The pregnancy, baby care and infant feeding sectors are booming, but with contradictory information in the media, parents are often left confused. Fortunately, community pharmacy can support and advise appropriately to inspire lasting confidence.
Women in the early stages of pregnancy should be given lifestyle advice, including on quitting smoking, and the implications of recreational drug use and alcohol consumption. From July 2019 pregnant women have been offered specialist stop smoking referrals to reduce the number of stillbirths, with electronic carbon monoxide tests at antenatal appointments. Expectant mums who smoke or who have recently quit will also be offered specialist support throughout their pregnancy.
E-cigarettes are thought to be significantly less harmful than cigarettes, although very little research exists on their safety during pregnancy. Advice from the Smoking in Pregnancy Challenge Group, endorsed by the Royal Colleges of Midwives, Nursing, Obstetricians & Gynaecologists and Paediatrics & Child Health, is that while products such as nicotine patches, gum and inhalers are the recommended option, “if a pregnant woman chooses to use an e-cigarette, and if that helps her to quit smoking and stay smoke free, she should be supported to do so”.
Pharmacists can advise pregnant women managing a long-term condition such as diabetes, asthma or epilepsy that requires continuous medication on the safety of their medication, if they are concerned. The Best Use of Medicines in Pregnancy leaflet and index (available from medicinesinpregnancy.org) can be a useful reference tool.
Pharmacy staff can refer women who might be on a low income, or under 18, to Healthy Start (healthystart.nhs.uk) for vitamins and infant formula, if needed after the birth. The current recommendation for vitamin D supplementation is 10 micrograms daily for pregnant or breastfeeding women. Babies from birth to one year who are being breastfed should also be given a daily supplement containing 8.5 to 10 micrograms.
“There are simple things expectant mothers can do from the moment they start planning a baby that can help them to have a happy, healthy pregnancy,” says Preconceive brand manager Samantha George. “Five to 10 per cent of babies in the UK are born with spina bifida [Most have a mild - closed - form in which there is a tiny gap between the vertebrae of the spine], and NHS guidelines highlight that taking 400 micrograms folic acid daily will help to reduce the chance of neural tube birth defects.”
Women trying for a baby are advised to take folic acid as soon as they start planning to get pregnant, and should continue until the end of the third month of pregnancy. Many mothers are unaware of this and take supplements only once they have conceived. “When stocking folic acid supplements such as Preconceive, pharmacists should look to dual-site alongside ovulation kits,” says Ms George. “We recommend community pharmacists stock Preconceive to help address the NHS folic acid recommendations.”
First trimester (0 to 13 weeks)
The first trimester can trigger symptoms such as:
Vomiting and/or nausea affects about 80 per cent of women, but should ease off by week 20. According to NICE guidelines, pharmacy staff should recommend ginger, P6 (wrist) acupressure or antihistamines if nausea is a serious problem.
Second trimester (14 to 26 weeks)
During the second trimester many women find that the effects of early pregnancy disappear, although some women experience:
If heartburn persists after lifestyle changes and diet modification, antacids may be offered. NICE recommends women with pregnancy-related constipation try diet changes, including bran or wheat fibre supplementation.
“Muscular back pain affects many women at some time during their pregnancy,” says Wendy George, brand manager at The Mentholatum Company. “ A Cochrane Review found it can affect more than two-thirds of mums-to-be, while research carried out on behalf of Deep Freeze puts the figure at 98 per cent.”
Third trimester (27 to 40 weeks)
Some of the physical symptoms during this period include:
Diet modification is the first option for haemorrhoids, but if symptoms remain troublesome, standard haemorrhoid creams should be considered. Compression stockings can improve the symptoms of varicose veins, but will not prevent them.
“A lack of joined-up information from dentists, doctors or health visitors means many parents are at a loss as to how they can and should look after a baby’s oral welfare, which is why the pharmacist has a key healthcare role to play in the community,” says Marian Greally of Brush-Baby. Brush-Baby produces a free leaflet, You And Your Baby’s Dental Health, which is also distributed via dentists to expectant mums.
“Brush-Baby is the only range that caters for every dental developmental stage of a baby through to the first set of teeth,” says Ms Greally.
Pharmacies can help with mild eczema management and can even offer a dermatology review to help parents monitor their child’s eczema. A survey carried out by Epaderm indicates that parents need more advice about emollients. Some 57 per cent want more information on how to manage their child’s eczema and 74 per cent need to know about using emollients. Sixty per cent of parents who took part in the Epaderm survey found that monitoring their child’s skin improved their eczema.
“Weleda Calendula Baby Oil is celebrating its 60th anniversary this year, so it’s a great time to be stocking this product as there will be quite a bit of media coverage over the next few months,” says communications director Susie Fairgrieve. Weleda’s PET bottles will soon be made from 100 per cent recycled plastic.
“At any one time, one in three babies will have nappy rash and with changes in guidance for CCGs, more parents are likely to seek pharmacy advice about management,” says Amy Barker, Metanium brand manager. “Metanium Nappy Rash Ointment is one of the few products licensed to treat the condition.” She suggests pharmacists may find it useful to advise on nappy rash prevention if a parent asks for advice about any of the following conditions known to be triggers: diarrhoea, teething, colds, antibiotic use, baby first sleeping through the night, weaning or change in diet. In terms of promotional support for the range, there has been considerable investment in a digitally focused campaign, as well as sampling to parents.
Snufflebabe will launch new vapour bath bubbles this autumn, ready for cold and flu season. It is formulated to be hypoallergenic and is suitable for babies over three months.
The next six months will be important for the infant feeding category. Legislation is due to be introduced in February 2020 that will affect all infant formula, follow-on formula and infant food for special medical purposes. “We welcome the new legislation as it enhances existing regulation across the industry and reflects the latest scientific advances in nutrition while also allowing manufacturers to continue to innovate and update products in line with research,” says Zoë-Marie Ellis, senior science and innovation manager, Danone Nutricia Early Life Nutrition.
The new rules will update composition criteria and permitted claims for infant formula, so pharmacists and parents may notice changes to product labels and formulations over the next few months. Sign up to the Danone newsletter at eln.nutricia.co.uk for more information.
What are the main health benefits of breastfeeding? It provides colostrum, which lines the baby’s gut and provides a range of immune factors, plus enzymes, hormones and growth factors. Breastfeeding is estimated to reduce the risk of sudden infant death syndrome by 50 per cent after one month and 36 per cent in the first year.
Are there any medicines that are safe to use while breastfeeding? Manufacturers are cautious when it comes to use in pregnancy, so few will say that their products are completely safe for babies while mothers are breastfeeding. However, every case should be considered individually. The UK Drugs in Lactation Advisory Service website (www.sps.nhs.uk/articles/ukdilas/) has links to general guidance and evidence summaries, as well as contact details for health professionals.
When can I introduce cow’s milk? Cow’s milk with foods such as cereals can be added from six months, but it is not recommended as a main drink until babies reach one year old.
How can I reduce the risk of allergies? Breastfeeding exclusively for at least six months is the best option.
Although most UK mums try breastfeeding, after six to eight weeks only four in 10 are still exclusively breastfeeding despite advice that it’s recommended for the first six months.
At about six months the process of weaning onto solid foods can begin, if the child is ready. Parents may ask pharmacy staff for advice and they should be advised that fruit, vegetables and non-wheat cereals are the best foods for first weaning. Parents should also be advised that from six months onwards, infants receiving breast milk as their main drink should be given a liquid supplement with vitamins A, C and D.
Earlier this year, Cow & Gate launched its First Spoons range with two single-vegetable jars designed to kickstart weaning. Jars come in two flavours – carrot and peas – and use natural, steam-cooked vegetables with no artificial preservatives or colouring. “We developed this new range to support parents in giving their little ones the best possible start in life, by helping them learn to love veggies early, as we know that this increases the chances that they’ll develop healthier eating preferences as they grow up,” says marketing director Sandra Eglau.
The UK Government has challenged businesses to improve the nutritional content of commercial baby food and drinks, ostensibly in a bid to reduce childhood obesity. Public Health England is expected to publish guidelines for the infant feeding industry in early 2020, and progress will be monitored.
According to the Advancing Our Health: Prevention in the 2020s document, “if insufficient progress is made, the Government will consider other levers. PHE will also explore including baby food within the popular Change4Life Food Scanner app to help parents and carers make healthier choices for their infants.”
Perhaps with this in mind, Cow & Gate has also overhauled its cereals portfolio for stages one and two of the weaning journey to include eight new and improved recipes, with a 45 per cent reduction in naturally occurring sugar across the range. As part of the overhaul, the brand has also introduced resealable packaging in response to feedback from parents.
“The piece of nutritional advice pharmacists should provide to mothers first and foremost is that breast milk is the best source of nutrition for infants and they should encourage them to breastfeed if they are able,” says Ms Ellis. “But if mums are unable to breastfeed or choose to move to formula milk, it’s important they understand which formula will best suit their baby’s needs.
“For formula-fed infants, specialist milks containing specific ingredients could help with the dietary management of the signs and symptoms of functional GI disorders. Specialist milks should only be used under medical supervision, on the advice of a healthcare professional responsible for maternal and childcare.”
Danone believes that well-informed pharmacists play a key role in supporting parents, and the brand aims to provide meaningful education to healthcare professionals around the UK. “We feel we have a mutual responsibility to share what we know about the importance of early life nutrition and we are privileged to be in that position,” says Ms Ellis. To support pharmacy, Danone has a range of case studies, tools and education available on its UK healthcare professionals website, including CPD-accredited e-learning modules that were launched in February 2019.
According to Nannycare, the brand’s goats milk formula provides a possible solution for parents seeking advice on unsettled babies or looking for an alternative to standard cow’s milk formula. The brand’s advice to pharmacy is: “Nannycare products sit well with the pharmacist’s role as a provider of healthcare advice and strengthen their point of difference in being able to deliver a more personalised service. Pharmacists and pharmacy assistants could take a proactive role in advising parents about different types of formula milk. This can be effective when building relationships, which can encourage repeat and cross-category purchases.”
• Colic - symptoms include prolonged bouts of crying in the evenings, while drawing up knees, clenching fists or arching the back.
• Croup – croup causes a barking cough, fever and raspy breathing. In most cases, steam inhalation can help, but if there are breathing difficulties, parents should seek urgent medical advice.
• Cradle cap – characterised by yellow, greasy scales, which can be treated with baby washes or oils. Flakes should be left to fall off naturally.
• Ear infections – often make babies irritable, rub their ears and lose their appetite. Infant liquid paracetamol or ibuprofen can help relieve pain.
• Nappy rash – appears as red spots or patches around the nappy area and is caused by irritation from contact with urine and faeces. Changing nappies more often may help, along with keeping the area clean and treating with a barrier or medicated cream.
• Sticky eyes – common in newborn babies as their tear ducts are still developing, it usually resolves by itself. Parents should be advised to keep the eye area clean.
• Teething pain – usually starts at about four months and can cause red, hot cheeks, dribbling, loss of appetite, irritability and the urge to chew. There are gels that may help along with aids such as teething rings.
Day Lewis, London SW1
Well Pharmacy, Birmingham
Shaftesbury Pharmacy, Harrow
|“For us, pregnancy is a more important category than baby care. We sell a lot of pregnancy tests, vitamins and supplements. We sell medication for babies, but we don’t stock nappies, wipes or formula. Queries are mainly about colic. For pregnancy, women want to know which vitamins they should be taking. We sell a lot of Wild Nutrition and Equi London supplements. For babies, best sellers include Woodward’s Gripe Water and Infacol. We give out educational leaflets to mums when they buy pregnancy vitamins. It’s important to stock different formulations of vitamins.”||“The most common question we get asked is: ‘Is this safe to take if I’m pregnant?’ Vitamins are popular so it is important to check these are suitable. The biggest opportunity to grow this category is to stock a range of products, such as baby milk, bottles, nappies – items that can be purchased all in one place. It’s important to have an understanding of baby care and pregnancy and to have access to up-to-date information as this will build trust. Customers will then return and it can be the beginning of a great customer/pharmacy relationship.”||“Pregnancy has become an important category as GPs now advise women to come to us for folic acid supplements. There are lots of multivitamins, so they need reassurance they are taking what they need in the right strength. For babies, common queries include colic, nappy rash, and multivitamin drops. Baby care takes up a large area in our pharmacy. Customers want trusted brands although there aren’t many generic alternatives anyway. As parents and pregnant women are being directed to their local pharmacy by health professionals, it’s important to keep up to date.”|