tag:theconversation.com,2011:/uk/topics/baby-formula-23280/articlesBaby formula – The Conversation2023-03-23T12:42:19Ztag:theconversation.com,2011:article/2010852023-03-23T12:42:19Z2023-03-23T12:42:19ZInfant formula shortages forced some parents to feed their babies in less healthy ways<figure><img src="https://images.theconversation.com/files/515955/original/file-20230316-2480-ieroj6.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5267%2C3500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies still need to eat even when formula is hard to come by.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/shelves-are-empty-as-natalia-restrepo-a-member-of-la-news-photo/1240791802">Joseph Prezioso/AFP via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>One third of families who relied on formula to feed their babies during the COVID-19 pandemic were forced by severe infant formula shortages to <a href="https://doi.org/10.1111/mcn.13498">resort to suboptimal feeding practices</a> that can harm infant health, according to our research published in the journal Maternal and Child Nutrition.</p>
<p>Infant formula shortages left <a href="https://www.kff.org/medicaid/issue-brief/key-characteristics-of-infants-and-implications-of-the-recent-formula-shortage/">70% of U.S. store shelves bare</a> in May 2022, with 10 states reporting out-of-stock rates of <a href="https://news.bloomberglaw.com/health-law-and-business/us-baby-formula-shortages-hit-74-despite-biden-action">90% or greater</a>.</p>
<p><a href="https://scholar.google.com/citations?user=hI28SJIAAAAJ&hl=en&oi=ao">As psychology</a> <a href="https://jessicamarinocom.wordpress.com">researchers</a> who study breastfeeding, this situation left us concerned for the safety of infant nutrition. With two <a href="https://scholar.google.com/citations?user=mrwyVwIAAAAJ&hl=en&oi=ao">colleagues who focus</a> <a href="https://scholar.google.com/citations?user=NChgQR4AAAAJ&hl=en">on public health</a>, we conducted an online survey of over 300 infant caregivers in the U.S. to understand how many families had trouble obtaining infant formula and what they fed their babies when they did.</p>
<p><iframe id="dxSI9" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/dxSI9/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Considering the scope of the formula shortages, we were not surprised that 31% of the formula-feeding families we surveyed reported challenges obtaining infant formula, the most common being that it was sold out and they had to travel to more than one store.</p>
<p>But their babies still needed to eat. Being unable to get their hands on infant formula pushed caregivers to potentially unhealthy or even dangerous stopgaps. For example, 11% of the formula-feeding families surveyed said they practiced “formula-stretching” – diluting infant formula with extra water to make formula supplies last longer, which provides a baby with less nutrition in each bottle.</p>
<p>Furthermore, 10% of formula-feeding families reported substituting cereal for infant formula in bottles, 8% prepared smaller bottles and 6% skipped formula feedings for their infants, which all provide infants with less nutritious meals.</p>
<p>Exclusively breastfeeding families were insulated against these supply disruptions. Almost half of breastfeeding families surveyed reported that COVID-19 lockdowns actually allowed them time to increase their milk supply. </p>
<h2>Why it matters</h2>
<p>Our study suggests that the waves of formula shortages from 2020 to 2022 in the U.S. were more than just an inconvenience for parents. Instead, this study is the first to document that formula shortages likely had real and widespread adverse impacts on infant nutrition, given that a large proportion of parents surveyed resorted to feeding their baby in ways that can harm infant health.</p>
<p>For instance, studies have shown that adding extra water to “stretch” formula can result in infant <a href="https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf">malnutrition, growth and cognitive delays</a> and even <a href="https://doi.org/10.1542/peds.100.6.e4">seizures and death</a> in extreme cases. Adding cereal to bottles increases the risk of <a href="https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf">choking-related deaths</a> and <a href="https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf">severe constipation</a>. Moreover, feeding infants age-inappropriate foods can have lifelong consequences for <a href="https://doi.org/10.1111/nure.12102">cognitive development</a> and <a href="https://doi.org/10.1093/ajcn/87.6.1852">growth</a>, leading to a higher <a href="https://doi.org/10.1159/000351486">risk for chronic illnesses</a> like obesity and cardiovascular disease.</p>
<p>Given that <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">approximately 75% of infants</a> in the U.S. are fed with infant formula in the first six months of life, formula shortages could put roughly 2.7 million babies each year at risk for suboptimal feeding practices.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A formally dressed man with gray hair seated in front of a screen that says 'Operation Fly Formula'" src="https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">President Biden met with baby formula manufacturers in June 2022 to discuss shortages.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-joe-biden-meets-virtually-with-baby-formula-news-photo/1400488773">Kevin Dietsch/Getty Images</a></span>
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<h2>What’s next</h2>
<p>A perfect storm of formula recalls, ingredient shortages and shipping delays <a href="https://theconversation.com/whats-causing-the-us-baby-formula-shortage-and-how-to-make-sure-it-doesnt-happen-again-182929">contributed to COVID-19-related formula shortages</a> in the U.S. Although President Joe Biden’s administration has taken some steps to <a href="https://highways.dot.gov/newsroom/biden-administration-announces-new-protect-formula-program-73-billion-bipartisan">improve distribution infrastructure</a>, the U.S. does not currently have infant nutrition disaster plans in place beyond <a href="https://www.hhs.gov/formula/index.html">common-sense recommendations for individuals</a>.</p>
<p>Unfortunately, <a href="https://theconversation.com/breastfeeding-can-help-tackle-climate-crisis-but-its-on-governments-not-mums-to-save-the-world-124676">climate change will likely increase the risk</a> of formula-supply disruptions over the next century because of the <a href="https://e360.yale.edu/features/how-climate-change-is-disrupting-the-global-supply-chain">increased frequency of natural disasters</a>.</p>
<p>The best way to protect infant nutrition from supply chain issues is to promote and support breastfeeding, which provides optimal infant nutrition and insulates infants from those disruptions. Since <a href="https://www.healthgrades.com/right-care/pregnancy/9-reasons-you-may-not-be-able-to-breastfeed">not all babies can be breastfed</a>, though, governmental policies could help prevent and address acute formula shortages and ensure equitable formula access for all.</p><img src="https://counter.theconversation.com/content/201085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many families in the US encountered empty shelves when they went in search of infant formula during COVID-19.Jessica A. Marino, Doctoral Student in Health Psychology, University of California, MercedJennifer Hahn-Holbrook, Assistant Professor of Psychology, University of California, MercedLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1844082022-06-06T12:50:45Z2022-06-06T12:50:45ZThe US is importing baby formula to help end supply shortage – what parents need to know<figure><img src="https://images.theconversation.com/files/467053/original/file-20220605-58806-z06n5u.jpg?ixlib=rb-1.1.0&rect=0%2C53%2C4500%2C2937&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hopefully not staying empty for much longer.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/shelves-normally-meant-for-baby-formula-sit-nearly-empty-at-news-photo/1240839231?adppopup=true">Samuel Corum/AFP via Getty Images)</a></span></figcaption></figure><p><em>Industry and federal efforts to <a href="https://www.cnn.com/2022/06/03/politics/baby-formula-crisis-timeline/index.html">alleviate a baby formula shortage</a> in the U.S. are ramping up, with the <a href="https://www.npr.org/2022/05/28/1101931160/baby-formula-shortage-overseas-shipments">import of foreign brands</a> supplementing increased domestic production.</em></p>
<p><em>It follows a crisis in which mothers, fathers and caregivers across the U.S. have had to <a href="https://www.seattletimes.com/seattle-news/baby-formula-shortage-in-washington-has-caregivers-parents/">scramble to find scarce supplies</a> or <a href="https://www.wfaa.com/article/news/local/texas/lake-jackson-texas-mom-drives-hour-baby-formula-amid-shortage/287-d1638ecb-4153-415d-ab63-58e342ec764f">drive long distances</a> to buy formula.</em></p>
<p><em>But are the efforts enough to overcome the supply problem – and protect against it happening again in the future? The Conversation asked Dr. Steven Abrams, a leading <a href="https://dellmed.utexas.edu/directory/steven-a-abrams">expert on pediatric health</a> at the University of Texas who has advised both the formula industry and government on infant nutrition, what parents should know about the imported formula.</em> </p>
<h2>Remind me, what caused the shortage?</h2>
<p>First, we had a <a href="https://theconversation.com/4-reasons-americans-are-still-seeing-empty-shelves-and-long-waits-with-christmas-just-around-the-corner-168635">supply chain problem</a> that affected all manner of goods since the onset of the pandemic. Then in February 2022 a <a href="https://wwmt.com/news/local/baby-formula-shortage-crisis-intensifies-as-sturgis-plant-remains-shut-down">major baby formula manufacturing plant in the U.S. went down</a>. </p>
<p>The U.S. Food and Drug Association <a href="https://www.nbcboston.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/2717440/">shut down Abbott Nutrition’s factory</a> in Michigan after Abbott’s nationwide <a href="https://www.similacrecall.com/us/en/home.html">recall of multiple brands of formula</a> amid concerns over <a href="https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022">bacterial infections</a>.</p>
<p>The Michigan plant is the largest producer in the country, so when it went down, it put added strain on the entire U.S. formula distribution system.</p>
<h2>Are there still shortages?</h2>
<p>The situation is beginning to improve in some parts of the country. People are reporting fewer incidents of going to stores and finding no formula on the shelves. But it is patchy – urban areas seem to be doing better than rural places with one store serving an area.</p>
<p>I can see the supply issue easing further in the coming weeks. This is down to three factors: First, the <a href="https://www.reuters.com/world/us/baby-formula-makers-ramp-up-us-supplies-tackle-shortage-2022-05-17/">domestic production of baby formula has improved</a>. Secondly, <a href="https://www.cnn.com/2022/05/16/politics/baby-formula-biden-administration-steps/index.html">imported formulas</a> – part of the Biden Administration’s <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/01/president-biden-announces-third-operation-fly-formula-mission/#:%7E:text=Under%20Operation%20Fly%20Formula%2C%20the,can%20get%20to%20store%20shelves">Operation Fly Formula</a> mission – have helped supplement the domestic brands. Lastly, there seems to be anecdotal evidence of less hoarding by panicked parents as time goes on. This will all help alleviate the shortage.</p>
<figure class="align-center ">
<img alt="A FedEx pane is seen with a cargo shipment of baby formula being unloaded." src="https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A shipment of baby formula being delivered as part of Operation Fly Formula.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/fedex-workers-unload-a-shipment-of-baby-formula-as-part-of-news-photo/1240902959?adppopup=true">Nathan Posner/Anadolu Agency via Getty Images</a></span>
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<p>The good news is, more relief is on the way. The factory that closed had already been allowed to release its stock of specialized formula for babies with severe allergies. And as of June 4, it <a href="https://www.cnbc.com/2022/06/04/abbott-nutrition-restarts-baby-formula-production-in-reopened-michigan-plant.html">also restarted production</a> of specialty formulas after being given the green light from the FDA. However, it is expected to take 6-8 weeks for more routine formulas to be produced from this factory and make it to store shelves.</p>
<p>On top of that, more shipments <a href="https://www.businessinsider.com/baby-formula-shortage-us-operation-fly-formula-royal-family-2022-5">on the way from the U.K.</a> <a href="https://www.upi.com/Top_News/World-News/2022/05/28/australia-goats-milk-operation-fly-formula/6091653750809/">and Australia</a> will add to the shipments of specialty formula from Europe we <a href="https://www.axios.com/2022/05/17/nestle-baby-formula-netherlands-switzerland">have already seen from Nestle</a>. Additional <a href="https://www.foxnews.com/health/baby-formula-imports-mexico-july-october-fda">shipments from Mexico</a> from Nestle of routine formula are also expected within the next few weeks. We are expecting two shipments in the coming days. It will take a few days to get to stores, but parents should start seeing them on the shelves soon.</p>
<h2>What do American parents need to know about imported formula?</h2>
<p>Formula from Europe, Australia and Mexico are labeled differently: as “stage 1” formula for newborns and up to 12 months and “stage 2” for babies over six months.</p>
<p>And their mixing instructions are different. For a start, EU and Australia formula uses milliliters rather than ounces. Some, but not all, will have substantially different powder to water ratios. Parents will need to pay attention to this. Anyone preparing imported formula will need to take careful note of the mixing instructions – too much powder and you will over-concentrate the formula, risking too much salt. Over-diluting will mean too little salt and nutrients.</p>
<p>In addition, two of the brands being imported will include formula made from goats milk protein – the Australian firm Bubs and the U.K. company Kendamil. This isn’t uncommon in the rest of the world, but in the U.S., all animal-based infant formula is based on cow’s milk.</p>
<p>This isn’t a bad thing. Some scientific evidence suggests goat’s milk is more digestible for babies than cow’s milk.</p>
<p>The other thing to note is that we are still waiting on the FDA to find out which of the imported formulas will get approved for distribution through the federal food program <a href="https://www.fns.usda.gov/wic">called WIC</a>. WIC provides formula for a majority of babies in low-income families.</p>
<h2>How has the shortage affected low-income families?</h2>
<p>A majority of all parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">all their nutrition through breast milk</a>. But by the age of six months, the <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">majority of babies get at least some formula</a>. The proportion of 1-year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures – mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.</p>
<p>But the shortage has affected some parents more than others. And not surprisingly, the most affected parents are those on the lowest income.</p>
<p>During the shortage, some families drove long distances to find stores selling formula. Obviously that is harder to do for poorer families, as there are costs involved. Likewise, more affluent parents have been able to buy more expensive, so-called elite brand formulas.</p>
<p>The other thing to note is that the shortage affected both regular infant formula and <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">specialized versions</a>. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type.</p>
<p>Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs.</p>
<h2>Why is getting sufficient supplies of formula so important?</h2>
<p>In the first six months, babies should <a href="https://www.cdc.gov/breastfeeding/faq/index.htm">only have breast milk or formula</a> – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.</p>
<p>Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm">nutritionally incomplete</a>, they may not be entirely sterile. Indeed, we have seen <a href="https://www.newsweek.com/baby-fed-homemade-formula-hospitalized-shortage-1708626">reports of babies</a> <a href="https://www.insider.com/er-doc-says-watered-down-homemade-formulas-putting-infants-danger-2022-5">being hospitalized</a> as a result of being fed homemade formula.</p>
<p>After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.</p>
<h2>Are there any viable alternatives?</h2>
<p>Over the age of six months of age, for only reasonably short periods of time, <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx#.Ynr6sYw9zEQ.twitter">parents can feed infants whole cow’s milk</a> and look into iron supplements.</p>
<p>It isn’t ideal, and only applies for older babies. For those under six months old, cow’s milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow’s milk also has a misbalance of minerals, especially for younger babies.</p>
<h2>What can be done to prevent this situation from happening again in the U.S.?</h2>
<p>First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas – the worst thing would be that those who have moved to homemade formulas continue to do so after stocks are supplied.</p>
<p>Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. Competition could potentially drive down prices. One positive to come from the shortage is that it is introducing new entrants into the U.S. market. Meanwhile, there is now a recognition that the U.S. needs to diversify its production of formula.</p>
<p>I believe America also needs to look at the country’s breastfeeding support system. Don’t get me wrong: Some parents will always need formula. But those who want to breastfeed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.</p>
<p><em>Editor’s note: This is an updated version of an article <a href="https://theconversation.com/whats-causing-the-us-baby-formula-shortage-and-how-to-make-sure-it-doesnt-happen-again-182929">originally published</a> on May 12, 2022.</em></p><img src="https://counter.theconversation.com/content/184408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.</span></em></p>An infant nutrition expert explains the efforts to ensure there is enough baby formula for US consumption and the differences between domestic and imported produce.Steven A. Abrams, Professor of Pediatrics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1830852022-05-19T17:36:02Z2022-05-19T17:36:02ZWhat you need to know about the Defense Production Act – the 1950s law Biden invoked to try to end the baby formula shortage<figure><img src="https://images.theconversation.com/files/464308/original/file-20220519-15-2p9dzb.jpg?ixlib=rb-1.1.0&rect=96%2C66%2C4836%2C3216&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Biden invoked the Defense Production Act to help end the shortage of baby formula. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BabyFormulaShortage/cbffe3810313405ca11283cdc7531bf3/photo?Query=baby%20formula&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=265&currentItemNo=0">AP Photo/David J. Phillip</a></span></figcaption></figure><p>U.S. President Joe Biden on May 18, 2022, <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2022/05/18/memorandum-on-the-delegation-of-authority-under-the-defense-production-act-to-ensure-an-adequate-supply-of-infant-formula/">announced he is invoking</a> the Defense Production Act to help end the <a href="https://theconversation.com/baby-formula-industry-was-primed-for-disaster-long-before-key-factory-closed-down-183016">shortage of baby formula</a> stressing out parents nationwide.</p>
<p>He said he will direct suppliers of baby formula ingredients to prioritize delivery to formula manufacturers and control their distribution as necessary.</p>
<p>You might well wonder what babies going without formula has to do with defense production, which calls to mind big warships and weapons systems. While using the <a href="https://www.fema.gov/disaster/defense-production-act">Defense Production Act</a> to force companies to make baby formula would certainly be a novel use of the act, it would hardly be the first time the postwar law has been used beyond its originally intended purpose to support national defense.</p>
<p>And in fact, the law is used a lot more frequently than you might think. But as a <a href="https://michiganross.umich.edu/faculty-research/faculty/erik-gordon">business professor</a> who studies strategies to maximize efficient allocation of resources, I believe when presidents invoke the act it’s often more about political theater – showing the public you’re doing something – than addressing the problem in the most effective way.</p>
<h2>Sweeping authority</h2>
<p>The Defense Production Act was passed in 1950 and modeled on the War Powers acts of <a href="https://www.visitthecapitol.gov/exhibitions/artifact/hr-6233-bill-expedite-prosecution-war-effort-first-war-powers-act-december-15">1941</a> and <a href="https://www.govinfo.gov/app/details/USCODE-2009-title50/USCODE-2009-title50-app-secondwar">1942</a>. </p>
<p>The War Powers acts <a href="https://www.cfr.org/in-brief/what-defense-production-act">gave the president sweeping authority</a> to control domestic manufacturing. For example, it helped the U.S. <a href="https://www.si.edu/spotlight/wwii-aircraft">increase production of warplanes</a> from 2,500 a year to over 300,000 by the end of the war.</p>
<p>In 1950, America faced war in Korea, and Congress feared that growing postwar demand for consumer goods would crowd out defense production needed to face China and the Soviet Union, which both backed North Korea in the conflict. There were also concerns <a href="https://www.minneapolisfed.org/about-us/monetary-policy/inflation-calculator/consumer-price-index-1913-">about inflation</a> during that postwar period.</p>
<p>The <a href="https://sgp.fas.org/crs/natsec/R43767.pdf">Defense Production Act gave the president</a> – who later delegated this authority to Cabinet officials like the secretary of defense – broad powers to force manufacturers to make goods and supply services to support the national defense, as well as to set wages and prices and even ration consumer goods. </p>
<p>“We cannot get all the military supplies we need now from expanded production alone,” President Harry Truman <a href="https://www.presidency.ucsb.edu/documents/radio-and-television-address-the-american-people-following-the-signing-the-defense">told Americans in a radio address after signing the act</a> into law. “This expansion cannot take place fast enough. Therefore, to the extent necessary, workers and plants will have to stop making some civilian goods and begin turning out military equipment.” </p>
<p>The <a href="https://sgp.fas.org/crs/natsec/R43767.pdf">original law focused on</a> “shaping U.S. military preparedness and capabilities,” which limited the scope of the president’s authority. </p>
<h2>Routinely invoked</h2>
<p>Although the Defense Production Act makes news only when the president dramatically invokes it, the government uses the law – or just the threat of using it – routinely to force private companies to prioritize government orders. The Department of Defense, for example, <a href="https://www.fema.gov/sites/default/files/documents/fema-dpac-report-to-congress_2019.pdf">uses it to make</a> an estimated 300,000 contracts with private companies a year.</p>
<p>Congress <a href="https://www.investopedia.com/defense-production-act-dpa-5187806">has to reauthorize</a> the act every several years and has amended it frequently to expand or limit its scope. Over time, <a href="https://sgp.fas.org/crs/natsec/R43767.pdf">this has significantly broadened</a> the definition of national defense to include supporting “domestic preparedness, response, and recovery from hazards, terrorist attacks, and other national emergencies.” </p>
<p>The Department of Homeland Security invoked it about 400 times in 2019, mostly to help prepare for and respond to hurricanes and other natural disasters, such as by providing resources to house and feed survivors. And Presidents Bill Clinton and George W. Bush, for example, <a href="https://journals.library.columbia.edu/index.php/bioethics/article/view/8678">both used it to divert electricity</a> and natural gas to California during the 2000-2001 energy crisis. </p>
<p>The act has also been used extensively during the COVID-19 pandemic. President Donald Trump used it to <a href="https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-prioritizing-allocating-health-medical-resources-respond-spread-covid-19/">prioritize the allocation of medical resources</a>, prevent hoarding of personal protective equipment and <a href="https://www.cbsnews.com/news/trump-defense-production-act-wartime-general-motors/">require General Motors</a> to build ventilators. He also <a href="https://www.cnn.com/2020/04/28/politics/defense-production-act-executive-order-food-supply/index.html">ordered beef, pork and poultry processing facilities</a> to stay open during the lockdowns to ensure a supply of protein for the American population. </p>
<p>Biden, for his part, has also already used the act a number of times, mainly to fight the pandemic. For example, in March 2021, <a href="https://www.npr.org/sections/health-shots/2021/03/13/976531488/defense-production-act-speeds-up-vaccine-production">he invoked it</a> to speed up vaccine production by ensuring extra facilities were up to snuff, as well as to expedite the production of critical materials, equipment, machinery and supplies. In March 2022, <a href="https://electrek.co/2022/03/31/biden-invokes-defense-production-act-to-boost-ev-storage-battery-minerals/">he issued</a> a directive to increase the supply of materials for large-capacity batteries that are used mainly in civilian electric vehicles.</p>
<p>Biden’s use of the Defense Production Act to address the baby formula problem illustrates a limitation of it. It can be used to set priorities for ingredients and manufacturing capacity, but it’s not a magic wand. A president can’t by decree make capacity that doesn’t exist instantly appear. And it isn’t clear how much it will do to quickly end the formula shortage – given the <a href="https://abbott.mediaroom.com/2022-05-16-Abbott-Enters-into-Consent-Decree-with-U-S-Food-and-Drug-Administration-for-its-Sturgis,-Mich-,-Plant-Agreement-Creates-Pathway-to-Reopen-Facility">main problem is manufacturing issues</a> that closed production at a key plant, not just a shortage of ingredients. </p>
<p>The act is widely used and has been widely useful, but it is no substitute for advance planning and preparedness.</p><img src="https://counter.theconversation.com/content/183085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erik Gordon does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Biden said the Defense Production Act would help end the shortage by directing suppliers of baby formula to prioritize delivery to formula manufacturers.Erik Gordon, Professor of Business, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1830162022-05-19T12:23:54Z2022-05-19T12:23:54ZBaby formula industry was primed for disaster long before key factory closed down<figure><img src="https://images.theconversation.com/files/464068/original/file-20220518-15-f6cjil.jpg?ixlib=rb-1.1.0&rect=211%2C125%2C4204%2C2814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cities are trying to address the baby formula shortage with community drives.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BabyFormulaShortage/978d1f02dc1043938f71dadae095fe96/photo?Query=baby%20formula&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=263&currentItemNo=34">AP Photo/David J. Phillip</a></span></figcaption></figure><p>The conditions that led to a <a href="https://theconversation.com/whats-behind-the-us-baby-formula-shortage-and-how-to-make-sure-it-doesnt-happen-again-182929">shortage of baby formula</a> were set in motion long before the February 2022 closure of the Similac factory <a href="https://www.washingtonpost.com/business/2022/05/14/baby-formula-shortage-sturgis/">tipped the U.S. into a crisis</a>.</p>
<p>Retailers nationwide <a href="https://datasembly.com/news/out-of-stock-rate-in-april-2022-copy/">reported supplies of baby formula were out of stock</a> at a rate of 43% during the week ended May 8, 2022, compared with less than 5% in the first half of 2021. In some states, such as <a href="https://www.cbsnews.com/news/baby-formula-shortage-rationing-national-crisis/">Texas and Tennessee</a>, shortages were over 50%, which has prompted parents to <a href="https://www.wsj.com/articles/baby-formula-shortage-leaves-parents-scouring-country-for-supplies-11652466530">travel long distances</a> and <a href="https://www.eatthis.com/news-baby-formula-shortage-price-gouging/">pay exorbitant sums of money</a> to grab dwindling supplies of formula for their babies.</p>
<p>News that the Food and Drug Administration and Similac-maker Abbott <a href="https://www.nytimes.com/2022/05/16/health/baby-formula-shortage-fda.html">have reached a deal</a> to reopen the formula factory in Sturgis, Michigan, is welcome news for desperate parents, but it will do little to alleviate the shortage anytime soon. This is in no small part because of the very nature of America’s baby formula industry.</p>
<p>I <a href="https://ilitchbusiness.wayne.edu/profile/dx7877">research and teach supply chain management</a>, with a special focus on the health care industry. The closure of the Similac factory may have lit the fuse for the nationwide shortage, but a combination of government policy, industry market concentration and supply chain issues supplied the powder. </p>
<h2>What prompted the baby formula shortage</h2>
<p>On Feb. 17, Abbott <a href="https://www.similacrecall.com/us/en/home.html">initiated a voluntary recall</a> after <a href="https://www.miamiherald.com/news/recalls/article258913143.html">four infants</a> were hospitalized with infections from the bacteria <em>Cronobacter sakazakii</em> – two of them died – after consuming baby formula manufactured in their Sturgis facility. The factory was also shut down.</p>
<p>The FDA has identified no new cases but has <a href="https://www.washingtonpost.com/business/2022/05/14/baby-formula-shortage-sturgis/">not yet approved reopening</a> the Sturgis facility, which is responsible for about half of Abbott’s U.S. supply. Abbott said it <a href="https://abbott.mediaroom.com/2022-05-16-Abbott-Enters-into-Consent-Decree-with-U-S-Food-and-Drug-Administration-for-its-Sturgis,-Mich-,-Plant-Agreement-Creates-Pathway-to-Reopen-Facility">entered into a consent decree</a> with the FDA that paves the way to reopening the facility once certain conditions are met. </p>
<p>Shortages of baby formula have led major U.S. retailers including Target, CVS, Walgreens and Kroger to <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/baby-formula-shortage-forces-cvs-health-limit-purchases-2022-05-10/">restrict the amount of formula</a> a consumer may purchase. These shortages <a href="https://www.washingtonpost.com/health/2022/05/18/baby-formula-shortage-impact/">are disproportionately hurting low-income families</a> and those who do not have the resources to travel long distances to find alternative sources of baby formula. </p>
<figure class="align-center ">
<img alt="Shelves at a a grocery store are mostly bare with a small number of baby formula packages here and there" src="https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464118/original/file-20220518-19-fb0u1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Baby formula is in short supply across the U.S.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BabyFormulaShortage/c7645da15acb467ba6b2bf3c6a588f82/photo?Query=baby%20formula&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=265&currentItemNo=105">AP Photo/Michael Conroy</a></span>
</figcaption>
</figure>
<h2>Government-created monopolies</h2>
<p>The root of the problem begins with a concentration of production. </p>
<p>Two companies – Abbott and Reckitt Benckiser, which makes Enfamil – <a href="https://www.wsj.com/articles/baby-formula-shortage-could-last-months-11652371827?mod=hp_lead_pos3/">dominate the industry with about 80% of the U.S. market</a>. Nestlé, which sells baby formula in the U.S. under its Gerber brand, controls another 10%. </p>
<p>Part of the reason these companies are so entrenched in their position is that Abbott, Reckitt and Nestlé <a href="https://www.ers.usda.gov/amber-waves/2011/september/infant-formula-market/">are the only makers approved</a> by the U.S. government to provide baby formula through the Special Supplemental Nutrition Program for Women, Infants and Children, <a href="https://www.fns.usda.gov/wic">known as WIC</a>, which provides supplemental food to low-income families. </p>
<p>WIC, which <a href="https://www.ers.usda.gov/amber-waves/2004/september/sharing-the-economic-burden-who-pays-for-wic-s-infant-formula/#:%7E:text=Taxpayers%20alone%2C%20however%2C%20do%20not,formula%20purchased%20by%20WIC%20participants.">reimburses companies at 15%</a> of the wholesale cost, <a href="https://www.ers.usda.gov/amber-waves/2011/september/infant-formula-market/">is responsible for 92%</a> of supermarket sales of milk-based powder formula in 12-to 16-ounce containers and 51% of all sales in other sizes. </p>
<p>The federal government provides WIC grants to each state, which then contracts with one of the three companies. While WIC is a critical program to feed the most vulnerable, government support of this program has the unintended consequence of creating a de facto monopoly in each state.</p>
<p>The amount of WIC funding to these three established companies makes it difficult for any startup to make significant inroads in the baby formula industry. There is little chance they can capture the market share necessary to justify a significant investment. Since only a handful of manufacturing facilities are approved for production of baby formula in the U.S., <a href="https://www.cnbc.com/2019/08/02/silicon-valley-is-eyeing-the-giant-market-for-infant-formula.html">startups don’t have the volume</a> required to produce in these facilities. </p>
<h2>Import restrictions</h2>
<p>Another reason for the intense concentration is import controls.</p>
<p><a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/12/fact-sheet-president-biden-announces-additional-steps-to-address-infant-formula-shortage/">About 98% of the formula consumed</a> in the U.S. is produced domestically, whether by a U.S. or international company. While facilities abroad such as those in Mexico, Chile, Ireland and the Netherlands meet the FDA’s nutrition standards, a <a href="http://www.doi.org/10.1097/MPG.0000000000002395">failure to meet its labeling guidelines</a> prevents them from exporting to the U.S. As a result, <a href="https://www.nytimes.com/2020/04/18/parenting/baby/european-formula.html">some consumers order unapproved formula</a> over the internet from Europe and elsewhere, which may then be confiscated at the border. </p>
<p>International manufactures also face high tariffs, which <a href="https://www.freightwaves.com/news/protectionism-red-tape-hinder-baby-formula-resupply-analysts-say">can be as high as 17.5%</a> depending on volume. That’s one reason Canadian producers, which are subsidized by their government, <a href="https://www.freightwaves.com/news/protectionism-red-tape-hinder-baby-formula-resupply-analysts-say">have mostly steered clear</a> of the U.S. market. And the United States Mexico Canada Agreement, which came into force in 2020, included a provision that made it even harder for Canada to ship baby formula south in an effort to protect domestic producers. </p>
<h2>‘Lean’ supply chains</h2>
<p>The pandemic-related problems that have beleaguered global supply chains have also played a role. </p>
<p>Like in other industries, baby formula makers have long tried to make their supply chains as “lean” and efficient as possible. That means they aimed to minimize the amount of time baby formula spent sitting – unprofitably – on warehouse shelves and send the goods from factory to retailer as quickly as possible. The problem is that when there’s a surge in demand or a drop in supply, shortages can result. The leaner the supply chain, the larger the potential disruption. </p>
<p>The WIC program also encourages a lean supply chain because <a href="https://www.ers.usda.gov/amber-waves/2004/september/sharing-the-economic-burden-who-pays-for-wic-s-infant-formula/#:%7E:text=Taxpayers%20alone%2C%20however%2C%20do%20not,formula%20purchased%20by%20WIC%20participants.">it reimburses just 15%</a> of the wholesale price. The huge volume means the companies can still be profitable, but the lower margins per sale encourage them to keep a very efficient supply chain.</p>
<p>In March 2020, <a href="https://www.theatlantic.com/ideas/archive/2022/05/baby-formula-shortage-abbott-recall/629828/">formula sales surged</a> as people stockpiled pretty much everything. But that led sales to drop as parents worked through all that extra formula. That prompted makers to reduce production. And now in 2022, demand jumped again, <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">especially after reports spread</a> of the Similac recall. And with demand soaring and supply down significantly because of the Sturgis plant’s closure, shortages were inevitable.</p>
<figure class="align-center ">
<img alt="A woman in a white lab coat and wearing a black mask holds a bottle of frozen breast milk in a big clear bottle" src="https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464115/original/file-20220518-25-knccop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Milk banks are trying to ease the formula shortage by distributing frozen milk donated by lactating mothers.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BabyFormulaShortage/a37d842efd3c4a399e7604b62971dbee/photo?Query=baby%20formula&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=265&currentItemNo=42">AP Photo/David Zalubowski</a></span>
</figcaption>
</figure>
<h2>Shortage is far from over</h2>
<p>Both the Biden administration and companies have announced a variety of measures to end the shortage. </p>
<p>Some companies, such as Reckitt, say they <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/baby-formula-shortage-forces-cvs-health-limit-purchases-2022-05-10/">have stepped up production</a> and are running factories <a href="https://www.wsj.com/articles/why-baby-formula-shortage-11652188230?mod=article_inline">seven days a week</a> to get more formula to stores. </p>
<p>The FDA is expected to soon announce the <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/12/fact-sheet-president-biden-announces-additional-steps-to-address-infant-formula-shortage/">loosening of import rules</a> for baby formula, and some states are allowing WIC recipients to use their rebates to buy formula from companies other than the one on the contract. Abbott has already agreed to <a href="https://www.washingtonpost.com/business/2022/05/14/baby-formula-shortage-sturgis/">honor rebates</a> for competitor products in states where they have WIC contracts. </p>
<p><a href="https://www.reuters.com/business/healthcare-pharmaceuticals/baby-formula-shortage-forces-cvs-health-limit-purchases-2022-05-10/">Abbott</a> and <a href="https://www.bloomberg.com/news/articles/2022-05-17/nestle-ships-baby-formula-to-us-from-europe-to-help-shortage">Nestlé</a> are also speeding up shipments from their FDA-approved facilities overseas. </p>
<p>The best way to end the shortage – getting the Sturgis plant online and its formula on retail shelves – <a href="https://www.fastcompany.com/90751300/baby-formula-shortage-panic-buying">will take two months</a>.</p>
<p>Ultimately, preventing this kind of situation from happening again will require changes to government policy and business practices. I believe the government’s de facto monopolies should be opened up to more competition. And formula makers may just have to accept a little less profit from supply chain efficiencies as a cost of doing business – and as a way to ensure families won’t again be faced with the loss of a product so vital to their babies’ survival.</p><img src="https://counter.theconversation.com/content/183016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Ketels does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The closure of a factory in Michigan is the incident that put new parents across the US on edge, but the real causes for the shortage of baby formula are many years in the making.Kevin Ketels, Assistant Professor, Teaching, Global Supply Chain Management, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1829292022-05-12T13:09:02Z2022-05-12T13:09:02ZWhat’s causing the US baby formula shortage – and how to make sure it doesn’t happen again<figure><img src="https://images.theconversation.com/files/462578/original/file-20220511-18-x6ls08.jpg?ixlib=rb-1.1.0&rect=53%2C341%2C6000%2C3646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No easy formula.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/grocery-store-shelves-where-baby-formula-is-typically-news-photo/1240603860?adppopup=true">Stefani Reynolds/AFP via Getty Images</a></span></figcaption></figure><p><em>A <a href="https://www.nytimes.com/2022/05/10/us/baby-formula-shortage.html">baby formula shortage</a> has added to the woes of American parents already confronted with the pressures of <a href="https://www.theatlantic.com/culture/archive/2021/03/isolation-becoming-new-parent-during-pandemic/618244/">raising an infant during a pandemic</a> in a country <a href="https://www.forbes.com/sites/marybethferrante/2019/06/21/unicef-study-confirms-the-u-s-ranks-last-for-family-friendly-policies/?sh=176ff24133ba">ranked low for family-friendly policies</a>.</em></p>
<p><em>Media reports have highlighted the plight of mothers, fathers and caregivers across the U.S. who have <a href="https://www.seattletimes.com/seattle-news/baby-formula-shortage-in-washington-has-caregivers-parents/">scrambled to find scarce supplies</a>, or <a href="https://www.wfaa.com/article/news/local/texas/lake-jackson-texas-mom-drives-hour-baby-formula-amid-shortage/287-d1638ecb-4153-415d-ab63-58e342ec764f">driven long distances</a> to buy formula.</em></p>
<p><em>But what is behind the shortage? And how can it be prevented from happening again? The Conversation asked Dr. Steven Abrams, a leading <a href="https://dellmed.utexas.edu/directory/steven-a-abrams">expert on pediatric health</a> at the University of Texas who has advised both the formula industry and government on infant nutrition, these questions along with what advice he could give parents facing problems getting adequate supplies of infant formula.</em> </p>
<h2>1. Why there is a shortage of formula now?</h2>
<p>There are really two factors that have driven the current shortage. First, we have the <a href="https://theconversation.com/4-reasons-americans-are-still-seeing-empty-shelves-and-long-waits-with-christmas-just-around-the-corner-168635">supply chain problem</a>, which has affected all manner of goods since the onset of the pandemic. It eased off a little, but then at the beginning of 2022 it <a href="https://www.wired.com/story/supply-chain-crisis-data/">became worse</a>.</p>
<p>Then in February a <a href="https://wwmt.com/news/local/baby-formula-shortage-crisis-intensifies-as-sturgis-plant-remains-shut-down">major baby formula manufacturing plant in U.S. went down</a>. The FDA <a href="https://www.nbcboston.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/2717440/">shut down Abbott Nutrition’s factory</a> in Michigan. The closure came after Abbott’s nationwide <a href="https://www.similacrecall.com/us/en/home.html">recall of multiple brands of formula</a>, including routine Similac cow milk-based formulas such as Similac Advance and several specialty formulas for allergic babies, including Similac Alimentum and and Similac EleCare.</p>
<p>Closing the factory had to be done amid an <a href="https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022">investigation into bacterial infections</a> in connection to powdered formula produced at the plant, and the deaths of at least two babies. The problem is there just isn’t much redundancy in U.S. infant formula production. In other words, there aren’t enough other factories to pick up the slack when one goes down. The Michigan plant is the largest producer in the country, so when it goes down, it put added strain on the entire U.S. formula distribution system, especially for certain formulas for babies with high-risk allergic diseases and metabolic disorders.</p>
<p>Over the last couple of weeks the shortage has gotten worse. I can’t say for sure why this has happened. But I suspect there has been some hoarding going on as parents get anxious. Stores can limit the amount of formula that people can buy, but that doesn’t stop people going online to buy more.</p>
<p>On top of that, the shortage has gained wide publicity in newspapers, on TV and in political speeches. All that publicity feeds into public sense that the system is failing, prompting more panic buying and hoarding.</p>
<h2>2. Who is the shortage affecting?</h2>
<p>A majority of parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">all their nutrition through breast milk</a>. But by the age of 6 months, the <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">majority of babies get at least some formula</a>. The proportion of year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures - mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.</p>
<p>But the shortage will affect some parents more than others. Not surprisingly, the most affected parents are those on the lowest income. The federal food program for poorer women, infants and children, <a href="https://www.fns.usda.gov/wic">called WIC</a>, provides formula for a majority of babies in low-income families. But costs have gone up and formula has become scarcer.</p>
<p>I’m hearing of some families driving two hours to find stores selling formula. Obviously that will be harder to do for poorer families as there are costs involved. Likewise, more affluent parents may be able to buy more expensive, so-called elite brand formulas.</p>
<p>The other thing to note is that the shortage is affecting both regular infant formula, and <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">specialized versions</a>. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type. Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs. Before the Michigan factory closed, it made most of the specialized infant formula used in the U.S. So it is an absolute crisis for families needing that type of formula.</p>
<h2>3. What are the potential consequences of the shortage?</h2>
<p>In the first six months, babies should <a href="https://www.cdc.gov/breastfeeding/faq/index.htm">only have breast milk or formula</a> – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.</p>
<p>Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm">not nutritionally complete</a>, they may not be entirely sterile.</p>
<p>After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.</p>
<h2>4. Are there any viable alternatives?</h2>
<p>Over the age of six months of age, for only reasonably short periods of time, <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx#.Ynr6sYw9zEQ.twitter">parents can feed infants whole cow milk</a> and look into iron supplements.</p>
<p>It isn’t ideal, and only applies for older babies. For those under six months old, cow milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow milk also has a misbalance of minerals, especially for younger babies.</p>
<h2>5. So what guidance is there for low-income parents?</h2>
<p>It is challenging and I can’t provide a magic answer. But food banks and the WIC program have been a crucial lifeline. The WIC program in particular has proved itself to be very flexible during this shortage. When Abbott had to recall products and then couldn’t provide enough non-recalled formulas in states in which they were the WIC provider, WIC was able to change providers and reprogram EBT cards to allow low-income parents to buy different brands.</p>
<h2>6. What can be done to prevent this situation happening again in the U.S.?</h2>
<p>First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas.</p>
<p>Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. This doesn’t necessarily mean increased costs – competition could potentially drive down prices.</p>
<p>I believe America also needs to look at the country’s breast feeding support system. Don’t get me wrong, some parents will always need formula. But those who want to breast feed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.</p><img src="https://counter.theconversation.com/content/182929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.</span></em></p>An infant nutrition expert explains what is behind the current formula shortage and what can be done to support hard-pressed parents.Steven A. Abrams, Professor of Pediatrics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1807932022-04-08T12:35:39Z2022-04-08T12:35:39ZKenya puts in place tougher labelling for baby foods, bottles, teats and pacifiers<figure><img src="https://images.theconversation.com/files/456599/original/file-20220406-24-llhu1n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman breastfeeds her baby. </span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>The Kenyan government has provided <a href="http://www.parliament.go.ke/sites/default/files/2020-12/The%20proposed%20Breast%20Milk%20Substitute%20%28General%29%20Regulations%2C%202020.pdf">more stringent measures</a> for the labelling of feeding bottle, teat and pacifier packages. It wants the labels of these products to include a warning that their use can have negative effects on breastfeeding.</p>
<p>The new regulations show the government’s commitment to revisiting a <a href="http://kenyalaw.org:8181/exist/kenyalex/actview.xql?actid=No.%2034%20of%202012">law</a> passed in Kenya in 2012 that laid the ground work for key regulations around the marketing of breast milk substitutes. These substitutes include infant formulas, follow-on formulas and any other food or drink, alongside feeding bottles and teats, intended for babies and young children.</p>
<p>The act was passed to regulate the promotion of the substitutes, which can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967752/">interfere</a> with breastfeeding. The law is aligned to the World Health Organization’s <a href="https://apps.who.int/iris/bitstream/handle/10665/40382/9241541601.pdf?sequence=1&isAllowed=y">International Code</a> of Marketing of Breast-milk Substitutes.</p>
<p>The act outlines the prohibitions on advertising of substitutes. It also covers the rules on education and informational materials, as well as the labelling of packages. For instance, it requires that any educational materials on substitutes be approved by the cabinet secretary in charge of the health ministry. Health workers and proprietors of health centres are additionally not allowed to accept breast milk substitutes as gifts or donations without the approval of the health ministry.</p>
<p>The act doesn’t prohibit the sale of breast milk substitutes or the distribution of factual information. Rather, it aims to ensure parents make informed choices on infant feeding based on evidence, not biased, misleading claims.</p>
<p>The new regulations target bottles, teats and pacifiers. All can interfere with breastfeeding. The regulations introduce fresh labelling requirements for baby feeding bottles, teats and pacifiers. These products will include a warning in both Swahili and English <a href="http://www.parliament.go.ke/sites/default/files/2020-12/The%20proposed%20Breast%20Milk%20Substitute%20%28General%29%20Regulations%2C%202020.pdf">stating that</a> the use of bottles, teats and pacifiers can interfere with breastfeeding.</p>
<p>The updated act also includes prohibitions around labelling, marketing and donation of pre-packaged complementary baby foods, which are increasingly being consumed.</p>
<p>The implementation of infant and young child feeding strategies, such as legislation around breast milk substitutes as well as labelling of key products, has been associated with an increase in breastfeeding rates. In Kenya, implementation of the 2012 act was associated with an increase in exclusive breastfeeding in the country. A report released in 2014 found that there had been an <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf">increase</a> in exclusive breastfeeding rates from 32% to 61% over a five-year period. Although the act only came into effect in 2012, it was deemed to have contributed to this rise.</p>
<p>The stringent measures included in the updated regulations are likely to further improve the exclusive breastfeeding rate in Kenya – at 61%, it is already higher than the global average of <a href="https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding#:%7E:text=About%2044%25%20of%20infants%200,are%20appropriate%20for%20their%20age.">44%</a>. This will lead to further improvements in child health, growth and development.</p>
<h2>The history</h2>
<p>Since it was passed in 2012 the health ministry has updated the Breast Milk Substitutes act to improve its clarity and enforcement. The updated version was published as a legal notice in August 2021. It will be enforced on 30 May 2022. The amendments followed an increase in aggressive, inappropriate marketing by manufacturers of breast milk substitutes in Kenya.</p>
<p>As part of the process, the ministry conducted an <a href="https://www.health.go.ke/wp-content/uploads/2021/07/Draft-Regulatory-Impact-statement-on-the-Proposed-Breast-Milk-Substitutes-Regulations-1.7.21-1.pdf">impact assessment</a>on the legislation with the aim of examining and measuring the likely benefits, costs and effects of the proposed regulations. <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/906260/RPC_Impact_Assessments_Room_for_Improvement.pdf">This is done to</a> support legislative change, regulation of markets, policy development and parliamentary decision making.</p>
<p><strong><em>Read more: <a href="https://theconversation.com/whats-missing-in-south-africas-strategy-to-get-breastfeeding-levels-up-165548">What’s missing in South Africa’s strategy to get breastfeeding levels up</a></em></strong></p>
<p>The impact assessment focused on the following sections of the Breast Milk Substitutes act:</p>
<ul>
<li><p>donations, labelling, and the interaction between health workers and manufacturers or distributors</p></li>
<li><p>advertising and promotion</p></li>
<li><p>demonstrations of the use of designated products</p></li>
<li><p>publication of information, education and communication materials on substitutes</p></li>
<li><p>penalties for failure to adhere to the Breast Milk Substitutes act and its regulations.</p></li>
</ul>
<h2>The science behind it</h2>
<p>The World Health Organization <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommends</a> exclusive breastfeeding for the first six months of a child’s life. It also recommends continued breastfeeding up to and beyond two years.</p>
<p>Breast milk has been found to have significant <a href="https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding">health and nutrition benefits</a> for both the child and mother. These include protection against infant death and common childhood illnesses, such as diarrhoea and pneumonia. Breastfeeding also lowers the risk of breast and ovarian cancers, and diabetes. It additionally improves birth spacing.</p>
<p><strong><em>Read more:<a href="https://theconversation.com/breastfeeding-trends-show-most-developing-countries-may-miss-global-nutrition-targets-166853">Breastfeeding trends show most developing countries may miss global nutrition targets</a></em></strong></p>
<p>For mothers to exclusively breastfeed, they need accurate information on the benefits of breast milk, the importance of breastfeeding and a supportive environment. However, there has been an increase in the <a href="https://journals.sagepub.com/doi/full/10.1177/0379572115602174">marketing</a> and <a href="https://www.thelancet.com/action/showPdf?pii=S0140-6736%2815%2901044-2">availability</a> of breast milk substitutes. This could <a href="https://journals.sagepub.com/doi/pdf/10.1177/0379572115602174">influence</a>some mothers to stop breastfeeding.</p>
<p>Promotion tactics, such as the use of health workers to endorse baby formulas, aggressive media advertising and point-of-sale marketing, have been widely used to advance the use of breast milk substitutes. This has created a <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/international-code-of-marketing-of-breastmilk-substitutes-lessons-learned-and-implications-for-the-regulation-of-marketing-of-foods-and-beverages-to-children/4F94026E6F983C45DB0423530FC314AE">false sense of superiority</a> of substitutes over breast milk, hence the need for heightened regulations around the marketing of these products.</p>
<h2>The impact</h2>
<p>The importance of protecting and promoting breastfeeding is recognised across most of Africa. A recent report by the <a href="https://www.who.int/publications/i/item/9789240006010">World Health Organization</a> found that 32 of the 47 countries that fall under the WHO African Regional Office have implemented the International Code on Marketing of Breast-milk Substitutes. However, researchers found that adoption has happened at varying levels. For instance, Kenya is moderately aligned with the code, while South Africa is substantially aligned with it.</p>
<p><strong><em>Read more: <a href="https://theconversation.com/kenya-is-a-breastfeeding-success-story-but-still-has-its-challenges-45378">Kenya is a breastfeeding success story but still has its challenges</a></em></strong></p>
<p>To complement the enactment of the code, countries must regularly monitor barriers and bottlenecks to exclusive breastfeeding. These can then be addressed and resolved through research, regulatory impact assessments and more effective legislation.</p><img src="https://counter.theconversation.com/content/180793/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Antonina Mutoro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kenya wants parents to be able to make more informed choices about feeding their babies.Antonina Mutoro, Postdoctoral Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1657892021-11-10T15:16:33Z2021-11-10T15:16:33ZWhy are babies going hungry in a food-rich nation like Canada?<figure><img src="https://images.theconversation.com/files/431095/original/file-20211109-17-1nj4al0.jpg?ixlib=rb-1.1.0&rect=22%2C8%2C1894%2C1218&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Whether they breastfeed or use formula, food insecure mothers are struggling to feed their babies. </span> <span class="attribution"><span class="source">(Hessam Nabavi/Unsplash)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-are-babies-going-hungry-in-a-food-rich-nation-like-canada" width="100%" height="400"></iframe>
<p>Jean, a 24-year-old mother of two, said: “People don’t think there’s hungry kids out there [in Canada].” She would like us to know “there definitely is.” </p>
<p>More than <a href="https://proof.utoronto.ca/food-insecurity/">1.2 million children in Canada live in food-insecure households</a>, including babies of the families as well. In Nunavut, that number is higher than any other part of Canada. Many of the children in food insecure families go hungry: parents often need to cut the size of meals, or skips meals altogether. </p>
<p>The first 1,000 days of a baby’s life is the <a href="https://doi.org/10.1002/ajhb.22952">most important time for growth and development</a>. There are special and <a href="https://www.canada.ca/en/health-canada/services/publications/food-nutrition/prenatal-nutrition-guidelines-health-professionals-iron-contributes-healthy-pregnancy-2009.html">costly nutritional needs for both mother and baby such as increased iron and folic acid for mothers</a>, <a href="https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html">vitamin D for breastfed babies, and commercial formula for those not breastfed</a>. But for many, this is also a time of diminished incomes. </p>
<p>People have often said to me that even the most undernourished women can successfully breastfeed and that the real cause of infant food insecurity too much access to infant formula. This misses the point I’m making.</p>
<p>At the heart of infant <a href="https://doi.org/10.2752/175174415X14101814953927">food insecurity in Canada is poverty and food access, which disrupts maternal eating and infant feeding habits</a> regardless of how and what babies are fed. </p>
<p>To really understand infant food insecurity, one needs to listen to mothers. While researching my book, <a href="https://www.ubcpress.ca/out-of-milk"><em>Out of Milk: Infant Food Insecurity in a Rich Nation</em></a>, I spoke to many mothers, those who were breastfeeding and those who had opted to use formula. Their stories reveal how poverty and food insecurity are disrupting their eating and infant feeding habits. I recount some of their stories here; all of the following names are pseudonyms.</p>
<h2>The breastfeeding paradox</h2>
<p>When breastfeeding works, it is praised by the mothers we spoke with as the ideal healthy and secure food system. Some mothers said they were drawn to breastfeeding because of health benefits and the high cost of food. Lorraine explained: “There is no risk of cross-contamination, it’s there, it’s ready, it’s the right amount, it’s the perfect food.” </p>
<p>Erica said: “You know your baby is never going to go hungry. You don’t have to worry about where you’re going to get food and where the money is going to come from.” </p>
<p>Yet the most food-insecure mothers stop breastfeeding after one or two months. Some never start. For them, breastfeeding is a non-sustainable food system. This is referred to as the “<a href="https://doi.org/10.2752/175174415X14101814953927">breastfeeding paradox</a>.” It means that those that can least afford to stop breastfeeding <a href="https://doi.org/10.1503/cmaj.170880">are actually more likely to do so</a>. </p>
<p>The reasons include the struggles of daily living: lack of practical support, insufficient public services and poverty brought on by inadequate income supports. A mother’s own lack of food is at the root — and like any food system, the system breaks down when producers are not supported.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&rect=75%2C117%2C5543%2C3622&q=45&auto=format&w=1000&fit=clip"><img alt="A woman browses infant formula at a grocery store." src="https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&rect=75%2C117%2C5543%2C3622&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mothers least able to afford infant formula are more likely to rely on it to feed their babies.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Mary said: “I don’t know if what I was producing was really enough, nutrient-wise, if it was … healthy enough for him, giving him what he needed. Plus, in order to be able to produce milk, the mother needs to be food secure, and you don’t have that all the time. You still have to buy food for yourself to keep yourself healthy and the price of fruits and vegetables and proper meat is really high.”</p>
<p>Another mother, Sally, challenged the idea that breastfeeding is free, saying: “It might be cheaper than formula feeding but it still costs.” </p>
<h2>Inadequate access to formula</h2>
<p>When breastfeeding fails and infant formula is not affordable, the outcomes are tragic. </p>
<p>Unlike <a href="https://www.fns.usda.gov/wic/about-wic">other developed countries</a>, Canada has no government-provided infant formula for low-income mothers. The reasons are, at a minimum, twofold: One, there are concerns that <a href="https://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/pdf/ppsb-ppsam-eng.pdf">supplying free formula will affect infant feeding choices</a>; and two, Canada doesn’t use food as a form of welfare benefits for anyone.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman feeds a baby with a milk bottle." src="https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Without income supports, struggling mothers resort to using watered-down formula and buying it second-hand online.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This, on top of a failed social safety net, leaves families struggling to feed their babies with limited options. Parents can look to food banks, <a href="https://doi.org/10.15353/cfs-rcea.v5i1.230">but infant formula may not be consistently available, if at all</a>. Reasons for its scarcity are embedded in the nature of food charity, which is marked by inconsistent donations, and more specifically, beliefs in Canada and elsewhere that <a href="https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/05/Provision-of-formula-milk-at-food-banks-Unicef-UK-Baby-Friendly-Initiative.pdf">formula provision in food banks may put breastfeeding and babies at risk</a>. </p>
<p>When we allow food insecurity to disrupt breastfeeding, or make formula inaccessible with the intent to protect breastfeeding, it punishes already struggling mothers.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/podcasts">Click here to listen to Don’t Call Me Resilient</a></span>
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<p>Unsurprisingly, <a href="https://globalnews.ca/news/4864964/baby-formula-under-lock-and-key-as-thefts-rise-say-winnipeg-retailers/">infant formula is now one of the most shoplifted items</a>, leading some retailers to keep it locked-up. </p>
<p>Desperate mothers are <a href="https://www.ubcpress.ca/out-of-milk">turning to online platforms</a> like Facebook Marketplace and Kijiji to get second-hand formula, which is sometimes already opened.</p>
<p>Heather said: “You take what you can get. It is a matter of being able to feed the baby at all.… We sold stuff. Stole stuff. Stole it to sell it and stole formula from the store. Whatever we had to do to feed them we did it — I am not proud of it but my kids are still alive.” </p>
<p>Mothers sometimes resort to watering-down formula to make it last longer and introduce solids and other liquids early when there is no formula to be found. These survival tactics show the lengths families must go to find food.</p>
<h2>A nutritious diet is expensive</h2>
<p>Most low-income families with babies who receive federal maternity benefits or income assistance cannot afford a basic nutritious diet. If they tried, according to <a href="https://doi.org/10.17269/s41997-020-00306-5">our research</a>, they would likely be short hundreds of dollars each month, whether they breastfeed or use formula. </p>
<p>According to many mothers, no matter where you live in the world, poverty and food insecurity is a threat to maternal and infant health. The consensus among mothers we spoke with say the solutions lie in their economic security. </p>
<p>Yes, breastfeeding is a robust physiological system and malnourished mothers can breastfeed. But we need real upstream policy solutions that ensure mothers and their babies don’t go hungry in the first place. Canada needs adequate social welfare that protects sustainable breastfeeding and ensures that non-breastfed babies have access to food. </p>
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<p class="fine-print"><em><span>Lesley Frank receives funding from the Social Science and Humanities Research Council, Research Nova Scotia, and Acadia University. She is affiliated with the Canadian Centre for Policy Alternatives - Nova Scotia as a Research Associate and Steering Committee member of Campaign 2000. </span></em></p>With the high cost of infant formula, food-insecure mothers who cannot breastfeed are struggling to feed their babies.Lesley Frank, Tier II Canada Research Chair in Food, Health, and Social Justice, Acadia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1518202021-02-08T20:51:20Z2021-02-08T20:51:20ZBreastfeeding research improves lives and advances health, but faces conflicts<figure><img src="https://images.theconversation.com/files/380821/original/file-20210127-19-1a4si88.jpg?ixlib=rb-1.1.0&rect=207%2C0%2C5591%2C4012&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows the breast milk of women who have recovered from COVID-19 offers a source of COVID-19 antibodies.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Breastfeeding and breast milk provide <a href="https://doi.org/10.1016/S0140-6736(16)00012-X">big opportunities to support maternal, infant and population health</a>. This is especially true during the current pandemic because breastfeeding can help alleviate food insecurity, and research shows the breast milk of women who have recovered from COVID-19 offers a source of <a href="https://doi.org/10.1016/j.isci.2020.101735">COVID-19 antibodies</a>. </p>
<p>Breastfeeding <a href="https://doi.org/10.1016/S0140-6736(15)01024-7">saves lives</a> and prevents illness. It is <a href="https://doi.org/10.1136/bmj.l5646">environmentally friendly</a> and profoundly important to children’s long-term development. After all, breast milk is the <em>only</em> food that has evolved specifically to feed humans. </p>
<h2>Breastfeeding matters</h2>
<p>Beyond supplying nutrition, breast milk provides personalized <a href="https://doi.org/10.1093/nutrit/nuz019">immune protection and shapes the developing microbiome</a>. Scientists have discovered enzymes, hormones, antibodies and live cells in <a href="https://doi.org/10.3345/cep.2020.00059">breast milk</a>, and these bioactive components could hold the key to <a href="https://doi.org/10.1007/s13577-019-00251-7">developing new therapies</a> — not only for COVID-19, but also autoimmune diseases, diabetes and cancer.</p>
<p>Yet, remarkably, we still don’t fully understand the composition of breast milk, or the biological basis for its many health effects. In fact, more scientific papers have been published on <a href="https://pubmed.ncbi.nlm.nih.gov/?term=headache&sort=pubdate">headaches</a> than <a href="https://pubmed.ncbi.nlm.nih.gov/?term=breastfeeding&sort=pubdate">breastfeeding</a>, and more federal research dollars from <a href="https://cihr-irsc.gc.ca/e/37788.html">Canadian Institutes of Health Research</a> and the <a href="https://www.nserc-crsng.gc.ca/db-tb/index-eng.asp">Natural Sciences and Engineering Research Council of Canada</a> have been invested to <a href="https://webapps.cihr-irsc.gc.ca/funding/Search?p_language=E&p_version=CIHR">study corn</a> than <a href="https://www.nserc-crsng.gc.ca/ase-oro/index_eng.asp">breast milk</a>. </p>
<p>The act of breastfeeding also <a href="https://doi.org/10.1089/bfm.2019.0106">supports mother-infant bonding</a> and helps to prevent <a href="https://doi.org/10.1111/apa.13102">breast and ovarian cancer in mothers</a>. Unfortunately, most mothers <a href="https://doi.org/10.1542/peds.2012-1295">do not even meet their own breastfeeding goals</a>, let alone <a href="https://www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard-2017.pdf">achieve recommendations</a> of exclusive breastfeeding for six months, followed by 18 months of breastfeeding along with other foods.</p>
<p>This is particularly concerning during this pandemic, when mothers infected with COVID-19 may be <a href="https://theconversation.com/separating-mothers-with-covid-19-from-their-newborns-does-more-harm-than-good-141291">separated from their newborns</a> (despite <a href="https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19">World Health Organization guidance</a> to the contrary) and <a href="https://doi.org/10.1111/mcn.13088">breastfeeding support is often unavailable</a> because public health visits are being cancelled and lactation services have been suspended in many places.</p>
<h2>Tensions abound</h2>
<p>Every parent knows that infant feeding is a complex issue, often evoking strong emotions based on personal experience. Difficult or negative breastfeeding experiences can fuel a defensive “<a href="https://raisingwonder.wordpress.com/2019/08/08/its-time-to-talk-about-the-breastfeeding-science-backlash-movement/">breastfeeding denialism</a>” attitude.</p>
<figure class="align-right ">
<img alt="A woman with tattoos breastfeeding her infant" src="https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Breastfeeding support such as public health visits may not be available during the pandemic.</span>
<span class="attribution"><span class="source">(Pexels/Anna Shvets)</span></span>
</figcaption>
</figure>
<p>Conversely, some breastfeeding advocates refuse to acknowledge that for some families, formula is necessary for medical, personal, societal or socioeconomic reasons. These extreme attitudes cause a tense and unproductive environment for researchers working to generate inclusive evidence-based guidance for infant feeding.</p>
<p>Industry partnerships also cause tension in this field because the infant feeding industry frequently violates the <a href="https://www.unicef.org/nutrition/index_24805.html">World Health Organization code for marketing of breastmilk substitutes</a>, and transgressions have <a href="https://doi.org/10.1016/S0140-6736(20)32119-X">worsened during the pandemic</a>. However, due to lack of funding for breastfeeding research, scientists are often faced with choosing between industry funding or no funding at all.</p>
<p>Unfortunately, these tensions often detract from the energy and resources that breastfeeding advocates, researchers, health professionals and policy-makers could be using to advance their shared goal of supporting maternal and child health.</p>
<h2>What can be done</h2>
<p>Of course, members of the diverse breastfeeding advocacy and research communities will not always agree — but we should aim to find common ground and work together. There are many stakeholders involved, each with a role to play:</p>
<p><strong>Governments and non-profit funding organizations</strong> should acknowledge the importance of breastfeeding and breast milk and invest more resources into this field.</p>
<p><strong>Researchers</strong> should build interdisciplinary teams to study breast milk as a biological system and think broadly about “breastfeeding challenges” in the context of complex social systems - including social inequities, parental leave policies, lactation difficulties and donor breast milk.</p>
<p><strong>Companies, researchers and advocacy groups</strong> should co-develop a conflict of interest framework for research on breastfeeding and breast milk and reporting of results.</p>
<p>Messaging is key to achieving these goals. All groups need to communicate effectively with each other, and with the health-care, research and public sectors. This means <a href="http://www.azadlab.ca/resources">providing or sharing clear resources</a> to convey scientific evidence free of conflict of interest, targeted to each audience, such as fact sheets for policy-makers, engaging videos for the public and infographics for health-care providers. </p>
<p>Stakeholders also need to actively discredit unfounded claims and misinformation, such as <a href="https://doi.org/10.1136/bmj.m875">unsubstantiated health claims made by infant nutrition companies</a>, or rumours about the transmission of COVID-19 via breastfeeding, when <a href="https://doi.org/10.1111/nyas.14477">there is no evidence of this occurring</a>.</p>
<h2>Looking forward</h2>
<figure class="align-center ">
<img alt="A woman breastfeeding a baby" src="https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 has highlighted both the importance and fragility of breastfeeding support systems.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Progress in breastfeeding, breast milk and lactation research is being hampered by tensions among researchers, advocates and industry.</p>
<p>As breast milk scientists, breastfeeding researchers and lactation specialists, we are concerned about these tensions and their potential to impede or delay discoveries in our field. Last year, we <a href="https://www.chrim.ca/2020/breastfeeding-and-the-origins-of-health-interdisciplinary-perspectives-and-priorities/">held a workshop</a> to discuss these concerns and develop solutions.</p>
<p>Our <a href="https://doi.org/10.1111/mcn.13109">workshop paper</a> was written before the pandemic, but its recent publication is timely. The pandemic has brought researchers together in ways that seemed impossible before.</p>
<p><a href="http://doi.org/10.1001/jama.2020.15580">Breast milk research</a> that would normally take years has been completed in months with unprecedented efficiency. A <a href="https://doi.org/10.1016/S2352-4642(20)30134-6">global network of human milk banks</a> was established in a matter of days to share information about safe operations during the pandemic. Milk scientists and breastfeeding researchers are <a href="https://www.who.int/docs/default-source/mca-documents/research/working-group-document-22june2020.pdf?sfvrsn=fbb43e6c_2">meeting monthly with the WHO</a> to speed up the transition from discovery to policy. </p>
<p>We hope these trends will continue beyond the pandemic and become the new standard for doing and sharing research.</p>
<p>COVID-19 has also emphasized both the importance and fragility of breastfeeding support systems, which <a href="https://doi.org/10.1111/mcn.13088">have suffered considerably due to current restrictions</a>. The pandemic has also highlighted the potential of breast milk to inform new avenues of biomedical research, such as <a href="https://doi.org/10.1016/j.isci.2020.101735">milk antibodies</a> as potential therapeutics. </p>
<p>We hope this added urgency will encourage researchers, advocates, funders and policy-makers to work together to accelerate progress in supporting breastfeeding and breast milk research.</p><img src="https://counter.theconversation.com/content/151820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meghan Azad co-Directs the Manitoba Interdisciplinary Lactation Centre. She holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease at the University of Manitoba and is a Fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. She receives research funding from the Canadian Institutes of Health Research, Research Manitoba, the Canada Foundation for Innovation, the Bill and Melinda Gates Foundation, the Manitoba Children’s Hospital Foundation, Prolacta Biosciences, Mitacs, CIFAR, and the Garfield G. Weston Foundation. She regularly speaks at conferences and workshops on infant nutrition, some sponsored by Medela, the Institute for the Advancement of Breastfeeding & Lactation Education, and Prolacta Biosciences. She has contributed to online courses on breast milk and the infant microbiome produced by Microbiome Courses. She serves in a volunteer capacity as Secretary to the International Society for Research on Human Milk and Lactation and as a member of the National Academy of Sciences, Engineering and Medicine Committee on Scanning New Evidence on the Nutrient Content of Human Milk. </span></em></p><p class="fine-print"><em><span>Katie Hinde's research has been supported by grant funding from the National Science Foundation and the National Institutes of Health. </span></em></p><p class="fine-print"><em><span><a href="mailto:lbode@health.ucsd.edu">lbode@health.ucsd.edu</a> works for University of California San Diego. He receives funding from the National Institutes of Health and the Family Larsson-Rosenquist Foundation. </span></em></p><p class="fine-print"><em><span>Luisa Zuccolo receives funding from the UK Medical Research Council and the Jean Golding Institute at the University of Bristol. She consults for the Human Milk Foundation and sits on the Advisory Board of the UK National Institute of Health Research's Cochrane review on breastfeeding support strategies. She is a trained volunteer in breastfeeding peer support and co-chairs a breastfeeding peer supporter group, which is audited by the UK Baby Friendly Initiative. </span></em></p><p class="fine-print"><em><span>Merilee Brockway receives funding from The Molly Towell Perinatal Research Foundation and the Garfield Weston Foundation.</span></em></p><p class="fine-print"><em><span>Nathan Nickel, PhD is an Associate Professor of Community Health Sciences, Associate Director at the Manitoba Centre for Health Policy, and Co-Director of the Manitoba Interdisciplinary Lactation Centre. Dr. Nickel is the Scientific Chair for Breastfeeding at the American Public Health Association and he works with the Breastfeeding Committee of Canada and the Centre for Health Equity Education and Research. He receives funding for breastfeeding and population health research from the Public Health Agency of Canada, Health Canada, the Canadian Institutes for Health Research, Research Manitoba, and the Canadian Foundation for Innovation. </span></em></p><p class="fine-print"><em><span>Rafael Pérez-Escamilla, PhD is professor of public health and director of the Office of Public Health Practice, the Global, the Global Health Concentration, the Yale-Griffin CDC Prevention Research Center, and the Maternal Child Health Promotion Program at the Yale School of Public Health. He receives funding from The National Institutes of Health (NIH), the US Centers for Disease Control and Prevention (CDC), The World Health Organization, The Bill and Melinda Gates Foundation, The Robert Wood Johnson Foundation, The Kellogg Foundation, and The Family Larsson-Rosenquist Foundation </span></em></p>Researchers don’t fully understand the composition of breast milk and its benefits. Beyond nutrition, it contains enzymes, hormones and the mother’s antibodies — including antibodies for COVID-19.Meghan Azad, Associate Professor of Pediatrics and Child Health; Canada Research Chair in the Developmental Origins of Chronic Disease, University of ManitobaKatie Hinde, Associate Professor, School of Human Evolution and Social Change, Arizona State UniversityLars Bode, Professor of Pediatrics and Director of Mother-Milk-Infant Center of Research Excellence, University of California, San DiegoLuisa Zuccolo, Senior Research Fellow, Health Sciences, University of BristolMerilee Brockway, Post-doctoral Fellow, Department of Pediatrics and Child Health, University of ManitobaNathan C. Nickel, Associate Professor of Community Health Sciences; Co-Director MILC; Associate Director, Manitoba Centre for Health Policy, University of ManitobaRafael Perez-Escamilla, Professor of Public Health, Yale UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1483502020-10-19T15:40:40Z2020-10-19T15:40:40ZBottle-fed babies may consume millions of microplastic particles, our research suggests<figure><img src="https://images.theconversation.com/files/364263/original/file-20201019-21-hqber1.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bottles-breast-milk-on-background-mother-1032775489">Evso/Shutterstock</a></span></figcaption></figure><p>Microplastics can now be found in almost <a href="https://www.theguardian.com/environment/2019/mar/07/microplastic-pollution-revealed-absolutely-everywhere-by-new-research">every environment on Earth</a>, but scientists know surprisingly little about how the products we use every day shed these tiny plastic particles. </p>
<p>If you drink from a plastic water bottle or eat out of a microwaveable container today, there’s a good chance that you’re using polypropylene. Polypropylene is thought to be <a href="https://www.creativemechanisms.com/blog/all-about-polypropylene-pp-plastic">safe and suitable</a> for lots of different applications – which is why it’s the most widely used plastic in food preparation.</p>
<p>Another place you’d expect to find polypropylene is in baby feeding bottles. We generally assume that bottles made from this plastic are rigid and stable when they’re sterilised with hot water and shaken while preparing formula. But <a href="https://www.nature.com/articles/s43016-020-00171-y">in new research</a>, we’ve shown that baby formula preparation with polypropylene bottles exposes infants around the world to an average of one million microplastic particles per day. </p>
<p>This is an astoundingly large increase on previous estimates. <a href="https://www.nationalgeographic.co.uk/environment/2019/06/you-eat-thousands-bits-plastic-every-year">Earlier studies</a> had suggested that adults and children in the US were exposed to between 74,000 and 211,000 particles over the course of an entire <em>year</em>, through the food they eat, the water they drink and the air they breathe.</p>
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Read more:
<a href="https://theconversation.com/youre-eating-microplastics-in-ways-you-dont-even-realise-97649">You're eating microplastics in ways you don't even realise</a>
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<h2>Microplastics in formula feeding</h2>
<p>Like many research projects, our investigation began with a chance observation and conversation. One day a colleague was preparing instant noodles in a plastic container. The container looked rigid to start with, but after he poured hot water in it, it changed to become more malleable and soft. We were curious and wondered whether microplastics might be released in the process. </p>
<p>We did a quick test in our lab and found that the container released over one million microplastics per litre of hot water. We began testing other polypropylene containers, such as plastic bottles, with liquids at room temperature and found very few microplastic particles were released with each litre, from none at all to a few hundred. Heat, it seemed, was the problem.</p>
<p>We wanted to design an experiment that could test how a single polypropylene product responds to regular heating, and hit upon the idea of using baby feeding bottles. Through a survey of bottles in 48 regions and covering 78% of the world population, we found that polypropylene baby feeding bottles account for 83% of the global market. </p>
<p>We decided to test these bottles by choosing ten polypropylene baby bottles and following the World Health Organization’s 2007 <a href="https://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf">guidelines</a> for preparing bottle feeding formula at home. We tested how many microplastics were released while following these steps, including cleaning, sterilising and mixing liquids in each of the ten bottles, and found that they released up to 16 million particles per litre of 70°C water. The majority of these microplastics were smaller than 20 micrometres and were flake-like with a coarse surface, and an average thickness one-tenth of their width.</p>
<p>When the temperature of the water was raised from the recommended 70°C to 95°C – the temperature of recently boiled water – the release of microplastics increased from six million particles per litre to 55 million. The sterilisation process alone – in which the bottle is disassembled and placed in a pan full of 95°C water – increased microplastics release by at least 35%.</p>
<figure class="align-center ">
<img alt="A pair of tongs lifting a plastic baby bottle from a boiling pan." src="https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/364261/original/file-20201019-13-dcss8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sterilising baby bottles in boiling water released more microplastics than any other process.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boiled-feeding-milk-bottle-pothigh-temperature-743242120">Kitawit Jitaton/Shutterstock</a></span>
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<p>We felt we had a really comprehensive scientific approach. We rigorously adhered to the WHO procedure, used control tests, repeated the test with different liquids and across different temperatures multiple times and used statistical analysis to determine if our results were significant. But we also sent our methodology and sample products to an independent lab for them to verify. They came back with similar results, and so we can be confident in our findings – as shocking as they might seem.</p>
<h2>How to reduce exposure</h2>
<p>Given how widespread the use of polypropylene bottles is and the large quantity of microplastics released in our experiment, we decided to take our research a step further. We estimated how exposed 12-month-old infants are likely to be in 48 regions across the world by comparing the average release rates of microplastics from feeding bottles, the market share of plastic bottles, rates of bottle feeding and how much milk babies tend to drink daily. From this, we concluded that infants are likely to consume an average of 1.6 million polypropylene microplastic particles each day.</p>
<p>We don’t want to be alarmist. We don’t fully understand the risks to human health through exposure to these tiny plastic particles yet, but this is an area of research that we, and other teams, are actively pursuing.</p>
<p>In the meantime, there are ways to reduce a child’s exposure to microplastics during formula feeding. We are looking at coatings that can prevent microplastics being release during use and filters that could prevent microplastics entering our water supplies.</p>
<p>We’ve also developed a set of procedures for sterilising bottles and preparing formula feeds while reducing your exposure to microplastics from polypropylene bottles. The four quickest and easiest steps are:</p>
<ol>
<li><p>Rinse sterilised feeding bottles with cool, sterile water.</p></li>
<li><p>Always prepare formula in a non-plastic container.</p></li>
<li><p>After formula has cooled to room temperature, transfer it into the cooled, sterilised feeding bottle.</p></li>
<li><p>Avoid rewarming prepared formula in plastic containers, especially with a microwave oven.</p></li>
</ol><img src="https://counter.theconversation.com/content/148350/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dunzhu Li receives funding from Enterprise Ireland (grant number CF20180870), Science Foundation Ireland (grants numbers 12/RC/2278, 16/IA/4462 and 16/RC/3889), the School of Engineering Scholarship at Trinity College Dublin and the China Scholarship Council (201506210089).</span></em></p><p class="fine-print"><em><span>Yunhong Shi receives funding from Enterprise Ireland (grant number CF20180870), Science Foundation Ireland (grants numbers 12/RC/2278, 16/IA/4462 and 16/RC/3889), the School of Engineering Scholarship at Trinity College Dublin and the China Scholarship Council (201608300005).</span></em></p>Shaking polypropylene bottles and washing them with very hot water can release millions of tiny plastic particles. Here are four ways to reduce exposure.Dunzhu Li, Research Fellow in Environmental Engineering, Trinity College DublinYunhong Shi, Postdoctoral Researcher in Environmental Engineering, Trinity College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1296552020-02-20T13:27:02Z2020-02-20T13:27:02ZSome infant formula milks contain more sugar than soda drinks – new research<figure><img src="https://images.theconversation.com/files/315015/original/file-20200212-61952-1cvrhiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhealty-baby-food-concept-problem-hidden-1365243554">Shutterstock/Lithiumphoto</a></span></figcaption></figure><p>Some formula milks have double the sugar per serving than a <a href="https://www.bbc.co.uk/news/magazine-35831125">glass of soda</a>. That was the key finding of our <a href="https://www.nature.com/articles/s41415-020-1252-0">global investigation</a> into the sugar content of infant formula and follow-on milks. But perhaps more shocking is the fact that there are so few regulations in place to control sugar content and to make sure consumers are well informed. </p>
<p>We all love sugar. But too much of the sweet stuff can lead to obesity, type 2 diabetes and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133084/">dental disease</a>. Our preference for sugary foods stems from our primitive ancestors, who were scavengers and sought out sweet foods for energy. But if we are hardwired to like sweet foods, being fed lots of sugar as babies can increase our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738223/">desire for sweet things</a> and increase the risk of developing disease in later life. </p>
<p>Breast milk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/">the recommended</a> source of nutrition for infants, especially during the first six months of life. Although it is sweet and high in energy, the sugar is mainly lactose and the content is specific to the needs of the growing infant. Conversely, infant formula milks have a standardised make-up and contain added sugars such as corn syrup which are added during production and are not found in breast milk. This is bad for babies because high consumption of added sugars <a href="https://www.sciencedirect.com/science/article/pii/S2212267219313401?via%3Dihub">may contribute</a> to tooth decay, poor diet and lead to obesity in children.</p>
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<img alt="" src="https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A baby being fed formula milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-feeding-her-little-cute-1300509853">Shutterstock/OlenaChukhil</a></span>
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<p>We investigated the sugar content of 212 commercially available infant formula milk products targeted at infants under three. The products were being sold in supermarkets in 11 countries. We collected data on sugar content from nutrition labels and compared it to average breast milk compositions and sugar content guidelines. We also noted the clarity of the labels and the marketing strategies used on the packaging. </p>
<p><a href="https://www.nature.com/articles/s41415-020-1252-0">Our findings</a> revealed that over half of the products contained more than 5g of sugar per 100ml. In many cases, the sugar content was over 7.5g per 100ml, which exceeds <a href="http://www.babymilkaction.org/archives/8274">European parliament</a> recommended levels for infants. For example, we found that a powdered product for infants under six months sold in France contained 8.2g of sugar per 100ml, or nearly two teaspoons, while a ready-to-drink milk formula for infants under 12 months sold in the UK contained 8.1g of sugar per 100ml. </p>
<p>This comes at a time when sugar-sweetened beverages have been subject to widespread taxation to reduce their sugar content due to <a href="https://www.wcrf.org/sites/default/files/PPA-Building-Momentum-Report-WEB.pdf">negative impacts on health</a>. As a result, many formula products included in our study contained almost double the sugar of well known drinks such as <a href="https://www.coca-cola.co.uk/drinks/fanta/fanta-orange">Fanta Orange</a>. </p>
<h2>Nutritional information</h2>
<p>Obtaining information from the labels of these formula products was difficult as the fonts used were small and the facts provided varied between countries. For example, some products listed sugar content per 100g while others listed it per 100kcal. This is despite <a href="http://www.legislation.gov.uk/uksi/2007/3521/regulation/18/made">guidelines</a>, such as those in the UK, which state that values should be expressed as kJ/kcal per 100ml.</p>
<p>There are also <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">codes</a> in place to limit the marketing of infant formula products because they are not the best way to feed a growing baby. But most of these are voluntary codes of practice which manufacturers do not have to abide by. </p>
<p>Even guidelines which are enforced by law can be side-stepped by manufacturers, since they are <a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">not strictly monitored</a> and have loopholes. In some cases, manufacturers themselves have even influenced their development. </p>
<p><a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">For example</a> it was revealed that the industry has funded research into infant health and has given doctors free formula products. This almost certainly helps ensure that their sale is affected as little as possible by such guidelines. It is possible that the sale of infant formula products has increased worldwide as a result. </p>
<p>The World Health Organization’s <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">International Code of Marketing of Breastmilk Substitutes</a> stipulates that infant formula products should not be promoted over breastfeeding. <a href="http://www.legislation.gov.uk/uksi/2007/3521/regulation/17/made">In the UK</a> the guidelines state that the labels on products targeted at infants under six months should not include images of infants or any other pictures that idealise their use. </p>
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<img alt="" src="https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-woman-choosing-milk-powder-632850146">Shutterstock/VirojtChangyencham</a></span>
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<p>But we found that many of the formulas had labels that included images of infants or cute toys of animals, presumably designed to entice caregivers into buying. Such findings are not unsurprising as there is evidence that <a href="http://www.babymilkaction.org/monitoring-global">harmful marketing strategies</a> have been used extensively by infant formula and follow-on milk manufacturers. </p>
<h2>Recommendations</h2>
<p>Our findings are alarming, as is the potential negative impact of the high sugar content on the health of babies. We urge parents and caregivers to opt for breast milk whenever possible. However, to help those families unable to breastfeed their babies, we also have two key recommendations for policymakers:</p>
<p>1) Regulate the amount and type of sugar in infant formula products as a matter of urgency. Encourage manufacturers to aim for formulations as close to breast milk as possible. Such regulations could be conducted in a similar way to the taxes on sugar-sweetened beverages which have been <a href="https://www.worldobesity.org/resources/policy-dossiers/pd-1/case-studies">implemented across the world</a>. </p>
<p>2) We are also calling for the mandatory disclosure of added sugar by manufacturers and suggest that this could be implemented alongside the introduction of a clear front-of-pack labelling system. Such disclosures and clear labelling could aid consumers to make informed choices about what products they purchase.</p><img src="https://counter.theconversation.com/content/129655/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Bridge is affiliated with the World Federation of Public Health Associations. She thanks the members of the organisation for helping to collect the data included in the study. This article was published with the support of co-researchers Raman Bedi, an emeritus professor at Kings College London, and Marta Lomazzi, a Medical Biotechnologist, from the University of Geneva.</span></em></p>Researchers investigated 212 commercially available infant formula milk products on sale in 11 countries.Gemma Bridge, Research Evidence Impact Officer, Leeds Business School, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1271212019-11-15T06:58:41Z2019-11-15T06:58:41ZConditions built into Frydenberg’s okay for Chinese baby formula takeover<figure><img src="https://images.theconversation.com/files/301919/original/file-20191115-66945-odhjk5.jpg?ixlib=rb-1.1.0&rect=36%2C60%2C1166%2C599&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bellamy’s will have to have to manufacture in Victoria and keep its Australian headquarters for ten years.</span> <span class="attribution"><span class="source">Bellamy’s Australia</span></span></figcaption></figure><p>The proposed acquisition of infant formula producer Bellamy’s Australia Ltd by China Mengniu Dairy Company Limited has been given approval by Treasurer Josh Frydenberg.</p>
<p>Strict, legally enforceable conditions, have been set by the treasurer, which have provided critics with a degree of reassurance, although the decision still came under some fire when it was announced on Friday.</p>
<p>Frydenberg indicated he acted on the basis of a unanimous recommendation from the Foreign Investment Review Board.</p>
<p>Bellamy’s sells into China but has had trouble getting the needed Chinese approval for its formula to be sold in retail outlets there, in a period of significant change to China’s dairy industry.</p>
<h2>Ups and downs ahead of takeover</h2>
<p>It achieved some brand recognition when its product was bought in local supermarkets and shipped to China through daigou, a micro export channel of individual and small buying operations.</p>
<p>Mark Harrison, senior lecturer in Chinese studies at the University of Tasmania, told The Conversation Bellamy’s performance had been “up and down” and it had been through significant management upheavals in recent years. These had opened the possibility of a takeover.</p>
<p>It had brand value but the failure to run a consistent business would have made it an attractive target for the Chinese company, Harrison said.</p>
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<strong>
Read more:
<a href="https://theconversation.com/chinese-personal-shoppers-have-created-a-new-type-of-retail-store-in-australia-86844">Chinese personal shoppers have created a new type of retail store in Australia</a>
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<p>Frydenberg said the approval “will ensure Bellamy’s can continue to support jobs in Australia and strengthen its ability to expand its domestic market as well as its export opportunities, particularly into the growing Asian market.</p>
<p>"The decision will also provide opportunities for the suppliers that contribute to Bellamy’s products, including Australian dairy farmers.”</p>
<p>The conditions require:</p>
<p>• a majority of Bellamy’s board to be Australian resident citizens</p>
<p>• maintenance of its headquarters in Australia for at least ten years; and</p>
<p>• an investment of at least $12 million in establishing or improving infant milk formula processing facilities in Victoria.</p>
<p>Frydenberg said the conditions would ensure that Bellamy’s maintained its presence in Australia, and that Bellamy’s proceeds with previously announced investment in infant milk formula processing facilities.</p>
<p>He pointed out the conditions were legally enforceable.</p>
<p>Independent MP Andrew Wilkie, from Tasmania, said it was “very disappointing to see another iconic Australian company fall into foreign hands”.</p>
<blockquote>
<p>Although Bellamy’s is a relatively new company with a limited physical presence in Australia, … it has achieved a very important role in the supply of high-quality baby formula for Australian consumers. </p>
</blockquote>
<p>Bellamy’s is number four by market share in the Australian infant milk formula market.</p>
<p>Wilkie warned against “a repeat of the farcical sale of the Van Diemen’s Land Company, where foreign buyers promised the world but failed to deliver on just about any of it.</p>
<blockquote>
<p>The Foreign Investment Review Board must be sure that the Bellamy’s approval is accompanied by an ironclad guarantee that Australian jobs will be maintained, and that the continued supply of baby formula to Australian markets is not interrupted.</p>
</blockquote>
<p>Greens Treasury spokesman Peter Whish-Wilson, also from Tasmania, said the decision was regrettable but he highlighted the conditions.</p>
<p>"We welcome the decision to apply binding and enforceable conditions on the sale of Bellamy’s such as compelling local investment and employment”.</p>
<h2>‘Regretable’ but conditional</h2>
<p>Whish-Wilson said Frydenberg’s move “clearly acknowledges the problems with the previous controversial Van Diemen’s Land approval where promises were voluntary and have not been implemented”.</p>
<p>Pauline Hanson slammed the decision. “Stop, just stop! Enough with the rampant sell off of Australia,” she said on Facebook. </p>
<p>She said this took “another chunk out of Australia’s ability to produce enough food for our own people”.</p>
<p>Shadow treasurer Jim Chalmers said it was up to Frydenberg to explain how and why the the decision was in the national interest.“We need to know more about the undertakings that have been given and that they’ll be followed through”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-agents-of-foreign-influence-just-look-at-who-owns-australias-biggest-companies-123343">Worried about agents of foreign influence? Just look at who owns Australia's biggest companies</a>
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<p>Former Nationals leader Barnaby Joyce told the Australian he was “disappointed to see yet another piece of Australia sold to the Chinese” but pointed out Bellamy’s was not a monopoly.</p>
<p>He emphasised that there should not be slippage in the application of the conditions.</p><img src="https://counter.theconversation.com/content/127121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The proposed acquisition of infant formula producer Bellamy’s Australia Ltd by China Mengniu Dairy Company Limited has been given approval by Treasurer Josh Frydenberg. Strict, legally enforceable conditions…Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1061652018-11-20T18:54:01Z2018-11-20T18:54:01ZIf you’re feeding with formula, here’s what you can do to promote your baby’s healthy growth<figure><img src="https://images.theconversation.com/files/246315/original/file-20181119-76147-1c8dlvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If a baby isn’t breastfed, or is partially breastfed, commercial infant formula should be the only other food given until around six months, and should be continued alongside solid foods until 12 months.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While breastfeeding is the <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf">recommended approach</a> to infant feeding, some mothers may not be able to breastfeed. Others may find themselves moving on from breastfeeding to infant formula.</p>
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Read more:
<a href="https://theconversation.com/breastfeeding-is-not-easy-stop-telling-new-mothers-that-it-is-98026">Breastfeeding is not 'easy' – stop telling new mothers that it is</a>
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<p>If a baby isn’t breastfed, or is partially breastfed, commercial infant formula should be the only other food given until around six months, and should be continued alongside solid foods until 12 months. <a href="https://www.aihw.gov.au/reports/mothers-babies/2010-australian-national-infant-feeding-survey/contents/table-of-contents">Some 80% of parents in Australia</a> introduce formula within the first year of life. </p>
<p>Formula feeding, however, may <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Systematic+review+and+meta-analyses+of+risk+factors+for+childhood+overweight+identifiable+during+infancy">increase the risk</a> of being overweight or obese during childhood. The exact reason for this is unclear. </p>
<p>To address this, we undertook <a href="https://www.ncbi.nlm.nih.gov/pubmed/29655200">a review of studies</a> linking infant formula feeding practices with unhealthy weight gain. The evidence tells us there are a number of things parents using formula can do to promote optimal growth for their baby. These centre around choice of formula and feeding methods.</p>
<h2>Choose a formula with the lowest amount of protein</h2>
<p>There are many infant formulas on the market to choose from. But for healthy full-term babies, <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf">there is little evidence</a> to say that one formula is better than another. The only recommendation we can provide is around protein levels.</p>
<p>A large <a href="https://www.ncbi.nlm.nih.gov/pubmed/19386747">randomised controlled trial in Europe</a> found that a higher protein content of infant formula is associated with higher weight in the first two years of a child’s life. Based on this research, the <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf">Australian Infant Feeding Guidelines</a> recommend choosing a formula with a lower amount of protein.</p>
<p>Breastmilk contains about 1-1.1g of protein per 100ml. Infant formulas available in Australia have a protein content within the range of 1.3-2g per 100ml, so choosing a formula at the lower end of this range is preferable.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246313/original/file-20181119-76154-80qbpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s best to choose an infant formula with less protein.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Infant formulas (known as step 1, stage 1 or from birth) typically have lower amounts of protein than follow-on formulas (step 2 or stage 2). So if you’re using formula, it’s best to stick with infant formula. This is the only type of formula babies need until they’re 12 months old. No studies have shown <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf">any advantages</a> in using follow-on formulas.</p>
<p>At 12 months (but not before) babies can have full cream cow’s milk. Most healthy toddlers do not need formula or toddler milk from this point.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-stress-about-the-shortage-toddlers-dont-need-formula-51903">Don't stress about the shortage, toddlers don't need formula</a>
</strong>
</em>
</p>
<hr>
<h2>Follow preparation instructions carefully</h2>
<p>It’s important that instructions on the tin are followed to make up the formula so it isn’t under or over concentrated. To ensure formula is prepared correctly, remember to:</p>
<ul>
<li>use the right scoop (the one that came with the tin)</li>
<li>use level, lightly packed scoops (not over or under filling it or packing it in tightly)</li>
<li>add water first and then the powder. </li>
</ul>
<p>It’s also important not to add anything else to the bottle.</p>
<h2>Follow the baby, not the clock</h2>
<p>All babies, whether breast or formula fed, should be fed “on demand”. That is, when they show signs of hunger (being awake and alert, mouth opening, sucking hand or fist) rather than by the clock. Crying can also be a late sign of hunger; <a href="https://raisingchildren.net.au/newborns/behaviour/crying-colic/soothing-a-crying-baby">but babies cry</a> for many reasons, so this is not always a cue to feed.</p>
<p>Responding to signs of fullness (such as turning away and closing the mouth) is another important part of responsive feeding. For bottle-fed babies, it’s important parents attend to these cues to avoid pressuring their baby to finish the bottle. This may override a baby’s innate ability to self-regulate their intake and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25183759">may even impact</a> later eating behaviours.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246316/original/file-20181119-76144-18cyqpy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">At six months of age, parents should introduce a sippy cup with the aim of phasing out bottles by 12 months.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheerful-baby-girl-sitting-chair-holding-85771501?src=ZT7M-sj5yZPS46jPhN1feA-1-68">Shutterstock</a></span>
</figcaption>
</figure>
<p>To be attuned to these cues, it’s important to hold your baby when feeding them. This may seem obvious, but parents can be tempted to let older babies feed themselves, or put them in their cot with a bottle to go to sleep. This is <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf">not recommended</a> as it can be a choking hazard, lead to tooth decay, ear infections, unhealthy weight gain and disturbed sleep.</p>
<p>Babies will vary in how often they want to feed in response to factors including hunger, thirst, and hot weather. This is normal. The information on the formula tin about how much and how often to feed is a guide only. Parents shouldn’t worry if their baby does not drink as much or as often as suggested – as long as they’re producing plenty of wet nappies, and are growing and developing normally.</p>
<p>If parents do have concerns, they should discuss these with a GP or maternal and child health nurse. The <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf">Australian Infant Feeding Guidelines</a> also have a helpful table of formula requirements by age and weight.</p>
<h2>Phase out bottles by 12 months of age</h2>
<p>Finally, it’s best to phase out bottles by the time a child is a year old. Prolonged use of bottles into the toddler years is associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/20055929">a higher risk</a> of later overweight and obesity, along with other problems including tooth decay, ear infections, iron deficiency and speech difficulties. </p>
<p>It’s recommended parents introduce a “sippy” or training cup at six months and aim to phase out bottles by 12 months of age.</p>
<p>If you would like to learn more about feeding your baby across the first year of life , join <a href="https://www.futurelearn.com/courses/infant-nutrition">Deakin University’s free Infant Nutrition online course</a>, starting again on November 19 and running until January 14.</p><img src="https://counter.theconversation.com/content/106165/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Laws receives funding from the National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Elizabeth Denney-Wilson receives funding from the Australian Primary Health Care Research Institute and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Jessica Appleton receives a PhD scholarship funded through the Australian Government Research Training Program.</span></em></p><p class="fine-print"><em><span>Karen Campbell receives funding from National Health and Medical Research Council. </span></em></p>Formula feeding has been linked to higher weight gain in children. But parents who are formula feeding their babies can take measures to promote healthy weight gain.Rachel Laws, Senior Lecturer in Public Health Nutrition, School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin UniversityElizabeth Denney-Wilson, Professor of Nursing, University of SydneyJessica Appleton, PhD Student, Sydney Nursing School, University of SydneyKaren Campbell, Professor Population Nutrition, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037882018-10-05T12:27:45Z2018-10-05T12:27:45ZBreastfeeding is good for mothers’ mental health – but those who struggle need support<figure><img src="https://images.theconversation.com/files/238746/original/file-20181001-195282-1jyyaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-mother-suffering-post-natal-depression-238716724?src=-5g6AuMBP2JWkzsk9uZ1vA-1-16">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>If you believed some newspapers you would think that breastfeeding was inherently bad for maternal mental health. Headlines regularly shout about “<a href="https://www.channel4.com/news/bressed-pressure-to-breastfeed-has-gone-to-far">pressure to breastfeed</a>” and “<a href="https://www.dailymail.co.uk/femail/article-3255275/Thought-breastfeeding-bullies-gone-away-nastier-ever.html">breastfeeding bullies</a>” making mums feel anxious and miserable. Calls are made for breastfeeding promotion <a href="https://www.theguardian.com/commentisfree/2017/mar/28/an-unrealistic-pressure-mothers-on-what-its-like-to-breastfeed">to stop</a> due to the perceived risk of ruining the motherhood experience. </p>
<p>But breastfeeding does not damage maternal mental health. In fact, a good breastfeeding experience can do marvellous things for women’s well-being. Alongside reducing risk of <a href="https://www.researchgate.net/profile/Np_Magula/publication/6076615_Breastfeeding_and_Maternal_Health_and_Infant_Health_Outcomes_in_Developed_Countries/links/557651a508aeacff1ffe62c2.pdf">reproductive cancers, heart disease and diabetes</a>, it can help mothers feel <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2010.0097">empowered, confident</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0277953605002716">heal birth trauma</a> too. Breastfeeding hormones are even thought to help <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">reduce the impact of stress and sleep deprivation</a> upon the body. It’s no wonder that <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1552-6909.2002.tb00063.x">numerous</a> <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">studies</a> have found that when breastfeeding is going well, a woman’s <a href="https://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007">risk of postnatal depression is lower</a>. </p>
<p>But when women are unable to breastfeed as they had expected their <a href="http://pediatrics.aappublications.org/content/123/4/e736.short">mental health can be badly affected</a>. Having a difficult breastfeeding experience and feeling forced to stop can leave women feeling <a href="http://journals.sagepub.com/doi/abs/10.1177/0890334407312002">devastated, grief stricken and very, very angry</a>.</p>
<p>But, I repeat, the problem is not breastfeeding itself. Instead it is the <a href="https://www.huffingtonpost.co.uk/entry/lack-of-support-for-breastfeeding-mothers-in-britain-is-inhumane_uk_5b5b0bb2e4b0b15aba9813f9">lack of support and investment</a> in infant feeding, new mothers and families more broadly. More than two-thirds of mothers who stop breastfeeding in the first few weeks do so because they <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">needed more support, had pain, or difficulty latching a baby on</a>. However, lack of investment in health services means that mothers are often forced to get on with it by themselves – often with the further blow of being told “the main thing is your baby is being fed” – rather than have the one-to-one support they actually need. </p>
<p>In fact, issues such as not getting enough <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2010.00446.x">professional help</a>, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12219">exhaustion</a> and <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0581-5">misinformation</a> mean that more than half of UK babies have had formula by the <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">end of their first week</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A positive breastfeeding experience for both mother and child.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horizontal-shot-happy-young-mixed-race-1104404429?src=y3YDVRuiHydKAhGA631m0Q-1-6">shurkin_son/Shutterstock</a></span>
</figcaption>
</figure>
<p>Difficult experiences also raise the risk of postnatal depression, over and above the hormonal implications of not breastfeeding. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12832">Our research</a> – conducted with 217 mothers who stopped breastfeeding in the first few months – shows where women were ready to stop, or stopped for reasons that they perceived to be positive, their mental health was not affected. But when they stopped because of pain, physical difficulties, or because they couldn’t get the support they needed, their risk of depression was much higher. </p>
<p>This study expanded on a <a href="http://pediatrics.aappublications.org/content/123/4/e736.short">large body of research</a> showing a link between a short period of breastfeeding and postnatal depression. The findings are perhaps unsurprising. Experiencing <a href="https://www.sciencedirect.com/science/article/pii/S1526590011004871">pain and exhaustion</a> are both linked to increased risk of depression – before you add on <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-6712.2007.00572.x">shattered expectations</a> and often <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-9566.2007.01020.x">a lack of advice about what to do next</a>.</p>
<p>What is confusing is that investment still isn’t being made to support women in reaction to this. We know that breastfeeding <a href="https://www.sciencedirect.com/science/article/pii/S0140673615010247">protects maternal and infant health</a>. We know it <a href="https://adc.bmj.com/content/early/2014/11/12/archdischild-2014-306701.short">saves money</a> for the healthcare system. We know the majority of women <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">want to do it</a> – and lots, once they get past the early weeks, find it <a href="https://www.sciencedirect.com/science/article/pii/S0266613809001211">simpler, more convenient and cost-effective</a>. And we know the potentially damaging effect on their mental health if they cannot breastfeed. </p>
<p>It’s not as if we don’t know <a href="http://www.pinterandmartin.com/breastfeeding-uncovered.html">why women are struggling</a>. There is an absence of professionals to support women, no community to take care of them, and lack of a culture that understands, values and protects breastfeeding and breastfeeding mothers whether they are at home, work or out in public. </p>
<p>But instead of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12496">investing in the research, staffing, education and protection</a> that is needed, <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">cuts are being made to services</a>, and a bottle of formula is suddenly given as the solution to any <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">breastfeeding challenge</a>. Although formula is sometimes needed when breastfeeding really does not go to plan, the <a href="https://www.nice.org.uk/guidance/ng75">National Institute of Clinical Excellence</a> states that women who want to breastfeed should be given intensive support to increase their milk supply if necessary, before formula is offered. </p>
<p>Moreover, formula doesn’t solve the perceived issues that it is often presented as solving. It <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2014.0153">won’t help a baby sleep</a> at night, does not create a more “settled baby” and does not stop babies wanting to be held. These are normal baby behaviours, <a href="https://www.sciencedirect.com/science/article/pii/S0022347679805405">to help a them feel safe</a> and comforted, and often nothing to do with hunger. And, most importantly, simply telling a mother who wants to breastfeed to give formula rather than helping her work through any challenges will not make her any happier – in fact, as shown, the opposite is often true. Mothers who are let down in this way – <a href="https://www.huffingtonpost.com/jennifer-grayson/there-are-no-tests-the-st_b_11307426.html">often without answers</a> as to why their breastfeeding experience went – wrong blame themselves, stating that they <a href="https://www.sciencedirect.com/science/article/pii/S0277953607003590">feel like failures</a>. </p>
<p>Mothers who cannot breastfeed are absolutely not failing, rather, they are being failed – by a government who is far too quick to promote breastfeeding without protecting it.</p><img src="https://counter.theconversation.com/content/103788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.</span></em></p>Mothers who cannot breastfeed are absolutely not failing, rather, they are being failed.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779432017-09-11T19:41:21Z2017-09-11T19:41:21ZEssays on health: Australia is failing new parents with conflicting advice – it’s urgent we get it right<figure><img src="https://images.theconversation.com/files/181928/original/file-20170814-28487-1h0x1q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Much of the baby's distress, as well as that of the parents, can be prevented.</span> <span class="attribution"><a class="source" href="https://unsplash.com/search/photos/baby?photo=EpbIXGCrtK0">Janko Ferlič/Unsplash</a></span></figcaption></figure><p>Every year, hundreds of thousands of Australians embark on a disorienting, life changing journey. They have a baby.</p>
<p>What happens after a woman gives birth should be a matter of serious public interest. Screaming babies, breast pain, baby weight-gain worries, breastfeeding issues, wind, colic, reflux, allergies, tongue tie, sleep deprivation, and parental anxiety and depression. These are common concerns at the beginning of the life of every Australian citizen. </p>
<p>In reflecting on these, we’re actually considering the developmental origins of disease. This is so for many reasons, including that the infant gut microbiome <a href="https://www.ncbi.nlm.nih.gov/pubmed/26663826">affects</a> metabolism and immunity even as an adult, and that postnatal depression has <a href="https://www.ncbi.nlm.nih.gov/pubmed/25455250">long-term effects</a> on a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412485/">child’s cognitive potential and mental health.</a></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
</strong>
</em>
</p>
<hr>
<p>Throughout the developed world, <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/AFF3C1C460BA5300CA257BF0001A8D86/$File/NFUCFHS.PDF">non-communicable diseases</a> are now the <a href="http://adc.bmj.com/content/early/2016/08/29/archdischild-2016-310991">major cause of illness</a> and death in children, mirroring trends in adults. Among these, immune, gut, developmental disorders and mental illness feature prominently. All are shaped by environmental factors in very early life.</p>
<p>Yet, our health professionals often recommend approaches to behaviour problems in infants - such as with <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">breastfeeding</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">crying</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">fussing</a>, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/26555938">sleep</a> - that have been demonstrated to be ineffective. Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/23905907">recommendations</a> actually <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">risk worse health outcomes</a> for both the mother and baby.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What happens after a woman gives birth is a matter of serious public interest.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>From the moment their baby is born, Australian parents receive vastly conflicting advice from <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">different health disciplines</a>, or even from different health professionals in the one discipline. Confusion during an already challenging life transition drives parents to seek <a href="https://www.ncbi.nlm.nih.gov/pubmed/21679331">opinions from multiple providers</a>: the GP, paediatrician, midwife, child health nurse, pharmacy nurse, lactation consultant, dentist (yes dentist), and the emergency department. Many visit complementary and alternative medicine practitioners.</p>
<p>Yet <a href="https://www.mja.com.au/journal/2016/205/2/prioritising-general-practice-research">less than 2%</a> of the National Health and Medical Research Council funding goes to research into primary care, the first port of call for new parents. Research performed in hospitals or specialised settings, including concerning issues of early life care, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221610/">often isn’t relevant in the community</a>. We must take primary care research seriously if we want to ensure parents are provided with consistent, evidence-based advice that is beneficial to the baby, themselves and society at large.</p>
<h2>Breastfeeding confusion</h2>
<p>Up to <a href="http://www.health.gov.au/breastfeeding">96% of Australian women</a> want to breastfeed at the time of the birth. Women want to breastfeed so much that not being able to do so <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">affects their mental health</a>. Yet multiple studies demonstrate <a href="https://www.ncbi.nlm.nih.gov/pubmed/25864129">serious gaps</a> in health professional training in the two most common post-birth problems: <a href="https://www.ncbi.nlm.nih.gov/pubmed/28167998">breastfeeding difficulty</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">unsettled</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">infant</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">behaviour</a>. Both <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">increase</a> a woman’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/19432839">risk of postnatal depression</a> and are <a href="http://www.bmj.com/content/343/bmj.d7772">linked with</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26869575">poorer infant outcomes</a>.</p>
<p>Undiagnosed problems with the baby latching on to the breast and finding a stable position during breastfeeding (which I call “fit and hold”) can lead to a range of distressing infant behaviours. These include back arching, refusing or fussing at the breast, crying, poor weight gain and excessive night waking. These signs of positional instability are often thought to be signs of reflux and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23495859">treated with acid medications</a>. But evidence shows these medications <a href="https://www.ncbi.nlm.nih.gov/pubmed/25556017">don’t help</a> the problem.</p>
<p>Existing approaches used to support fit and hold, including letting the baby find their own way to the breast, don’t <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">improve outcomes</a> for many. Common advice, such as using one hand on the back of the baby’s neck while the other creates a particular shape of the breast, has been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">increase nipple pain</a>. </p>
<p>I commonly see women who have been told by multiple professionals their fit and hold is good, even though the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24075595">baby’s behaviour communicates</a> inability to fit stably into the mother’s body. That is, the baby is showing their <a href="https://www.ncbi.nlm.nih.gov/pubmed/18243594">position is uncomfortable</a> or there is a drag of breast tissue pulling in another direction in the baby’s mouth, in conflict with the inward pull created by the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">vacuum when the jaw drops</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australian mothers need more support to breastfeed.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Oral tie ‘epidemic’</h2>
<p>Then there’s the issue with tongue tie, upper lip tie, and buccal (cheek to gum) tie. This is another way health professionals are dealing with breastfeeding problems and unsettled behaviour – by referring the child for oral surgery. A classic tongue-tie needs a simple scissors snip. But normal <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas%20BFM%202013.pdf">variations of the frenulum</a> - the bits of connective tissue under the tongue and upper lip - are these days <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">often labelled abnormal</a> and blamed for problems. </p>
<p>If we put aside the situation of a classic tongue-tie, the belief cutting or lasering the frenula (called a frenotomy) helps breastfeeding is <a href="http://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies">not supported by research</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">Our work</a> suggests that diagnoses of normal variants of connective tissue as abnormal are based on an <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">outdated and inaccurate</a> model of how infants attach to the breast.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/deep-cuts-under-babies-tongues-are-unlikely-to-solve-breastfeeding-problems-54040">Deep cuts under babies' tongues are unlikely to solve breastfeeding problems</a>
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</em>
</p>
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<p>Parents are <a href="http://tonguetie.net/consequences/">sometimes warned</a> if the baby doesn’t have a frenotomy for the diagnoses of posterior tongue-tie or upper lip-tie, their baby is at risk of speech and swallowing problems, expensive orthodontic problems, sleep disorders and other developmental problems in later childhood, though <a href="http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2015-0658">there is no evidence</a> to support these claims. </p>
<p>There are now studies demonstrating that the diagnosis of “oral ties” in breastfeeding babies has reached epidemic proportions in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28168891">United States</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27280112">Canada</a>. Exponential increases in frenotomy rates are also evident in our team’s analysis of early Australian Medicare data (yet to be published). Many, if not most, frenotomies are <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">performed by dentists</a> using laser, and are not captured by Medicare. </p>
<p>I regularly see <a href="https://griffithreview.com/articles/tongues-tied-about-tongue-tie/">babies after laser surgery</a> with worsened breastfeeding problems. Sometimes their <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12773/abstract">wounds become infected</a>. I often see pale cords of scarred tissue under the tongue. I have also seen the underbelly of a little tongue somewhat separated by a too-deep cut. I have seen suture knots hanging from a newborn’s upper gum after scissors frenotomy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Breastfeeding problems are often blamed on the baby’s frenulum - the bit of connective tissue under the tongue and upper lip.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The tongue-tie epidemic hasn’t come from a sudden burst of new congenital abnormalities in the mouths of infants in the English-speaking world in the past ten years, as <a href="http://mthfr.net/the-intersection-of-tongue-tie-mthfr/2014/05/23/">some proponents argue</a>. The epidemic parallels broader <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32585-5/abstract">international trends of medical overtreatment</a> and is, in my mind, a painful sign clinical breastfeeding support is in crisis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-rein-in-the-widening-disease-definitions-that-label-more-healthy-people-as-sick-76804">How to rein in the widening disease definitions that label more healthy people as sick</a>
</strong>
</em>
</p>
<hr>
<h2>The importance of sleep</h2>
<p>Parents are also being advised their child’s healthy development and their own wellbeing depends on implementing sleep training. This includes strategies such as: don’t breastfeed your baby to sleep; don’t let the baby get overtired or overstimulated; put the baby down in the cot at the first tired sign; teach the baby to self-settle in the cot; make sure the baby is getting big blocks of sleep instead of catnapping during the day; and use feed-play-sleep cycles. </p>
<p>Technically known as <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">first wave behaviourism</a>, these approaches arose in the 1950s and 1960s. Girls like me were taught them in the 1970s in compulsory mothercraft classes at high school – a long time before the emergence of evidence-based medicine. </p>
<p>But now, <a href="https://www.nhmrc.gov.au/book/promoting-social-and-emotional-development-and-wellbeing-infants-nhmrc-report-evidence-5">high-level evidence</a> demonstrates these approaches do not <a href="http://www.smrv-journal.com/article/S1087-0792(15)00100-8/abstract">decrease night waking</a> or reliably improve women’s mental wellbeing in the first year of life, and especially not in the <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf">first six months</a>. </p>
<p>A <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjep.12109/abstract">small subgroup of babies</a> with sleep problems go on to have sleep problems in later childhood. The evidence <a href="https://www.ncbi.nlm.nih.gov/pubmed/22748447">does not support</a> the idea that applying sleep training in the first year will prevent this, yet I hear parents are often told if the baby doesn’t get enough sleep, or if they let “bad habits” grow, their baby’s development and capacity to learn in later childhood will suffer. The threat they are doing the wrong thing if they don’t sleep train <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934563/">heightens parental anxiety</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents are advised their baby’s healthy development depends on implementing conventional sleep strategies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/sleeping-baby?photo=WCbCRXk7nmU">Carlo Navarro/Unsplash</a></span>
</figcaption>
</figure>
<p>In my experience in general practice, where I’ve had the privilege of following many families over months and years, first wave behavioural approaches cause parent-baby communication confusion, and also unnecessarily disrupted nights for many, due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312214/">disruption of the baby’s circadian clock</a>. </p>
<p>In Australia, many sleep-deprived mothers seek help from <a href="https://www.stayathomemum.co.uk/my-kids/behaviour/sleep-schools-in-australia">residential sleep schools</a>. Some are even referred there by health professionals if the baby just <a href="http://www.saveoursleep.com.au/free-reading/triggers-sleep-problems/">catnaps during the day</a> and doesn’t go to sleep alone in the cot, due to fear of developmental implications. Yet only families with the most severe problems should require this hospital-based solution, which is extremely expensive to the health system. </p>
<h2>So, what are the solutions?</h2>
<p>We have enough evidence to show what works. For instance, <a href="http://www.cppah.com/article/S1538-5442(11)00049-6/pdf">latest research</a> tells us it is important to respond to our baby’s cues for the baby to develop secure psychological attachment. Babies should not be left to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113571">grizzle or cry</a> as a pattern over time, and breastfeeding to sleep is one sensible tool for making the days and nights manageable. </p>
<p>It’s also important to know about the young human’s biological need for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223372/">rich sensory nourishment</a>. This means encouraging parents to enjoy a social life outside the house, trusting that the baby’s biological sleep regulators will take whatever sleep he or she needs with minimal effort on the parent’s part.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents should trust the child’s natural sleep sensors will kick in when he or she is tired.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We’ve developed an <a href="https://education.possumsonline.com/sleep-film">alternative parent-baby sleep program</a>. This repairs <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">unnecessary disruption to night-time sleep</a> either by identifying underlying breastfeeding problems in younger babies, or by helping to reset the circadian clock, which is commonly disrupted by the first wave behavioural focus on long blocks of sleep during the day. </p>
<p>And breastfeeding problems can resolve when women are <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">helped to stabilise</a> the way their and their baby’s <a href="https://education.possumsonline.com/programs/gestalt-breastfeeding-online-program">unique anatomies fit together</a>. This is when the baby’s breastfeeding reflexes are turned on, his or her face is symmetrically buried into the breast, and as much breast tissue as possible is drawn deep into the baby’s mouth without a drag in another direction. </p>
<p>Our programs have a well-developed and published evidence base, and <a href="http://www.publish.csiro.au/PY/PY13011">promising preliminary evaluations</a>. Obviously, these require bigger trials. But there is too little funding available for clinical primary care research. The UK’s <a href="https://www.nuffieldtrust.org.uk/">Nuffield Trust</a> recently issued <a href="http://adc.bmj.com/content/101/12/1084">a report</a> advising that if we are to care for our children’s health needs in a sustainable health system, models need to shift the focus from hospital-based care to integrated child health care in community settings.</p>
<p>Investing in primary health care <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12348/abstract">has been demonstrated</a> to be more effective, at a fraction of the price of treating problems in hospitals. Just a single visit to an Australian hospital’s emergency department costs the tax-payer <a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">ten times</a> the cost of a visit to a GP. </p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">Medicare spending on general practice is value for money</a>
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<p>We can’t expect hospital-based parenting support centres to improve outcomes when mothers and babies are seen there by health professionals who continue to offer conflicting advice. It would be much cheaper and more cost effective to invest in freely accessible, evidence-based, perinatal services in a family’s own community, co-ordinated by their own GP.</p>
<p>In view of the health system costs and tsunami of mental health problems and chronic disease, this is a matter for urgent political and health system attention.</p><img src="https://counter.theconversation.com/content/77943/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Pamela Douglas is Medical Director of a charitable organisation, the Possums Clinic <a href="http://www.possumsonline.com">www.possumsonline.com</a> (Possums for Mothers and Babies Ltd). Possums Education sells two educational products online, the Gestalt Breastfeeding Online Program and the Possums Sleep Film (also available as a DVD). All proceeds are invested into the development of further educational materials.</span></em></p>From the moment their baby is born, Australian parents receive conflicting advice on how to cope with newborn issues. What we are doing wastes our resources, but we’re not investing in alternatives.Pamela S Douglas, General Practitioner, Researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/804032017-07-04T01:35:51Z2017-07-04T01:35:51ZNo, nanoparticles in baby formula will not harm your baby<figure><img src="https://images.theconversation.com/files/176674/original/file-20170704-12293-t2rt7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The health scare surrounding nanoparticles might lead to people abandoning formula unnecessarily, with serious impacts on babies' health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/392125570?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you watched Channel 7 news this week, you would have learnt about a <a href="http://www.smh.com.au/business/consumer-affairs/study-finds-potentially-toxic-nanoparticles-in-australian-baby-formula-20170622-gwwb2j.html">study</a> commissioned by <a href="http://www.foe.org/projects/food-and-technology/nanotechnology/baby-formula">Friends of the Earth</a> that found “potentially toxic” <a href="https://theconversation.com/nanoparticles-and-nanosafety-the-big-picture-22061">nanoparticles</a> in Australian baby formula.</p>
<p>The study’s spokesperson said calcium phosphate nanoparticles (nano-hydroxyapatite, also known as nano-hydroxylapatite) caused kidney and liver damage. That claim was, how shall I put it kindly, just a little <em>misleading</em>.</p>
<iframe src="https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2F7NewsAdelaide%2Fvideos%2F1606605372703445%2F&show_text=0&width=560" width="100%" height="450" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="true"></iframe>
<p>I have the <a href="http://pubs.rsc.org/en/content/articlepdf/2012/nr/c2nr00044j">study</a> the spokesperson mentioned before me, which was conducted in rats, not humans.</p>
<p>The researchers injected calcium phosphate nanoparticles directly into rats’ body cavities (instead of oral administration as happens with baby formula) at concentrations around a million times higher than found in the baby formula.</p>
<p>Let me quote from the study’s findings:</p>
<blockquote>
<p>The normal levels of AST, ALT and A/G [liver enzymes indicating liver damage] in the n-HA [nano-hydroxyapatite] group suggested no inflammation and necrosis induced by accumulation of 100 mg of n-HA particles. In the liver function there was almost no damage. Moreover, no significant change on values of BUN and CR [urea and creatine] than the control, which also suggested n-HA has no effect on renal function.</p>
</blockquote>
<p>In other words, there were <em>no</em> ill effects on liver or kidney function, the direct opposite of what the media reports were claiming.</p>
<p>Even <em>if</em> you injected 100 milligrams of pure nano-hydroxyapatite directly into a newborn baby’s body (equivalent in baby terms to the dose given to the rats) there would be <em>no</em> significant effect on liver or kidney function.</p>
<p>The spokesperson’s misleading message caused unwarranted concern. On a now deleted <a href="https://www.facebook.com/Sunrise">Sunrise Facebook</a> post discussing this report, the commentors’ concern and fear was palpable. Causing unreasonable fear is irresponsible.</p>
<h2>Nanoparticles occur naturally</h2>
<p>Nanoparticles have become the latest bogeyman, despite nanoparticles occurring naturally. The <a href="http://www.smh.com.au/business/consumer-affairs/study-finds-potentially-toxic-nanoparticles-in-australian-baby-formula-20170622-gwwb2j.html">media report</a> that fuelled the controversy failed to put nanoparticles in their natural biological context, provide any significant support that particles detected in milk are engineered nanomaterials, nor provide evidence of harm for the levels found.</p>
<p>Infant formula is based on milk, which naturally contains calcium and phosphorus (as calcium phosphates). Milk is an important source of calcium, which forms the basis of bones and teeth. The calcium and phosphates are in a complex balance between soluble and protein-bound forms.</p>
<p>One of the forms of calcium phosphate in milk is <a href="https://hal.archives-ouvertes.fr/hal-00900570/document">hydroxyapatite</a> (also found in <a href="https://en.wikipedia.org/wiki/Hydroxylapatite">tooth enamel</a>). So it is unsurprising that hydroxyapatite is found in dried infant formula, which is mainly dried milk powder. </p>
<p>Nanometre-sized particles of calcium phosphate also <a href="https://www.ncbi.nlm.nih.gov/pubmed/6626580">form naturally</a> in drying milk.</p>
<h2>Other studies have found no effect</h2>
<p>Researchers have studied the safety of consuming hydroxyapatite nanoparticles before.</p>
<p>Animals who ate the nanoparticles (added to their food, as opposed to having them injected) showed <a href="http://www.sciencedirect.com/science/article/pii/S0928493116315703">no toxicity</a> at levels well above those present in milk (up to 100 milligrams per kilogram of body weight a day for a year). </p>
<p>Even if you inject them (into veins or into body cavities), you need levels well above those found in infant formulas to <a href="http://onlinelibrary.wiley.com/doi/10.1002/jat.3073/full">cause damage</a> (50 milligrams nano-hydroxyapatite per kilogram body weight in rats).</p>
<p>To give you an idea of how much higher this is with respect to infant formula, the highest levels of hydroxyapatite nanoparticles in any formula is 287 particles in 10 grams of formula.</p>
<p>Yes, that’s <em>particles</em> not milligrams, not micrograms but actual particles. We are talking nano- to femtograms here, amounts so small it is hard to visualise. These levels are a million times or more less than levels found to have produced no effects in animals (and even lower than levels that do cause damage).</p>
<p>Hydroxyapatite nanoparticles have been widely developed to aid bone repair, deliver drugs and have been extensively tested. All results suggest that even <a href="http://onlinelibrary.wiley.com/doi/10.1002/cphc.201200080/full">levels required to be drug delivery agents</a>, well above those found in baby formula, have no significant adverse effects.</p>
<h2>The body dissolves the nanoparticles anyway</h2>
<p>These nanoparticles will also not stay nanoparticles: they dissolve in the stomach fluids, allowing their calcium to be absorbed. </p>
<p>Newborns and very young babies’ stomach fluids are less acidic than older babies and young children (pH5), but <a href="http://www.sciencedirect.com/science/article/pii/S0003996997000447">still acidic enough to dissolve hydroxyapatite</a>. </p>
<p>And particles are more easily dissolved the smaller they are. So, nanoparticles are likely to be even more rapidly dissolved into their component calcium and phosphate ions than larger particles.</p>
<h2>What’s the take-home message?</h2>
<p>There are no significant public health implications for these small crystals of naturally occurring calcium phosphates in milk-based baby formula. </p>
<p>The way the Friends of the Earth study results have been presented, with misleading references to irrelevant studies, has caused unnecessary fear and concern, and may lead some to abandon formula unnecessarily, with negative impacts on baby health.</p><img src="https://counter.theconversation.com/content/80403/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adverse reaction to herbal medicines, and has previously been funded by the Australian Research Council to study potential natural product treatments for Alzheimer's disease. In previous years he has collaborated on work on the formation of amyloids from milk proteins. </span></em></p>A widely publicised study that cast doubt on the safety of milk formula was misleading, based on dubiously reported studies and may have serious consequences.Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759322017-04-10T09:38:40Z2017-04-10T09:38:40ZVegan restaurant ban on cows’ milk formula is another way to stigmatise mothers<figure><img src="https://images.theconversation.com/files/164431/original/image-20170407-29407-1h2qlx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bottle or breast isn't the only debate.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/infant-nutrition-woman-feeds-newborn-modified-272971688?src=bPkVl52Z1B7XrN0-ruOUWw-1-60">Robert Przybysz/Shutterstock</a></span></figcaption></figure><p>A vegan restaurant in Spain has been both praised and criticised for banning the use of <a href="http://metro.co.uk/2017/04/04/this-vegan-restaurant-has-been-trashed-for-imposing-a-bottle-feed-ban-6552719/">infant formula derived from animals</a>. </p>
<p>The first I knew about the ban was when it sparked considerable debate in the UK-based vegan Facebook groups, of which I, as a vegan, am a member. Some posters in the group suggested that the practice was OK – the restaurant in Spain (and indeed British restaurants too) should be allowed to ban any non-vegan food. Comparisons were made to steak being taken to the premises. Other people were more compassionate and understood why cows’ milk-based infant formula may be the best option available to some parents. </p>
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<p>Vegan or not, the banning of any infant formula from a public restaurant is inappropriate and harmful, not only to hungry babies but also to new mothers.</p>
<h2>Vegan babies</h2>
<p>Baby feeding is a minefield of a topic: search “vegan newborn diet” on Google and you’ll receive more than 700,000 results, <a href="https://www.theguardian.com/commentisfree/2016/jul/19/parents-raising-vegan-babies">promoting the idea</a> and <a href="https://www.washingtonpost.com/news/morning-mix/wp/2016/07/11/italian-baby-fed-vegan-diet-hospitalized-for-malnutrition/?utm_term=.fa5f49e93ffe">telling horror stories</a> from the first page.</p>
<p>The debate over giving young babies cows’ milk or plant-based formula is not based on <a href="https://www.theguardian.com/commentisfree/2017/mar/30/dairy-scary-public-farming-calves-pens-alternatives">the ethics of the dairy industry</a> alone. Babies can healthily be vegan from birth, and <a href="http://www.who.int/topics/breastfeeding/en/">breast milk is the ideal vegan milk</a>. Where vegan mothers are unable to breastfeed or choose not to, the NHS <a href="http://www.nhs.uk/chq/Pages/can-I-give-my-baby-soya-based-infant-formula.aspx">specifically recommends</a> cows-milk based formula – and not infant formula made from soya – as the best alternative to breast milk for babies aged under six months, unless one has been recommended by a health professional. Soya milk is not supported as a choice from birth because chemicals in the soya formula “could affect babies’ reproductive development” and it is likely to damage babies’ teeth more than breast or cows’ milk. </p>
<p>But we’re not here to debate whether it is right or wrong to raise a child as vegan, that is a choice to be made by a child’s parents or guardians in line with <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/vegetarian-vegan-children.aspx">guidance on how to do so healthily</a>. The discussion here is over the fact that nothing should be done that stops a baby being fed when they need to be, in a healthy way that supports their growth and development.</p>
<h2>Milk discrimination</h2>
<p>The majority of formula available in the UK is <a href="https://www.nct.org.uk/parenting/introducing-formula-milk">cows’ milk-based</a>, so, taking into account <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pregnancy-and-baby-care.aspx">NHS advice</a>, we might expect that vegan mothers should all “just” breastfeed their babies, because breastfeeding is “natural” and “easy”. But there are <a href="https://www.shef.ac.uk/scharr/sections/ph/research/breastmilk/bfinuk">many barriers</a> that make it <a href="https://www.theguardian.com/commentisfree/2017/mar/28/an-unrealistic-pressure-mothers-on-what-its-like-to-breastfeed">very difficult for some women</a> to breastfeed. </p>
<p>Once women feel that they have got the hang of breastfeeding, and are used to the general exhaustion of new parenthood, you might think they would be OK. But they aren’t. The Equality Act provisions which relate to <a href="https://www.gov.uk/guidance/equality-act-2010-guidance">infant feeding in public</a> have been poorly enforced. The legislation would make the Spanish restaurant ban illegal in the UK: the Equality Act 2010 treats “maternity” <a href="https://www.gov.uk/guidance/equality-act-2010-guidance">as a protected characteristic</a> and women have protected status to breastfeed within business premises such as cafes, restaurants and shops. Despite this, <a href="http://content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">breastfeeding discrimination still happens</a>.</p>
<p>While it is not completely clear if the legal rules extend to feeding babies with infant formula, the fact that the majority of women in the UK are not able to breastfeed <a href="http://content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">for as long as they would like to</a>, means that it would likely be discriminatory to ban formula feeding mothers from a business.</p>
<p>But these kinds of bans cut deeper than just stopping parents being able to feed their babies in specific places. A large, <a href="http://content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">nationally representative survey</a> found that 11% of breastfeeding women have been stopped from breastfeeding in public and 43% felt uncomfortable breastfeeding in public. </p>
<p>My <a href="https://theconversation.com/pregnant-women-and-new-mothers-feel-like-their-health-is-under-surveillance-74793">own recent research</a> has shown that mothers of young babies, and pregnant women, are asked intrusive questions about their feeding methods. These mums were frequently questioned over whether they are or will be breast or formula feeding – and unwelcome and often unhelpful advice is sent their way. Well-meaning it may be, but the comments became a source of anxiety and caused self-doubt. </p>
<p><a href="https://theconversation.com/mothers-are-made-to-feel-guilty-whether-they-breastfeed-or-formula-feed-their-baby-66101">Other research</a> has supported our finding that, whichever way mothers feed their babies, they are often stigmatised and made to feel guilty. This leads to reduced satisfaction with infant feeding, which is bad for mothers well-being.</p>
<p>It may be easy to understand why a vegan restaurant would not want animal products on the premises, but this rule does more than simply protect a strict moral code. Bans such as this in countries so close to the UK show that however mothers choose to feed their babies they cannot escape scrutiny and stigma. </p>
<p>To refuse to allow cows’ milk infant formula when it is the best option for formula-fed babies damages both parent and child health. Society should support mothers, regardless of infant feeding method, and stop making them feel like their choices are bad.</p><img src="https://counter.theconversation.com/content/75932/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from the National Institute for Health Research, the Wellcome Trust ISSF Public Health Scheme and the Welsh Crucible Small Grant Scheme. She has also undertaken paid consultancy for Public Health Wales NHS Trust, where she previously held the role of Senior Health Promotion Practitioner. She is affiliated with the Action on Smoking and Health (ASH) Wales Cymru research committee, where she previously held the role of Research and Policy Officer.</span></em></p>However mothers feed their babies, there is always some kind of criticism.Aimee Grant, Research Associate, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/635502016-08-05T14:58:40Z2016-08-05T14:58:40ZTraumatic breastfeeding experiences are the reason we must continue to promote it<figure><img src="https://images.theconversation.com/files/133155/original/image-20160804-466-1i6c6nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's not all sunshine and roses for some mums.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-301455563/stock-photo-mother-holding-her-crying-little-son-in-studio.html?src=7IxJ0dyhYy-BiDVgEKrUyA-1-0">Shutterstock/Konstantin Tronin</a></span></figcaption></figure><p><a href="http://worldbreastfeedingweek.org">World Breastfeeding Week</a> was designed to promote, protect and encourage breastfeeding. To celebrate the marvel of women nourishing a whole new tiny person. To highlight why we need to invest in our new mothers, babies and the future. </p>
<p>Yet for many mums, this week sends a chill straight through their core. It makes them want to shout and throw things because breastfeeding certainly isn’t something to celebrate for them. </p>
<p>For far too many women, any mention of breastfeeding reminds them of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738467/">pain</a>, <a href="https://bfmed.wordpress.com/2013/05/30/breastfeeding-and-depression-its-complicated/">anxiety</a> and a <a href="https://www.breastfeedingnetwork.org.uk/crisis-in-bf/">lack of support</a>. It reminds them of their determination to do what had been promised to them as simple, enjoyable and the right way to feed their baby. Determination which slowly turned to desperation when it didn’t work for them. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babe in arms.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-281210201/stock-photo-happy-baby-in-the-mothers-breast.html?src=n_8bJP6qeNiu3YXOJTZ79g-1-21">Shutterstock/Luca Elvira</a></span>
</figcaption>
</figure>
<p>It reminds mothers of the heartbreak they felt as they stopped breastfeeding <a href="http://www.herfamily.ie/parenthood/5-mums-stopping-breastfeeding-ready-no-one-listened/227281">before they were anywhere near ready</a> – it wasn’t just about the promised health benefits but the feeling that their body wasn’t doing what it was meant to do, and the fact they just really wanted to do it. </p>
<p>All the pain, regret and anger that mothers feel is the reason we need to shout so loudly about breastfeeding. This hurt comes from women being so badly let down by a society that does not protect breastfeeding. Because, while there are many mums and babies who experience health problems that stop them from breastfeeding, there are even more who would breastfeed if the right support was in place. </p>
<p>We need to change this attitude, and one of the best ways we can do that is by drawing attention to its importance. Because although it might not seem like it to some, breastfeeding has become the underdog in a society that might shout about its importance but actually works rather hard <a href="https://blogs.unicef.org.uk/2016/04/11/breastfeeding-call-to-action/">to undermine it</a>. </p>
<h2>Breaking down barriers</h2>
<p>Britain has ended up in a situation where, despite the <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/">known health</a> and <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Financial-benefits/">economic benefits of breastfeeding</a>, rates are abysmal. In fact they’re <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/The-Lancet-Increasing-breastfeeding-worldwide-could-prevent-over-800000-child-deaths-every-year/">the lowest in the world</a>. More importantly, 80% of mothers who stop breastfeeding in the first six weeks <a href="http://digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">are not ready to do so</a>, and stop because breastfeeding has become seemingly impossible for them. </p>
<p>Breastfeeding should not be so difficult for so many and should only be impossible for a <a href="https://bfmed.wordpress.com/2012/10/15/how-often-does-breastfeeding-just-not-work/">very, very small minority of mothers</a>. However, while society appears to promote breastfeeding, there are actually <a href="https://blogs.unicef.org.uk/2016/07/07/removing-barriers-breastfeeding-uk/">numerous barriers</a> ranging from formula milk adverts to a lack of community support, that ultimately make breastfeeding feel impossible. </p>
<p>Society <a href="http://online.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">does not understand</a> what it is like to breastfeed. Women are given information that damages breastfeeding such as babies <a href="http://www.dailymail.co.uk/health/article-2084874/Study-finds-babies-fed-formula-milk-easier-to-sleep.html">should sleep through the night</a>, rather than wake to feed, for example. Some think misunderstand studies, and come to believe that breastfeeding causes things that are actually <a href="https://www.theguardian.com/lifeandstyle/2012/jan/10/breastfeeding-babies-temperamental-study">just normal baby behaviour</a> and that formula is the solution. Others believe self-styled experts who make money out of telling mothers that their baby should be in a routine – despite research showing that strict routines are actually <a href="http://www.swansea.ac.uk/humanandhealthsciences/news-and-events/latest-research/newresearchsuggestsearlyparentingroutinesmayharmbreastfeeding.php">incompatible with or discourage breastfeeding</a>. </p>
<h2>Invest in breast</h2>
<p>Rather than protecting breastfeeding, the government doesn’t invest properly in the services, support and expertise that would actually enable mothers to breastfeed – despite reports finding it could actually <a href="https://www.theguardian.com/lifeandstyle/2012/oct/18/increase-breastfeeding-nhs-savings-unicef">save the NHS money</a>. Instead, <a href="http://www.nursingtimes.net/news/news-topics/public-health/warning-of-uk-breastfeeding-crisis-amid-budget-cuts/7002416.fullarticle">cuts to services</a> take away essential volunteer groups and funding of breastfeeding specialists. What should be an easily fixable issue gets turned into months of suffering. </p>
<p>Though <a href="http://www.telegraph.co.uk/news/uknews/1570179/Clampdown-on-milk-firms-targeting-newborns.html">no longer allowed</a> to advertise to mothers of babies under six months, the multi-billion formula milk industry <a href="http://www.telegraph.co.uk/women/mother-tongue/11697178/Breastfeeding-Formula-industry-has-hijacked-breastfeeding-for-profit.html">still dominates</a>. Some might argue that the world doesn’t need a week celebrating breastfeeding but in reality, every week is world formula feeding week. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breastfeeding in public should be the norm.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-333965063/stock-photo-thessaloniki-greece-november-1-2015-mother-breastfeeding-her-baby-on-the-6th-nationwide-public-breastfeeding-in-celebration-of-world-breastfeeding-week.html?src=n_8bJP6qeNiu3YXOJTZ79g-9-92">Ververidis Vasilis / Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Mothering is not <a href="http://www.nhs.uk/news/2014/09September/Pages/Mums-feel-shame-about-how-they-feed-their-babies.aspx">valued or supported</a>. Instead <a href="http://www.dailymail.co.uk/femail/article-2090277/How-I-banished-baby-belly-Celebrity-mums-ping-shape-weeks-easy-real-women-regain-figures-One-mother-shares-diary-.html">weight loss is celebrated</a>, tips on reviving your sex life are published, and the focus is on “getting your life back” post-pregnancy. Celebrities are <a href="http://www.instyle.com/celebrity/celebrity-moms/star-bodies-after-baby">snapped back in their jeans</a> and out partying a week after having a baby. “Normal” mothers meanwhile are <a href="http://www.mirror.co.uk/news/uk-news/mum-left-humiliated-after-being-7945539">ridiculed and criticised</a> for simply trying to feed their hungry baby in public. </p>
<p>The simple truth is that we set women up to fail. Most breastfeeding problems are created by a society that is not breastfeeding friendly: the actions of others are <a href="https://blogs.unicef.org.uk/2016/07/07/removing-barriers-breastfeeding-uk/">responsible for poor breastfeeding rates</a> and the trauma of mothers. And we must change this.</p>
<p>If as a society we encouraged breastfeeding, properly supported women and the government cracked down on the way in which formula is promoted, there might not be this level of problem. </p>
<p>Ultimately if we did all of this then there would be no need to shout about breastfeeding and no need for special events. Because it would just be normal. Just how babies are fed.</p>
<p>In the words of the <a href="https://act.unicef.org.uk/ea-action/action?ea.client.id=375&ea.campaign.id=52979&ea.tracking.id=g8yt4l55">UNICEF Baby Friendly Initiative Call to Action</a>: “It’s time to change the conversation.” We need to keep speaking out about breastfeeding and direct our trauma into action, until everyone who can plays their part in creating a supportive environment for new mothers.</p><img src="https://counter.theconversation.com/content/63550/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC. </span></em></p>Negative breastfeeding experiences can make special drives to encourage it all too painful for some.Amy Brown, Associate professor of child public health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/592462016-05-17T10:04:47Z2016-05-17T10:04:47ZNanoparticles in baby formula: should parents be worried?<figure><img src="https://images.theconversation.com/files/122746/original/image-20160516-15906-1ymu3xg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's in the bottle is good for me, right?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/21524179@N08/3669555322">nerissa's ring</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>There’s a lot of stuff you’d expect to find in baby formula: proteins, carbs, vitamins, essential minerals. But parents probably wouldn’t anticipate finding extremely small, needle-like particles. Yet this is exactly what a team of scientists here at Arizona State University <a href="http://www.foe.org/projects/food-and-technology/nanotechnology/baby-formula">recently discovered</a>.</p>
<p>The research, commissioned and published by Friends of the Earth (<a href="http://www.foe.org/">FoE</a>) – an environmental advocacy group – analyzed six commonly available off-the-shelf baby formulas (liquid and powder) and found nanometer-scale needle-like particles in three of them. The particles were made of hydroxyapatite – a poorly soluble calcium-rich mineral. Manufacturers use it to regulate acidity in some foods, and it’s also available as a dietary supplement.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=596&fit=crop&dpr=1 600w, https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=596&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=596&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=748&fit=crop&dpr=1 754w, https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=748&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/122339/original/image-20160512-5088-12g9emr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=748&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Needle-like particles of hydroxyapatite found in infant formula by ASU researchers.</span>
<span class="attribution"><span class="source">Westerhoff and Schoepf/ASU</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Looking at these particles at super-high magnification, it’s hard not to feel a little anxious about feeding them to a baby. They appear sharp and dangerous – not the sort of thing that has any place around infants. And they are “nanoparticles” – a family of ultra-small particles that have been <a href="http://dx.doi.org/10.1038/444267a">raising safety concerns within the scientific community</a> and elsewhere for some years.</p>
<p>For all these reasons, questions like “should infants be ingesting them?” make a lot of sense. However, as is so often the case, the answers are not quite so straightforward.</p>
<h2>What are these tiny needles?</h2>
<p>Calcium is an essential part of a growing infant’s diet, and is a <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=107.100">legally required component</a> in formula. But not necessarily in the form of hydroxyapatite nanoparticles.</p>
<p>Hydroxyapatite is a tough, durable mineral. It’s naturally made in our bodies as an essential part of bones and teeth – <a href="https://en.wikipedia.org/wiki/Hydroxylapatite">it’s what makes them so strong</a>. So it’s tempting to assume the substance is safe to eat. But just because our bones and teeth are made of the mineral doesn’t automatically make it safe to ingest outright.</p>
<p>The issue here is what the hydroxyapatite in formula might do before it’s digested, dissolved and reconstituted inside babies’ bodies. The size and shape of the particles ingested has a lot to do with how they behave within a living system.</p>
<p>Size and shape can make a difference between <a href="http://www.webmd.com/news/breaking-news/food-additives/20150723/nanoparticles-food-additives">safe and unsafe</a> when it comes to particles in our food. Small particles aren’t necessarily bad. But they can potentially get to parts of our body that larger ones can’t reach. Think through the gut wall, into the bloodstream, and into organs and cells. Ingested nanoscale particles may be able to <a href="http://dx.doi.org/10.1080/02652030701744538">interfere with cells</a> – even beneficial gut microbes – in ways that larger particles don’t.</p>
<p>These possibilities don’t necessarily make nanoparticles harmful. Our bodies are pretty well adapted to handling naturally occurring nanoscale particles – you probably ate some last time you had burnt toast (carbon nanoparticles), or poorly washed vegetables (clay nanoparticles from the soil). And of course, how much of a material we’re exposed to is at least as important as how potentially hazardous it is. </p>
<p>Yet there’s a lot we still don’t know about the safety of intentionally engineered nanoparticles in food. Toxicologists have <a href="http://dx.doi.org/10.1289%2Fehp.7339">started paying close attention to such particles</a>, just in case their tiny size makes them more harmful than otherwise expected.</p>
<p>So where does this leave us with nanoscale hydroxyapatite needles in infant formula?</p>
<h2>What do regulators know about nano-safety?</h2>
<p>Putting particle size to one side for a moment, hydroxyapatite is classified by the US Food and Drug Administration (FDA) as “Generally Regarded As Safe.” That means it considers the material safe for use in food products – at least in a non-nano form. However, <a href="http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ucm300661.htm">the agency has raised concerns</a> that nanoscale versions of food ingredients may not be as safe as their larger counterparts. </p>
<p>Some manufacturers may be interested in the potential benefits of “nanosizing” – such as increasing the uptake of vitamins and minerals, or altering the physical, textural and sensory properties of foods. But because decreasing particle size may also affect product safety, the FDA indicates that intentionally nanosizing already regulated food ingredients could require regulatory reevaluation.</p>
<p>In other words, even though non-nanoscale hydroxyapatite is “Generally Regarded As Safe,” according to the FDA, the safety of any nanoscale form of the substance would need to be reevaluated before being added to food products.</p>
<p>Despite this size-safety relationship, the FDA confirmed to me that the agency is unaware of <em>any</em> food substance intentionally engineered at the nanoscale that has enough generally available safety data to determine it should be “Generally Regarded As Safe.”</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=597&fit=crop&dpr=1 600w, https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=597&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=597&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=751&fit=crop&dpr=1 754w, https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=751&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/122057/original/image-20160511-18165-nr0qig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=751&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hydroxyapatite nanoparticles may have different health effects from larger versions of the mineral.</span>
<span class="attribution"><span class="source">Westerhoff and Schoepf/ASU</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Casting further uncertainty on the use of nanoscale hydroxyapatite in food, a 2015 report from the European Scientific Committee on Consumer Safety (SCCS) suggests there <a href="http://ec.europa.eu/health/scientific_committees/consumer_safety/docs/sccs_o_191.pdf">may be some cause for concern</a> when it comes to this particular nanomaterial. </p>
<p>Prompted by the use of nanoscale hydroxyapatite in dental products to strengthen teeth (which they consider “cosmetic products”), the SCCS reviewed published research on the material’s potential to cause harm. Their conclusion?</p>
<blockquote>
<p>The available information indicates that nano-hydroxyapatite in needle-shaped form is of concern in relation to potential toxicity. Therefore, needle-shaped nano-hydroxyapatite should not be used in cosmetic products.</p>
</blockquote>
<p>This recommendation was based on a handful of studies, none of which involved exposing people to the substance. Researchers injected hydroxyapatite needles directly into the bloodstream of rats. Others exposed cells outside the body to the material and observed the effects. In each case, there were tantalizing hints that the small particles interfered in some way with normal biological functions. But the results were insufficient to indicate whether the effects were meaningful in people.</p>
<p>Importantly, these studies didn’t consider what happens when particles like this end up in the digestive system, including the stomach.</p>
<h2>So what happens when a baby eats them?</h2>
<p>The good news is that, according to preliminary studies from ASU researchers, hydroxyapatite needles don’t last long in the digestive system.</p>
<p>This research is still being reviewed for publication. But early indications are that as soon as the needle-like nanoparticles hit the highly acidic fluid in the stomach, they begin to dissolve. So fast in fact, that by the time they leave the stomach – an exceedingly hostile environment – they are no longer the nanoparticles they started out as.</p>
<p>These findings make sense since we know hydroxyapatite dissolves in acids, and small particles typically dissolve faster than larger ones. So maybe nanoscale hydroxyapatite needles in food are safer than they sound.</p>
<p>This doesn’t mean that the nano-needles are completely off the hook, as some of them may get past the stomach intact and reach more vulnerable parts of the gut. But the findings do suggest these ultra-small needle-like particles could be an effective source of dietary calcium – possibly more so than larger or less needle-like particles that may not dissolve as quickly.</p>
<p>Intriguingly, recent research has indicated that calcium phosphate nanoparticles form naturally in our stomachs and go on to be <a href="http://doi.org/10.1038/nnano.2015.19">an important part of our immune system</a>. It’s possible that rapidly dissolving hydroxyapatite nano-needles are actually a boon, providing raw material for these natural and essential nanoparticles.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/122747/original/image-20160516-15926-1q2xeo4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The formula’s safe, but begs other questions.</span>
<span class="attribution"><span class="source">Andrew Maynard</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Tempest in a baby bottle</h2>
<p>And yet, even if these needle-like hydroxyapatite nanoparticles in infant formula are ultimately a good thing, the FoE report raises a number of unresolved questions. Did the manufacturers knowingly add the nanoparticles to their products? How are they and the FDA ensuring the products’ safety? Do consumers have a right to know when they’re feeding their babies nanoparticles?</p>
<p>Whether the manufacturers knowingly added these particles to their formula is not clear. At this point, it’s not even clear why they might have been added, as hydroxyapatite does not appear to be a substantial source of calcium in most formula. (Calcium in formula can come from a number of sources, including milk solids, calcium carbonate and calcium chloride.) If the nanoparticles’ inclusion was intentional, though, current FDA guidelines suggest that the regulator wouldn’t consider the material safe by default, and should be subject to further evaluation.</p>
<p>Certainly, from the data presented, these particles – so uniform in size and shape – look like they were intentionally manufactured to be nanoscale and needle-like. It’s possible they were supplied to the various manufacturers without any indication of their “nano-ness.” This doesn’t absolve the manufacturers of responsibility. But it does suggest that greater scrutiny and accountability is needed in the supply chain for food ingredients.</p>
<p>And regardless of the benefits and risks of nanoparticles in infant formula, parents have a right to know what’s in the products they’re feeding their children. In Europe, food ingredients must be <a href="http://ec.europa.eu/food/safety/docs/labelling_legislation_infographic_food_labelling_rules_2014_en.pdf">legally labeled if they are nanoscale</a>. In the U.S., there is no such requirement, leaving American parents to feel somewhat left in the dark by producers, the FDA and policy makers.</p>
<p>Given the state of science on nanoscale hydroxyapatite in foods, this is as much an issue of trust as it is safety. The FoE report may exaggerate the possible risks, and raise concerns where few are justified. Yet it’s hard to avoid the reality that, if manufacturers are adding nanoparticles to what we feed our children, we need to know more about how to ensure their safety and benefits. How else can we enable informed decisions? </p>
<p>Luckily, current research suggests hydroxyapatite nanoparticles in formula are most likely safe, and arguably, even beneficial. But given how high the stakes are, safety here should not, and indeed cannot, be taken for granted.</p><img src="https://counter.theconversation.com/content/59246/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Andrew Maynard receives funding support from the Center for Research on Ingredients Risk (CRIS) at Michigan State University. He is also on the Board of Trustees of the International Life Sciences Association North America. He was an independent reviewer on the Friends of the Earth report on nanoparticles in infant formula</span></em></p>Microscopic needle-like particles don’t seem like something you’d want to feed a baby. Whether safe or not, the way we deal with nanoscale food additives leaves plenty of other questions.Andrew Maynard, Director, Risk Innovation Lab, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/519032015-12-10T01:36:08Z2015-12-10T01:36:08ZDon’t stress about the shortage, toddlers don’t need formula<p>With Chinese exporters emptying supermarket shelves of toddler formula and an accompanying <a href="http://www.dailytelegraph.com.au/news/nsw/baby-formula-raiders-empty-supermarket-shelves-to-cash-in-on-demand-from-china/story-fni0cx12-1227635815687">increase</a> in the price, parents who rely on these products are expressing alarm. </p>
<p>Discussion has focused on why formula is being sent to China. However, the greater question of why so many Australian parents are buying toddler formula at all has been largely ignored.</p>
<p>Health authorities in <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n56_infant_feeding_guidelines.pdf">Australia</a> and <a href="http://www.efsa.europa.eu/sites/default/files/scientific_output/files/main_documents/3408.pdf">across</a> the <a href="http://www.dailymail.co.uk/news/article-3347932/Are-parents-conned-Doctor-claims-babies-DON-T-need-follow-formulas-simply-waste-money.html">world</a> have unequivocally decried toddler formula as unnecessary. Just this week, the <a href="http://www.phaa.net.au/advocacy-policy/media-releases/media-releases">Public Health Association of Australia</a> again urged pharmacists, GPs and nurses to inform parents that these products are a waste of money. </p>
<p>But it seems health authorities and professionals are losing this battle. Growth in toddler formula sales is <a href="http://croakey.org/driving-demand-for-baby-milk-the-australian-competition-and-consumers-commissions-gift-to-industry-marketing/">unrelenting</a>.</p>
<h2>What is toddler formula?</h2>
<p>Toddler formula is a modified milk that is marketed as suitable for children 12 months and older. It is made from powdered cows’ milk to which fat, vitamins and minerals <a href="http://www.firststepsnutrition.org/pdfs/infant_milks_june13.pdf">are added</a>. But processing also reduces some nutrient levels – for example, most toddler formulas contain <a href="http://www.firststepsnutrition.org/pdfs/infant_milks_june13.pdf">less calcium than whole cows’ milk</a>. </p>
<p>There is no regulation of the composition of toddler formula, so products vary in what they contain. What <em>is</em> common to all toddler formula is the <a href="http://www.efsa.europa.eu/sites/default/files/scientific_output/files/main_documents/3408.pdf">lack of evidence that the product is of any benefit</a>. </p>
<h2>Why such demand, then?</h2>
<p>Toddler formulas did not exist until relatively recently. And the evidence is that they were created, not as a product intended to be profitable in itself, but as a sneaky way of <a href="http://ro.uow.edu.au/cgi/viewcontent.cgi?article=2228&context=hbspapers">circumventing restrictions</a> on the marketing of infant formula. </p>
<p>Decades ago it was identified that aggressive marketing of infant formula was causing sickness and even <a href="http://www.nytimes.com/1981/12/06/magazine/the-controversy-over-infant-formula.html?pagewanted=all">death of babies</a>. The international community agreed that infant formula marketing should be <a href="http://www.who.int/nutrition/publications/code_english.pdf">restricted</a>. </p>
<p>However, national definitions of infant formula varied. In some countries, it included only milk products for babies up to <a href="http://www.unicef.org.uk/Documents/Baby_Friendly/Statements/feedingreport.pdf">six months of age</a>. In others (including <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-brfeed-maif_agreement.htm">Australia</a>) all formula for babies up to one year of age met the legal definition and was restricted in marketing.</p>
<p>Formula manufacturers’ reaction was simply to create new products that were outside the restricted age range (whatever that was). And so toddler formula was born. </p>
<p>Toddler formula was identically packaged and branded and used the same health, nutrition and other benefit claims that were used on infant formula products. Parents understand toddler formula advertising to be <a href="http://www.ncbi.nlm.nih.gov/pubmed/20443436">advertising infant formula</a>. And so companies continue to market infant formula with impunity, using toddler formula as a trojan horse.</p>
<p>But the companies enjoyed an unexpected benefit from creating toddler formulas. They became profitable in their own right. </p>
<p>Powdered milk is an abundant and inexpensive commodity. By adding a few cents worth of fats, vitamins and minerals, cheap powdered milk could be presented to parents as “Premium”, “Pro”, “Gold+”, “Organic” or even “Platinum”. This turned a product that might otherwise sell for A$7 a kilogram into something that retails for <a href="https://www.woolworths.com.au/Shop/SpecialsGroups/catalogue">A$19-28 a kilogram</a>. </p>
<p>Anyone who knows a toddler, knows they are fussy eaters. Dietary guidelines are complex and not always easy to follow. Toddler formula advertising <a href="https://www.youtube.com/watch?v=Xt4J0Km9zuo">articulates and amplifies</a> parents’ reasonable concerns about their child’s health, then offers an expensive solution to their anxiety. </p>
<p>Advertising offers “peace of mind” by claiming to provide a simple, effective way to be sure children’s nutritional needs are fully met. However, consuming toddler formula in the volumes recommended on the package is likely to discourage children from eating the very foods that will ensure they are properly nourished (because <a href="https://www.choice.com.au/shopping/packaging-labelling-and-advertising/advertising/articles/marketing-of-childrens-products">it fills up</a> their tummies).</p>
<p>As a result, parents will often notice that “my child won’t eat”. That increases their anxiety, creating a dependence on the very product that discourages their children from eating a variety of foods.</p>
<h2>Nutrients after 12 months</h2>
<p>One question parents sometimes ask is why it is recommended children be breastfed <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n56_infant_feeding_guidelines.pdf">past their first birthday</a> and up to or <a href="http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/">beyond two years of age</a> but it is only recommended that children be formula fed until the age of one. </p>
<p>The answer comes down to the difference between what breastmilk and infant formula contain. Breastmilk is a complex human tissue providing not just protein, carbohydrate, fats, vitamins and minerals but a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/">variety of growth and immune factors</a>. Infant formula contains a broad approximation of the major nutritional components of breastmilk but lacks the growth and immune factors of breastmilk. </p>
<p>Children who are breastfeeding beyond a year continue to obtain natural growth and immune support from breastmilk. In contrast, formula milk (including toddler formula) confers no nutritional or health benefit to children over a year old, beyond that provided by a diet of normal healthy foods, including ordinary, fresh, cheap, cows’ milk.</p>
<p>So the solution to the shortage of toddler formula in Australian supermarkets is to resist the power of advertising to part you with your money. Keep breastfeeding if you’ve been breastfeeding, or switch to fresh cows’ milk if you’ve been formula feeding. Avoid offering toddlers foods that are high in calories and low in nutrients (like fruit juice, biscuits and processed snack foods) so that they develop an appetite for nutritious foods. And relax!</p><img src="https://counter.theconversation.com/content/51903/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Discussion has been rife on why toddler formula is being sent to China, causing shortages here, but the greater question of why so many Australian parents buy it at all has been largely ignored.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityNina Jane Chad, Post-doctoral Research Associate, Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.