Improving Maternal and Infant Nutrition: A Framework for Action

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2.31 Infant formula is manufactured using modified cows’ milk and does notcontain any of the protective antimicrobial or bioactive substances describedpreviously. Powdered infant formula is not a sterile product and can therefore be agrowth medium for harmful bacteria. It is essential that parents who choose toformula feed are shown how to prepare and use infant formula safely to minimise therisk of the infant becoming ill. Current advice from the Food Standards Agencyrecommends preparing one feed at a time, using boiled tap water that has beenallowed to cool for no more than 30 minutes and adding water to the bottle firstbefore powdered infant formula. 382.32 Clearly, mothers who choose not to breastfeed, and their infants, do notreceive any of the health benefits of breastfeeding. It is not only the absence ofbreast milk that poses a risk to future health; giving infant formula in itself isassociated with specific risks to infant health, for example, contamination ofEnterobacter sakazakii (5) during manufacture and preparation of powdered infantformula 39 or inappropriate reconstitution of powdered formula during preparation.2.33 The Infant Formula and Follow-on Formula (Scotland) Regulations 2007regulate minimum and maximum nutrient concentrations and food ingredients thatcan be used in the manufacture of infant formula. 40 There are two main types ofinfant formula – whey and casein based formula. It is recommended that wheybased formula is used throughout the first year of life. There is no sound medical ornutritional reason to advise changing brand of infant formula or from whey to caseinbased infant formula. 332.34 Follow-on formula is manufactured for infants from the age of six months,however for most infants it has no advantage over standard infant formula and istherefore not recommended. 41 There is evidence that some mothers, particularlythose in lower socio-economic groups, are giving their infants follow-on formulabefore the age of six months 30 , posing additional risk to an infant’s immaturedigestive system.2.35 The WHO Code on the marketing of breast milk substitutes (which includesinfant formula, other milk products, foods and beverages used as a partial or totalreplacement for breast milk, feeding bottles and teats) was launched in 1981 toprotect all infants from inappropriate marketing of infant formula. 42 The Code doesnot prohibit the sale of breast milk substitutes but regulates their marketing to thepublic, limits the provision of product information to health professionals to ascientific and factual basis only and prohibits the promotion of products in allhealthcare facilities. Promotional items such as pens, diary covers, calendars andweight conversion charts, for example, from infant formula manufacturers should notbe accepted or used within any health service premises in Scotland. Sponsorshipfrom infant formula manufacturers in the form of grants for attendance at study daysor equipment or other materials should not be accepted by any part of the NHS inScotland.
2.36 The Scottish Government is fully committed to the principles underpinning theWHO Code and expects all partner organisations, e.g. NHS, local authorities and thethird sector, involved in improving infant feeding practices in Scotland to comply fullywith it.Introduction of Complementary Foods and Early Eating Habits2.37 The introduction of complementary foods is commonly referred to as‘weaning’ and means the gradual introduction of solid foods to an infant’s dietalongside usual milk feeds (breast or formula).2.38 Scottish Government policy, based on WHO guidance, is to recommend theintroduction of solid foods at around the age of six months for all infants. 43 Breast 44or infant formula milk provides all the nutrients most infants need for the first sixmonths. At around six months and beyond infants’ requirements for nutrients,particularly iron, cannot be met by breast or infant formula milk alone. Most infantsare developmentally ready for complementary foods at around six months – thismeans they can sit with minimal support, hold their head up and can pick up foodand put it in their mouth.2.39 This allows parents to offer a variety of soft finger foods, and mashed familyfoods can be provided instead of smooth purees. This approach, often referred to as‘baby-led weaning’ can have a positive effect, with the child being willing to try awider range of healthy foods throughout early life.2.40 Currently, the majority of infants in Scotland are introduced to complementaryfoods before six months 30 , despite the fact that introducing complementary foods tooearly has been shown in the literature to pose risks to infant health. Before the ageof four months an infant’s bowel is immature therefore they are not able to digest andabsorb food normally. There is evidence of increased risk of eczema ifcomplementary foods are given before four months 45 and evidence of increased riskof type 1 diabetes if foods containing gluten are given before the age of threemonths. 46 Infants who receive complementary foods too early are more likely tosuffer from respiratory and gastrointestinal illness compared to those givencomplementary foods at a later stage. There is also evidence, from the MillenniumCohort Study, to suggest that infants who receive complementary foods early aremore likely to be overweight later in childhood. 472.41 A few studies have recently been published that are not fully consistent withthe recommendations on age of introduction of complementary foods at around sixmonths. 45, 48, 49 Any change to Scottish Government policy on exclusivebreastfeeding and the age of complementary foods would be based on revisedadvice from SACN (Scientific Advisory Committee on Nutrition) following their reviewof more recent evidence. Current SACN advice on the introduction of solidscontinues to be at around six months for all infants.2.42 The main influences on the timing of introduction of complementary foods aresocio-economic status, maternal age, educational attainment and prior feedingexperiences. 30 Mothers who introduce complementary foods early are more likely tobase their decision on advice from family or friends, while mothers who introduce
Page 1 and 2: Improving Maternaland Infant Nutrit
Page 3 and 4: © Crown copyright 2011ISBN: 978-0-
Page 5 and 6: • Indicators for Outcomes 6.9•
Page 7 and 8: Executive SummaryImproving the nutr
Page 9 and 10: IntroductionIn order to change infa
Page 11 and 12: important for the scope to go beyon
Page 13 and 14: 1.6 In 2003, the Royal College of P
Page 15 and 16: 1.17 The Healthy Start Scheme was i
Page 17 and 18: Chapter 2: Why is Maternal and Infa
Page 19: Birth Weight and Health2.10 A mothe
Page 22 and 23: her wider community. The factors ar
Page 27: Summary2.48 The diet and nutritiona
Page 31 and 32: Birth weight of infants born in Sco
Page 33 and 34: Breastfeeding at Birth3.23 Informat
Page 35 and 36: Figure 5: Breastfeeding at the 6-8
Page 37 and 38: 3. Water should be added to the bot
Page 39 and 40: Chapter 4: Current Activity across
Page 41 and 42: AccreditedAyrshire Maternity Unit,
Page 43 and 44: Community Mothers Breastfeeding Sup
Page 45 and 46: 4.18 Just over half of Boards had a
Page 47 and 48: policies for each nursery, provisio
Page 49 and 50: 4.26 Eight Boards had an obesity st
Page 51 and 52: Promoting and Supporting Breastfeed
Page 53 and 54: Parents Cooking Group, Gowans Child
Page 55 and 56: Chapter 5: Process for Development
Page 57 and 58: FoodMediaKnowledgeSkillsIncomeCommu
Page 59 and 60: Government and WHO publications. It
Page 61 and 62: OUTCOMESShort Term (0-3 yr) Medium
Page 63 and 64: 5.24 The activities were compared t
Page 65 and 66: • Introduce new routinely collect
Page 67 and 68: Chapter 7: Action Plan7.1 It is rec
Page 69 and 70: training and be integrated into und
Page 71 and 72: 2. Baby Friendly InitiativeActivity
Page 73 and 74: 3.5 Work with private sector compan
Page 75:
Breastfeeding Mothers• Access to
Page 83 and 84:
18. Kelly Y, Panico L, Bartley M, e
Page 85 and 86:
56. Gregory J, Collins D, Davies P
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Appendix 1: Membership of Maternal
Page 89 and 90:
Appendix 2: Membership of sub-group
Page 91 and 92:
Appendix 3: Healthy eating advice f
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Appendix 4: NICE Public Health Guid
Page 95 and 96:
Appendix 5: Indicators for Short, M
Page 97 and 98:
6 All relevant national & localpoli
Page 99 and 100:
complementary feedingRelevant resou
Page 101 and 102:
15 Increased acceptability ofbreast
Page 103 and 104:
23 reduced inequalities in childnut
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Improving Maternal and Infant Nutrition: A Framework for Action

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