24/10/18 – A collaborative approach to nutritional needs in the first 1000 days

Speakers: Ross McKahon, CEO, Kendal Nutricare; Declan O’Brien, Director General, BSNA; Catherine Elwig, paediatric specialist, BDA

24th October 2018

All-Party Parliamentary Group on a Fit and Healthy Childhood

“A collaborative approach to nutritional needs in the first 1000 days”

Speakers: Ross McKahon, CEO, Kendal Nutricare; Declan O’Brien, Director General, BSNA; Catherine Elwig, paediatric specialist, BDA

Chair: Jim Fitzpatrick MP

The Chair welcomed members, guests and speakers. He apologised for the very long wait members had in queuing to get into parliament. He provided an overview of the APPG group aims, an update on the forthcoming reports and an update on the Children First campaign seeking a Cabinet Minister for all children and young people. There has been very good support from the sector and a public petition will shortly be launched. The Chair has tabled an Early Day Motion and an evening reception will be held in the House of Commons in January. Baroness Benjamin will be writing to the Prime Minister.

The Chair welcomed the three speakers and encouraged them to address the need for a full Government Inquiry into Infant Nutrition. The last feeding survey was in 2015 and we now need Government, NGOs and the industry to work closely together in the best interests of the child.

Ross McMahon, CEO, Kendal Nutricare:

A main factor was the fact that Kendamil Infant Formula does not use palm oil combined with skimmed milk. They proposed that parents deserve to know where the food they feed their infants is from and that there should be traceability back to the processor to ensure the quality of infant formula and to assist in helping parents make informed decisions. Ross proposed an Independent body to guide the ethics, ingredients, safety, quality and traceability of infant formula including the banning of using palm oil. He stated that the Abbott Study (2003) shows palm oil reduces calcium absorption.

He highlighted the inadequate justification made by manufacturers on the need for lactose-free, comfort and hungry formulas which are expensive for parents. He called for Government to carry out clinical studies/research in connection with work done on childhood obesity by PHE and reinstatement of the ‘Infant Feeding Survey’ (last published in 2015). He called for a banning of ready-to-feed bottles being given out in hospitals and consideration for post Brexit legislation on infant formula.

Declan O’Brien, Director General, BSNA

Declan outlined his role and thanked the Chair for the opportunity to speak. His focus was on the first 36 months of age including breastfeeding, Infant Formula and supplementary foods. He proposed the importance of individual needs and suggested that the Infant Feeding Industry was highly regulated both in UK and European Legislation. A code of practice was soon to be launched, again demonstrating this regulation. He supported an Inquiry into Infant Feeding and the need to reinstate the Infant Feeding Survey and the Diet and Nutrition Survey for young children as both surveys provide evidence on which to build policy with the objective of ensuring that the nutritional needs of every child are met. There was a focus in the identification of gaps in Nutrition, including prevention and management of childhood obesity. He concluded the importance of working together including working with the RCPCH to improve nutritional outcomes.

Catherine Elwig, Paediatric specialist, BDA

I would like to thank the committee for inviting us, the BDA, to speak at today’s meeting on “How we can develop a truly collaborative approach to supporting nutritional needs during a child’s first 1000 days”

For many years I have been a lead clinical paediatric Dietitian caring for infants and children at St Mary’s Paddington, part of Imperial Healthcare NHS Trust and I’m here this evening to represent the BDA.

The first 1000 days are now accepted as being the most significant in a child’s development. We believe that care given during the first 1000 days has more influence on a child’s future than at any other period in their whole life. This time offers a unique “window of opportunity” to build a healthier and more prosperous future.

The BDA firmly believe that getting the right nutrition during this window has a profound impact on a child’s ability to grow, learn, thrive and therefore have a lasting effect on their health and general wellbeing and as a consequence that of the UK as a whole.

Nutrition during pregnancy and in the first years of a child’s life provides the essential building blocks for brain development, healthy growth and a strong immune system. In fact, a growing body of scientific evidence is showing that the foundations of a person’s lifelong health—including their predisposition to obesity and certain chronic diseases—are largely set during the first 1000 day window.

A need for a government inquiry into infant feeding:  –

As a high priority the BDA strongly supports and encourages the promotion of breastfeeding for all infants with improved education on appropriate complementary feeding practices. Breastfeeding more than any other health behaviour has a broad spectrum and long-lasting impact on public health in general, providing a range of health benefits to mothers and infants. Recent evidence from the most robust series of meta-analyses to date published in the Lancet in 2016 showed that there is a protective effect of breastfeeding against obesity, risk of gastro-intestinal, respiratory and ear infections leading to a reduced need for hospitalization for infections in all types. There is also documented evidence of advantages to developmental and educational achievement. This association is strongest for exclusive and longer duration breastfeeding. The BDA strongly advocate the need for improved initiatives to encourage and support breastfeeding which should include education for prospective and new mothers as well as training for healthcare professionals to help mothers breastfeed successfully. Further measures are recommended to support mothers to breastfeed in the home, at work and in public places. We must remove the stigma around breastfeeding in public spaces so that it is seen as acceptable and part of daily life.

By the time an infant is 6 months of age they will need to be moving onto solids to support healthy growth and development. Evidence suggests early complementary feeding (before 4 months) is associated with increased risk of obesity therefore the timely introduction of appropriate complementary foods from around 6 months of age and not before 4 months is recommended in line with the BDA’s policy and advice on complementary feeding. Too late and there is a risk of nutritional deficiencies with slow growth and development, too early and there is a risk of a low nutrient diet, reduction in breast milk leading to a less protective diet. The BDA would like to support the government in ensuring access to research funds to investigate appropriate infant feeding practices including responsive feeding and the introduction of solids (timing, amount and type of foods needed to support optimal growth and development.)

A need to re-instate the infant feeding survey last published in 2015 based on 2012 data:-

In the last 6 years there is little doubt that there have been changes to our economy which will have had and continue to impact on our family life, infant feeding practices being a prime example e.g. we know a higher percentage of mothers are now in work.

The infant feeding survey which until 2010 has run every 5 years since 1975 has been an invaluable and robust tool enabling health professionals to monitor change in practice, for example – in 2001 WHO made the recommendation of “exclusive breastfeeding up until 6 months of age”. This was a change for the UK who had been following the recommendations on timing of weaning based on the 1994 DoH/COMA report which recommended introducing solids between 4-6 months. The infant feeding survey of 2005 highlighted that a very small percentage of mothers were following the new recommendations but by 2010 there was a marked change in timing of weaning. With this in mind –

How can we drive forward new initiatives without robust up to date data?

How can we benchmark the success of any future 1000 day initiatives?

How will we be able to compare our feeding practices against other countries globally?

How can we assess whether recent schemes such as the PHE 2016 “Commissioning of local infant feeding services” has been a success and had an impact on our 2012 breast feeding rates?

Infant feeding surveys give healthcare professionals, policy makers and industry a great insight into the feeding practices of the nation which in turn can identify barriers, drive change and subsequent improvements across the whole of the UK

A need for the Government, NGOs and industry to work closely together:

The BDA supports access to evidence based multi-component interventions starting with expectant mothers through to infants and their families.

One good example of the BDA’s collaborative work is paediatric dietitians being actively involved in the delivery of the HENRY programme (Health, Exercise, Nutrition in the really young) which was developed in line with the 2009 “Healthy Child Programme” which is a universal preventative programme that begins in pregnancy and continues through childhood. It is evidence based, formed of developmental reviews, screening, immunizations, health promotion and parenting support. HENRY integrates proven behaviour change models into a supportive and effective approach that increases parental confidence and their ability to provide a healthy start for their child. The approach brings together support for parenting efficacy, family emotional wellbeing and behaviour change with information about nutrition, physical activity, oral health and more.

Dietitians have also played key roles in the education of other healthcare professionals on the DoH/HEE commissioned “e-learning for health programme” of which I am one. It is an on-line learning tool which supports the implementation of the healthy child programme

The BDA continue to work closely with UNICEF developing and delivering training to dietitians to support breastfeeding.

The BDA have also been involved in the early stages of PHE’s sugar reformulation programme for baby, weaning and toddler foods (those targeted at children aged 4/6 months to around 3 years). This will undoubtedly lead to future collaborative work with industry, guiding them in the reformulation of weaning and toddler products in line with the new guidelines.

The BDA look forward to continuing in its role, supporting and delivering evidence- based initiatives, working closely with the many different organizations involved in improving the health and nutrition during the first, so important 1000 days of a child’s life.

Questions were invited by the Chair for the speakers. This is a summary of questions and discussion:

  1. Why are we adding sugar to some infant weaning foods, such as sugar with bananas? Asked by a GP who gives advice on infant feeding to parents. Discussion followed around food labelling, the need for anti-oxidants in some jars and food in pouches.
  2. Disagreement over the level of processed nutrients in weaning foods. It was highlighted that parents do not have sufficient guidance in understanding labelling and nutritional content. Collaboration was needed with industry and government to ensure sugar content is restricted.
  3. A reformulation strategy is required if early intervention in weaning is to be effective in reducing sugars. New guidance required on weaning foods agreed by all.
  4. Dieticians are noticing higher levels of dental caries amongst children using pouches of food. Portion sizes of weaning foods to be more controlled and to encourage texture variety, education for parents etc. required This would provide a joined-up approach towards combatting childhood obesity,
  5. Is there a need for follow-on, toddler milks? A discussion followed around some milks lacking micronutrients and often ‘filled’ with additional carbohydrates. Often Iron and Vit D added to the follow-on formula but often it is not necessary and more expensive.
  6. More education for parents about the nutritional components of these milks required, rather than parents following the ‘rules’ of stages 1-3 led by inaccurate advertising. Parents need more guidance and health professionals, nursery practitioners etc need to be able to guide families and intervene earlier.
  7. Questions and discussion around the need for a national (and post Brexit) pricing strategy followed, including taxing sugar levels and specific pricing of formulas with added Omega 3 and 6.