Dietitians (NDIGuk)

Clinical guidelines/position statements

Exclusive Breastfeeding/Weaning

NB - These both relate to term infants

1. WHO statements on exclusive breastfeeding:
‘The optimal duration of exclusive breastfeeding: a systematic review ’
Geneva, World Health Organization, 2001 and ‘Nutrient adequacy of exclusive breastfeeding for
the term infant during the first six months of life’, Geneva, World Health Organization, 2008. Both documents can be downloaded, along with numerous other WHO publications at: http://www.who.int/nutrition/publications/infantfeeding/en/index.html

2. BDA Paediatric Group statement on exclusive breastfeeding tries to give a pragmatic interpretation of the above for infants in the UK at:
https://www.bda.uk.com/publications/professional/
bda_complementary_feeding__weaning__policy_statement

This statement was last reviewed in April 2013.

Preparation of infant formulas from powder

There have been some major changes to guidance on preparation of infant formula in recent years both in hospital and at home. This is due to concerns over the 'sterilisation process' of infant formula powders not effectively removing all risk of contamination, particularly cronobacter sakazaki, so boiled water at a higher temperature than previously thought is required and feeds should preferably be made just prior to feeding rather than for 24 hours. Parents who have had previous children may not be aware of these changes so should be educated by hospital staff prior to discharge from maternity wards and neonatal units and/or community health professionals at home.

In 2013 the Dept of Health reiterated this guidance in a statement from the Chief Medical Officer

with resources for families available at
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/making-up-infant-formula.aspx

http://www.nhs.uk/start4life/Documents/PDFs/Start4Life_Guide_to_bottle_feeding.pdf

Guidelines for preparation of feeds in hospital were produced for the UK in 2007 and published by the Food Standards Authority and can be viewed here. An update expected during 2016 will be available on the British Dietetic Association website, Paediatric Group pages at: https://www.bda.uk.com/regionsgroups/groups/paediatric/home


Use of soya formulas


1. Committee on toxicity (COT)
COT have produced a very detailed 444 page report ; COT 2003 Phytoestrogens and Health
Food Standards Agency: http://www.food.gov.uk/multimedia/pdfs/phytoreport0503

2. DoH statement - CMO’s Update 37 January 2004 page 2 stated:

The CMO is reiterating advice that soya-based infant formulas should not be used as the first choice for the management of infants with proven cow’s milk sensitivity, lactose intolerance, galactokinase deficiency and galactosaemia. Soya-based formulas have a high phytoestrogen content, which could pose a risk to the long-term reproductive health of infants, according to a 2003 report from the Committee on Toxicity (COT), an independent scientific committee that advises the Department of Health and other government agencies. Furthermore, the Scientific Advisory Committee on Nutrition (SACN), another independent advisory body, has advised that there is no particular health benefit associated with the consumption of soya-based infant formula by infants who are healthy (no clinically diagnosed conditions). SACN also advised there is no unique clinical condition that particularly requires the use of soya-based infant formulas. As an alternative to soya-based products, more appropriate hydrolysed protein formulas are available and can be prescribed. Soya-based formulas should only be used in exceptional circumstances to ensure adequate nutrition. For example, they may be given to infants of vegan parents who are not breast-feeding or infants who find alternatives unacceptable.
This information is reiterated for the lay public on the NHS Choices website at: http://www.nhs.uk/chq/Pages/can-I-give-my-baby-soya-based-infant-formula.aspx

3. The BDA Paediatric Group position statement on use of soya protein for infants (October 2010) gives a pragmatic interpretation of this topic for infants in the UK. It is currently under review but a copy of the 2010 version is available for reference from the BDA office by emailing - info@bda.uk.com or telephone - 01212008080

Breast Milk Fortification

The use of breast milk fortifiers poses a series of arguments among neonatologists in terms of which babies should receive it, when to start, how much to give, how to add it, etc. There is wide variation in practice across the UK and Ireland making a definitive consensus difficult to achieve. A discussion paper based on available evidence and current practices has been written by NDIG members – Caroline King and Sue Bell and has been published by BLISS in 2010. This can be used as a basis for developing local guidelines for use and is available to download at: http://www.bliss.org.uk/wp-content/uploads/2012/07/bliss_briefings_webV2.pdf

To order hard copies, please email katien@bliss.org.uk or call 0207 378 1122


Weaning Preterm Infants

There is lack of good evidence to inform practice concerning the most appropriate time to introduce foods other than human breast milk or infant formula to the infant born prematurely. Questions include ‘should we use the same indicators as for infants born at term’ and if so, when using age ‘should this age be from premature birth, expected date of delivery or somewhere in between’?
The Department of Health issued the following statement on breastfeeding in 2003 but this is probably not appropriate for preterm infants.
‘Breastfeeding is the best form of nutrition for infants. Exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life as it provides all the nutrients a baby needs. ’ 

In 2007 a group of neonatal dietitians and speech and language therapists with expertise in feeding issues relating to premature infants, met to discuss weaning. Following this very useful meeting an evidence based statement/guideline was produced and updated in 2011 and is available to download - click here 

A review of the available literature to inform practice was published in 2009 – King C, An evidence based guide to weaning preterm infants, Paediatrics & Child Health, 2009, vol19: 9, p405-414.

The practical interpretation of the limited evidence base is written by Caroline King and colleagues regularly updated and published by BLISS both online and as a booklet. The current booklet is available from the BLISS website - http://www.bliss.org.uk/weaning



Last updated July 2016