Infant feeding guidance and pregnancy guidance during COVID-19 outbreak

Many parents are very concerned about how to feed their babies during the COVID-19 outbreak. Here, we share the latest statement on best practice from Unicef UK Baby Friendly Initiative – who also suggest that all practitioners follow latest updates from the UK governments and the World Health Organization (WHO) as these could change as more information becomes available.

The Unicef statement (on the link below) includes:

Public Health England (PHE) guidance – If you are breastfeeding while infected
Accessing infant formula – information from First Steps Nutrition Trust

Go to Unicef website - Infant feeding during the COVID-19 outbreak

Download pdf version of Unicef UK - Infant feeding during the COVID-19 outbreak

In addition, the Royal College of Obstetricians and Gynaecologists (RCOG) has updated their guidance on Coronavirus (COVID-19) infection and pregnancy (published today 18 March) to reflect the announcement on Monday evening (16 March) that pregnant women have been placed in a ‘vulnerable group’. Check the summary of updates on pages 3-5 to see all the changes.

Go to RCOG updated guidance

As a result RCOG Information for pregnant women is updated:

Go to RCOG Information for pregnant women and their families

Statement on protecting breastfeeding

iHV welcomes a statement from a group of breastfeeding organisations calling on the new government to invest in the health of women and children by supporting and protecting breastfeeding.

They call on all political parties to commit to the following actions, if elected:-

To appoint a permanent, multi-sectoral infant and young child feeding strategy group and develop, fund and implement a national strategy to improve infant and young child feeding practices.
To include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
To implement the Unicef UK Baby Friendly Initiative across community and paediatric services, building on the recommendation for maternity services in the NHS Long Term Plan.
To protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.
To commission, and sustainably fund, universal breastfeeding support programmes delivered by specialist/lead midwives and health visitors or suitably qualified breastfeeding specialists, such as IBCLC lactation consultants and breastfeeding counsellors, alongside trained peer supporters with accredited qualifications.
To maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline and sustaining the Drugs in Breastmilk Service.
To deliver universal health visiting services and the Healthy Child Programme by linking in with local specialist and support services.
To establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.
To make it a statutory right of working mothers and those in education to work flexibly as required and to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.
To commit to resourcing for charitable organisations who play a key role within the health agenda working at a national and local level to support families and communities with infant feeding.
To support the commitment to undertake an Infant Feeding Survey which builds on the data previously collected in the Infant Feeding Survey 2010 (now discontinued). To implement the recommendations of the Becoming Breastfeeding Friendly (BBF) study.

Read full statement to protect breastfeeding

Breastfeeding more than one

As part of National Breastfeeding Celebration Week 2019, we are publishing a series of blogs to #CelebrateBreastfeeding. Today’s blog is from Kathryn Stagg, Breastfeeding Counsellor/IBCLC, Association of Breastfeeding Mothers. Kathryn, together with Alison Spiro , Independent Specialist Health Visitor, presented a poster on breastfeeding more than one at our recent evidence-based practice conference in Manchester.

Breastfeeding more than one baby is very possible with good postnatal support and antenatal information, even if babies are born prematurely. Challenges include higher rates of prematurity, early delivery and medical intervention at birth, greater chance of early supplementation due to jaundice/hypoglycemia, and lack of confidence in adequate milk supply.

Antenatal preparation for breastfeeding is key. Supporting mothers to harvest their colostrum can give them confidence that their breasts are already producing colostrum and they will be able to give their babies this, if supplementation is necessary. Couples can have the chance to discuss normal baby behaviour, benefits of tandem feeding positions, recognising the signs of good positioning and attachment and good milk transfer. Health Visitors can signpost mothers to postnatal breastfeeding support.

For further information for parents and health professionals, our Breastfeeding Twins and Triplets UK website has articles and blogs to support multiple birth families with breastfeeding.

Go to Breastfeeding Twins and Triplets UK website

We also have a very active facebook group where mothers can access support 24/7 and it is fully moderated by trained breastfeeding supporters. Mums are supported to fulfil or exceed their feeding goals. Many find they can move from supplementation to exclusive breastfeeding. This is a closed Facebook group to support multiple birth mums in the UK with breastfeeding. This is a closed group to protect privacy.

Go to Breastfeeding Twins and Triplets UK Facebook page

We also have a public facebook page – Breastfeeding Twins and Triplets UK Public Page

Go to Breastfeeding Twins and Triplets UK Public Facebook Page

And Twitter/Instagram @BfTwinsUk

Kathryn Stagg, IBCLC

Breastfeeding Celebration Week 2019

This week is Breastfeeding Celebration Week 2019.

The theme for the week in 2019 is promoting the benefits of skin to skin contact, both immediately after birth and throughout the early weeks of life.

We have several blogs coming this week in support of #CelebrateBreastfeeding – so keep an eye out for them!

Breastfeeding is a Health Visiting High Impact Area #CelebrateBreastfeeding

Some key points to share:

At 6 to 8 weeks after birth, just 44% of women breastfeed in England, one of the worst rates in the world.
Evidence shows that exclusively breastfeeding for around 6 months provides a range of benefits for the mother and baby, in England, only 1% of babies are exclusively breastfed at 6 months.
Not breastfeeding is linked to increased risk of infections such as ear, chest and gut infections
Responsive feeding helps form important emotional bonds and mental resilience
Breastfeeding can help lower the risk of breast cancer for mothers.
All healthcare professionals can make a contribution to increasing breastfeeding rates, giving children the best start in life.
Making organisations and places breastfeeding friendly is vital to encouraging and supporting women and improving breastfeeding rates.
By understanding the long-term benefits and impact of breastfeeding, health commissioners, managers and professionals can make the best decisions to meet local needs
Eight out of ten women stop breastfeeding before they want to and could have continued with more support
Women may need a wide range of support to breastfeed, such as readily available advice, support groups and apps.
Supporting families to breastfeed and increasing the number of babies who are breastfed gives babies the best possible start
There is growing evidence linking breastfeeding with protection against later overweight/obesity
Breastfeeding can help to reduce health inequalities for babies and improve their life chances
Breastfeeding can support family budgets – less illness and time off work, feeds babies for significantly less
Raise awareness that breastfeeding matters, Provide effective professional support to mothers and their families, ensure that mothers have access to support, encouragement and understanding in their community

Launch of Baby Feeding Law Group website

The Baby Feeding Law Group UK, of which the iHV is a member, has launched a new website.

The Baby Feeding Law Group UK has been working for over 20 years to strengthen UK baby feeding laws in line with UN recommendations. It is a group of organisations working together to protect infant, young child and maternal health by ending marketing practices which commercialise infant feeding, mislead consumers and threaten breastfeeding. While the aim is to protect breastfeeding, it does not seek to limit the accessibility of safe and appropriate infant formulas for those who need or want them. Rather, it wants to enable parents to make informed decisions about how they feed their babies, including where necessary, their formula choice and use.

Go to the BFLG UK website

iHV publishes report from well-regarded breastfeeding conference

During #WorldBreastfeedingWeek, the iHV is delighted to publish a report from its well-regarded breastfeeding conference held in April with the World Breastfeeding Trends Initiative (WBTi) and Royal Society for Public Health (RSPH).

The Breastfeeding: A Public Health Priority report gives a conference summary and implications for Public Health.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“This highly successful breastfeeding conference included, as speakers, some of the leading researchers in the field, as well as a range of successful local initiatives. We are delighted to be sharing a report from the day.”

Dr Cheryll Adams opening the breastfeeding conference

Go to members only Breastfeeding resources to download Breastfeeding conference report

Please note that these resources are available to iHV members only – if you’re not a member, please join us to get access to all of our resources.

The iHV is a self-funding charity – we can only be successful in our mission to strengthen health visiting practice if the health visiting profession and its supporters join us on our journey. We rely on our membership to develop new resources for our members.

Read the news story from the breastfeeding conference

Start4Life launches new Breastfeeding Friend tool

Start4Life launches new Breastfeeding Friend tool on Google Assistant during World Breastfeeding Week

As World Breastfeeding Week launches (1 August), the 24/7 Breastfeeding Friend from Public Health England’s programme Start4Life has been made available on Google Home and the Google Assistant app for mobile to provide even more parents with advice and support during the first few weeks of breastfeeding.

Start4Life Google Assistant

The 24/7 Breastfeeding Friend has been developed to provide friendly advice to mums who have questions and need support with breastfeeding at any point day or night. The tool is voice activated on the Google Assistant app and Google Home, meaning mums can get NHS-approved advice and daily breastfeeding tips in the moment and when they may have their hands full. Anyone with a smartphone can download the Google Assistant app for free and say “Hey Google, talk to Breastfeeding Friend” to access the service. Those with a Google Home device set up can access the service with the same phrase.

Start4Life Google Assistant

The 24/7 Breastfeeding Friend is also available on Amazon Alexa and Facebook Messenger and joins a suite of breastfeeding tools from Start4Life, including the relaunched Start4Life website, the ‘Off to the Best Start’ breastfeeding leaflet and the Start4Life Information Service for Parents, all of which provide 24/7 access to expert NHS advice and useful information, in a friendly and accessible way.

Whilst three-quarters of women start breastfeeding when their child is born, by 6-8 weeks this drops to just 44%^[1] , making breastfeeding rates in England amongst the lowest in the world.

However, new research^[2] among 1,000 mothers commissioned by Public Health England shows that 42% of breastfeeding mums wish they had known that breastfeeding may not come easy at first but getting support and advice can really help. When mothers reflected on breastfeeding, the poll also illustrated that 26% wished they had known that asking for help breastfeeding can make a real difference. Almost one in four (24%) wish they had known that there is lots of help and support from breastfeeding groups, other parents and online.

Public Health England recommends exclusive breastfeeding for around the first six months. Breastfeeding boosts a baby’s ability to fight illness and infection, and babies who are not breastfed are more likely to get diarrhoea and chest infections. Breastfeeding also lowers a mother’s risk of breast cancer and may reduce the risk of ovarian cancer.

For more information, please visit the Start4Life website

^[1] Public Health England annual data on breastfeeding at 6-8 weeks

^[2] Kantar data collected from 1,005 mothers of children under the age of 4 on behalf of PHE, 26th January to 7th February 2018

iHV welcomes SACN ‘Feeding in the first year of life’ report

The Scientific Advisory Committee on Nutrition (SACN) has published its report on ‘Feeding in the first year of life’, providing recommendations on infant feeding from birth up to 12 months of age.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“We welcome the SACN ‘Feeding in the first year of life’ report and having timely access to the latest advice and recommendations on infant feeding, especially reinforcing the existing guidance on breastfeeding and the introduction of solids.

“I would like to advise all health visitors to read the report and its recommendations and ensure that they use it to inform all nutritional advice they give to parents.”

SACN recommends babies are exclusively breastfed until around 6 months of age and continue to be breastfed for at least the first year of life. Additionally, 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.

SACN recommends that a wide variety of solids foods, including iron-containing foods should be introduced in an age appropriate form from around 6 months of age.

SACN recommends that 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.

Other recommendations include:

Breast milk, infant formula and water should be the only drinks offered between 6 and 12 months of age. Cows’ milk should not be given as a main drink, as this is associated with lower iron status.
A wide range of solid foods, including foods containing iron, should be introduced from around six months of age, alongside breastfeeding. These foods should have different textures and flavours and may need to be tried several times before the infant accepts them, particularly as they get older.

Breastfed infants up to 12 months should receive a daily supplement containing 8.5 to 10µg of vitamin D (340-400 IU/d). Formula-fed infants do not need a supplement unless consuming less than 500ml of infant formula a day.

Go to Feeding in the first year of life: SACN report

Excellent breastfeeding conference!

Dr Cheryll Adams opening the breastfeeding conference

What an amazing day we had at the breastfeeding conference, held on Thursday 19 April 2018 in London! Lots of great information shared and we’ve received some fab feedback from #breastfeeding2018. Breastfeeding: a public health priority was joint hosted with the Royal Society of Public Health (RSPH) and supported by the World’s Breastfeeding Trends Initiative (WBTi).

Professor Russell Viner, RCPCH, addressing the conference

Professor Viv Bennett addressing the conference.

A huge thank you to all the exceptional speakers – it was a very dynamic day with masses of learning and collaboration.

In addition, Jonathan Ashworth MP, Shadow Secretary of State for Health, announced a pledge to introduce an additional mandated health visit at 3-4 months, as part of Labour’s commitment to making Britain’s children the healthiest in the world. See our previous news story on this.

Jonathan Ashworth MP, Shadow Secretary of State for Health addressing the breastfeeding conference

For those of you who could not either join us on the day or could not follow the #breastfeeding2018 hashtag on Twitter, we’ve collected and made a little “Storify” of the tweets so you can follow some of what was shared.

Go to Storify - Breastfeeding

iHV welcomes PHE/COHIPB briefing on breastfeeding and dental decay

iHV welcomes PHE/COHIPB paper on breastfeeding and dental decay, and the statement below from Dr Jenny Godson MBE, Chair of the Child Oral Health Improvement Programme Board.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“Health visitors will be very pleased to have this clarity.”

There have been a number of recent queries received by Public Health England (PHE) and the Child Oral Health Improvement Programme Board (COHIPB) with regard to policy and guidance on breastfeeding and dental decay.

The briefing paper clarifies current evidence and guidance.

Key points from the briefing are:

Dental teams should continue to support and encourage mothers to breast feed
Not being breastfed is associated with an increased risk of infectious morbidity (for example, gastroenteritis, respiratory infections, middle ear infections)
Breastfeeding up to 12 months of age is associated with a decreased risk of tooth decay
Exclusive breastfeeding is recommended for around the first 6 months of life. Complementary foods should be introduced from around 6 months of age alongside continued breastfeeding.
The prevalence of breastfeeding in UK is low with 34% of mothers still breastfeeding their child at 6 months with only 1% exclusively breastfeeding
Further advice for dental teams can be found in Health Matters: Child Dental Health and Delivering Better Oral Health (2014)

With regard to the recent British Society of Paediatric Dentistry (BSPD) position statement on infant feeding, it supports breastfeeding and seeks to provide individual level preventive advice to all. With regard to the small proportion of parents who continue to breastfeed after 1 year, the statement advises that with diversification of the infant diet to include foods and drinks other than breast milk or infant formula, the risk of dental decay changes depending upon the free sugar content of the complementary foods and drinks, and how frequently such foods are consumed and access to fluoride through the commencement of tooth brushing with fluoride toothpaste. The BSPD statement recognises these confounding issues, and advises careful consideration of all factors and individual patient counselling.

There is evidence of benefits to child health including oral health from breastfeeding however levels of exclusive breastfeeding at 6-months remain very low (1%). PHE and BSPD agree that dental teams have a key role to play in supporting and encouraging mothers to breastfeed.

Download PHE briefing on breastfeeding and dental decay