Infant Nutrition

Infant health research

These studies explore breastmilk composition, the introduction of solids and the portrayal of infant feeding in the media.

First‐food systems transformations and the ultra‐processing of infant and young child diets: The determinants, dynamics and consequences of the global rise in commercial milk formula consumption

This article addresses how the inappropriate marketing and aggressive promotion of breastmilk substitutes undermines breastfeeding and harms child and maternal health in all country contexts. The study describes trends and patterns in global formula sales volumes (apparent consumption) by country income and region. Data are reported for 77 countries, for the years 2005–19, and for the standard (0–6 months), follow‐up (7‐12 m), toddler (13‐36 m), and special (0‐6 m) categories. Second, it draws from the literature to understand how transformations underway in first‐food systems – those that provision foods for children aged 0–36 months – explain the global transition to higher formula diets.

Baker, P., Santos, T. et al. First‐food systems transformations and the ultra‐processing of infant and young child diets: The determinants, dynamics and consequences of the global rise in commercial milk formula consumption.

Use and understanding of labelling information when preparing infant formula: Evidence from interviews and eye tracking

This article examines the risks associated with incorrect preparation and storage of infant formula, including microbiological hazards and aims to increase understanding of how Australian caregivers perceive, interpret and use mandatory and voluntary “on-pack” label information when preparing and storing infant formula. Findings from the study show the need for clearer and more noticeable mandated food-safety elements on infant formula products.

Two studies released by the World Health Organization (WHO)/Europe found that a high proportion of baby foods were incorrectly marketed as suitable for infants under six months of age. Findings from four cities found that 28-60% of foods were marketed as being suitable for infants under six months and in three cities over half of all products provided 30% of calories from total sugars. WHO maintain their recommendation of exclusive breastfeeding for six months and reference the 2016 global Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children which stipulates that “commercial complementary foods should not be advertised for infants under six months of age.” The study further explores the steps taken by WHO to combat inappropriate promotion of certain foods, including the Nutrient Profile Model (NPM) for children aged six to 36 months and a WHO/Europe-developed methodology that identifies commercial baby foods in retail settings and collects information from packaging and promotion.

World Health Organization (2019). WHO/Europe studies find baby foods are high in sugar and inappropriately marketed for babies. [online]

SACN report on Feeding in the First Year of Life

The Scientific Advisory Committee on Nutrition’s new report on Feeding in the First Year of Life supports current recommendations to exclusively breastfeed for six months and introduce solids around six months. It highlights the important role that breastfeeding plays in infant health, and notes that “The available evidence indicates that the introduction of solid foods or infant formula before 6 months of age reduces the amount of breast milk consumed and is associated with greater risk of infectious illness in infants.”

Portrayal of infant feeding in women’s magazines

This study explored the written and visual portrayal of infant feeding in women’s weekly magazines in Britain and Ireland. Breastfeeding and formula feeding written references were found in equal number, and both were portrayed predominantly positively. However, there was only one visual representation of breastfeeding, compared with 11 of bottle feeding. The magazines identified numerous barriers to breastfeeding, including concerns about adverse health benefits. The authors concluded that an improvement in visual representations of and factual information about breastfeeding may be helpful in re-defining social norms about infant feeding.

O’Brien, E, et al (2016). The portrayal of infant feeding in British women’s magazines: a qualitative and quantitative content analysis. Journal of Public Health, doi: 10.1093/pubmed/fdw024  

Nutrition and health-related claims on pre-packaged foods – A five country study in Europe

This study mapped the prevalence of symbolic and non-symbolic nutrition and health-related claims (NHC) on foods and non-alcoholic beverages in five European countries. At least one claim was identified for 26% of all foods and drinks sampled. Eight percent of the health claims were children’s development and health claims but these were only observed on less than 1% (0.4%–1.1%) of the foods.

Hieke, S, et al (2016). Prevalence of Nutrition and Health-Related Claims on Pre-Packaged Foods: A Five-Country Study in Europe. Nutrients, DOI:10.3390/nu8030137

Baby-led weaning

In this article, the author discusses baby-led weaning (BLW) as an approach to the introduction of solid foods. She argues that while there is currently little direct evidence to justify the approach, there exists a range of research that provides support for the principles that underpin it, including the developmental readiness of infants to feed themselves using their hands, and their innate ability to respond appropriately to both appetite and satiety. She contends that BLW in its practical application is in line with current weaning recommendations and there is tentative evidence that suggests it may lead to positive health outcomes. The author concludes that health visitors should be prepared to discuss BLW with parents.

Rapley, G. (2015). Baby-led weaning: The theory and evidence behind the approach. Journal of health visiting, 3, pp 144 – 151.

Methods of introducing solid food and impact on food preferences and body mass index (BMI)

The authors examined whether two different styles — spoon feeding or self-feeding, also known as baby-led weaning — influenced food preferences and health-related outcomes.A total of 155 parents recruited through the Nottingham Toddler Laboratory and relevant internet sites completed a questionnaire concerning infant feeding style and introduction of solid food (baby-led=92, spoon-fed=63, age range 20–78 months); their child’s preference for 151 foods (analysed by common food categories, e.g. carbohydrates, proteins, dairy); and exposure (frequency of consumption). Food preference and exposure data were analysed using a case–controlled matched sample to account for the effect of age on food preference. All other analyses were conducted with the whole sample.

The authors concluded that results suggested infants who were introduced to solid food through the baby-led approach learned to regulate their food intake in a manner which leads to a lower BMI and a preference for healthy foods like carbohydrates. The authors postulate that this “has implications for combating the well-documented rise of obesity in contemporary societies.”

Ellen Townsend, Nicola J Pitchford (2012) Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample. BMJ Open 2012;2:e000298 doi:10.1136/bmjopen-2011-000298

Premature delivery influences composition of breastmilk

Human milk samples were collected from mothers delivering at term, preterm, and very preterm. Milk from the mothers was collected at 3 different time points after delivery corresponding to colostrum, transitional and mature milk and then concentrations of a range of immune factors and growth factors measured. Term and preterm colostrum were found to have very high levels of immune and growth factors, with some levels being higher in the preterm colostrum. However, the very preterm colostrum had lower levels of some factors than in term milk. The authors conclude that maternal lactogenic compensatory mechanisms may take effect only after 30 weeks gestation.

Cristina Castellote, Rosario Casillas, Carolina Ramirez-Santana, Francisco J. Perez-Cano, Margarida Castell, M. Gloria Moretones, M. Carmen Lopez-Sabater, and Angels Franch. Premature delivery influences the immunological composition of colostrum and transitional and mature human milk. J Nutr. 2011 Jun; 141(6):1181-7. Epub 2011 Apr 20.

“Fussy” infants more likely to receive food before 4 months

This study looked to assess early infant-feeding patterns in a cohort of low-income black mothers in the United States and to examine associations between maternal perception of infant temperament and complementary feeding before 4 months. It was hypothesised that a “fussy” infant temperament may lead parents to use food as a soothing technique.

The researchers used cross-sectional data from the 3-month visit (n = 217) of the Infant Care, Feeding and Risk of Obesity Study to assess relationships between early feeding of solids or juice and 6 dimensions of perceived infant temperament. The authors concluded that low-income black mothers may represent a priority population for interventions aimed at improving adherence to optimal infant feeding recommendations. That maternal perceptions of several aspects of perceived infant temperament are related to early complementary feeding suggests that this is an important factor to include in future observational research and in the design of interventions.

Wasser H, Bentley M, Borja J (2011). Infants Perceived as “Fussy” Are More Likely to Receive Complementary Foods Before 4 Months. Pediatrics; 127(2): p. 229-237

Breastfeeding may support earlier hospital discharge for moderately preterm infants

Moderately preterm infants (30-34 weeks) account for a large proportion of admissions and bed-days in neonatal units. A large study (2,388 infants) of the postmenstrual age (PMA) at hospital discharge and its relationship to perinatal risk factors and to organisation of care was carried out in Sweden. The researchers found that average PMA at discharge was 36.9 weeks. High (35 years) maternal age, multiple birth, small for gestational age, respiratory distress syndrome, infection, hypoglycaemia and hyperbilirubinaemia were significantly associated with higher PMA at discharge, but could only explain 13 per cent of the differences. Mean PMA at discharge differed by up to two weeks between hospitals. Infants treated at units without fixed discharge criteria had 4.7 days lower PMA at discharge and infants receiving domiciliary care had 9.8 days lower PMA at discharge. Breastfed infants also had lower PMA at discharge (mean 2.7 days lower) than those not breastfed, partly explained by lower morbidity in the breastfed infants and the researchers recommend that supporting the establishment of successful breast feeding in preterm infants should therefore be given high priority in neonatal care.

Altman M, Vanpee M, Cnattingius S et al (2009) Moderately preterm infants and determinants of length of hospital stay. Arch. Dis. Child. Fetal Neonatal Ed; 94: F414-F418

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