The final ‘Feeding in the First Year of Life’ report published by the Scientific Advisory Committee on Nutrition (SACN) supports current government recommendations including breast is best, introduction of allergenic foods from six months and the importance of variety and textures.
Covering infant feeding from birth to 12 months, it provides its recommendations to government based on the best available evidence for the short- and long-term health outcomes for infants and mothers.
The one note of significant difference to existing advice is the recommendation that vitamin A supplements for infants should be discontinued. This will cause some inconvenience as most infant vitamin drops, which were developed on government advice, include vitamin A.
What is the SACN recommending to government?
- More strategies and support to help mums breast feed exclusively for the first six months of the infant’s life and to continue breast feeding alongside weaning for the first year.
- Where breast feeding is not possible, infant formulae based on either cows’ or the more recent goats’ milk are the only suitable alternative options. Soya-based formulae should only be introduced under medical advice.
- Only breast milk, formula or water as a drink should be offered between six and 12 months.
- Solids should be introduced from around six months of age, ‘having achieved developmental readiness’. The SACN found no evidence for the critical window of opportunity (four-six months) for increased acceptance of solids.
- Reducing risk of ‘fussy eaters’. Based on the evidence available, it is recommended that perseverance with repeated exposure of a variety of textures and flavours should be encouraged.
- Introduction of textures is critical for the development of munching and chewing. Textures should be introduced incrementally depending on the infant’s individual development rate.
- Baby-led weaning: due to too few studies, the SACN could not make any recommendations. However, it did make the point that the limited evidence to date is promising for earlier self-feeding and less food fussiness.
- All allergenic foods should be introduced from six months in small quantities and one at a time. This is of course for infants not at high risk of or diagnosed with an allergy. It is particularly important for peanuts and hen’s eggs, where the evidence is strong that delayed introduction increases the risk of allergy later in life. Additionally, nuts such as peanuts should not be given whole until the age of five years to prevent choking risk.
- Vitamin D intakes remain a concern for infants who are being breast fed or on less than 500ml formula daily. The SACN acknowledges the poor update of vitamin drops for babies but continues to emphasise the importance of encouraging breast feeding mums to use vitamin D supplements from birth.
- Iron continues to be an issue beyond six months of age and greater emphasis should be placed on the introduction of iron rich foods, rather than supplements, from the start of weaning.
- Vitamin A supplementation should no longer be encouraged as risk of deficiency is low and advises the government to review its current baby vitamin drop recommendations.
- Energy intakes remain too high and infant weights exceed standard weight charts. There is a need to better monitor overweight and obesity in infants.
- Salt and sugars intakes remain high in infants, with commercial baby foods, especially fruit purees, being the main contributors.
- Throughout the report, the SACN make no distinction in their advice between commercial or home-made complementary foods – could this be a sign that reality and practicality has been taken into consideration?
The Public Health England (PHE) sugar reduction programme for complementary foods will be far more controversial than the new SACN recommendations.
We have heard this week that PHE have just finished their scoping work for their sugar reduction programme of complementary foods for infants and are preparing for discussions with industry, NGOs and other interested parties.
Setting sugar reduction targets for this category will be challenging, to say the least.
- The complementary foods’ regulation, which PHE cannot over-ride, permits significantly high levels of sugars: up to 20g total sugars per 100g for ‘fruit only’ products and up to 25g per 100g for desserts and puddings.
- There are huge discrepancies between PHE’s classification of ‘free sugars’ and regulatory and labelling classifications of ‘added sugars’. Sugars naturally present in fruit and vegetable purees are classified as ‘free sugars’ by PHE but not as ‘added sugars’ by foods or labelling regulations.
- Some will argue that pureed formats of fruit and vegetable are essential as first foods, especially by those from the ever-exploding pouch market, and as such should be excluded from the ‘free sugars’ classification. However, there should be a strong opposition from health experts and very active pressure groups:
- There is a growing consensus that fruit and sweet tastes should no longer be recommended as first foods in order to reduce the infants’ continued preference for sweetness.
- Additionally, with the SACN’s affirmation that complementary feeding should start around six months, purees are no longer essential. At that age the infant is ready, and should be encouraged, to develop their munching and chewing skills which means the need for textures. Pureed food on the other hand only rely on an infant’s innate skills of sucking and swallowing.
Interesting times…let’s wait and see.
Complementary foods regulation update – will this rock the boat?
The updated version of the 2006 regulation on processed cereal-based foods and baby foods for infants and young children has yet to be published. The revised regulation was rejected last year for numerous reasons, including pesticide and sugar upper limits being too high.
The next version should be with us this year and it will be interesting to see how it aligns with the SACN’s and PHE’s recommendations – especially with regard to sugars and when solid foods should be introduced. Currently, the regulation (and the failed 2017 revision) permitted solid food introduction from four months.
Welcoming the findings
Only recently, the BBC reported the potential benefits of feeding solids as early as three months, which is likely to have caused confusion for parents.
So we’re pleased that this new SACN report helps to give support for the current advice in the UK: babies should ideally be exclusively breastfed for six months, and solid foods should be introduced after this. Or, as Dr Alison Tedstone, Chief Nutritionist at Public Health England (PHE) put it: “SACN’s robust advice puts to bed any arguments about a beneficial effect of early introduction of solid foods.”
We do however notice the very precise wording of ‘around six months’.
There is some concern amongst dietetic paediatric experts that setting a specific time for solid food introduction is unrealistic, may place some infants at risk and is an added pressure for mums on top of guilt faced by those who do not wish to or cannot breast feed.
The important factor is that solid foods should only be introduced when an infant is developmentally ready: when they can sit with minimal support and hold their head steady; can co-ordinate eyes, hands and mouth; and are able to reach out to pick up food and bring it to their mouth. Some infants may be ready before six months; a few may not be ready yet at that stage.
It’s important government advice should ensure mums understand that there is flexibility ‘around’ the six months.
Further advice on early feeding and breastfeeding
In the UK we have some of the lowest breastfeeding rates in the world, so it is important to provide help and support to mothers wishing to breastfeed. The NHS gives information about where to get help.
- British Dietetic Association – Complementary feeding and Breastfeeding
- National Health Service – Vitamins for Children
- Start 4 Life – Introducing Solid Foods Leaflet