In the past few weeks the European Food Safety Authority, the EFSA, has updated recommended intake levels of energy, macronutrients and micronutrients in infant and follow-on formulae. The proposed amounts for fat and carbohydrate do not differ significantly from those in the current regulations. However, the panel proposes that the maximum for protein be reduced from 3g/100 kcal in infant formula and 3.5g/100 kcal in follow-on formula to 2.5g/100kcal in formulae (infant and follow-on) based on milk protein, and to 2.8g/100kcal in formulae (infant and follow- on) containing isolated soy protein or hydrolysed protein. The organisation says that its experts considered there to be no evidence of a physiological need for such high protein intakes and because current protein intakes are well above requirements (www.efsa.europa.eu).
Other key findings were that:
Whether or not these proposed recommendations influence the formulations available on the market and their use is yet to be seen, but is something that pharmacists will want to keep aware of. This is an important and complex area for advice and one that pharmacy teams should regularly revisit for training.
Feeding infants and babies is a subject that can create much debate and confusion among parents and wider society. For example, Breast Feeding Awareness Week this year coincided with a series of stories in the national media about women being ‘shamed’ for breast feeding their babies in public. Breastfeeding flash mobs of mothers were organised in retaliation.
It is clear that it’s a topic that engenders strong opinion – whether that be concerning breastfeeding or feeding with infant formula. Parents may feel that have conflicting opinions to evaluate when deciding whether or not to breastfeed their new baby, and parents certainly need excellent advice on all aspects of infant health and infant feeding. Community pharmacies are in a good position to offer unbiased advice, expert and detailed information about infant feeding at this crucial time.
With such an important topic, where can pharmacists and their teams get their information from in order to be fully up to date about this category? Speaking to P3, co-ordinator for the National Breastfeeding Programme for Wales, Sally Tudstone, recommends a new Infant feeding e-learning package for pharmacies that has recently been developed by the Continuing Education for Pharmacists team at Cardiff University. The pack covers all aspects of infant feeding from breast to formula, through to starting solids, and is available by registering on the Wales Centre of Pharmacy Professional Education website (www.wcppe.org.uk).
Wendy Jones, a pharmacist specialising in breastfeeding and a registered supporter and trainer at Glasgow-based charity The Breastfeeding Network, helped develop the materials, along with impartial information from First Steps Nutrition, an independent organisation that collates information about formula milk and early nutrition.
Debra Roberts, head of programme development at Cardiff school of pharmacy says, ‘The programme will provide users with an overview of breastfeeding, infant formulas and starting solid foods, as well as how to deal with common problems associated with infant feeding, including the safe use of medicines for breastfeeding mothers.’
The Pharmacy Guide to Infant Feeding, produced by Training Matters magazine, has recently been distributed to pharmacies. Parents are given so much advice about caring for their baby that they are become confused or simply miss things that are said. The guide is designed to give pharmacists and support staff information on all aspects of infant feeding from breast vs bottle to fussy eaters. It also focuses on the importance of understanding customers’ needs and how to advise them appropriately, confidently and sensitively. The guide is available free to pharmacies by calling 020 7434 1530.
Data from market analysts suggests that while the infant feeding total market is stable at £372 million, the market in pharmacy (excluding Boots and Superdrug) has declined by 6.4 per cent in the past 12 months (to 14 June 2014).
Pharmacist Pallavi Dawda of Masons Chemists in Coalville says, ‘We stopped stocking standard baby foods several years ago when the demand dropped. More and more parents are turning to their health visitor or GP so as more infant feeding issues become medicalised, this category is going to continue to be challenging for many pharmacies.’
And pharmacist Bina Patel of Kalsons Chemists, Essex, also describes the challenge in the category, ‘We have supermarkets close by so infant feeding is not an important category for us. We find that customers come in to the pharmacy for advice and support but they won’t purchase the products from us because we are expensive compared to the supermarkets.’
So, what news is there from the brands in the category that pharmacies can use to boost their share and encourage new parents into the pharmacy as a result?
Mark Bentley, category marketing manager for Danone Nutricia Early Life Nutrition UK, responsible for Cow & Gate and Aptamil, does feel that community pharmacy faces some challenges when it comes to the infant feeding category, but community pharmacy can compete with supermarkets and large retailers’ buying power, he believes. ‘The opportunity is there for pharmacies that are willing to advertise their services to the local community, and by adopting a proactive approach it is possible to increase footfall and encourage more mums to visit their local pharmacy.’
He has positive news. A recent initiative in test pharmacies resulted in an impressive 65 per cent increase in babycare sales. Staff were trained in infant nutrition and feeding problems and advertised a local Baby Advice service, which was successful in attracting customers. According to Mr Bentley, ‘This demonstrates that pharmacy can compete in the baby category, by playing to its strengths and combining training with the right range and communicating the service that it can offer to customers.’
It can also be hard to raise awareness of specialist products, he says. ‘We know from speaking to parents and healthcare professionals that specialist milks can have real benefits, offering a dietary solution to feeding problems for bottlefed babies instead of medicalising them...changing from standard formula milk to a specialist formula – after consultation with a pharmacist or other healthcare professional – is an easy change to make, and there is strong evidence to show that specialist formula milks are an effective solution.’
The Aptamil Professional Expert Advice programme is designed to equip pharmacy staff with everything they need to support customers looking for advice about infant nutrition, and Danone has developed an e-learning programme suitable for pharmacists and technicians along with training materials specifically for pharmacy assistants, available at: aptamilprofessional.co.uk/pharmacy.
Sarah Mills, nutritionist for Danone Nutricia Early Life Nutrition, comments on recent Which? articles that questioned differences between the products offered by the available infant formula brands. ‘There are clear variations between the infant formula brands in terms of added ingredients over and above the required basic nutritional composition of infant formula and follow-on milk. Ingredients such as oligosaccharides, nucleotides and increased levels of long chain polyunsaturated fatty acids (LCPs) are added to some formulas for their functional benefits based on research. For example, Aptamil Pronutra+ contains a unique blend of ingredients, including a patented blend of galacto- and fructo-oligosaccharides (GOS/FOS), shown to reduce the risk of allergies up to five years. In addition, the European Food Safety Authority (EFSA) scientific panel have approved a health claim regarding the level of omega-3 LCPs in Aptamil Pronutra+ to support normal visual development. This highlights the large amount of robust evidence behind the benefits they can bring to the visual system.’
A new online resource offers the UK’s first, evidence-based MAP Guideline (Milk Allergy in Primary Care) specifically to diagnose and manage cow’s milk allergy in primary care, from www.cowsmilkallergyguidelines.co.uk. Only three per cent of GPs say they are confident in diagnosing the condition, says Dr Jo Walsh, a GP and member of the independent expert group that developed the guidance. Cow’s milk allergy is the most common food allergy among infants and young children, says the advice, affecting 1.9 to 4.9 per cent of children, usually presenting in the first months of life with symptoms of reflux, colic and eczema. Most children will grow out of this around the age of one to three years of age. It can occur in breastfed or formula-fed infants.
A EU directive and UK regulations on infant and follow-on formula were updated earlier this year to include goat milk for use in infant formulae. Goat’s milk can be gentler on an immature digestive system for babies intolerant of cow’s milk, suggests Claire MaGee, managing director of goat milk brand Nannycare. The brand is working with wholesalers to raise awareness of goat milk formula. ‘Now that Nannycare is recognised as a nutritionally complete breast milk substitute this marks a new era in infant feeding,’ comments Ms MaGee.
The opportunity is in understanding what specialist products parents can't purchase at the supermarket.
Bina Patel, Kalsons Chemists, Essex ‘Improving over the counter sales in this category is about understanding what is available and being able to suggest specialist products that a parent might not be able to get at the supermarket. You have to be alert to what your patients’ needs are. For example, if a baby has diarrhoea, you need to find out if the mum is breastfeeding and, if so, what did the mum eat, because this will have an impact on the baby. If a mum is breastfeeding we find that they will often come in when the pharmacy is less busy to ask us about concerns around combining being on the pill or taking emergency hormonal contraception with breastfeeding, among other issues. We offer general advice to parents on how to administer medication with feeds and not to put it in the bottle.’
Pallavi Dawda, Masons Chemists, Coalville ‘This category has declined significantly over recent years as parents turn increasingly towards supermarkets for infant feeding products. We stock a limited range of non-standard products, such as specialist anti-colic bottles and milks, along with feeds for special situations such as a baby with a food allergy or intolerance. Most of the advice we give to customers on this area focuses around feeding issues, such as reflux or colic, and it is often linked to the prescription business rather than an over the counter purchase. The challenge with this category for us is the viability.’
Nemesh Patel, pharmacy manager at AMG Pharmacy, Braintree, Essex ‘Being able to give informed advice on feeding issues and colic can set your pharmacy aside from the competition, so product training is vital. The competition to gain share in this category appears to be increasing, so pharmacists need to ensure their teams are on hand to provide specialist advice that many of the supermarkets fail to provide through self-selection. I frequently recommend Aptamil Comfort Milk to parents who are experiencing colic and constipation issues and Aptamil First Infant Milk for combination feeding or pure breastfed babies. I would suggest merchandising child and baby-care products near the door to facilitate access for parents with pushchairs. Merchandising by brand and infant size and age will also aid quick selection for busy parents.’