FOR HEALTHCARE PROFESSIONALS ONLY


Infant feeding issues A guide to how they can be managed in the pharmacy


I


nfant feeding issues are common in the first few months of a baby’s life as they adjust to digesting milk as


their main source of nourishment. More than half of babies (55%) will experience symptoms such as regurgitation, constipation, colic and wind up to the age of six months.1


Well-informed pharmacists can provide advice and reassurance for worried parents. Special formula milks have a role to play for babies experiencing feeding issues. However, parents should be advised that breastfeeding may help reduce many of the common feeding issues. The Department of Health recommends exclusive breastfeeding for the first six months.


Colic Colic is the term for a baby that is otherwise healthy but cries excessively for more than three hours a day, three days a week, for at least three weeks. The condition starts in the first few weeks after birth but will stop at around four to six months at the latest. Colic occurs equally in breast- and bottle-fed infants and in both sexes.2


The cause is unknown however multiple hypotheses have been proposed including immature GI function; variable food intolerance; related transient low lactase activity; intestinal microflora imbalance, etc.3


Frequently winding a baby during feeding, holding and soothing a crying baby or gently massaging a baby’s tummy may help.


Alternatively, a specialist formula such as SMA®


Comfort may be used for


bottle-fed babies who are experiencing colicky symptoms. SMA® Comfort is an easy-to-digest infant milk suitable for unsettled babies who are experiencing tummy troubles.4


It


has been modified in three ways to help a baby’s immature digestion:


• Contains partially hydrolysed 100% whey protein to make the formula easier to digest5,6


• The levels of lactose are reduced which can help to reduce the amount of wind babies produce. For some colicky babies reducing the concentration of lactose in formula has been found to result in an improvement in crying and wind7


• SMA® Comfort contains an SN-2


palmitate enriched fat blend that structurally resembles that found in breast milk and is well absorbed by


44 pharmacyinfocus.co.uk


Cows’ milk protein allergy Cow’s milk protein allergy (CMPA) affects a small percentage of babies under one year of age and is more common in bottle than breastfed babies.9


infants. Research has shown that infants fed on formula enriched with an SN-2 palmitate enriched fat blend spent significantly less time crying than those not fed the SN-2 palmitate enriched formula.8


SMA® Comfort is also the only


comfort milk without an added thickener (so no need to use a fast flow teat), and is vegetarian and Halal approved. It is available in 800g cans of powder and is available on the NHS Healthy Start Scheme.


breastfeed, but if they are unable to breastfeed or choose not to do so, soya formula would be the appropriate choice


3 Infants with galactosaemia. SMA®


Wysoy® is the only soya based


infant formula for babies and infants who are intolerant to cows' milk: • It is cow’s milk protein-free and is based on soya protein isolate


• It is lactose free and sucrose free • It has good palatability • It is approved by the Vegetarian Society and suitable for Halal diets


• It is available in pharmacy or on prescription.


Formula-fed infants who develop lactose intolerance may be given a specialist milk such as SMA LF® Lactose Free Formula as a temporary substitute for standard cows’ milk formula. Although temporary, it may take weeks rather than days for lactase secretion to be adequately re-established.


Infants fed lactose-free formulas have shown comparable growth and key nutrient absorption when compared to infants fed lactose-containing fomula.7, 11


Other studies have shown It is different to an intolerance


because it affects the immune system. A reaction may be immediate or delayed. Symptoms include swelling of the face, hives, wheezing, diarrhoea and vomiting, constipation, bloating and abdominal pain.9


From the age of six months, soya- based infant formulas can be used for the treatment of CMPA and lactose intolerance where soya is being considered or already being used in the weaning diet and where there is no identified soya allergy. 9,10


The British Dietary Association 2010 guidelines10


also acknowledge


that there is a clinical need for feeding soya-based infant formula for babies under six months in the following groups:


1 Infants with cow’s milk allergy/intolerance who refuse extensively hydrolysed/ elemental formulas


2 Vegan mothers – these mothers should be strongly encouraged to


Lactose intolerance Babies diagnosed with lactose intolerance have difficulty digesting lactose, a natural sugar found in milk. This is because they have a reduced level of the enzyme lactase, which breaks down the lactose found in milk. Undigested lactose remains in the intestine and can cause: diarrhoea, bloating, abdominal distension, wind and nausea.11


In populations with a predominance of dairy foods in the diet, particularly northern European people, as few as 2% of the population has primary lactase deficiency.11


in Hispanic, Asian and black populations with around one in five children under five affected.11


Babies can also experience a temporary lactase deficiency when something damages the cells in the lining of the gut which produce lactase. It often occurs after a stomach infection such as gastroenteritis.11


Babies more than six weeks premature may be born with very low levels of lactase leading to temporary lactose intolerance. The condition disappears as the baby gets older.


that infants with acute diarrhoea fed a lactose-free formula recovered in significantly less time than those fed a formula containing lactose.12 The key features of SMA®


LF Lactose


Free Formula are: • It is the only whey dominant lactose free formula available in the UK and Ireland


• It contains omega-3 and 6 long chain polyunsaturates (LCPs)


• It is fortified with iron to help support normal cognitive development


• It is Halal approved and suitable for vegetarians.


It is more common


Infant regurgitation Gastro-oesophageal reflux (GOR) is very common, affecting at least 40% of infants. It usually begins before the infant is eight weeks old, may be frequent (five per cent of those affected have six or more episodes each day) but becomes less frequent with time. In most cases, GOR will resolve before 12 months and does not usually need further investigation or treatment.13


In infants, children


and young people with vomiting or regurgitation, look out for the ‘red flags’ which may suggest disorders other than GOR, such as gastro- oesophageal reflux disease (GORD).


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