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Infant Feeding Guidelines

We are excited to see the release of the latest Scientific Advisory Committee on Nutrition (SACN) report on ‘Feeding in the first year of life’. The last report, in 2004, shaped government recommendations and we have been eagerly awaiting an update. The latest report provides recommendations on infant feeding from birth up to 12 months of age.

We love having the opportunity to answer questions from parents and early years staff on infant nutrition and this report supports the team in providing consistent evidence based, information.

SACN Report

What does the report tell us?

You can access the full report here however, we have summarised the key points based on the most common questions we are asked.

What age should infants be introduced to solid foods?

Around 6 months! The report continues to recommend babies are exclusively breastfed until around 6 months of age and continue to be breastfed for at least the first year of life.

  • Solid foods should not be introduced until around 6 months to benefit children’s overall health. By around 6 months of age, infants are usually ready to accept foods other than breastmilk or formula
  • The report highlights that the idea of a ‘critical window’ between 4 and 6 months is not supported by the evidence and delaying solid foods to around 6 months will not lead to difficulty in accepting solid foods later on
  • There is limited evidence on the Baby Led Weaning (BLW) approach to complementary feeding. However, a single trial reported that a ‘BLW approach’ did not have a significant effect on the primary outcome of BMI, but did result in earlier self-feeding, less food fussiness and greater enjoyment of food (secondary outcomes self-reported by parents). With appropriate guidance, BLW did not appear to decrease energy or micronutrient intakes
  • It is beneficial to offer infants a variety of foods and support texture progression from 6 months. Infants will need to develop skills such as munching and chewing by exposing them to progressively firmer food textures. Evidence suggests that exposure to lumpy foods before 9 months may be beneficial
  • It is important to be responsive to baby’s feeding cues. Interventions to promote responsive feeding, have reported beneficial effects on the quality of the infant diet in the context of obesity prevention.

Baby Feeding

What milks should be offered up to 12 months?

Breast milk or infant formula should be the main drink throughout the first year of life.

  • Infant formula (based on either cows’ or goats’ milk) is the only suitable alternative to breast milk for babies who are under 12 months of age. The use of soya-based formula should only be upon medical advice. Fresh tap water can be offered from 6 months alongside solid foods.
  • Cow’s milk as a drink is not suitable for infants under 12 months

What are the key nutrient requirements?

Offer variety and repeat exposure to ensure children are receiving key nutrients. To ensure infants meet their nutrient requirements it is important to offer a wide range of solid foods, including iron- rich foods.

  • Offer a range of foods, flavours and textures to satisfy nutritional requirements and offer foods repeatedly as infants may need to be offered foods on many occasions before they are accepted, particularly as infants get older
  • Fruit and sweet vegetables are well accepted at every age compared with bitter tasting vegetables. A range of evidence indicates that repeated exposure to new foods enhances infants acceptance, the number of exposures required varies depending on the age of the child and the flavour in question. The key message is to keep trying new foods and tastes, including bitter vegetables
  • Iron and vitamin D were identified as the key micronutrients for which there were concerns regarding possible deficiency and vitamin A regarding possible excess in infancy in the UK.

Let’s talk more about Iron

Healthy term infants are born with sufficient body iron stores, which along with iron in breast milk, are sufficient to meet their needs for growth and development for the first 6 months of life. Iron status at birth is the most important contributing factor to the iron status throughout infancy. It is important to introduce iron rich foods from around 6 months of age to meet the increasing iron requirements of older infants as after 6 months of age, iron stores reduce. Iron deficiency in infancy and early childhood, may have long-term consequences for cognitive, motor and behavioural development Therefore, dietary requirements for iron increase and the introduction of iron-containing solid foods from a diverse diet is recommended. Iron is found in animal sources of food such as meat, chicken and fish and in non animal sources such as eggs, pluses, lentils and vegetables. Vegetarian diets can provide adequate dietary iron.

What about Vitamin D?

Vitamin D plays an important role in the absorption of calcium and phosphorus and is therefore important for bone health. All infants from birth to 1 year of age who are being exclusively or partially breastfed should be given a daily supplement containing 8.5 to 10μg of vitamin D (340-400 IU/d). Infants who are fed infant formula should not be given a vitamin D supplement unless they are consuming less than 500ml (about one pint) of infant formula a day, as infant formula is fortified with vitamin D.

Considerations for Vitamin A

Vitamin A is a fat-soluble vitamin and is required for vision, growth and immune function. The UK infant diet provides sufficient vitamin A, even with low uptake of supplements. For some infants who routinely consume large amounts of fortified foods such as formula milk in addition to vitamin supplements, their vitamin A intake may exceed the Tolerable Upper Limit (TUL). Studies suggest that infants under 1 year, even those with the lowest intakes of vitamin A are consuming above the level of the Estimated Average Requirement, suggesting that vitamin A deficiency is not likely to be a public health concern for this age group. Recent studies show that infant formula was the largest contributor to vitamin A intake for infants aged 4 to 11 months followed by the food group ‘commercial infant foods’. The government recommends that children from the age of 6 months to 5 years are given a daily supplement of vitamin A (233μg), unless they are consuming over 500ml of infant formula a day. This is a precautionary measure, to ensure that their requirements for this nutrient is met, at a time when it is difficult to be certain that the diet provides a reliable source

Up until what age should we avoid peanuts and eggs?

These foods can be introduced from around 6 months of age and need not be differentiated from other solid foods. The deliberate exclusion of peanuts or hen’s egg beyond 6 to 12 months of age may increase the risk of allergy to these foods.

  • The deliberate exclusion of peanut or hen’s egg, gluten or fish beyond 6 to 12 months of age may increase the risk of allergy to the same foods. Once introduced, and where tolerated, these foods should be part of an infant’s usual diet. If initial exposure is not continued as part of an infant’s usual diet, then this may increase the risk of sensitisation and subsequent food allergy. Families of infants with a history of early-onset eczema or suspected food allergy may wish to seek medical advice before introducing these foods
  • There was no indication that avoidance or consumption of allergenic foods by mothers during pregnancy or lactation would reduce the risk of allergic or autoimmune disease in their children
  • Government is recommended to keep the risk from lead, acrylamide and arsenic under review. Efforts to reduce the levels of inorganic arsenic in food and water, and levels of acrylamide in commercially-produced and home-cooked foods should continue.

Foods

How can I look after infants teeth?

Existing guidance relating to dental caries prevention in under 3 year olds includes the following:

  • From 6 months of age infants should be introduced to drinking from a non-valve free-flowing cup to enable children to learn the skill of sipping, which is important in the development of the muscles used for talking
  • From age one year onwards, feeding from a bottle should be discouraged
  • Sugars should not be added to solid foods or drinks
  • The frequency and amount of sugary food and drinks should be as low as possible: only plain milk or water should be provided between meals and offering baby juices or sugary drinks should be particularly discouraged at bedtime.

Oral health is part of general health and wellbeing and contributes to the development of a healthy child. Dental caries is largely preventable; however it is still the most common oral disease affecting children.

Baby Feeding

What else does the report highlight?

Other considerations from SACN highlight the proportion of infants with energy intakes above requirements and the proportion exceeding growth standards for their weight. The report recommends monitoring the prevalence of overweight and overfeeding in infants, and ways to address high energy intakes in this age group. The report also re-emphasises the risks associated with added salt and free sugars in foods given to infants during the complementary feeding period and to ensure these levels are kept under review.

There are lots of useful resources out there for families to support them in implementing these messages:

  • PHE’s Start4Life website provides a range of advice and resources to help parents through pregnancy, birth and parenthood. This includes tips on infant feeding to help give children the best nutritional start in life
  • Book our Food and Nutrition for Infants module for more information on introducing solid foods

By Edwina revel

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