The publication recommends a ‘safe intake’ of vitamin D (8.5-10 micrograms per day (µg/d)) for all breastfed infants from birth after figures found 6% of infants were at risk of vitamin D deficiency.
However, the report also points out data from both Infant Feeding Surveys (IFS) and the Diet and Nutrition Survey of Infants and Young Children (DNSIYC) showed the proportion of infants receiving vitamin supplements was low (less than 14%).
“Infants who are fed infant formula should not be given a vitamin D supplement unless they are consuming less than 500ml (about one pint) of infant formula a day, as infant formula is fortified with vitamin D,” the report made clear.
“Previously there was not a recommendation for breastfed infants, as it was assumed that maternal vitamin D supplementation during pregnancy and then breast milk would provide the infant with adequate vitamin D for the period of exclusive breastfeeding.”
Iron, vitamin A and D
Along with iron and vitamin A, the report identifies these key micronutrients as “concerning” regarding possible deficiency or excess in infancy in the UK.
While the report’s authors acknowledged the UK infant diet provides ample vitamin A, even with low uptake of supplements, infants that consume excess formula milk and vitamin A supplements run the risk of exceeding its Tolerable Upper Intake Levels (TUL).
The report believed that healthy term infants are born with sufficient body iron stores, which along with iron in breast milk, were sufficient to meet their needs for growth and development for the first six months of life.
“From around six months of age, a diverse complementary diet is needed to meet the increasing iron requirements of older infants,” the reports said.
“Complementary feeding should be given alongside continued breastfeeding or the use of infant formula as a main drink throughout the first year of life.”
Breast milk, formula and water only
The publication, an update to the Committee on Medical Aspects of Food Policy’s (COMA) version written back in 1994, springs few surprises in its recommendations, further advising that breast milk, infant formula and water should be the only drinks offered between six and 12 months of age.
It stated that cows’ milk should not be given as a main drink, as this was associated with lower iron status.
“SACN concludes breastfeeding makes an important contribution to infant and maternal health. This includes the development of the infant immune system, while not breastfeeding is associated with a higher risk of infant hospital admission for infectious illness.”
Regarding the introduction of solid foods, the SACN’s main recommendation advised exclusive breastfeeding for babies until around six months of age, with breastfeeding for at least the first year of life.
Ideally, solid foods were not be introduced until around six months to benefit the child’s overall health.
A wide range of foods, including those containing iron, with different textures and flavours is also encouraged, as is the need to present the food on many occasions before acceptance, particularly as infants get older.
In addressing the allergy risk, the guidelines thought foods such as eggs and peanuts could be introduced from around six months of age and need not be differentiated from other solid foods.
The deliberate exclusion of peanuts or hen’s egg beyond six to 12 months of age may increase the risk of allergy to these foods, the report said.
“The SACN report reinforces existing advice on infant feeding in relation to breastfeeding and the introduction of solid foods,” said Dr Alison Tedstone, chief nutritionist at Public Health England (PHE)
“In new advice, it provides clear guidance on the introduction of allergenic foods. SACN’s robust advice puts to bed any arguments about a beneficial effect of early introduction of solid foods.”