Prepare for a healthy start
Exclusive breastfeeding is recommended for the first six months of a baby’s life, but the UK has some of the lowest breastfeeding rates among high income countries, with just 44 per cent of mothers still breastfeeding at six to eight weeks. This year’s National Breastfeeding Week, from 27 June to 3 July, focused on “Everyone has a part to play in helping mums to breastfeed” – from partners and the wider family to communities, health and education services and workplaces.
In July, an exploration of the delivery of breastfeeding support in England and Wales since 2015, published by The Breastfeeding Network and Cardiff University, found that most UK mothers stop breastfeeding before they plan to, switching to formula feeding instead. Repeated surveys have indicated that many don’t experience supportive postnatal care to help with baby feeding, particularly breastfeeding.
Challenges commonly associated with breastfeeding include colic, milk supply, reflux, sore nipples and tongue-tie, and pharmacy teams are often the first port of call for advice.
Better Health Start for Life Breastfeeding, the Office for Health Improvement and Disparities (OHID)’s breastfeeding marketing programme, offers a suite of digital and hard copy support tools to assist new parents through their first weeks of breastfeeding and beyond. Support may also be available from a local breastfeeding support group or the National Breastfeeding helpline (0300 100 0212). The NHS-approved Breastfeeding Friend from Start for Life is a digital app that provides 24/7 expert advice.
“Independent pharmacies are caring and motivated by listening and passing on valuable knowledge and product recommendations to enable customers to take the best care of themselves and get better quickly,” says Ruth Giles, senior brand manager for Care at Thornton & Ross. “Following the pandemic, the role of local health advisors has never been more important – pharmacists can play a vital role when it comes to supporting pregnant women and the parents of young children, sparking the beginning of a lasting relationship between teams and customers.”
Not all parents can or choose to breastfeed. The First Steps Nutrition Trust is concerned that infant formula prices may become unaffordable for many parents, especially with the cost-of-living crisis. Baby milk sales have grown in value by 8.6 per cent over the last year, while volumes have only grown by 6.7 per cent.
The Grocer published its Infant and Childcare 2022 report in June, focusing on the ongoing inappropriate marketing of formula milks by the industry. According to the First Steps Nutrition Trust, stronger regulations are needed to protect parents and babies from misleading marketing, alongside meaningful enforcement of compliance with the regulations.
For those who do choose to use formula milk, it’s important that healthcare professionals are able to advise on the most appropriate formula for each baby, as well as the most cost-effective products.
A First Steps Nutrition Trust report published in April this year revealed that starter packs of first infant formula (as 70ml or 90ml bottles) are extremely expensive, when compared to powdered infant milks. Ready-to-feed milks in Tetra Pak cartons or plastic bottles may be a useful option when parents are out and about or travelling, but are also expensive to use regularly.
When to wean
Weaning is a key milestone within a child’s first 1,001 critical days, influencing their eating habits and health later in life. Official NHS advice recommends that solid food should be introduced when a baby is around six months old, alongside breast milk or formula milk.
Three signs indicate that a baby is ready for weaning: staying in a sitting position, holding their head steady; coordinating their eyes, hands and mouth so they can look at food, pick it up and put it in their mouth; and swallowing food, rather than pushing it back out of their mouth. However, there is still a lot of confusion among parents.
In March this year, research led by the OHID found that 40 per cent of first-time parents introduced solid food before their babies were five months of age, and almost two-thirds said they had received conflicting advice on what age to start weaning.
The Better Health Start for Life Weaning campaign from the OHID includes an online Start for Life Weaning Hub, featuring tips, advice and guidelines from the NHS, including healthy and easy-to-prepare recipes and meal ideas.
Oral care in babies and young children shouldn’t be overlooked when discussing weaning with parents. In July, the British Dental Association called for action on the high levels of sugar in many popular brands of baby food pouches. Contents are often sucked directly from the pouch, ensuring the food spends more time in contact with baby teeth, just as they are erupting and putting teeth at risk of erosion and decay.
“Pregnancy and parenthood can be a daunting time, so pharmacy teams can play to their strengths by ensuring that they are continually building upon their skill sets and expanding their roles,” says Ms Giles. “This can be done by utilising educational tools and support services readily available to them. A prepared and focused pharmacy team is likely to be a more effective one when it comes to providing the best possible experience for expectant parents or families.”
The Government recommends that all children between six months and five years are given daily vitamin A, C and D supplements. Babies having more than 500ml of formula milk a day don’t need supplements, but breastfed babies should be given a daily vitamin D supplement from birth.
New research from Natures Aid released in June showed that more than a third of parents are more conscious of their children’s nutritional health because of the cost-of-living crisis, and almost a quarter of millennial parents say they
are buying more vitamin supplements than they did before the pandemic.
“Whether their children are newborn, toddler or teenagers, nutrition is always a concern,” says Bahee Van de Bor, children’s nutrition expert and paediatric dietitian speaking on behalf of Natures Aid. “That’s why knowing which children’s multivitamin supplements to give and in the correct amounts can prove helpful – not only are they cost-effective, but also quick and easy to use, saving busy parents all-important time without compromising on their children’s health.”
Coping with colic
Colic can be very distressing for parents and babies, and can affect a baby’s ability to feed comfortably. “Community pharmacists can advise on over-the-counter medicine to help with symptoms of colic, and general advice regarding how to hold babies, feed them, etc,” says Dr Hana Patel, private GP and mental health coach. “If a baby has an upset tummy, NHS advice is to give small feeds more often than usual. Also monitor for other symptoms, such as a temperature, rash, vomiting or diarrhoea. They may need to seek medical advice if babies are not able to feed as they normally do.”
According to Dr Brown’s, which offers a range of anti-colic bottles and other feeding equipment, 78 per cent of healthcare professionals agree that the most common cause of colic in young babies is digestive or feeding problems, including swallowing air/trapped wind.
“Our research shows that parents are reluctant to speak to pharmacists about colic, so we highly recommend that pharmacies are proactive when offering this advice,” says a Dr Brown’s spokesperson. “Community pharmacies are often within walking distance for parents, so stocking a full range of products allows parents to find the right product for them by seeking advice and buying in person. We also recommend that pharmacies stock a selection of teats as parents often buy the next stage when purchasing their first bottle.”
According to researchers at BioGaia, a biotech company active in the probiotic arena, colicky babies have a lower number of a certain type of bacteria than babies without colic. Probiotics can replace the missing bacteria, regulating gut function and easing colic symptoms. “Community pharmacies traditionally have very strong links with parents,” says BioGaia’s UK managing director. “We see community pharmacies as key to helping us to get our messages across to parents and into the hands of parents whose babies will benefit from their use. If the staff have deep knowledge around tricky conditions such as colic, this information should be displayed as part of the pharmacy’s many services and those products highlighted on shelf.”
Drinks for babies
In July, the UK Health Protection Agency issued guidance on the ‘Public health impact of drought’, including the health consequences associated with dehydration. Signs of dehydration in babies include their nappies not being very wet, sunken eyes, and a lack of tears when they are crying.
According to the NHS website, fully breastfed babies don’t need any water to drink until they are weaned, but formula-fed babies may need some extra water in hot weather. Babies under six months shouldn’t be given water straight from the mains tap as it’s not sterile. Tap water needs to be boiled and then cooled down first. Water for babies over six months does not need to be boiled, but if bottled water must be used because tap water isn’t available, it should also be boiled and then cooled down first. Parents should check the label to ensure that there is less than 200mg per litre of sodium and no more than 250mg per litre of sulphate.
Babies should be introduced to drinking from a cup or beaker from around six months and offered sips of water with meals. “Using an open cup encourages natural sipping, an action that stimulates and encourages correct bone and muscle growth and development, in turn supporting healthy development of mouth, jaws and teeth,” says Sara Keel, founder of Babycup weaning cups and member of the All-Party Parliamentary Group on a Fit and Healthy Childhood. “Open cups also discourage sucking and the potential for prolonged exposure to sugary drinks.”
According to the Action on Pre-eclampsia charity, pre-eclampsia claims the lives of around six to eight women and 1,200 babies every year in the UK. The condition can also cause serious complications and may affect a baby’s growth and wellbeing.
Major risk factors include high blood pressure before pregnancy, kidney problems, diabetes or a condition that affects the immune system, such as lupus. Other risk factors include a first pregnancy, being 40 or over, being very overweight or carrying more than one baby. Mothers may be advised to take low-dose aspirin (75mg) once a day from 12 weeks of pregnancy to reduce their risk.
Pre-eclampsia is often diagnosed after 20 weeks of pregnancy, but sometimes not until labour or soon after the birth. It causes high blood pressure and protein in the mother’s urine. There are often no symptoms, so it’s usually picked up during routine checks. Symptoms of severe pre-eclampsia include headaches, problems with vision, severe pain just before the ribs, heartburn that doesn’t get better with antacids, rapidly increasing swelling of the face, hands or feet, and feeling generally unwell.
Mothers with pre-eclampsia are usually offered medicines to treat the high blood pressure, and they and their babies are monitored regularly. They are usually advised to have their babies at about 37 weeks of pregnancy or earlier.
Views of the P3pharmacy category panel
“This category is a big one for us as there are a lot of young families in Tonteg. We’ve had waves of chickenpox, nits, threadworms. You tend to notice the trends through the seasons. As well as available OTC treatments, customers ask how to prevent future incidents, symptoms to look out for, etc. Best sellers include Aveeno creams and washes, which are popular with younger patients, Ovex, Hedrin and Calpol. Big brand names like Calpol always sell well. Having baby items near the dispensary is important as recommendations are required for most new parents.”
Marisa Maciborka, Well Pharmacy, Tonteg, South Glamorgan
An important area for us. We do well with cough syrups and nasal saline sprays in the winter; lots of multivitamins all year round. Other good sellers in this category are Bonjela, Sterimar, Wellbaby and Vaseline. We keep a small range of nappies and wipes in stock too. Chickenpox has been rife, which means queries about shingles too. Customers want to know what they can put onto children’s skin to stop the itching, but at the moment we’ve only got Eurax as there’s no calamine lotion available. Very frustrating. We change displays seasonally.”
Hardik Desai, Ticehurst Pharmacy, East Sussex
“We stock lots of multivitamins and probioitics for children in chewable, sachet and liquid form, and the usual children’s medicines. More parents seem to be asking about fussy eating and what vitamins they can give babies and children to ensure they stay healthy. We stock Nature’s Plus and Biocare, which do well. We’ve had increased demand for vitamins due to Covid concerns too, especially vitamin D when children weren’t going outside as much. We tend to go for bold, colourful packaging as these appeal to children, and we spread vitamin products around the pharmacy.”
Sarina Mughal, Day Lewis, Knightsbridge