Scientific Advisory Committee on Nutrition (SACN) has published its latest report on ‘Feeding in the first year of life’, providing recommendations on infant feeding from birth up to 12 months of age. Prior to this review of infant feeding was undertaken by its predecessor Committee on Medical Aspects of Food Policy (COMA) in 1994.
Key Recommendations of Report are-
Breastfeeding makes an important contribution to infant and maternal health. This includes the development of the infant immune system, while not breastfeeding is associated with a higher risk of infant hospital admission for infectious illness.
- Babies should be exclusively breastfed until around 6 months of age and continue to be breastfed for at least the first year of life.
- The solid foods should not be introduced until around 6 months to benefit the child’s overall health. This represents no change to current government recommendations.
- In order to address rapid decline in the proportion of women breastfeeding over the first few weeks of an infant’s life in the UK, greater focus should be given to reducing attrition rates· supporting women who make the informed choice to breastfeed.·
- Increasing the proportion of women who continue to breastfeed or express breast milk beyond 6 months of age would yield additional health benefits.
- Infant formula (based on either cows’ or goats’ milk) is the only suitable alternative to breast milk for babies who are under 12 months old.
- The use of soy-based formula should only be on medical advice and the possible health effects of soy-based formula should be kept under review.
- Most infants should not start solid foods until around the age of 6 months, having achieved developmental readiness.
- Breast milk, infant formula, and water should be the only drinks offered after 6 months of age. Unmodified cows’ milk should not be given as a main drink to infants under 12 months of age. This is because cows’ milk consumption in infancy is associated with lower iron status as a result of gastrointestinal blood loss and because the iron content and bioavailability of cow’s milk is low.
- A wide range of solid foods, including iron-containing foods, should be introduced in an age-appropriate form10 from around 6 months of age, alongside continued breastfeeding, at a time and in a manner to suit both the family and individual child.
- Dietary, flavor and texture diversification should proceed incrementally throughout the complementary feeding period, taking into account the variability between infants in developmental attainment and the need to satisfy nutritional requirements. When introducing new foods it should be recognized that they may need to be presented to infants on many occasions before they are accepted, particularly as infants get older.
- In view of the high intakes of salt (sodium chloride) and free sugars in this age group, there is a need to re-emphasize the risks associated with added salt and free sugars in foods given to infants during the complementary feeding period and to keep reported intakes under review.
- Healthy infants do not require iron supplements. To optimize iron status throughout the first year of life, SACN and NICE recommendations on delayed cord clamping should be implemented and monitored.
- 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 (340-400IU/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.
- The low prevalence of vitamin A deficiency in the healthy infant population, despite the current low uptake of supplements, suggests the need to review recommendations on routine vitamin A supplementation, particularly in light of the COT conclusion that there is the potential for some infants to exceed the TUL for vitamin A. It is recommended that the government consider opportunities to review advice on supplements and foods containing vitamin A during infancy.
- Advice on complementary feeding should state that foods containing peanut and hen’s egg can be introduced from around 6 months of age and need not be differentiated from other solid foods. The deliberate exclusion of peanut or hen’s egg 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, to suit both the individual child and family. If initial exposure is not continued as part of an infant’s usual diet, then this may increase the risk of sensitization 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.
- The government should 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.
- The government should consider public health messages to help ensure that infants are fed an appropriate and diverse complementary feeding diet. 12.54 Government should consider ways to monitor the prevalence of overweight and overfeeding in infants, and ways to address high energy intakes in this age group.
- The government should consider how to address gaps in the evidence on infant feeding practices, in the absence of national monitoring of current practice. This includes evidence gaps on the prevalence and duration of breastfeeding, use of nutritional supplements, and use of foods other than breast milk in infancy. The questions and definitions previously adopted in the 5-yearly IFS would allow tracking of secular trends and changes in practice consequent to new recommendations and guidance.
The report suggests three-quarters of UK babies and toddlers may be eating more calories than they should, therefore, Scientific Advisory Committee on Nutrition, in addition, is deeply concerned about monitoring the prevalence of overweight and overfeeding in infants, and ways to address high energy intakes in this age group.
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Dr. Kamal Kant Kohli
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