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Specialised infant milks in the UK: Infants 0-6 months Information for health professionals March 2017 Specialised Infant Milks in the UK • March 2017 • page 1 Specialised Infant Milks in the UK: Infants 0-6 Months. Information for health professionals. March 2017. Authors: Helen Crawley, Susan Westland and Sarah Weston ISBN 978-1-908924-08-7 This resource is provided for information only and individual advice on diet and health should always be sought from appropriate health professionals. We have attempted to provide accurate information on the current composition of specialised infant milks sold in the UK in this report, and do so in good faith. However, composition, names and claims may change, so please refer to the specific manufacturers for up-to-date information. Acknowledgements Thanks are due to Debra Davidson, Alison Holmes, Caroline King, Anita MacDonald, June McMahon, Colin Michie and the Royal College of Paediatrics and Child Health, Jessica Williams and the BDA Paediatric Group, and the Unicef UK Baby Friendly Initiative, who all commented on the first edition of this report. We would like to thank all those working for infant milk companies who provided information about their specialised milk products for this edition. First Steps Nutrition Trust First Steps Nutrition Trust is a charity which provides evidence-based and independent information and support for good nutrition from pre-conception to five years of age. Also available from First Steps Nutrition Trust (www.firststepsnutrition.org) Breastmilk and Breastfeeding: A simple guide Fortified Milks for Children: A worldwide review of fortified milks marketed for children over 1 year of age ‘I Just Want to Find the Right Formula for My Baby’: Discussions around infant feeding among formula feeding parents Infant Milks in the UK: A practical guide for health professionals Infant formula: An overview Infant Milks: A simple guide to infant formula, follow-on formula and other infant milks Scientific and Factual: A review of breastmilk substitute advertising to healthcare professionals Websites and Organisations that are Funded by the Formula Milk Industry Author conflict of interest statement Helen Crawley, Registered Dietitian and Registered Nutritionist (public health). Director First Steps Nutrition Trust. No conflicts of interest. Susan Westland, Registered Nutritionist (public health). No conflicts of interest. Sarah Weston, Registered Dietitian, Breastfeeding Network Registered Breastfeeding Supporter, and board member of East London Food Access. No conflicts of interest. Specialised Infant Milks in the UK • March 2017 • page 2 Contents Acronyms 7 1 Introduction 9 1.1 Why have we written this report? 9 1.2 Current infant feeding guidance 10 1.3 What does this report contain? 12 2 Infant feeding 13 2.1 Supporting all new mums to exclusively breastfeed 13 2.2 Working within the WHO Code to protect breastfeeding and infant and young 15 child health 2.3 Critical appraisal of infant feeding marketing information 16 2.4 Medications and breastfeeding 18 2.5 Donor milk and milk banks in the UK 18 2.6 Supplementing the intake of breastmilk 19 2.7 Growth monitoring 19 2.8 Breastmilk fortifiers 21 2.9 Concentration of powdered infant milk to increase energy and nutrient content 27 2.10 Foods for special medical purposes (FSMP) 28 2.11 Indications for specialised infant milk 28 2.12 Appropriate prescribing 29 2.13 Current cost of specialised infant milks 30 2.14 Long-term consequences of using specialised infant milk 33 2.15 How much milk to use and how to make up milk safely 34 2.16 Making up feeds marketed as foods for special medical purposes 34 2.17 Current compositional regulations relating to foods for special medical 38 purposes Specialised Infant Milks in the UK • March 2017 • page 3 3 Specialised infant milks available in the UK 41 3.1 The composition of infant milks 41 3.2 The specialised infant milk market in the UK 41 3.3 Types of specialised infant milks available in the UK 42 3.4 Infant milks suitable for specific population groups 45 3.5 Infant milks for preterm and low-birthweight infants 48 3.6 Infant milks for preterm infants post-discharge 56 3.7 High-energy infant milks suitable for term infants from birth 60 3.8 Thickened (anti-reflux) infant milks suitable from birth 67 3.9 Lactose-free infant milks suitable from birth 72 3.10 Soy protein based infant formula suitable from birth 76 3.11 Partially hydrolysed infant milks suitable from birth 80 3.12 Extensively hydrolysed peptide-based infant milks suitable from birth 88 3.13 Amino-acid based infant milks for non-metabolic disorders, suitable from birth 100 3.14 Infant milks for disorders of protein metabolism, suitable from birth 107 3.15 Modified-fat infant milks for disorders of fatty acid metabolism, suitable from 114 birth 3.16 Modified-carbohydrate infant milks suitable from birth 119 3.17 Infant milk for the dietary management of calcium intolerance, suitable from 124 birth 3.18 Infant milk for the dietary management of liver failure, suitable from birth 127 3.19 Infant milks for the dietary management of renal disease, suitable from birth 131 3.20 Infant milk for the dietary management of epilepsy, suitable from birth 135 4 Foods for special medical purposes 138 5 Instructions for making up breastmilk fortifier 140 6 Infant feeding support and information 141 7 Specialised infant milk companies 144 References 146 Specialised Infant Milks in the UK • March 2017 • page 4
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