Literature review for - Flourish Paediatrics

One of the responses of the Australian Government was the development of more detailed
guidelines for health workers on the Code and the implementation of the Marketing in
Australia of Infant Formula (MAIF) agreement in Australia. The first edition of the Infant
Feeding Guidelines were developed by the Infant Nutrition Panel of the NHMRC beginning
in Oct 1992, but took several years to finalise and was published in 1996. The impetus to
develop the Infant Feeding Guidelines came from two sources. Firstly, the demand from
health workers for additional information on infant feeding to supplement the NHMRC
Dietary Guidelines (the development of the NHMRC Dietary Guidelines for Children and
Adolescents also commenced in 1992). Secondly, as a part of Australia’s response to the
signing of the World Health Organisation’s International Code of Marketing of Breastmilk
Substitutes (the WHO Code). At a national level the WHO Code is implemented under the
Agreement on the Marketing in Australia of Infant Formula for Manufacturers and Importers
(the MAIF Agreement) which has some differences from the original WHO Code.
While the WHO Code has never been revised, there have been supplementary resolutions and
decisions by the World Health Assembly leading to the publication of a consolidated edition
of the Code in 2008. As recently as May 2010 the WHA passed a resolution (Sponsored by
Norway) urging countries to strengthen their commitments to the WHO Code and the
companion Baby Friendly Hospital Initiative. This aim was clearly stated in the first edition
of the NHMRC Infant Feeding Guidelines: “The guidelines aim to help all health workers
understand how the WHO Code and Australian Agreement affect their work in both
breastfeeding and using infant formula.”
Since the last set of guidelines were published in 2003 there have been developments in
infant feeding that require revision, many references need updating and the Australian
context has changed. As the first stage of revision of the Guidelines this literature review was
undertaken to provide the underlying scientific basis for the revision.
The literature reviews that follow update most of the areas covered in the 2003 edition of the
Infant Feeding Guidelines. Generally they are narrative reviews as the evidence base for
infant feeding is not always as strong as other areas of nutrition. The issue of definitions of
breastfeeding continues to be a major problem in the interpretation of studies. While
standard definitions are usually agreed on, they are then operationalised in different ways.