Dietitians (NDIGuk)

Clinical guidelines/position statements

Exclusive Breastfeeding

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:
http://www.bda.uk.com/publications/statements/PositionStatementWeaning.pdf. This statement was last reviewed in April 2010.

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 Enterobacter 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.

Guidance from the Dept of Health on preparation of infant formulas at home for health professionals is available from:
http://www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_100887 and a practical leaflet for parents from:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_124525

Guidelines for preparation of feeds in hospital have been produced for the UK and are published by the Food Standards Authority and are available at:
http://www.food.gov.uk/multimedia/pdfs/publication/babypowdertoolkit1007

Use of soya formulas

1. DoH statement
CMO’s Update 37 January 2004 page 2

2. 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

3. BDA Paed Gp position statement on use of soya protein for infants (October 2010) gives a pragmatic interpretation of this topic for infants in the UK at:
http://www.bda.uk.com/publications/PaediatricGroupGuidelineSoyInfantFormulas.pdf

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. This can be used as a basis for developing local guidelines for use and is available to download at
http://www.bliss.org.uk/page.asp?section=58&sectionTitle=Publications+for+health+
professionals

Weaning Preterm Infants

There has always been considerable debate about the most appropriate time to introduce foods other than human breast milk or infant formula to the infant born prematurely. 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?

Since the Department of Health issued the following statement on breastfeeding in 2003 this question has been even more uncertain.

‘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 considerable expertise in feeding issues relating to premature infants, met to discuss weaning. Following this very useful meeting an evidence based statement/guideline was produced This was updated in 2011 and is now available - click here to download.

Specialised Formulas for Cow's Milk Intolerance and Malabsorption

The 2009-10 edition of the BDA Paediatric Group's 'Specialised Infant Formulas' Filofax insert is now available updated in April 2009. The leaflet provides a summary of currently available products for Cow's Milk Intolerance and Malabsorption Syndromes. It includes macronutrients and some minerals, sources of protein, fat and carbohydrate to help with selection of an appropriate formula and some sugested indications for use.

A pdf copy can be downloaded at:
http://www.bda.uk.com/publications/InfantSpecialisedFormulas.pdf
if you want an electronic copy but for those still using a Filofax or wanting a paper copy it doesn't print off as well as the proper leaflet! For free copies of the leaflet please contact Nutrition Services at SHS International. Email:  resourcecentre@nutricia.co.uk
Phone: 01225 751098

This leaflet is updated every 1-2 years depending on changes over time. Please direct any queries or comments to Chris Jarvis, Neonatal Dietitian, Tel: 0115 8231906
Email: chris.jarvis@nottingham.ac.uk

Last updated August 2011