Infant Feeding

by Dr Louise Santhanam, General Practitioner


Infant Feeding and the Role of the GP

The purpose of this website is to provide information to support GPs in caring for the families that they see, supporting optimal infant feeding practices and managing clinical infant feeding issues that present to the GP.  Understanding the role of our colleagues from maternity, early years care and infant feeding support can help the GP appropriately signpost or refer families and the website also addresses how collaborative working can improve infant and maternal outcomes.

Lunchtime

Concerns about infant feeding have been shown to be highly significant to women in the postnatal period. In a large 2017 survey, when women were unable to access their Midwife, 29% instead attended their GP, A&E or a walk in centre to address their concerns. The most common concerns were regarding ‘baby feeding’ (64%) and ‘sore nipples’ was also a commonly cited problem (27%)1.

As the GP is frequently a point of contact in the early weeks for parents of young babies, the GPIFN Team hopes that this website makes it easier for GPs to assist with such problems and enable families who are breastfeeding or feeding expressed breastmilk to continue for as long as they wish to. For those families who combination feed or formula feed, the website offers links to independent information on infant milks, responsive bottle feeding and the safe preparation of formula. We also include information on the introduction of solid foods, common infant feeding problems and childhood obesity (an increasing public health problem for the UK pre-school population).

Our page on ‘GP Education‘ outlines potential improvements in GP education on infant feeding.

The pages ‘The Role of the GP‘ and ‘Commissioning & Public Health‘ highlight how this knowledge can help clinical care.

The website section on ‘The Mother‘ includes information on the links between infant feeding and maternal health.

The section on ‘The Infant‘ includes information on issues affecting the infant’s ability to feed and also information on healthy growth.

Additionally, infant feeding has a role in wellbeing and secure infant attachment which is addressed in our pages on ‘Maternal Mental Health’ and the role of responsive feeding in ‘Building Secure Attachment and Infant Mental Health’.


Infant Feeding in the UK

Creating the right environment to promote and support breastfeeding’ is one of the important health interventions cited by Public Health England2 for enabling the best start for all infants, alongside other initiatives including the protection of perinatal mental health, smoking cessation support during pregnancy, routine neonatal and developmental screening, vaccination, healthy diet and physical activity.  The UK Department of Health3, NHS4 and The World Health Organisation (WHO)5 public health recommendation is for babies to be exclusively breastfed for the first 6 months, followed by the introduction complementary solid foods alongside continued breastfeeding, with the WHO specifying ‘up to 2 years of age or beyond’3-5.

The importance of this Public Health recommendation for UK infants has recently be underlined by the Lancet series on Breastfeeding in which 28 systematic reviews and meta-analyses were analysed, including studies from both low/middle and high income countries6.  The authors concluded that:

Our systematic reviews emphasise how important breastfeeding is for all women and children, irrespective of where they live and of whether they are rich or poor. Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections and otitis media. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome.  Available evidence shows that breastfeeding enhances human capital by increasing intelligence. It also helps nursing women by preventing breast cancer. Additionally, our review suggests likely effects on overweight and diabetes in breastfed children, and on ovarian cancer and diabetes in mothers.
Victora C.G. et al (2016) Lancet Breastfeeding Series

Our understanding of infant feeding trends in the UK has been informed by the national Infant Feeding Survey, conducted every five years between 1975 and 2010. Data collection provided statistics on the initiation and prevalence of breastfeeding and other feeding practices in the first 8-10 months of a baby’s life.  Over the lifetime of the survey breastfeeding rates in the UK were seen to rise7.  The Survey was decomissioned following 2010 and infant feeding statistics are now calculated from local provider data.

  • The latest available breastfeeding initiation rates in England are 72.7% (2015/16), from validated information from 126/135 NHS Maternity service providers8.
  • Estimates of 6-8 week breastfeeding (any breastfeeding) prevalence for England are now voluntarily submitted to Public Health England by Local Authorities and stand at around 44.4% (last published results from July-September 2016) from validated data obtained from 142 out of 150 Local Authorities9.

This data appears to show that breastfeeding rates in England have dropped slightly since the final national Infant Feeding survey in 2010 (data correct as of January 2017).  However, the detailed information previously gleaned from the 2010 Infant Feeding Survey can still highlight important issues for the clinician responsible for the health of infants and mothers, regardless of the method of feeding. The 2010 survey also includes important insights into the introduction of complementary solid foods and the safe preparation of formula feeds.


Breastfeeding in the UK

Breastfeeding initiation is known to be higher for babies who experience early skin-to-skin contact and among mothers from certain demographics7 (see infographic below). While breastfeeding initiation remains relatively high in the UK, in 2010 only 1% of mothers maintained exclusive breastfeeding to 6 months. The 2016 Lancet Breastfeeding Series6 recorded the UK as having the lowest prevalence of breastfeeding in the world at 12 months of age (less than 1%). The infographic below illustrates the summary findings of the 2010 Infant Feeding Survey7 including some of the significant barriers to breastfeeding in the UK.

The introduction of the Unicef UK Baby Friendly Initiative to hospitals in the UK in 199510 helped to improve breastfeeding initiation rates from low levels earlier in the 20th century.  There is a high correlation between intention to breastfeed and initial feeding method. In 2010 98% of those intending to breastfeed went on to do so. Additionally 18% of mothers who had planned in pregnancy to formula feed actually went on to breastfeed at the time of birth7.

There has previously been shown to be a substantial variation in breastfeeding rates in the four nations of the UK with initiation rates in 2010 highest in England at 83%, compared with 74% in Scotland, 71% in Wales, and 64% in Northern Ireland7. Exclusive breastfeeding at six weeks was 24% in England and 22% in Scotland, compared to 17% in Wales and 13% in Northern Ireland.

infant-feeding-gp-version
Statistics from the Infant Feeding Survey 2010

The 2010 Infant Feeding Survey demonstrated that 83% of mothers reported that they knew about the health benefits of breastfeeding7 but knowledge of health benefits does not translate to high breastfeeding continuation rates. Common reasons for stopping breastfeeding include ‘insufficient milk’, the baby rejecting the breast or difficulty attaching at the breast (the ‘latch’) and pain.

The survey showed that breastfeeding support is important to continuation in the early weeks.  While 4 out of 5 women who experienced breastfeeding problems in the early days were offered help, those who did not receive help or support for problems were more likely to stop breastfeeding within the first 2 weeks7.  The rate of continuation of breastfeeding decreases substantially within a few weeks, despite the fact that the majority of women would like to have breastfed for longer.  Other factors like family and peer support from friends also impact on breastfeeding continuation, as does the need for mothers to return to work and the facilities made available in the workplace7.


Artificial Baby Milk Feeding in the UK

In the 2010 Infant Feeding Survey 31% of breastfed babies received supplements of formula, water or glucose in hospital, and this was more common for babies in special care, preterm babies and those receiving phototherapy.  73% had given their baby milk other than breastmilk by the age of six weeks, and 88% by six months7.

Infants who were given milk other than breastmilk by 8-10 months old were more likely to have been given ‘follow-on’ formula (57%) as their main breastmilk substitute, despite the fact that infant formula (also labelled ‘stage 1’ formula) is suitable for use up to the age of 1 year11.

Data showed that the preparation of powdered infant formula feeds according to three key safety recommendations had increased (49% up from 13% in 2005)7, 12,13.  However, this does suggest that approximately half of the group receiving powdered infant formula were being fed formula prepared sub-optimally, with the associated risk of infection.


Introduction of Solid Foods in the UK

The timing of introduction of complementary solid foods was also studied in the 2010 Infant Feeding Survey.  30% of infants had been introduced to solids by 4 months, and  75% by 5 months7 .  Whilst this was an improvement towards the recommended introduction of solids at 6 months compared with the 2005 survey, the figures still show a considerable variation from public health recommendations.  Early introduction of solid food was more common amongst younger mothers and mothers from lower socioeconomic groups.

Following the decommissioning of the Infant Feeding Survey we have no subsequent national data collection on artificial milk feeding or the introduction of solid foods in the UK. 


References

  1. The WI and the NCT: Support Overdue- Women’s Experiences of Maternity Services 2017
  2. Public Health England: Health Matters-Giving Every Child The Best Start in Life May 2016
  3. UK Department of Health: Infant Feeding Recommendation 2003
  4. NHS Choices: Benefits of Breastfeeding
  5. WHO: Infant and Young Child Feeding Factsheet Updated September 2016
  6. Victora C, Bahl R, Barros A, França G, Horton S, Krasevec J et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490.
  7. Uk Infant Feeding Survey 2010
  8. NHS England: Maternity and Breastfeeding Data (Initiation)
  9. Public Health England: Breastfeeding Statistics (6-8 weeks continuation data)
  10. Unicef UK Baby Friendly Initiative: What is Baby Friendly?
  11. NHS Choices: Types of Formula Milk
  12. 1: make up only 1 feed at a time, 2: making feeds within 30 mins of water boiling, 3: adding water to the bottle before the powder (see ref 13 below)
  13. Food Standards Agency & Department of Health: Guidance for health professionals on safe preparation, storage and handling of powdered infant formula

Published April 2017