piccolo and Lupilu by Lidl), and from new research undertaken by researchers Dr Diane Threapleton, Ali Morpeth and Prof Janet Cade at the University of Leeds. Key findings include:

Very high levels of sugars, and low levels of vitamin C and iron
Misleading marketing suggesting products are nutritionally appropriate, can/should be used at an age when babies should only be drinking milk (i.e. 4 months+ instead of 6 months+), and that they can be used every day in place of home-prepared meals
Assumption of parents that the products are healthy and suitable as advertised, and shock that this is not the case
Concern that the common frequent use of these pouches is driving dental decay and obesity
The legislation governing commercial baby foods is very old, outdated and too narrow in scope and needs to be strengthened and made mandatory

Three of the companies in the programme have said they are going to change their age labels from 4months+ to 6 months+, but there were no clear commitments on other aspects of marketing or for reformulation.

The DHSC’s formal response included the statement that “Existing laws already set nutrition needs for baby foods”.

The Leeds University “Commercial baby foods in crisis” research is summarised here, along with links to their policy report, full technical report, brand score cards and information for parents. While Panorama focused on baby food pouches and used Leeds’ data, it should be noted that the Leeds’ research involved evaluation of 632 commercial baby foods, snacks and drinks across the product category as well as a survey of 1000 parents. Some of their key findings include:

25% of all products have sugar content that warrants a front-of pack warning label
7 in 10 parents agree with a front of pack warning label on high sugar baby foods
41% of main meals had high sugar levels
100% of products included nutritional or marketing claims
55% of snack products contain added sugars
21% of cereals, meals, and fruit products were too watery, with low energy density
Over one third of products (38%) were pouches with spouts
51% of products with a spout did not include any recommendation not to drink via the spout
30% of pouches had misleading names, often masking the use of cheap fruit fillers (apple, pear and banana)
40% of parents with babies under 6 months fruit-based products daily
64% of parents use savoury baby food snacks (including crackers, crisps and puffs) daily or several times per week
Financial pressures are having a noticeable impact on how parents purchase food for their children. Nearly one in five surveyed parents reported making significant adjustments to their household purchases because of financial strain, and 34% of parents reported making more home-made foods.
70% of parents of 1-3 year olds reported using growing up/toddler milks, 30% daily.

For anyone who has read our baby foods reports, many of the results above are not surprising. What is surprising, and infuriating, is that these persistent problems are being ignored by Government.

We wrote this policy briefing to accompany the documentary, outlining our three core policy asks as follows:

Revise, strengthen and independently monitor and enforce the UK baby food regulations to set new legally binding standards for composition, labelling and marketing in line with WHO Europe’s Nutrient and Promotion Profile Model and UK public health recommendations.
Upgrade and independently monitor and enforce the UK formula milk regulations in line with minimum international standards (the Code).
Better support parents/carers to feed their babies healthy home-prepared foods (which SACN states are preferable) by:
1. Enabling parents/carers in low-income households to better access healthy whole foods through strengthening the national nutrition safety net, the Healthy Start scheme.
2. Ensuring easy access to independent information and practical guidance through proper investment in the health visiting service and Family Hubs/Sure Start centres.
3. Supporting early years settings to apply Government guidelines on food provision.

If YOU would like to see the government strengthen the current weak and outdated baby foods regulations, please send a letter to your MP using this template. It takes less than two minutes.

To support practice, we have created this new infographic pictured below, and have been publicising our practical and pictorial Eating Well guides, especially ‘Eating Well: the first year’. These guides can help families to feel more confident in preparing foods for their babies and toddlers, without paying over the odds for less healthy pouches.

The Leeds University team also collated key information for parents, including advice for those shopping in the baby food aisle, which can be accessed here.

There has been a huge amount of media coverage around the Panorama documentary. We will share the TV and radio news and print press we feature in our website here.

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New SACN statement: The WHO guideline on non-sugar sweeteners (NNS)

The Scientific Advisory Committee on Nutrition (SACN) published this statement on 2 April, reviewing the 2023 WHO guidelines to consider whether non-sugar sweeteners (NSS) are effective for reducing overweight and obesity, preventing weight-related non-communicable diseases (NCDs) and promoting dental health within a UK context.

We give an overview of what non-sugar sweeteners are, what they’re used for and health concerns, in our 2019 report, with a focus on pregnant women, infants and young children.

While they are not allowed in commercial baby foods and drinks marketed for the under 3s, NSS are found in thousands of ultra-processed food and drink products, many labelled as ‘diet’, or low/reduced sugar, which are consumed by young children, e.g. fruit squash and fizzy drinks; jellies, ice creams and custard; baked beans, canned spaghetti and ketchup. Although there is limited data, the prevailing opinion is that drinks are the main dietary source. The most up to date national data indicates that 65% of 18-36 month olds consume NSS-containing soft drinks, with average intakes equivalent to a can a day.

As a backdrop to these high intakes, in 2023 the WHO published new guidelines with this ‘conditional’ recommendation to be considered by policy makers in specific contexts: “WHO suggests that non-sugar sweeteners (NSS) not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases.”

SACN’s approach to the evidence base for the WHO guidelines is somewhat different to the WHO’s view, because, as one would expect, they give more weight to the experimental evidence (from randomized controlled trials) than observational evidence (from prospective cohort studies). This is important as the results of these different study types when looking at adiposity, are different: RCT evidence consistently suggests NSS compared with free sugars reduce energy intake and therefore body weight (with low certainty). The opposite association was found between NSS and measures of body fatness in prospective cohort studies, noting concerns about potential for confounding and reverse causality. However, they acknowledge that the observational evidence may well give an insight in to consumption patterns of NSS sweetened foods and drinks in ‘real-life’ settings.

SACN states that the evidence on the impact of consuming NSS on dental health is poor and more good research is needed. But importantly, they highlight that soft drinks which contain acids (for example phosphoric, citric, carbonic) whether sweetened with free sugars or NSS, may increase the risk of dental erosion.

It is important to note a critical limitation in the evidence base is that there is lack of research comparing NNS with water.

Additionally, the WHO and SACN acknowledge that more research is needed among children and pregnant women, the latter group for which there may be unfavourable effects of NSS consumption on birthweight and adiposity (body fat) in offspring later in life while at the same time consumption may be increasing.

In relation to the use of NSS as a means to reduce free sugars intake, SACN concludes that “the evidence indicates that there may be some value in using NSS to help reduce weight gain in the short to medium term, but it is not essential and is not the only option”. It further concedes: “UK public health policies on overweight and obesity have reduced free sugars in soft drinks and some other products. The resulting reduction in intakes of free sugars may have increased NSS consumption. It remains unclear whether NSS play a useful role in supporting a long-term move to a diet lower in free sugars. Further research is needed to understand whether there are public health advantages to a gradual reduction in the overall sweetness of the diet. A process of gradual reduction of salt content in processed foods has been successful in reducing population salt intakes”.

Ultimately, SACN’s recommendations discourage NNS use, which matches the WHO view. “SACN and WHO agree that a reduction in consumption of free sugars, alongside other positive changes to diet, is likely to be beneficial to health overall”. SACN defer to policy makers on how to achieve this, but at the same time make these specific recommendations, in the context of existing UK government dietary recommendations, which they say should be read alongside SACN’s 2025 evidence update on processed foods and health (see below). They also highlight that they are precautionary because evidence on NSS and health outcomes is inconsistent (i.e. there is evidence of benefit and of harm). NEW recommendations are shown in green.

SACN recommends that intake of NSS be minimised

For younger children, SACN recommends:

not giving them drinks sweetened with sugar or NSS
giving them unsweetened food (not sweetened with either sugar or NSS

For older children and adults, SACN recommends:

swapping sugars for NSS may help reduce sugar intake from foods and drinks (and so reduce energy intake), at least in the short term - the long-term goal is to limit both sugar and NSS intake

SACN recommends that government:

monitors the NSS content of food and drinks in the UK diet and their consumption, including trends, particularly among high consuming and vulnerable groups
evaluates the impact of policies to reduce energy and sugar intakes on intakes of NSS, particularly among high consuming and vulnerable groups
compels industry to make publicly available data on the amounts of individual NSS within foods to enable monitoring and further research on associations with health outcomes

We’re pleased to see this statement and recommendations from SACN and will be updating our 2019 report in the coming months, including making new recommendations to Government in light of this new position. These recommendations will include calling for the SDIL levy to be extended to drinks containing NSS and for warning labels on products which contain them to ensure consumers can make informed decisions when shopping.

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SACN evidence update: Processed foods and health

SACN also published this rapid evidence update on 2 April, focusing on higher quality evidence from umbrella reviews (5), systematic reviews of prospective cohort studies (8), and prospective cohort studies with subgroup analysis of different types of foods and drinks in the UPF category (11).

SACN acknowledge that limitations identified in their 2023 position statement remain, including: that studies appear to inconsistently account for important covariates including SES, BMI, energy and nutritional intake; issues related to data collection and difficulties in reliably classifying ultra-processed foods (UPF); issues with short follow up; selection bias and limited generalisability of findings to the general population as well as a risk of residual confounding.

Nonetheless, they report that the new studies reviewed consistently indicated that increased consumption of UPF was associated with increased risks of adverse health outcomes, which included, but were not limited to, overweight and obesity, type 2 diabetes, cardiovascular, cancer and mental health conditions. SACN reports finding these observations very concerning. However, evidence from subgroup analyses also indicates that not all UPFs may affect health in the same way. The categories of UPF consistently associated with adverse health outcomes were those including meat and animal products and sweetened beverages, for which recommendations already exist. Vegetarian meat-alternative products were found to have no association with adverse health outcomes. Other categories including UPF breads and/or cereals, and savoury snacks; dairy products or dairy based dessert or sweets were all found to have mixed results.

With the exception of sweeteners (see above), SACN highlight that the evidence base they considered contains little information on the health impacts of processing or the ingredient markers of UPFs. They say it is therefore not possible to assess any effects these have on health separately from the established effects of the poor nutritional characteristics of UPF. We are unclear why they have not acknowledged the evidence on food texture, which is an impact of processing and especially relevant for the early years. Or the evidence which shows an association between the extent of processing of a diet and the health harms observed, independent of nutrient profile.

The rapid evidence update highlights existing recommendations of relevance to UPFs, including these from their 2023 report “Feeding young children aged 1 to 5 years”:

Foods (including snacks) that are energy dense and high in saturated fat, salt or free sugars should be limited
Dairy products including yogurts should ideally be unsweetened
Sugar-sweetened beverages should not be given
Follow on formula and commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements for this age group.

Notably, they excluded the recommendation “commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements”, even though a variable proportion of these products are UPF.

SACN stress that diets high in UPF are often energy dense, high in saturated fat, salt or free sugars, high in processed meat and/or low in fruit and vegetables and fibre. They highlight their existing lines that consumption of excess energy, saturated fat, salt, free sugars and processed meat is linked to poor health outcomes, and higher consumption of fruit and vegetables, wholegrain foods and fibre reduces health risks. Furthermore, they acknowledge that higher UPF intakes will be indicative of less healthy dietary patterns. This content of their report is important, because it indicates the importance of rebalancing diets away from highly processed foods - both HFSS (high fat, salt and sugar) and reformulated - in favour of healthy whole foods, and ensuring the public understand and are enabled to make food choices that align with this dietary advice.

In their conclusions, SACN report that there may be potential to develop subcategories within the existing NOVA classification, based on nutritional composition in addition to processing. They also note a substantial but incomplete overlap between HFSS and UPF foods.

The recommendations state:

On balance, most people are likely to benefit from reducing their consumption of processed foods high in energy, saturated fat, salt and free sugars and low in fibre.
SACN reiterates its existing advice in relation to processed foods, particularly in relation to minimising intake of sugar-sweetened beverages and the avoidance of high intakes of red and processed meat.
SACN reiterates its recommendations on sugar and existing and new recommendations on sweeteners (see above).
That government should:
- consider strategies and actions to implement SACN’s existing recommendations on processed foods, including those from SACN’s Feeding young children aged 1-5 listed above
- Consider whether the inclusion of messaging on processing improves dietary intakes, particularly in relation to reducing consumption of processed foods that are HFSS, without unintended adverse consequences
- Compel industry to make processing data (including the amounts of individual additives such as emulsifiers and NSS within food products and the specific processes used) publicly available to enable monitoring and further research on associations with health outcomes - publicly available data are required
- Monitor the consumption of individual additives such as emulsifiers and NSS in the UK diet, particularly among high consuming and vulnerable groups
- Continue to review opportunities to monitor consumption of processed foods within the national diet and nutrition survey (NDNS)

Our Director Dr Vicky Sibson recently gave a keynote lecture on Ultra-Processed Foods in the diets of the UK’s infant and young children at the University of Central Lancashire’s MAINN (Maternal and Infant Nutrition and Nurture) conference on April 29th. This presentation summarises the content of our 2023 report and provides an up-to-date overview of the relevant evidence as regards intakes, health harms and plausible mechanisms as well as addressing why there is controversy about the UPF concept, and expanding on our recommendations as to what should be done about excessive intakes. You can watch a pre-record of the presentation here.

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New obesity data: Changes in BMI category of children between the first and final years of primary school

The Office for Health Improvement and Disparities (OHID) has published data on changes in BMI for primary school children moving from reception (age 4 to 5 years) in 2017/2018 to year 6 (age 10 to 11 years) in 2023/2024 in England. Most children in reception were a healthy weight (84.8%), and most stayed a healthy weight (77.6%), although this percentage was slightly lower for boys, and those living in the most deprived areas.

Source: OHID report, Changes in BMI category of children between the first and final years of primary school, 2023 to 2024

It is encouraging that children who are a healthy weight are likely to remain a healthy weight. However, it is concerning that those living with obesity were very likely to remain living with obesity (35.6%) or move to living with severe obesity (35.4%). The data also shows that for many minority ethnic groups, including Bangladeshi, Indian, Pakistani, Black African and Caribbean or mixed-race children were more likely to move from a healthy weight to a higher BMI category than all children overall.

These findings highlight the importance of actions to enable healthy diets in the early years, including strengthening the Healthy Start scheme, so that those in the most deprived areas are enabled to eat a nutritious diet based on unprocessed and minimally processed nutritious foods. See our new joint briefing on Healthy Start and asks of Government below.

For our practical guides to support eating well in the early years, you can download our resources for free here.

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New briefing: Strengthening the Healthy Start Scheme to protect children’s health by the Food Foundation and First Steps Nutrition Trust

On 2 May this new joint policy briefing written by ourselves and colleagues at the Food Foundation was published and shared widely with relevant DHSC civil servants, civil society organisations and local authorities. The briefing seeks to make the case for strengthening the Healthy Start scheme so that it can function as the nutrition safety net it is intended to be. It covers why the scheme is needed, its health benefits, and necessary improvements. We hope it will be a useful reference in our ongoing advocacy.

Read the briefing here.

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New report: Corporate Lobbying: The Dark Side of the Plate by the Food Foundation

On 3 April, the Food Foundation published this briefing to share initial findings from research on food industry lobbying in the UK. The briefing provides a good explanation of lobbying, commercial influence and conflicts of interest. It explains that while lobbying of elected officials is key to transparent and democratic policymaking, there are clear power imbalances in the UK food system that limit the government's ability to implement policies supporting public health. For example, during January 2020 – June 2024, at Defra (the government department responsible for food and farming), ministers met with food businesses and their trade associations 40 times more than with food NGOs and ministers (!). The briefing concludes with general recommendations for how transparency in lobbying can be improved in the UK, and a list of specific engagement questions for investors. A 10-minute Pod-Bite summarising the findings is available here.

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New report: Infant and young child feeding in emergencies (IYCF-E) on the island of Ireland: a guidance document for creating an all-island preparedness plan

Aileen Kennedy, Dr Liz O’Sullivan (both TU Dublin) and Dr Clare Patton (Queens University Belfast/ Leeds University) led this project, researching and highlighting why infant and young child feeding is so important in emergencies, including those that occur on the island of Ireland, and what needs to be done to ensure the needs of this vulnerable group are met. The report draws both on pre-existing published evidence and involved new primary research. It provides guidance for developing an IYCF-E plan, including how to prepare for, respond to, and recover from a variety of emergencies that may occur on the island of Ireland.

Preparatory activities include developing and implementing an IYCF-E plan under the leadership of a coordinator, investing in milk bank services, implementing the Code, prioritizing breastfeeding protection, promotion and support to build resilience, and providing detailed guidance for families on what they should do in anticipation of an emergency, or what they should bring if they need to evacuate their homes.

This report and its recommendations are relevant to the UK, where currently there is no national plan or public guidance on infant and young child feeding in emergencies.

Read the report here.

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House of Lords Debate: Report from the Food, Diet and Obesity Committee: 'Recipe for health: a plan to fix our broken food system'

This debate on 28 March was an opportunity for the inquiry committee to react to the very disappointing Government response to their inquiry report, which we wrote about in our February newsletter. You can watch the debate in two halves here: part 1 (105 mins) and part 2 (42 mins) or read the transcript here.

The debate was opened with introductory remarks from the Chair, Baroness Walmsley, followed by 6-minute statements from each of the 12 (former) committee members and closed with a response from the Parliamentary Under-Secretary of State, Department of Health and Social Care, DHSC, Baroness Merron.

The statements that explicitly mentioned the early years were as follows:

Baroness Walmsley highlighted the gap in commitments to improving Healthy Start and restricting the marketing on foods for infants and young children.
The Earl of Caithness described how pregnant women, infants and children, in particular, are being neglected by government.
Baroness Brown of Silvertown welcomed recent NICE guidelines on maternal and child nutrition (nutrition and weight management in pregnancy, and nutrition in children up to 5 years) but reiterated the limitations of guidance which needs to be accompanied by structural actions to address inequalities.
Baroness Suttie raised questions around the availability, composition and marketing of commercial produced baby foods and drinks, including food pouches, follow-on formula and growing up milks, criticising the government’s lack of response to suggestions for how obesity prevention needs to start in the early years.
Baroness Merron’s response on behalf of the DHSC, highlighted the importance of affordable and high-quality infant formula products for those who use it, and welcomed the Competition and Markets Authority (CMA) report, stating that the DHSC “will consider carefully the recommendations and will respond to it.” We are anticipating the DHSC response to the CMA report by mid-May.

Baroness Merron ended by thanking the Committee and stating “We know we have to go further, where previous Governments have not done so. I look forward to being able to set out further actions that we will take in due course.” We eagerly await government action, especially given the Labour government’s commitment to give all babies the best start in life and to have the healthiest generation of children ever.

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Infant milk news

New paper: Cross‐Sectional Associations Between Exposure to Commercial Milk Formula Marketing, Beliefs About Its Use, and Socioeconomic Position Among Pregnant Women and Mothers in the UK

Martha Athanasiadou and colleagues published this research which explores associations between exposure to commercial milk formula marketing and beliefs about its use among pregnant women and mothers in the UK. Over 1000 women were interviewed from lower, middle and higher socioeconomic positions. Most participants were exposed to commercial milk formula marketing on TV (67.6%), and nearly half on social media (45.3%). In-store marketing and magazines/newspapers were also a common marketing source (33.5% and 20.6% of participants), as well as active participation in baby clubs run by commercial milk formula companies. Women in each socioeconomic background were equally exposed to commercial milk formula marketing, with around six forms of marketing each. Alarmingly, this study found that over a quarter agreed with the statement ‘breastfeeding and formula feeding provide a baby with the same health benefits’, with a higher percentage of women from the lower (35.7%) compared to the higher socioeconomic position group (20.8%).

We are concerned by the findings of this research which highlights that so many women in the UK are exposed to commercial milk formula marketing contravening the International Code for the Marketing of Breastmilk Substitutes. Similarly, we also concerned that UK public health messaging is being drowned out by marketing messages. The NHS is clear that breastfeeding protects infant and maternal health in ways which cannot be replicated by formula milks, including reducing babies’ risk of SIDS (sudden infant death syndrome), child diabetes, and leukaemia, as well as protecting them from infections.

As secretariat of the Baby Feeding Law Group UK, we continue to challenge widespread commercial milk formula marketing, and high cost of infant formulas positioned as equivalent or even better than breastmilk. Last month, we compiled a formal and comprehensive BFLG-UK response to the CMA infant and follow-on formula market study calling for the Government to accept and implement all 11 recommendations.

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New FAQ: Can food insecure women breastfeed?

We have written this new FAQ to help myth bust widespread misconceptions about how maternal diet affects breastfeeding. It can be found under ‘General questions about infant feeding’ on our Infant milk info website.

In short, yes, food insecure women can breastfeed. Hunger, malnutrition, poor diets and stress can all have negative effects on breastfeeding, but women experiencing these situations can and should be supported to breastfeed if they want to. Some of the key points from our FAQ are:

Household food insecurity prevalence in the UK is high; the Food Foundation found that 23.6% of households with children under 4 were food insecure.
Women living in food insecure households breastfeed for a shorter duration. This has been called ‘the breastfeeding paradox’, as mothers who are least likely to breastfeed are also least likely to be able to afford infant formula.
The reasons for lower breastfeeding rates in food insecure households include women's perceptions that their poor diets and stress negatively affect their breastmilk supply and/or quality (see more below), compounded by a lack of breastfeeding support. Several studies also found that those experiencing food insecurity were exposed to misinformation about breastfeeding and likely to have a negative perception of it. However, breastfeeding is physiologically robust and mothers who want to breastfeed should be supported to do so, including with adequate hydration, foods and psychosocial support.
The public health recommendations about infant feeding are the same in emergencies and situations of food insecurity and in stable situations, the world over. It is widely accepted that breastfeeding is the safest method of infant feeding during emergencies in almost all cases, and that exclusive breastfeeding should be continued up to around 6 months and beyond.
The risk of malnutrition is increased if breastfeeding is interrupted and the protective benefits of breastfeeding can be more important during emergencies to limit the spread of infections and diseases. Breastfeeding is protective against hospitalisation for diarrhoea and respiratory infections.

To read the full FAQ, including links to further resources on this topic, please see here.

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

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Baby Feeding Law Group UK News

New briefing: Marketing restrictions for follow-on formula and growing-up milks: Global examples and guidance

We wrote this briefing to provide further evidence to support our ask of the Government to accept the Competition and Markets Authority recommendation to extend marketing restrictions on infant formula to follow on formula, and to further make the case that the extension needs to cover growing up milks marketed for use from 12 months plus as well. It outlines which countries regulate FoF and/or GUM marketing, the reasons why some countries do not regulate these products, the relationship between Code implementation status and infant feeing practices indicating why it is important to regulate FoF and GUM marketing, and a reminder of global guidance and recent, relevant evidence.

Read the briefing here.

For more information on growing up milks and plant-based alternatives on the market read our briefing here. Additionally we published this editorial on the high levels of sugar in plant-based growing up drinks. The Daily Mail published this article on these products based on our analysis.

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Forthcoming

World Health Assembly 78 (19-27 May 2025) and resolution on the digital marketing of breastmilk substitutes

From 19 – 27 May 2025, the 78^th session of the World Health Assembly will meet in Geneva. All official documents and livestreaming will be available here. Other information, including the list of side events will be available here. On the provisional agenda, item 13.9 Global Strategy for Women’s, Children’s and Adolescents’ Health is of interest, as this is when the decision regarding a proposed resolution for Regulating the digital marketing of breast-milk substitutes will be discussed, as put forward from the Executive Board meeting in February 2025, through item EB156(30). Several Non-State Actors (NSAs) will be attending and advocating in support of this, including the International Baby Food Action Network (IBFAN), International Lactation Consultants Association (ILCA), Save the Children and the World Cancer Research Fund (WCRF), among others.

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Webinar: Evaluation of the Healthy Start Scheme, 24 June

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April 2025

Image by freestockcentre on Freepik

Welcome to a *bumper* April edition of our newsletter – contents below.

News

Spring statement: Bad news for young families
New inquiry: The First 1,000 Days: a renewed focus
New podcast: Childhood Allergies - influence of Infant feeding practices
New podcast: Childhood Dental Decay – influence of infant feeding practices
New report: World Breastfeeding Trends initiative UK
New feature: Ultra-processed babies: are toddler snacks one of the great food scandals of our time?
New report: ‘Nourishing Our Future’: Exploring food provision in Essex early years settings
New survey: The Cost of Living on Maternity Leave 2025, by Maternity Action: interim findings
Call for participants *by 10 April*: Swansea research project on formula in food banks
New report: Nourishing the Future: making healthy food accessible for every child by Barnardo’s
New analysis: Nutrient analysis of cows’ milk
New supplement: VEG-1 baby and toddler liquid multivitamin

Infant milk news

News: Contaminants in infant formula
Updated FAQs: Whey: casein ratios in infant milks
Update: Arize hydrolysed rice formula

BFLG-UK news

Response to the Competition and Markets Authority formula Market study
New paper: A descriptive investigation of infant feeding bottles marketed in the UK designed to replicate breastfeeding and the evidence that underpins them

Forthcoming

MAINN Conference, 28-30 April, Cumbria
Webinar: Evaluation of the Healthy Start Scheme, 24 June

Happy reading!

News

Spring Statement: Bad news for young families

Babies, children, mothers and families barely got a mention in the Spring Statement on 26 March, and on the contrary the announced forthcoming changes are expected to worsen poverty and food insecurity. This is hugely worrying given already high rates of both, and the fact that young families are most at risk and it does not align with Labour manifesto promises. This 10-minute podcast from the Food Foundation provides an excellent summary of the issues.

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New inquiry: The First 1,000 Days: a renewed focus

The Health and Social Care Committee have launched this new inquiry on 21 March, with a deadline for submission of evidence now Tuesday 22 April, see here.
The background info explains that the first 1,000 days of life, from conception to age two, are widely recognised as a critical period for child development, shaping long-term health, well-being, and life outcomes. The previous Committee examined this period in its 2019 First 1,000 days of life inquiry considering national strategy, current spending and barriers to investment and local provision. Since then, there have been a number of significant policy developments in this area. The most notable being the shift to integrated care services (ICSs) under the previous Government in 2022.The current Government has allocated £126 million for early years support and the expansion of Family Hubs under its mission to “break down the barriers to opportunities”. The Committee’s inquiry will examine progress made since 2019, the effectiveness of family hubs and integrated care systems in improving early childhood outcomes and how inequalities in access can be most improved.

We at First Steps Nutrition Trust will be making an evidence submission focused on diet, nutrition and feeding in pregnancy and the first 2 years. Please help us raise the importance of maternal diet, and what and how babies and young children are fed – you can contact Vicky if you would like to see our draft, vicky@firststepsnutrition.org

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New podcast: Childhood Allergies - influence of Infant feeding practices

Food allergies are perceived to be on the rise, and a problem that may disrupt breastfeeding if maternal dietary restriction is recommended (as it commonly is). However, this is an area that is fraught with misinformation, driven by industry. Our friends at La Leche League GB have recently updated their ‘common concerns’ webpage on breastfeeding and allergy and now include a new podcast with paediatric allergy specialist Dr Robert Boyle. You can access it here.

Readers may also be interested in this 2022 Delphi consensus study which we participated in, on “Detection and management of milk allergy”.

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New podcast: Childhood Dental Decay – influence of infant feeding practices

A second new podcast which is well worth a listen to is this episode of ‘Makes Milk with Emma Pickett’ with dentist Gillian Smith. This podcast explores the evidence around breastfeeding and dental health and debunks the wide-held view that breastfeeding can cause dental decay. An evidence review on breastfeeding beyond the first year of life and development of dental caries can be found on pages 361-363 of the Scientific Advisory Committee’s Feeding young children aged 1-5 years. Evidence that breastfeeding beyond 1 year protects against malocclusions can be found in the same report, on pages 370-371. The NHS endorses the WHO recommendation that all babies are breastfed for up to 2 years or longer, and advises mothers to keep breastfeeding in to the second year and for as long as it suits, e.g. see here and here.

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New report: World Breastfeeding Trends initiative UK

On Tuesday 25 March 2025, through a hybrid event, the World Breastfeeding Trends Initiative (WBTi) UK 2024 Report was officially launched. The report documents include Part 1 – Full Report (132 pages), Part 2 – Supplementary Information (60 pages), a UK Report Summary 2024 (16 pages including an Executive Summary and Report Cards) and separate report cards for the UK, England, Northern Ireland, Scotland and Wales. This second WBTi UK report following the first WBTi UK 2016, unfortunately reveals little progress since the first assessment. The devolved nations continue to show national leadership, with stronger policies and programmes on infant feeding and consistently higher scores than England.

The WBTi assessment project was developed and is led by the International Baby Food Action Network (IBFAN) and has been conducted in 100 countries around the world. The WBTi assesses 10 key areas of infant feeding policies and programmes: National policies; UNICEF UK Baby Friendly Initiative; Regulation of marketing of infant milks, bottles and teats; Maternity protection in the workplace; Health systems and training; Breastfeeding support; Accurate information; Infant feeding and HIV; Infant feeding in emergencies and Data collection, monitoring and evaluation. The WBTi UK project is a collaboration of health professional bodies, organisations and experts, with an advisory group of government officials from all four nations and a Core Group responsible for providing inputs.

We at First Steps Nutrition Trust are a member of the WBTi UK Core Group and supported the hosting of Core Group meetings. As secretariat of the Baby Feeding Law Group UK, we provided technical support, responses and examples for Indicator 3 on the regulation of marketing of infant milks, bottles and teats, including Implementation of the International Code of Marketing of Breastmilk Substitutes.

At the launch event on 25 March 2025, the focus was on Indicator 5: Health Care Systems in support of breastfeeding and infant and young child feeding, where the UK scored 6/10 and revealing that UK health professionals lack sufficient training on infant feeding. The policy recommendations from the WBTi UK 2024 Report will be presented at a parliamentary event in June 2025, and we will share details for this when they are available.

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New feature: Ultra-processed babies: are toddler snacks one of the great food scandals of our time?

This feature written by Bee Wilson and published in The Guardian on 15 March, highlights concerns with baby snacks, pouches and ‘so-called’ growing up milks. The article draws on our reports on Commercial baby food marketed in the UK, Ultra-Processed Foods marketed for infants and young children, and Drinks for young children marketed as ‘growing up’ and ‘toddler’ milks and drinks. The concerns raised mirror ours, that baby and toddler foods and drinks often have too much sugar, salt, inappropriate textures, and are marketed in misleading ways which prey on parental anxieties. It draws attention to some concerning statistics – over 20% of the baby food retail offer consists of snacks which are consumed by a third UK babies.

What’s especially worrying is that parents believe that they are feeding their children healthy foods. This is the result of sophisticated and exploitative marketing tactics combined with regulations that are outdated and not fit-for-purpose. Bee writes, “Manufacturers have done a spectacular job of convincing many parents that feeding a baby with highly processed pouches, powders and crisp-like snacks is not just the convenient option but the healthier and better one. Does your baby refuse greens? A pouch will provide all the veg they require. Worried about your child choking? Give them a “melty” snack”. One low-income parent said she used the puree to “get the nutrients in” and the packaged finger foods to “explore the textures”. Similarly, parents often don’t realise that the ‘growing up’ and ‘toddler’ milk offerings are largely unregulated (unlike first infant formula) and are often concerningly high in sweet ingredients which can reinforce sweet food preferences.

This problem is not unique to the UK, as seen in this US article, and the latest concerns raised in Australia by the Food for Health Alliance and its ‘Kids are Sweet Enough’ campaign.

An example of the misleading marketing practices of baby food pouch manufacturers in Australia, from the Food for Health Alliance.

High levels of intakes of commercial infant and toddler foods likely drives weight gain and longer-term ill health (obesity, diabetes, cardiovascular disease). We strongly agree with Bee that “If anyone should be protected from the ultra-processed world we are now living in, you might think it would be babies”. Our advocacy ask of Government is to:

Revise and strengthen the 2003 “Processed Cereal-based foods and baby foods for infants and young children regulations”, setting new legally binding standards for composition, labelling and marketing of commercial baby and toddler foods and drinks in line with WHO Europe’s Nutrient and Promotion Profile Model (NPPM) and UK public health recommendations.

We would welcome the publication of the voluntary commercial baby food and drink guidelines in the short term, which could improve the composition, labelling, and marketing of baby and toddler foods while the process to update the regulations is ongoing.

For practical guidance for eating well in pregnancy, infancy and early childhood, on diets based on unprocessed and minimally processed nutritious foods, see our range of ‘eating well guides’ here.

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New report: ‘Nourishing Our Future’: Exploring food provision in Essex early years settings

On 15 March, academics at Anglia Ruskin University hosted a conference to launch the report of their research exploring food provision in early years settings in Essex, a project called “Nourishing Our Future”. Fundamentally the concern is that children attending settings may consume up to 90% of their daily nutrient intake at the setting, and what they eat and learn about food shapes lifelong habits, added to which more than 1 in 5 children start school in Essex already with an unhealthy weight classified as overweight or obese. The aim of the research was to explore food provision, environment, experiences and perceptions towards health eating for children aged 1-5 years in private, voluntary and independent settings in Essex. Methods included an online survey (201 responses), workshops (88 practitioner attendees), photo capture (749 photos), menu analysis (25) and parent interviews (5).

Some of the key findings are as shown:

In addition, the research found that 41% of food was parent-provided (i.e. packed lunches), rising to 70% in pre-schools, with significant variations in nutritional quality, including very high use of commercial baby/toddler foods and other packaged snacks and convenience foods.

Based on their research findings, their recommendations include:

Extended funding to ensure all children have access to high-quality, nutritious meals in early years settings
Provision of food and nutrition support for practitioners and parents
Creation of accessible, clear guidance tailored to the diversity of settings
Advocacy for a healthier, affordable, transparent food system
Targeted support for children’s food preferences, allergies, and special educational needs.

Read the report here.

For practical guidance on eating well in infancy and between 1 and under 5 years of age suitable for use in early years settings, see our range of ‘Eating Well guides’ here. Our ‘Packed lunches for 1 to under-5 year olds’ resource may be particularly useful if the findings from Essex are indicative of elsewhere in the country.

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New survey: The Cost of Living on Maternity Leave 2025, by Maternity Action: interim findings

Maternity Action published interim findings from its Maternity Action Cost of Living on Maternity Leave Survey 2025 in March, here. Over 1,000 women responded to the survey between mid-December 2024 and February 2025. The report highlights that Statutory Maternity Pay and Maternity Allowance are worth half the national living wage. Most survey participants reported money-related stress, and many shared concerns that the drop in income impacted food and fuel purchase. New mothers are struggling to feed themselves; 38% reported smaller or skipped meals due to money, and a quarter said that they go without food so that they can prioritise their children. On mother said “I will often go without in the middle of the day so that my child can eat. Sometimes his meals consist of part of mine so that I don't have to buy extra.” This also impacts the kinds of food new mothers buy, with 50% purchasing less healthy foods due to high costs. Nearly 60% told Maternity Action that money worries were impacting their mental health and physical wellbeing.

HuffPost reported on the survey here, highlighting that this survey comes ahead of a 1.7% rise (£3.15 a week) in Statutory Maternity Pay, lower than the current 3% inflation. A Government spokesperson responded to the findings, saying “These [Statutory Maternity Pay/Maternity Allowance] are increased each year and are just one part of the support available for pregnant women and new mothers, who may also be eligible for Universal Credit or Child Benefit”. But Maternity Action disputed this statement.

We are concerned by these findings and support Maternity Action’s call to improve maternity pay, agreeing that this could improve child health outcomes and help tackle child poverty. It is our goal that all children in the UK eat well from the start of life from preconception to age five. Ensuring that new mothers can afford safe, nutritious, and minimally processed foods is essential to achieving this goal.

Maternity Action’s findings also highlight the importance of strengthening the ‘Healthy Start’ scheme, by increasing the allowance value and expanding the coverage so that more vulnerable families can be supported to eat well through improved access to fruit, vegetables, pulses and milk, and access to free vitamin supplements. 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.

Email your MP calling for an end to pregnancy poverty.

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Call for participants: Swansea research project on formula in food banks by 10 April

We are collaborating with academics at Swansea university to conduct some research to understand how the cost-of-living crisis and financial difficulties are affecting parents’ ability to access formula milk for their baby. This is a Swansea University research project led by Professor Amy Brown from the Faculty of Medicine, Health and Life Sciences.

There has been lots of discussion in the media about this issue and what support parents need if they need formula and find themselves unable to buy it for their baby. The research aims to understand the impact on parents of not being able to afford formula milk for their baby under 12 months old, how they currently try to access it for their baby, and how they think things could be improved.

As part of this, participants are being recruited to take part in a short survey. There are TWO separate surveys, one for parents and another for people who are working or volunteering roles around parenting, infant feeding and food insecurity. Please share this survey link with parents based in the UK, aged 16+, with a baby 12 months or younger, who are fully or partly formula feeding before the 10 April 2025.

If you are working or volunteering in a role related to parenting, infant feeding or food insecurity, are based in the UK and aged 18+, please do consider participating yourself. You can fill out the survey here before the 10 April 2025.

We hope that the findings from our research will raise further awareness of the impact of formula milk prices and be used by policy makers and those working with families so that parents who use formula to feed their babies can access infant formula more easily in the future.

For more information about this research project, click here.

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New report: Nourishing the Future: making healthy food accessible for every child by Barnardo’s

Barnardo's published this new policy report on 12 March, highlighting the barriers facing many families in eating well. They make wide ranging recommendations to Government to improve food at home, in schools, in communities and in society, including to: improve Healthy Start; facilitate health worker referral of families to community kitchens and food pantries, cooking classes and support provided by local food partnerships; fund family centres in all communities to be a ‘one stop shop’ for family-friendly food advice including breastfeeding support, cooking skills and culturally informed food education; fund the above and other recommendations through a sugar/salt tax (see the Recipe for Change campaign we at First Steps are a part of), and lastly to develop a Children and Young People’s Food Strategy to address the challenges facing young people’s diet including structural issues with the food system that make it hard for children to eat well. It is great to see common asks of Government being made from diverse organisations, and we are in touch with Barnardo’s to see how we can work together in the future.

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New analysis: Nutrient analysis of cows’ milk

The Office for Health Improvement and Disparities released an updated nutrient analysis of cows’ milk in early March. The survey was carried out in 2022/2023 and its aim was to provide up-to-date composition data for selected micronutrients in commonly consumed types of cows’ milk. The reason was because the last comprehensive nutrient analysis was undertaken in 1996 since when changes in breeding, feeding practices, production and processing methods may mean changing levels of certain nutrients, the focus being riboflavin, vitamin B12 and iodine. The new data will be used in the National Diet and Nutrition Survey (NDNS) analyses, will update McCance and Widdowson’s ‘The Composition of Foods’ and will be incorporated into the next update of the composition of foods integrated dataset (CoFID).

In general, lower values for riboflavin, vitamin B12 and iodine in cows’ milk were observed in this latest survey compared to the 1996 data, especially in pasteurised milk. The differences between seasons were more consistent in the 2022 to 2023 survey, where winter samples had higher contents of all 3 nutrients compared to summer samples. These findings are important given than cows’ milk provides a significant proportion of riboflavin and iodine in children’s diets; read more in our briefing paper: “Animal milks in the diets of children aged 1 to under-5 years”.

Find out more here.

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New supplement: VEG-1 baby and toddler liquid multivitamin

The Vegan Society now sells a new supplement - VEG 1 Baby and Toddler which provides a 5-month supply (150ml) of a liquid multivitamin for children aged six months to four years, suitable for infants and young children being raised on vegan diets. Each dose provides Vitamin B12 (5μg – 200%), Vitamin A (400μg – 50%), Vitamin C (30mg – 37%), Vitamin D (10μg – 200%), Iodine (50μg – 33%), Selenium (10μg – 18%), therefore meeting the EU Nutrient Reference values of the vitamins included.

We will include this information in our Eating well: vegan infants and under-5s guide when we next update it, in Autumn this year. The timing of this update will depend on the final report from the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) on ‘Assessing the health benefits and risks of consuming plant-based drinks’. 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. We submitted a response to the draft report in September 2024 here.

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 to under-5 year-olds.

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Infant milk news

News: Contaminants in infant formula

This news report was published on 19 March: Investigation reveals heavy metals, including ‘potentially harmful’ levels of lead, in baby formula | The Independent and includes a number of products for sale in the UK.

It reports on this investigation by the US organisation ‘Consumer Reports’ in which 41 infant formulas were tested for lead, cadmium, mercury, aluminium, potassium, bisphenol A, bisphenol F and bisphenol S, acrylamide and PFAS (“forever chemicals”).

They report that more than 12 infant formula products among 41 tested had “potentially harmful” levels of heavy metals – specifically lead.

The report states that “almost all samples contained lead, and eighteen formulas contained 50 to 100 percent of the “Maximum Allowable Dose Level” for a three-month-old (as set by the California Office of Environmental Health Hazard Assessment)”. However, EU/UK regulations permit 0.02mg/kg lead in powdered infant formula (equivalent to 20 micrograms/kg). None of the samples tested exceed this level and all were a long way off; the highest level recorded was 4.1micrograms/kg.

They reported ‘high levels’ of inorganic arsenic in two formulas. The EU/UK regulations permit 20 micrograms/kg and the maximum reported was 19.7micrograms/kg in Abbott’s Elecare Hypoallergenic.

They found one product (Enfamil Nutramigen, an FSMP for infants with cows’ milk allergy) to contain Bisphenol-A and acrylamide. We have written about bisphenols and acrylamide in our report “Ultra-processed foods in the diets of infants and young children in the UK”, see page 48. BP-A is a chemical used to make plastics sturdier, and research has demonstrated its tendency to contaminate food and propensity to interfere with normal hormone functioning. Acrylamide is a process contaminant which may arise following high temperature processing and is a likely carcinogen. There are no regulations for these chemicals. Abbott disputes Consumer Report’s findings.

The Consumer Report authors go on to state “Environmental pollutants are pervasive in our food supply, and all the contaminants in our tests—arsenic, lead, BPA, acrylamide, and PFAS—have also been previously detected in breast milk, food, and water”. Nb. There is in fact evidence that breastfeeding protects infants from arsenic intakes, see here.

The day after the Consumer Report results and the news report were published the FDA launched “Operation Stork”: HHS, FDA Announce Operation Stork Speed to Expand Options for Safe, Reliable, and Nutritious Infant Formula for American Families | HHS.gov. We will have to see if/how this spurs any changes in the UK/EU noting that EU infant formula regulations have historically been much stronger than US regulations, as described in this briefing from 2020.

At First Steps Nutrition Trust we have done some investigations in to selected contaminants of concern in formula milks which you can read here. While we can be encouraged by products meeting the regulatory requirements that exist for some contaminants, we ought to be concerned that not all are covered by regulations, with key ones missing including aluminium, the bisphenols and acrylamide.

Practical steps to reducing potentially harmful contaminants in the diets of infants and young children include protecting, promoting and supporting breastfeeding and basing diets on nutrient-dense unprocessed and minimally processed foods, as shown in our ‘eating well’ guides.

Lastly, families who have been prescribed Nutramigen for their babies may wish to discuss the findings above with their GP, noting that alternative extensively hydrolysed peptide-based infant formulas are available, see our report “Specialised milks marketed for infants with allergies in the UK”.

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***Updated FAQs*: Whey:casein ratios in infant milks**

We have updated our FAQs: ‘What are the nutrition composition and ingredient differences between infant formula and follow-on formula on the market?’, and ‘What are the differences between marketing and promotional practices for infant formula and follow-on formula?’, to include updated information on whey:casein ratios.

Key points:

Whey and casein are the two major proteins of breastmilk. There are no specifications in the regulations regarding whey to casein ratio. However, brands commonly adapt the whey:casein ratios of infant formula to be whey dominant and apply claims regarding ‘closeness to breast milk’, and digestibility. Furthermore, for follow-on milk (and toddler milks), the whey content is often reduced alongside the claim that it reflects the changes in breast milk over time.
Most but not all infant and follow-on formulas have a whey:casein ratio which emulates breastmilk. However, there is no evidence that altering the whey:casein ratio of formula improves the functionality of the product. While infant formulas are modelled on breastmilk composition and ingredients, breastmilk has a dynamic nature and cannot be replicated.

You can read the FAQs here.

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Update: Arize hydrolysed rice formula

Since we wrote about this product in our March newsletter, we have been informed by Abbott that it has been approved by ACBS as of September 2024 and updated on the NHS Drug Tariff. The British National Formulary for Children is yet to be updated, and we plan to update our Specialised milks marketed for infants with allergies in the UK once it is.

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

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Baby Feeding Law Group UK News

BFLG-UK response to the Competition and Markets Authority (CMA) infant and follow-on formula market study

On 14 February 2025, the Competition and Markets Authority (CMA) published the final report in its infant formula and follow-on formula market study, setting out its findings and recommendations to the UK, Northern Irish, Scottish and Welsh governments for action to deliver “better outcomes” for parents who depend on infant formula to feed their babies.

Following consultation with the members of the Baby Feeding Law Group UK, we have compiled a formal and comprehensive BFLG-UK response to the CMA infant and follow-on formula market study. The response includes two parts:

The BFLG-UK’s full endorsement of implementing the 11 recommendations and recommended next steps
Comprehensive responses to each of the 11 CMA recommendations.

This response has been shared with Minister Ashley Dalton, Parliamentary Under-Secretary of State for Public Health and Prevention and the Department of Health and Social Care (DHSC) project team, who will be compiling the government response to the CMA report (which we are expecting to be published around mid-May). First Steps Nutrition Trust is also coordinating a joint letter to Minister Dalton to call on government to accept and implement ALL 11 measures recommended by the CMA.

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NEW paper: A Descriptive Investigation of Infant Feeding Bottles Marketed in the UK Designed to Replicate Breastfeeding and the Evidence That Underpins Them

This research paper by Clare Maxwell and colleagues was published in March. It is a descriptive study that included two stages. Stage 1 involved identification of the 10 most popular bottles marketed in the UK as “best for breastfeeding”. Marketing materials and information from these brands were captured from manufacturer websites and codes were identified to describe the main marketed bottle features claiming to be aligned with breastfeeding. Stage 2 included capturing of and then a quality appraisal of the evidence provided on brand websites that support the claims made that features of the bottles align with breastfeeding.

Main findings include that the eight marketed bottles claimed to: prevent or reduce nipple confusion; prevent or reduce bottle refusal; aid combi-feeding; mimic breast/nipple; mimic physiology of breastfeeding; aid latch; have high teat acceptance and positive impact on breastfeeding. These show how the bottles and teats are being marketed as ‘equivalent’ to breastfeeding, with claims that they can replicate and in turn replace breastfeeding. However, the scientific evidence used to support these claims was found to be extremely limited, almost universally of low quality, generally outdated, exhibited small sample sizes and at times misleading. The authors recommend that “greater awareness of the lack of evidence to support advertised features of bottles that are claimed to be aligned to breastfeeding is required”, so that parents can make better informed choices. Furthermore, author recommendations include that research is needed on the impact of the marketing of bottles on infant feeding choices and breastfeeding practices, and that more effective regulation of bottle company advertising is urgently required.

This research paper is important because there is hardly any published research on the marketing of bottles and teats in the UK, and they are currently unregulated. Bottles and teats fall under the International Code of Marketing of Breastmilk Substitutes, and our view is that their marketing should be regulated alongside stronger enforced marketing of commercial milk formulas.

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Forthcoming

MAINN Conference, 28 – 30 April, Cumbria

This interdisciplinary conference organised by the Maternal, Parental and Infant Nutrition and Nurture Unit (MAINN) of University of Central Lancashire will take place from Monday 28 – Wednesday 30 April 2025. Our team (Dr Vicky Sibson, Dr Katie Pereira-Kotze, Jasmine Brand-Williamson and Rachel Childs) will be there learning, presenting and networking. Please find us to say hello!

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Webinar: Evaluation of the Healthy Start Scheme, 25 June

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March 2025

Image by Wirestock on Freepik

Welcome to the March edition of our newsletter – contents below.

ICYMI we wanted to highlight that we’re now on Blue Sky (which works the same way as X/Twitter) as @1stepsnutrition.bsky.social and also Instagram @1stepsnutritiontrust, so if you’re a lover of social media please consider following us there, and/or on Facebook and LinkedIn.

News

NEW report: Civil Food Resilience
Early Years Nutrition Winners and Losers at Sustain’s Children’s Food Summit Awards
ICYMI: World Pulses Day
NEW data: Oral health survey of 5-year-old children in England
New report: Dietary Intake in Scotland’s Children (DISH) research

Infant milk news

NEW infographic: How do infant formulas compare?
NEW: Summary sheet of information for families who use formula
NEW FAQ: Rice-based formulas

BFLG-UK news

Competition and Markets Authority infant and follow-on formula Market Study final report
APPG on Infant Feeding update

Forthcoming

Nourishing our Future Conference, Saturday 15 March, Essex
World Breastfeeding Trends Initiative (WBTi) UK Report launch, Tuesday 25 March, London
House of Lords debate on the Government response to ‘Recipe for Health’, Friday 28 March, Online

Happy reading!

News

NEW report: Civil Food Resilience

Professor Tim Lang led on producing this report “Just in Case: narrowing the civil food resilience gap”, commissioned and published by the UK National Preparedness Commission to establish how well prepared the UK is for a range of different food system shocks, including military weaponisation, economic, political, health, environmental and societal. While retaining a UK focus, the report draws on experiences and data gathered from 10 different countries across the globe. Firm conclusions and clear recommendations are made not only for the UK Government, but also for researchers and civil society so we can collectively bolster our national food resilience.

We provided expert input on infant food resilience (see page 221/222), and our 2023 report “How secure is our infants’ food supply? Why the government’s food security assessment and emergency planning must include breastfeeding and the infant formula supply chain” is cited.

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Early Years Nutrition Winners and Losers at Sustain’s Children’s Food Summit

On 25 February, Sustain hosted their second ever ‘Children’s Food Summit’, as part of their Children’s Food Campaign, with fantastic engagement and attendance from Children’s Food Campaign members and supporters from across civil society and Government. A part of the event involved awards for different categories, including Early Years Nutrition Champion and ‘Yucky’ awards for commercial villains. We at First Steps partnered on the champion award, seeking public and peer organisation nominations and adding our own suggestions in to the mix. We also helped judge the awards (with the exception of the one we supported to avoid any conflict of interest). Amazingly, many of the winners across awards categories were for organisations and individuals working to support eating well in pregnancy, infancy and early childhood (see below). Interestingly, yucky awards were dominated by unnecessary and inappropriate commercial infant and toddler foods (read more from Sustain on this here: KFC plus infant and toddler food brands come under fire at 2025 Children's Food Awards). This goes to show how the importance of early years nutrition, and the commercial challenges to eating well in these critical stages of life, have really come into the spotlight in the last couple of years. Here’s hoping this will help galvanise positive changes in the foreseeable future.

Congratulations to all the early years nutrition award winners and finalists, both yummy and yucky:

Political Leadership in Championing Children's Healthy Food
Winner: Carolyn Wilson and the early years team, Scottish Government

Championing Equality, Diversity and Inclusion in Children's Food
Winner: Leicester Mammas (pictured)

Children's Food Commercial Villain
Finalist: Ella’s Kitchen

Worst Example of Health-Washing in Children's Food
Winner: Aptamil 3 Toddler Milk
Finalist: Kiddylicious

Recipe Most in Need of Change
Winner: Farley’s Rusk Reduced Sugar biscuits

Early Years Nutrition Legend
Winner: The Breastfeeding Network
Finalist: Early Start Nutrition
Finalist: Tiny Tums Best Practice Award

Best Local Healthy Food Advertising Policy
Finalist: Hounslow Council

Read more from the Children’s Food Campaign here.

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ICYMI: World Pulses Day

World Pulses Day, organised by the Food and Agriculture Organization for the United Nations, was on 10 February this year. It aims to increase awareness of the importance of pulses, such as beans, lentils, and peas, for their nutritional value in our diets, improving planetary health and food security worldwide.

Eating well in the first two years is important to ensure optimal nutrition for growth and development and the development of healthy food preferences. A healthy diet in the early years is one providing a wide variety of nutritious, minimally processed foods. Pulses are nutrient dense and are great sources of protein, iron, zinc, calcium, riboflavin (Vitamin B2) and fibre. Pulses can be offered from 6 months, among other first foods and as part of an increasingly varied diet. For infants and young children in families following a vegan dietary pattern, pulses form an important part of making sure that these children eat enough protein for their growth and development. You can access practical guidance on how to provide a nutritious diet for young children in vegan families in our Eating Well guide ‘Eating Well: Vegan infants and under 5s’, here.

Example of different ways to serve red lentils, a commonly used pulse, as part of introducing a wide variety of textures during the complementary feeding period.

A wide variety of pulses are also used in traditional South Asian dishes, and it is important to acknowledge how these dishes can be adapted for young children’s diets. You can read more on how to use pulses in South Asian cooking for infants and young children in our blog that we wrote in collaboration with Eating Better here, and in our South Asian Eating Well guide on feeding children aged 6 to 24 months, available in both English and Bengali, here.

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NEW data: Oral health survey of 5-year-old children in England

This England-wide survey, which happens every two years, reports on data collected in the school year 2023/2024. The results show a small decrease in obvious dentinal decay since the last survey, at 22.4% down from 23.7%. Among the 22.4%, each child had on average 3.5 teeth with decay experience (at age 5 years, children normally have 20 primary teeth).

While the decline is good, this prevalence is shockingly high and masks disparities at both regional and local authority levels. Prevalence for enamel and/or dentinal decay is also higher at 26.9%, with regional ranges from 23.3% in the East of England to 36.8% in the North West.

Children living in the most deprived areas of the country were more than twice as likely to have experienced dentinal decay (32.2%) as those living in the least deprived areas (13.6%). There were also disparities in the percentage of those who had experienced dentinal decay by ethnic group, which was significantly higher in the Other ethnic group (45.4%) and the Asian or Asian British ethnic group (37.7%).

The report highlights that most dental decay is preventable, by limiting sugary foods and drinks. Our guide “Eating well: the first year” covers how to look after baby teeth, providing advice aligned with NHS and NICE guidelines. Chapter 10 of this 2014 Government toolkit also has a specific section on early years diets: Delivering better oral health: an evidence-based toolkit for prevention.

Practice tips for preventing dental decay:

Promote and support breastfeeding
Advise introduction of a beaker/open cup from 6 months, and to stop using a bottle after 12 months
Advise to give only breastmilk, first infant formula, or water in the first year (water to drink after 6 months of age) and only breastmilk, water and cows’ milk up to the age of 5 (or a suitable, fortified and unsweetened/zero sugar plant-based milk alternative for dairy free diets)
Advise avoidance of all formula milks, including growing up and toddler milks after the age of 1 year
Advise avoiding sugary foods and drinks – noting this includes most commercial baby foods, even though they are marketed as healthy choices!
Advise to brush baby’s teeth twice a day every day as soon as they appear, using a smear of fluoridated toothpaste

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New Report: Dietary Intake in Scotland’s Children (DISH) research

Food Standards Scotland has published a report in collaboration with the University of Edinburgh with information on dietary intakes of 1,700 children aged 2-15 years in Scotland in 2024. For children aged 2-4 years, just 27% met their energy density goals and 13% had the appropriate amount of saturated fat in their diets. Concerningly, just 14% met the goal of less than 5% of energy intakes being attributed to free sugars, with the average being 9%. Most 2–4-year-olds did not have enough fibre in their diet (68%), and significantly less young children in the most deprived areas met their fibre intake goals than in the least deprived areas. Young children in the most deprived areas also consumed significantly less fruit and vegetables than those in the least deprived areas in all age categories. Additionally, confectionary, sweet biscuits, crisps and savoury snacks, cakes, sweet pastries, sugary drinks, puddings, ice cream, and dairy desserts made up 14% of 2–4-year old’s energy intakes and a third of their free sugar intakes. As well as the nutrient imbalance these foods create in young children’s diets, this is concerning because many of these foods are ultra processed (UPF). To read more about why a UPF-rich diet is a concern in early childhood, read our 2023 report here.

The DISH findings suggest poor diets are still a major challenge for Scottish children, especially for those most vulnerable, living with food security or in the most deprived areas. We support the call for collective effort from policymakers, the food industry, schools, and communities to support healthier diets by improving the food environment. Improving the food environment in Scotland could help rebalance children’s diets towards the nutrient-dense, less processed/whole foods necessary to meet dietary requirements.

Early years diets are important for children to develop healthy eating preferences as well as to meet their nutrition needs for optimal growth and development and prevent disease. Our ‘Eating Well’ guides provide practical advice on how to meet nutrient requirements during pregnancy, while breastfeeding and for infants and young children under 5, cost effectively and based on unprocessed and minimally processed foods. You can download or buy hard copies here.

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Infant milk news

NEW infographic: How do infant formulas compare?

From NHS Start for Life

For parents using formula, First Infant Formula is the only formula their babies will need in the first year of life. It doesn’t matter which brand they use as they are all very similar. The NHS provides some information on formula feeding your baby and types of formula milk. However, and not surprisingly, formula companies still seek to convince parents/carers that their high-priced products are superior to other, lower cost, alternatives.

In response to rising infant formula costs (and our advocacy), the Competition and Markets Authority’s (CMA) carried out a study of the infant and follow-on formula market and exposed brand profiteering via unjustifiable price hikes. The CMA has recently recommended a series of robust interventions to strengthen and properly implement existing marketing rules for formula, as well as to better support families in informed decision making around product choice (see BFLG news below). Unfortunately, since the CMA started investigating formula prices, companies have doubled down on their marketing and insistence that their products are superior to others. We decided to create our own, conflict of interest free infographics to set the record straight. See below our infographics compared to industry’s misleading marketing tactics.

In this first example of current marketing, Aptamil claims that Aptamil and Aptamil Advanced are better than ‘First Infant Milk Minimum Requirements’ when in fact the nutritional requirements are strictly regulated and cannot be bettered with the addition of extra or ‘special’ ingredients.

Our infographic highlights that all first infant formula meet strict nutritional requirements and that they are all equally suitable for babies’ growth and development. You can download this infographic here.

In this second example of current marketing, Kendamil compares its new lower cost Bonya formula with other low cost infant formulas to suggest theirs is better. They use ingredient claims such as ‘contains milk fats’ and ‘no fish oil’ which suggests these products are better quality when they make no difference to health and nutrition outcomes or product safety.

Our infographic highlights all the key nutrients that are included in infant formula in the UK, and the minimal differences between ‘premium’ branded formula products, and lower cost brands as well as supermarket own-brand alternatives. You can download this infographic here.

We encourage you to share these infographics on your social media and within your network. For further supplementary information for parents and carers who use formula, see below. This core reference provides an overview on infant formula for healthcare professionals.

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New: Summary sheet of information for families who use formula

At the request of a midwife, we have created a one-page handout that lists and provides links to the different parent-facing resources we provide on formula. These are intended for use by midwives and health visitors supporting post-partum families who are using formula. These resources are in line with and complement NHS guidance. You can find the handout on our website here.

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NEW FAQ: Rice-based formulas

We have had an increasing number of queries about ‘Sprout’ an Australian, vegan infant formula made from rice starch and rice and pea protein.

In addition, ‘Arize’ is a new specialised formula based on hydrolysed rice protein which has recently come on to the UK market, positioned as an alternative to extensively hydrolysed formulas for infants with cows’ milk allergy.

Two key points:

1. ‘Sprout’ does NOT meet UK/European regulations for infant formula composition in a number of ways, which means we would not endorse its use.

2. ‘Arize’ is an FSMP and should only be used under medical supervision.

You can find out more about both products in our new FAQ ‘what rice-based formula milks are available and are they recommended?’ here.

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

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Baby Feeding Law Group UK News

Competition and Markets Authority infant and follow-on formula Market Study final report

On Friday 14 February 2025, the Competition and Markets Authority published its much-anticipated final infant and follow-on formula market study report. We welcome the report and fully support the proposed set of recommendations, many of which we have been advocating for some time. The final documents include an 8-page overview of the findings, 34-page Executive Summary and comprehensive 185-page Final report, together with 6 Appendices, a qualitative research report and 35 submissions published in response to the CMA’s interim report (including ours).

The following figure (available here) summarises the 11 recommendations from the CMA’s final report:

First Steps Nutrition Trust and the Baby Feeding Law Group UK issued a press release with feedback on the morning of 14 February, together with quotes from Jess Brown-Fuller MP (Chair of the All Party Parliamentary Group on Infant Feeding), Baroness Walmsley (Chair of the House of Lords all party inquiry entitled ‘Recipe for health: a plan to fix our broken food system’), Alison Morton, CEO of the Institute for Health Visiting (iHV) and Dr Chris van Tulleken, doctor, author and broadcaster. Our Senior Nutritionist, Dr Katie Pereira-Kotze was also on BBC Breakfast at 08:30 the morning the report was launched, see here. On 21 February, the Food Foundation shared this helpful short podcast: "CMA formula update" and on the same day The Grocer published this feature about the report: "Can the CMA save parents from infant formula confusion?"

We are currently finalising a comprehensive response to the CMA’s final report, incorporating inputs from the members of the BFLG-UK, and this will be available in due course on the BFLG website here.

In the meantime, we strongly recommend that all four governments urgently implement the package of recommendations put forward by the CMA, to ensure that all parents, however they feed their babies, can make informed infant feeding choices. We urge the Department of Health and Social Care (DHSC) to take the lead on providing the clear, impartial, accurate messaging required. There are some recommendations that can be implemented without regulatory change (including improved enforcement and the standardisation of infant formula labelling in health care settings). An important recommendation that we fully agree with but understand may take time (requiring public consultation) is the strengthening of labelling and advertising rules. We see this as an opportunity for the UK legislation to be more aligned with global guidance, to protect all infants, by ensuring safe and appropriate formula feeding together with the protection of breastfeeding. We will continue to urge caution that formula price promotions will never be appropriate due to the potential associated risks, especially to the most vulnerable families, and are not a credible solution to high prices, where companies have maintained high profit margins. Lastly, the recommendations from the CMA need to be accompanied by proportionate action to ensure universal access to breastfeeding for mothers who want to breastfeed as well as improvements to the Healthy Start scheme to support pregnant women, breastfeeding women, babies, and young children to meet their nutritional needs.

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All Party Parliamentary Group on Infant Feeding update

The All-Party Parliamentary Group (APPG) for Infant Feeding has been reformed following the election last year and is now chaired by Jess Brown-Fuller, MP for Chichester. On 24 February 2025, Jess, together with the Chair for the APPG for Babies (Maya Ellis, MP) and the Chair for the Health APPG (Dr Simon Opher, MP), sent a letter to the Secretary of State for Health, asking that the Government implements the CMA market study recommendations (see above) as a matter of urgency.

On Tuesday 4 March, the first full meeting of this APPG took place, in a hybrid format with a face-to-face meeting at Portcullis House. There was a presentation from Rachel Smith from the Competition and Markets Authority who discussed the final report from the CMA on the infant formula and follow-on formula market study. Our Senior Nutritionist, Dr Katie Pereira-Kotze Katie shared the response from the BFLG-UK to the CMA recommendations, and this will be available in due course on the BFLG website here.

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Forthcoming

Nourishing our Future conference, Saturday 15 March 15, Essex

Anglia Ruskin University (ARU) and Essex County Council (ECC) Public Health are hosting this pioneering event dedicated to exploring and promoting healthy eating in early years settings. The event will take place on Saturday 15 March at ARU’s Chelmsford campus.

The Nourishing Our Future project is a research initiative led by ARU and commissioned by Essex County Council Public Health, that delves into the challenges and opportunities of fostering healthy eating habits in early years settings. By collaborating with educators, parents, and industry leaders, the project aims to create impactful resources and strategies that benefit children across the region and beyond. This project sought to understand the current food environment within early years settings in Essex and identify areas of need and realistic and effective opportunities for improvement. The conference will bring together local parents, early educators, researchers, experts, and policy leaders from the intersecting fields of early childhood education, nutrition, and public health. It seeks to exchange insights, highlight innovative practices, and develop real-world strategies for creating healthier food environments for young children.

The research findings will be presented, and there will be contributions from a range of actors including us at First Steps. Book to attend here.

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World Breastfeeding Trends Initiative (WBTi) UK 2024 Report launch, Tuesday 25 March, London

The 2024 World Breastfeeding Trends Initiative (WBTi) UK Report, assessing breastfeeding policies, programmes and practices in the UK, will be launched on Tuesday 25 March 2025 from 6-8pm. This will happen through a hybrid event with limited in-person places (at Guy’s Hospital in London). Please RSVP to Patricia Wise at patricia@wise141.co.uk, indicating whether you would like to attend in-person or virtually.

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House of Lords debate on the Government response to ‘Recipe for Health’, Friday 28 March, online

As reported in our February newsletter the formal response of Government to the House of Lords report ‘Recipe for Health’ published on Thursday 30 January was very disappointing, with no new meaningful commitments despite acknowledgement of the huge problem posed by persistent high levels of overweight and obesity. At 10am on Friday 28 March, the response will be debated in the House of Lords, and the debate can be watched on parliament TV. We will share links on our social media.

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February 2025

Image by Montypeter on Freepik

Welcome to the February edition of our newsletter – contents below.

Before you get stuck in, we wanted to highlight that we’re now on Blue Sky (which works the same way as X/Twitter) as @1stepsnutrition.bsky.social and also Instagram @1stepsnutritiontrust, so if you’re a lover of social media please consider following us there, and/or on Facebook and LinkedIn.

News

NEW guide: “Eating Well for pregnant and breastfeeding women, babies and young children living in Temporary Accommodation”
NEW guidelines: NICE guidelines on Maternal and Child Nutrition
NEW report: The Broken Plate 2025: The State of the Nation’s Food System
NEW paper: “Evaluating alignment of UK commercial baby food products with the WHO nutrient and promotion profile model”
Government response to the House of Lords Food, Diet and Obesity inquiry report recommendations
NEW paper: “The NOVA system can be used to address harmful foods and harmful food systems”
NEW video: Healthy Start
ICYMI: UK Food Security data from December

Infant milk news

SMA Soya discontinued

BFLG-UK news

New paper: “Formula labelling in the UK and (non-)compliance with the Code, UK legislation and guidance”
Tackling conflicts of interest: News in the British Medical Journal (BMJ)
New FAQs document on formula in food and baby banks
Update on the All Party Parliamentary Group on Infant Feeding

Forthcoming

Sustain’s Children’s Food Summit, 25 February, London
MAINN Conference, 28-30 April, Cumbria

HR Update

Happy reading!

News

NEW guide: “Eating Well for pregnant and breastfeeding women, babies and young children living in Temporary Accommodation”

This new addition to our suite of practical, photographic eating well guides has been written for those whose work involves catering for or supporting women and young families living in temporary accommodation to eat well.

It tackles challenges including limited access to practical resources such as kitchens, utensils and storage, money to purchase food and resources, and to social and community support, and offers practical advice to help families maintain good nutrition in resource-poor settings. It also includes lots of no-cook recipes suitable for different ages.

Download it here. We love feedback, please email admin@firststepsnutrition.org

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NEW guideline: NICE guidelines on Maternal and Child Nutrition

These new evidence-based guidelines were released on 15 January after a three year development process. The guidelines cover nutrition and weight management in pregnancy and nutrition in children up to five years. Pre-pregnancy weight management and post-partum weight loss, and infant feeding for the first 8 weeks are covered in other NICE guidelines which are signposted within.

The guideline refers to Government recommendations on healthy diets, which are not repeated within.

The purpose of the guideline is to support those working with new and expectant mums, babies and children in their practice (as health or early years professionals), in relation to offering advice and supporting eating well and feeding. It is also aimed at commissioners and service provides as well as individuals families themselves.

There are recommendations on the following areas, which have been carefully written to take into account context (such as cost of living pressures and widespread misleading marketing) and highlight the need for advice to be based on non-commercial, evidence-based, information sources (such as First Steps Nutrition Trust!):

vitamin supplementation
healthy eating, physical activity and weight management during pregnancy
breastfeeding and formula feeding
weighing babies and young children
healthy eating behaviours in babies and children from 6 months and up to 5 years.

Find the guidelines here.

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NEW report: The Broken Plate 2025: The state of the nation’s food system

The Food Foundation launched their latest annual Broken Plate report in parliament on Wednesday 29 January. It paints a concerning picture with persisting challenges across all three food environment metrics: price and affordability, appeal and availability of healthy food; and outcome metrics: diet quality and environmental and health outcomes.

Executive Director Anna Taylor highlighted “the barrage of marketing is delivering a health crisis starting in childhood” and called for “primary legislation to give the direction of travel for the food system”.

The report reveals that children are consuming less than half their recommended amount of fruit and vegetables yet double the amount of sugar. This may not be surprising considering healthier foods were found to be twice as expensive per kcal as unhealthy options in UK supermarkets.

Contributing to the report, Action on Sugar carried out a survey of front-of-pack labels for baby and toddler snacks and found that 74% of products with front-of-pack promotional claims had high or medium sugars (compared to recommendations for adults). In addition, just 24% of products surveyed were classified as low in sugar. In 2023, the WHO created new guidelines specifically for assessing foods marketed for children under 3 years of age, based on the “Nutrient and Promotion Profile Model”. When comparing the front-of-pack claims with these guidelines, 94% would not be permitted. We strongly agree with The Food Foundation’s call to reduce the inappropriate marketing of unhealthy foods, particularly to “Regulate marketing and composition of toddler and baby foods and restrict nutrition and health claims on the front of packaging”.

Due to the growing evidence linking poor health outcomes with the consumption of ultra processed foods (UPF), in their report the Food Foundation also highlights an opportunity to strengthen how we define “unhealthy” foods in food policy. Presently, foods are classified as unhealthy if they are high in salt, fat, sugar and salt (HFSS) and this report endorses a need to go beyond this definition to include other measures of healthfulness such as degree of processing and inclusion of harmful ingredients. We strongly agree that food policies should address UPFs as well as HFSS foods and drinks, to rebalance our children’s diets in favour of minimally processed nutritious foods.

We support The Food Foundation’s recommendations presented in the 2025 Broken Plate report, and the need to ensure healthy diets are affordable, appealing, and available to all, especially in the early years.

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NEW paper: “Evaluating alignment of UK commercial baby food products with the WHO nutrient and promotion profile model”

New research published this January by Cigdem Bozkir and colleagues explored whether 469 UK commercial baby food products aligned with the WHO Nutrient and Promotion Profile model (NPPM) guidelines. The WHO’s NPPM is a standardised tool which can be used to evaluate commercial baby foods which was designed in response to concerns about these products with regards to high sugar levels, especially in fruit purees, labelling that promotes the early introduction of solids, and nutrient deficiencies meaning products are unlikely to meet the nutritional needs of infants and young children. The researchers found only 45% of products met the WHO’s NPPM nutritional standards, and that 59% of products analysed did not meet the criteria for sugar content. In terms of promotion, no products met the standards for marketing, nutrient and health claims and just 5% had adequate messaging to support breastfeeding.

This study highlights that commercial baby foods in the UK are not meeting nutrition composition standards and that marketing practices are routinely inappropriate. You can find a broader discussion into UK commercial baby foods in our previous reports, which can be found here.

Currently, there are limited regulations for the nutritional composition of commercial baby foods in the UK, and none that restrict sugar levels. Additionally, NHS guidance makes no explicit mention of commercial baby foods leaving a gap in advice for parents/carers. We recommend that the UK Government strengthens and enforces regulations in line with WHO Europe’s NPPM (and ensures consistency with public health recommendations), and clarifies NHS complementary feeding advice to include explicit guidance on commercial baby foods in line with SACN recommendations which state:

Commercially manufactured foods and drinks marketed specifically for infants and young children are not needed to meet nutritional requirements.
Home-prepared foods are generally recommended to help introduce infants and young children to a range of appropriate flavours and textures.

These steps are necessary to enable parents/carers to make informed decisions about what foods to choose when feeding their infants and young children, in line with public health recommendations.

We produce practical ‘eating well’ guides to show parents/carers how to feed their babies and young children diets based on nutritious, minimally processed foods, avoiding the need for commercial baby foods. You can find our eating well guides for infants and new mums here, including for those following vegan diets.

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Government response to the House of Lords Food, Diet and Obesity inquiry report

The House of Lords inquiry report “Recipe for Health: A plan to fix our Broken Food System” was published on 24 October to overwhelming positive reaction from public health and food system advocates. This podcast released in December gives an insight into the inquiry and an overview of the evidence given. On 29 January, there was a long and well attended debate in the House of Commons on the report (find the transcript here). But, despite some enthusiasm in that debate for recommendations within the report, we were surprised and dismayed by the formal response of Government published on Thursday 30 January.

In short, the report acknowledges high levels of overweight and obesity and the need for action, but makes no new commitments, doubling down on work already in train and deferring any future action to the future National Food Strategy announced by DEFRA minister Steve Barclay on 10 December.

Focusing on chapter 6 (infants, children and young people), the Government:

Deflects any commitment to acting on the inquiry recommendation for a comprehensive and integrated maternal and infant nutrition strategy, stating that the new NICE guidelines (above) and work being undertaken by SACN will “inform future actions and goals”. It chooses to highlight ongoing work under the NHS England’s Three-year delivery plan for maternity and neonatal services (which started in 2023); the Better Health - Start for Life website; and the 24/7 National Breastfeeding Helpline.

Deflects any commitment to acting on the inquiry recommendation to strengthen regulations on the composition and marketing of follow-on, toddler and growing up milks, suggesting 1. That existing Government advice against using growing up milks is sufficient to tackle their very high levels of consumption and contribution to excessive sugar intakes, 2. They’re waiting for the CMA response and may do something about cross promotion of follow-on formula (though note there are a lot more far-reaching recommendations in the CMA report than addressing this one issue).

Ignores the recommendation of the inquiry to strengthen regulations on the composition and marketing of commercial baby foods, stating that they are already ‘comprehensive’, and they will keep them under review.

Takes on board the recommendation of the inquiry to review food standards for early years settings (noting the recommendation also includes making them mandatory, supporting early years settings to meet them and establishing a performance framework).

We are in the process of challenging the Government’s response to the recommendation to strengthen regulations on the composition and marketing of commercial baby foods on the basis that the regulations are far from ‘comprehensive’ (see pages 16, and 87 and 88 of our 2017 baby foods report, and Bozkir et al’s paper and Action on Sugar’s analysis of infant foods for the Food Foundation’s Broken Plate 2025 summarised above). We have also been in touch with DEFRA to feed into the promised National Food Strategy. While we are not feeling very optimistic, watch this space…

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NEW paper: “The NOVA system can be used to address harmful foods and harmful food systems”

An editorial published in PLOS Medicine by Jean Adams from the University of Cambridge explores how the NOVA system can be used to address the health of both people and the planet concurrently. Unhealthy diets cause 15% of deaths globally and the food system contributes to 15% of global greenhouse gas emissions. Both unhealthy foods and food production systems disproportionately impact those who are less affluent.

The NOVA system is proposed by Dr Adams as a potential indicator for the harmfulness of foods, both to people and the planet. There is extensive epidemiological research that suggests UPF-rich diets are harmful to health. In addition, UPF are often designed to encourage consumption in excess combined with wide profit margins and thus excessive profits for large multinational corporations whilst also contributing to knock-on costs to healthcare systems. There are concerns that the organisations profiting from UPF might be responsible for diluting the evidence surrounding UPF and even directly funding scientists and creating conflicts of interest in the research base.

This article highlights the urgent need for action to reduce UPF consumption to rebalance diets towards the nutrient-dense, less processed/whole foods necessary to meet dietary requirements, but also to reduce the burden that this system has on the environment.

We feel strongly that reducing UPF consumption in the early years will help lay the foundation for healthy dietary preferences and habits. Our policy recommendations for UPF in the UK are in our 2023 report here.

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NEW: Healthy Start video

The Centre for Food Policy has created a video in collaboration with Redbridge Borough Council in London to promote the Healthy Start Scheme. The Healthy Start scheme provides help for pregnant teenagers, low-income pregnant and breastfeeding women and families with children under the age of 4 years to buy infant formula (if needed) and healthy foods such as, fruit, vegetables, cows’ milk, and pulses. If parents/carers join the Healthy Start scheme, they are also entitled to vitamins for pregnant women and new mothers, as well as vitamins for their children up to the age of 4.

One parent, Jo, shares “We all want to be really good parents, and we all want them [our children] to grow and be healthy and be strong. Healthy Start helped me to be able to do that, and to be able to give and provide the best that I can for my son, which maybe I wouldn’t have been able to do if I didn’t have Healthy Start”.

This video outlines how and when to sign up, who might be eligible for the scheme and answers some common concerns about the scheme.

Watch the full video here.

The alternative to Healthy Start in Scotland is Best Start Foods, you can find out more information about this here.

ICYMI 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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ICYMI: Latest UK Food Security data from December

The UK Food Security Report (UKFSR) sets out an analysis of statistical data relating to food security in the UK. It examines past, current, and future trends relevant to food security.

The report states: “The combination of higher food prices and general inflation caused a rise in household food insecurity in the UK as household budgets were squeezed. Consumers have responded by buying cheaper goods and prioritising price over other factors (such as environment, health, and wider ethical values). Market and supply volatility has therefore weakened access to food and also agency by weakening choice. The impacts of these issues are felt most acutely by particular demographic groups, including those with lower incomes, households with children and those with disabilities. While for the majority a food security issue might mean limitation or reduced choice such as buying less meat, it could mean a significant reduction in food security for vulnerable groups. The continuing trend of most people not meeting UK dietary recommendations demonstrates ongoing issues with utilisation whether that’s through food environment, price, lifestyle, time or educational factors”.

The report is said to present “a full and impartial analysis of UK food security”...except it does not include babies.

This previous briefing of ours remains very relevant “How secure is our infants’ food supply? Why the government’s food security assessment and emergency planning must include breastfeeding and the infant formula supply chain”, and we are waiting for a meeting with DEFRA to discuss.

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Infant milk news

SMA Soya discontinued

We have received confirmation from SMA that its SMA Soya First Infant Milk has been discontinued. SMA reported that this was due to ongoing supply issues with a key ingredient since early 2024, and subsequent shortages and that they made the decision to discontinue the product due to the decrease in use as parents and caregivers explored different options as a result of shortages. This means that there is currently no soya-based infant formula available on the market. The UK government advises that soya protein-based infant formula should only ever be used if it has been recommended or prescribed by a health visitor or GP (typically for cows’ milk allergy), and then only from 6 months. There are other formula milks for non-breastfed infants with diagnosed cows’ milk allergy, so this discontinuation should not be cause for concern. Read our report “Specialised milks marketed for infants with allergies in the UK” for more information.

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

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Baby Feeding Law Group UK News

NEW paper: “Formula labelling in the UK and (non-)compliance with the Code, UK legislation and guidance”

On 31 January 2025, the Maternal and Child Nutrition journal published our original research paper, from a study conducted by Maiko Kamata, as part of a Master’s degree through the London School of Hygiene and Tropical Medicine with support of First Steps Nutrition Trust. This is the first study of UK infant and follow‐on formula labels which evaluates compliance with both UK legislation and Guidance Notes designed to interpret the law, as well as the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions (‘the Code’). This research provides compelling evidence of how commercial milk formula manufacturers in the UK violate national legislation and guidance, and the Code. A robust process was followed to assess all infant formula (IF) and follow-on formula (FoF) labels of products available for sale in the UK in 2022, using labelling checklists to systematically assess compliance and then compare compliance scores between the regulatory frameworks, formula types and brands.

There was low overall compliance among the 57 labels assessed (32 IF and 25 FoF): 50% complied with UK law, 32% with Guidance Notes and 40% with the Code. None of the labels complied with provisions prohibiting the provision of text and photographs that idealise formula milk and/or discourage breastfeeding. All labels contained nutrition and health claims. All labels (and therefore all manufacturers and all brands) used cross‐promotion between formula types, with similar text, images and/or colours on labels of infant and follow‐on formula milk (as shown in the photos). This provides clear evidence of inappropriate marketing across all IF and FoF products in the UK. Our main recommendations are that existing legislation has to be better enforced, and that current legislation needs to be strengthened to be in line with the Code. These measures would protect breastfeeding AND support safer, appropriate formula feeding AND lessen commercial influence on infant feeding practices.

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Tackling conflicts of interest: News in the British Medical Journal (BMJ)

During January 2025, three news pieces were published in the BMJ following our alert to conflicts of interest:

“Danone’s use of midwives to give branded infant feeding advice in supermarket sparks anger”

During November 2024, we were contacted by a midwife to alert us to a conflict of interest, where Tesco stores were piloting a service for midwives to be available in-store to provide infant feeding services while customers shopped. The problem was that Danone was funding this project, through its Aptaclub programme, run by Nutricia. The project included branded Aptaclub leaflets, uniforms and an online booking system done through Aptaclub. The Aptaclub branding is very similar to that of Aptamil formula, Danone’s flagship product. This raises a clear conflict of interest, where a company that stands to profit from increased sales of its product (infant formula) was paying health professionals to provide infant feeding support. The risk was that the service was not impartial or free from commercial and marketing influence. This news piece was published on 8 January 2025, drawing substantial media coverage, including a radio interview on LBC news between Shelagh Fogerty, with our Senior Nutritionist, Dr Katie Pereira-Kotze and the midwife who alerted us to this, Marina Jordan. Before publication, Tesco maintained they would continue the pilot and roll out the project to other stores.

“Unethical infant feeding service is axed in Tesco climbdown”

However, Tesco then subsequently announced that they would conclude the pilot at the end of January and re-evaluate how they support customers in future, as reported in a follow-up news piece in the BMJ on 15 January 2025. We feel this is an example of successful advocacy that created awareness of an inappropriate partnership and resulted in the service being stopped. While the principle of a retailer providing an infant feeding service is not objectionable, it would need to be implemented without funding or support from the formula industry using information that is aligned with NHS advice, evidence based, and free from any commercial influence.

“Midwifery conference criticised for repeatedly accepting formula milk sponsorship”

The British Journal of Midwifery (BJM) has presented an annual conference sponsored by the commercial milk formula industry for several years. We have repeatedly alerted the BJM to the conflict of interest this presents. In 2024, the British Medical Journal published this commentary, Midwifery conference is criticised over formula milk sponsors, and on 28 January 2025 they published this follow-up commentary: Midwifery conference criticised for repeatedly accepting formula milk sponsorship. It is very disappointing that despite the strong global guidance, and calls from academics, researchers, and health professionals in the UK and globally, the BJM conference still appears to be continuing with sponsorship from the formula industry, supporting businesses before infant and maternal health. It goes without saying, do avoid if you wish to adhere to the Code.

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NEW: briefing on distribution of infant formula from food banks and baby banks

In response to confusion regarding the legality and appropriateness of distribution of infant formula via food or baby banks (for example, here: Government confirms food banks can supply baby formula to families), we felt it was timely to collate a Frequently Asked Questions (FAQ) document on the subject. This briefing draws from the existing guidance including the 2022 Guide for local authorities and health boards supporting families with infants under 12 months experiencing food insecurity. We collaborated with endorsing organisations (BFLG members, the Independent Food Aid Network (IFAN), and the Trussell Trust) and consulted the Baby Bank Alliance to ensure that the information presented reflects the current realities for families, food and baby banks and statutory services. The FAQ provides interpretation and practical advice to common questions we are asked and concerns raised. This is an important topic and infant formula should always be accessible to families who need it, for as long as they need it. However, targeting is key and any additional support needs families may have to use it safely should also be met, to minimise risks to their baby’s health.

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All Party Parliamentary Group on Infant Feeding

The All-Party Parliamentary Group for Infant Feeding had its first meeting on 27 November 2024 and was formally registered on 2 January 2025. Jess Brown-Fuller, Liberal Democrat MP for Chichester, is the Chair. The APPG aims to “raise awareness of infant feeding and allow MPs, peers and policy stakeholders an opportunity to meet regularly to ensure that this topic remains a priority for HM Government with a view to reducing inequalities and improving health”. Current officers are listed as Andrew Griffith, Josh Fenton-Glynn and Alison Bennett. We anticipate that more information will be shared in due course, with a first meeting in early March. Follow us on social media for confirmation of date/time.

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Forthcoming

Sustain’s Children’s Food Summit Tuesday 25 February, London

Sustain’s Children's Food Campaign is hosting its second Children's Food Summit on Tuesday 25 February 2025 in London. It promises to be an exciting and interactive afternoon of discussion with policy makers, public health and education organisations, researchers, parent ambassadors, young people and other key figures making a difference in the children’s food space. We will be there, presenting the first ever award for “Early Years Nutrition Champion”. The three finalists are Early Start Nutrition, Tiny Tums Best Practice Award and the Breastfeeding Network.

You may be interested to see that early years food and nutrition pervades all awards categories (good and bad!), showing the high level of interest in and appreciation of the importance of eating well from preconception to age 5.

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MAINN Conference, Monday 28 - Wednesday 30 April, Cumbria

This interdisciplinary conference organised by the Maternal, Parental and Infant Nutrition and Nurture Unit (MAINN) of University of Central Lancashire aims 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.

We at First Steps Nutrition Trust are presenting several posters, workshops and a keynote lecture, and would love to see you there. You can find out more and book your place here.

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HR update

We’re excited to share news of our fourth First Steps Nutrition Trust baby - our (newly promoted) Senior Nutritionist Rachel’s beautiful baby boy Zacharias James Robert who arrived on his due date on 10 January, weighing 10lb 2oz. Mum and baby doing well.

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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

New investigation: Campaigners call for end to food and drink industry’s infiltration of UK children’s education
DHSC correspondence on folic acid supplementation
News: Little Freddie baby food pouches misleading customers over sugar levels
Spotlight: High free sugars in kids flavoured yoghurts
New editorial: Plant-Based and Dairy-Free Drinks: An Emerging Health Hazard for Young Children
New paper: Exposure to sugar rationing in the first 1000 days of life protected against chronic disease
Translated eating well guide: Eating Well 6 months to 2 years for South Asian children in Bengali
Two new reports on food insecurity in the early years
New report: Breastfeeding in focus: insights from the sector
New report: Nourishing Britain: a political manual for improving the nation’s health
New editorial: Conflicts of interest: moving towards zero tolerance

Infant milk news

New and discontinued products
New infographics: infant milk costs and trends
Update: Two-pager on responsive bottle feeding and which formula to choose

BFLG-UK news

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

Forthcoming

New: Eating Well for pregnant and breastfeeding women, infants and young children living in Temporary Accommodation

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

Latest childhood obesity data: release of NCMP data for 2023/2024 academic year
Autumn budget: reflections from an early years nutrition perspective
New House of Lords inquiry report: Recipe for health - a plan to fix our broken food system
New paper: Ultra-processed food intake in toddlerhood and mid-childhood in the UK
New editorial: Ending health care professional association conflict of interest with the nutrition industry
New paper: Stakeholders’ views of the Baby Friendly Initiative implementation and impact
Updated nutritional standards and practical guidance for early years settings in Scotland: “Setting the Table”
Update: Healthy Start and people with no recourse to public funds

Infant milk news

New and discontinued products
Infant milk cost report update and latest price trends

BFLG-UK news

Latest news from the Competition and Markets Authority: Interim report due on the infant formula market study “in Autumn 2024”
New paper: Outcomes of implementing the International Code of Marketing of Breastmilk Substitutes as national laws

Forthcoming

Unicef Baby Friendly Initiative Conference (online), Wednesday 20 - Thursday 21 November

HR Update

HR Update at First Steps Nutrition Trust

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)

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

New report: Drinks marketed as growing up and toddler milks and drinks
Updated: Good food choices and portion sizes
New article: UK government’s nutrition advisers are paid by world’s largest food companies
N ew report: Rethinking plant-based meat alternatives
More new baby food pouches marketed for infants from 6 months of age
New paper: Household food insecurity and novel complementary feeding methods in New Zealand
New paper: Response to: World Health Organization (WHO) guideline on the complementary feeding of infants and young children aged 6-23 months 2023
Draft recommendations on plant-based drinks from SACN/COT

Infant milk news

SMA news
Kendamil news
News coverage of our editorial: Specialised infant milks: over used, overpriced and obesogenic

BFLG-UK news

Latest news from the Competition and Markets Authority on the infant formula market survey
New resource: Countering Industry Arguments Against Code Implementation: Evidence and Rights-Based Responses
The proposed draft WHA resolution on Digital Marketing

Forthcoming

Breastfeeding Network (BfN) Conference and AGM: Saturday 5 October, Online
Unicef UK Baby Friendly Initiative qualifications framework applications open until 3pm Monday 21 October
Publication of updated NICE guidelines on Maternal and Child Nutrition: Wednesday 15 January 2025
Maternal, Parental and Infant Nutrition and Nurture Unit (MAINN) Conference: April 2025

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 78^th WHA in May 2025. More about the WHA is available here.

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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

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

Updated: Eating Well: The first year
Reminder: Eating Well packed lunches for children aged 1 to under-5 years
New paper: Prevalence and risk factors for milk allergy overdiagnosis in the BEEP trial cohort
The Grocer focus on infant and childcare
FSA guidance reminder: Slush ice drinks

Infant milk news

Aldi Mamia first infant formula price drop
Updated: Infant milks: A simple guide to infant formula, follow-on formula and other infant milks
New editorial: Specialised infant milks: over used, overpriced and obesogenic

BFLG-UK news

Update on the Competition and Markets Authority infant formula market survey

Forthcoming

World Breastfeeding Week 2024: 1 - 7 August. Strength in Numbers webinar: Tuesday 6 August
NICE consultation on updated Maternal and Child Nutrition Guidelines: deadline 10 September
SACN/COT consultation on plant-based milks: deadline 17 September
SACN consultation on maternal weight gain in pregnancy: deadline 17 September
Maternal, parental, and infant nutrition and nurture unit (MAINN) Conference: April 2025
HR Update

Happy reading!

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:

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.
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).
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
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.

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.

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)
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.
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.

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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

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

General Election 2024: Election day!
New survey: The Cost of Living and Maternity Leave
New paper: What factors drive parents’ choice of baby food products?
Updated: Recommendations on giving water in infancy
New report: Commercial determinants of non-communicable diseases in the WHO European Region

Infant milk news

New: ESPGHAN position on anti-reflux and comfort milks

BFLG-UK news

World Health Assembly Side Event on Digital Marketing of Breastmilk Substitutes

Forthcoming

Infant milk info webinar: Wednesday 17 July
Breastfeeding Network conference: Online, Saturday 5 October
Nourishing Futures Network conference: Newcastle, Wednesday 2 October
Unicef Baby Friendly Initiative conference: Online, Wednesday 20 and Thursday 21 November

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 77^th 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 77^th 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.

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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

General Election 2024: Our policy asks for Healthy Early Years Diets
News: Giving babies smooth peanut butter could provide lifelong allergy defence
New: Nutrition guidance from the Department for Education for Early Years Providers
New: UK Government Food Security Index
New: Resilience Directorate Cabinet Office ‘Get prepared’ campaign
New report: Prioritising early childhood for a happier, healthier society: How businesses can drive, and benefit from, transformative change in the UK
New: Start for Life children’s oral health campaign
Update on Healthy Start

Infant milk news

Product update: SMA Soya out of stock
Updated: Specialised infant milks marketed for infants with allergies in the UK

BFLG-UK news

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

Forthcoming

The World Public Health Nutrition Association Congress: London, 10-14 June
Consultation on updated NICE Maternal and Child Nutrition Guideline: *postponed*
Infantmilkinfo webinars: Wednesday 26 June and Wednesday 17 July

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.

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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 26^th June and will be repeated on Wednesday 17 July. You can register here.

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*|IFNOT:ARCHIVE_PAGE|* *|LIST:DESCRIPTION|*

May 2024

Image by wirestock on Freepik

Welcome to the May edition of our newsletter, featuring:

News

Updated: UK public health guidance on infant and young child feeding
Updated: First Steps’ Eating Well Packed Lunches for 1-under 5 year olds
New paper: “Either something is wrong or I am a terrible parent”
New manifesto: Sustain’s parent’s poll on children’s food
Updated training modules: NHS Health Education England’s e-learning for healthcare: Healthy Child Programme. Growth and Nutrition modules.
New: Access to Nutrition Initiative reports on the global commercial baby food and breastmilk substitute industries

Infant milk news

Updated: infant milks cost report and trends analysis
New formula preparation product which claims to reduce colic

BFLG-UK news

WHA 77 Side event on Maternal, infant, and young child nutrition: Digital marketing of breastmilk substitutes

Forthcoming

Consultation on updated NICE Maternal and Child Nutrition Guideline – 7 June 2024
iHV annual Evidence-based Practice Conference - 3 July 2024
Unicef UK annual Baby Friendly Initiative Conference - 20 - 21 November 2024

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:

module 4: Infant feeding part 3: Introducing solids
module 10: Common Nutritional Problems in Preschoolers
module 11: The Social Context of Food

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 infographic s 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 77^th 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.

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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

Welcome to the April edition of our newsletter, featuring:

News

New: Eating Well resource for South Asian families
New paper: What shapes parental feeding decisions over the first 18 months of parenting
Written response: OHID’s draft proposal for voluntary industry guidelines for commercial baby foods and drinks aimed at children up to 36 months
Update: First Steps’ inputs in to the House of Lords Inquiry in to Food, Diet and Obesity

Infant milk news

Which? guide to formula preparation machines
Infant milk costs: Further price cuts announced as more brands and retailers seek to remain competitive
Rickett Benckiser in the news again: landmark necrotizing enterocolitis lawsuit rules in favour of parents of a deceased baby
Reminder: Where to find more information on infant milks

BFLG-UK news

Submission to CMA invitation to comment: Infant and follow-on formula market study

Forthcoming

iHV annual Evidence-based Practice Conference: 3 July 2024
Unicef UK annual Baby Friendly Initiative Conference: 20 – 21 November 2024

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 7^th 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 14^th, 21^st and 25^th; 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.

The safest way to prepare infant formula is using a kettle, following NHS guidance.

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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 infographic s 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.

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Forthcoming

iHV annual Evidence-based Practice Conference - in person in Manchester or virtual, Wednesday 3 July 2024

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Unicef UK annual Baby Friendly Initiative Conference – virtual, Wednesday 20 - Thursday 21 November 2024

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March 2024

News

New: Policy asks for Healthy Early Years Diets
New: Academy of Medical Sciences report “Prioritising early childhood to promote the nation’s health, wellbeing and prosperity”
Latest: England Infant Feeding Survey
New: House of Lords Inquiry into Food, Diet and Obesity
Updated: BLISS guidance on weaning preterm babies
FAQs: organic formula, vitamin D for babies, milk for 6–11-month-olds

Infant milk news

Infant milk costs: More infant milk price reductions announced in the wake of the Competition and Markets Authority investigation
New product: Kendal Nutricare is the latest manufacturer to offer probiotic supplements for babies
Reminder: Where to find more information on infant milks

BFLG-UK news

British Journal of Midwifery formula sponsored conference
Ministerial view on loyalty/rewards schemes and infant formula purchase

Forthcoming

Webinar: Supporting families with introducing solid foods
World Public Health Nutrition Association Conference

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 30^th 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 8^th DHSC shared an update of progress implementing the 2023 Infant Feeding Survey in England. This survey will be the 9^th 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 7^th 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 8^th 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?

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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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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.

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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

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

New report from the Food Foundation: "Breaking down the barriers to breastfeeding to support healthy weight in childhood"
Updated: First Steps simple guide to breastmilk and breastfeeding
WHO recommendation on milk feeds for 6-11 month old infants who are fed milk other than breastmilk
Live: Dietary Intake in Scotland’s Children (DISH) survey
New report: The Grocer Baby and infant product report 2023

Infant milk news

Updated NHS guidance: Making up powdered infant formula
New statement: Nutramigen recall
News on infant formula prices
New infographic: How can families safely save on formula milk?

BFLG-UK news

New briefing: Clarifying misconceptions about the UK law on the marketing of infant formula

Forthcoming

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

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.

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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:

News

New FAQs: Ultra-Processed Foods
New paper: Snacking practices from infancy to adolescence

On Healthy Start:

New resources for frontline staff
New paper: Evaluation of the Healthy Start voucher scheme
New survey: Food access among families with No Recourse to Public Fund

Updated Eating Well Guides
New guidance: Feeding Baby at Nursery

Infant milk news

First Steps response to the Competition and Markets Authority report on price inflation and competition in the infant formula market
Update on infant milks costs

BFLG-UK news

New: WHO Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes
Updated statement: Legal restrictions on the marketing of commercial milk formulas and the cost-of-living crisis

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.

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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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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.

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:

The consultation on the disclosure of industry payments to the healthcare sector response was submitted on 16 October 2023 and it is available here.
The consultation on nutrition and health claims on food response was submitted on 31 October 2023 and it is available 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 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New report: First Steps Nutrition Trust user evaluation

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

What we have learnt:

Most survey respondents were UK health care professionals, indicating we’re reaching our primary audience.
Our First Steps website is a widely used and familiar resource among HCPs: 75% rated the useability as 8 or more out of 10, and 91% of respondents were able to find the information they were looking for.
In the current formats offered, 75% rated the useability of our resources as 8 or more out of 10.

Feedback on our resources included:

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

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

This newsletter has 2839 subscribers and the engagement rate (40% open rate and 20% clickthrough rate) is very good compared to sector averages (of 25% and 3% respectively).
58% of respondents to the survey we sent to newsletter subscribers do not follow FSNT on social media, meaning this newsletter is a key channel of communication for many of you.
91% of survey respondents find the newsletter useful or very useful and 78% of respondents report reading the newsletter every month.

Feedback on our social media presence included:

"I think your social media is positive and engaging"

Recommendations we’re going to be considering include:

Making our resources available in a mobile friendly format.
Producing more infographics or bite sized summary sheets of resources.
Offering webinars to provide guidance on using the Infant Milk Info website to maximise its utility.
Relaunching the dormant Instagram.
Including bitesize versions of the newsletter stories to social media throughout the month.
Posting more practical nutrition advice and recipes on social media.

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

Infant Milk News

Update on infant milk costs

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

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

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

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

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

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

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

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

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

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

Baby Feeding Law Group UK news

Statements issued

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

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

Consultation response

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

Department of Health and Social Care (DHSC) open consultations

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

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

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

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

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.

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.

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.

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).

The broken plate report 2023 outcome metrics

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

UNICEF 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.

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

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:

A UNICEF guide to understanding and combatting industry interference and conflicts of interest Protecting Infant and Young Child Nutrition from Industry Interference and Conflicts of Interest
A WHO and UNICEF information note on Clarification on sponsorship of health professional and scientific meetings by companies that market foods for infants and young children
A Universal Monitoring and Reporting Form for reporting Code violations

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.

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:

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

Response from PM Rishi Sunak:
https://twitter.com/TomSkyNews/status/1659430759688437761

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.

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:

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

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

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.

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.