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Pharmacy support

Pharmacy is often the first port of call for parents, both for making purchases for the care of their baby and seeking advice on healthcare needs. Pharmacy team members may be able to recognise when a parent needs further support with any feeding issues during these conversations.


Reminding parents that breastfeeding is best whenever possible and giving advice and support to encourage breastfeeding is a key role.


However parents/carers choose to feed their baby, professional support and advice is available from pharmacy teams.


As well as giving tips on managing any feeding issues, it may also be appropriate to signpost them to other resources and support such as health visitor, GP, child health clinics, Sure Start centres or local parent and baby groups. Online support from sites such as Start4life or Cry-Sis may also help some customers.

Reflection

Are you and the team familiar with the different support groups for parents in the local area?

The team should also be aware of restrictions around promoting and advertising formula milks or giving advice that could be interpreted as suggesting formula-feeding is better than breastfeeding.


If the team are concerned about any symptoms, they should always refer to the pharmacist.

Reflection

Are all the pharmacy team aware of the different types of milk and when they should refer to the pharmacist?

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REFERENCES

REFERENCES

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2. NICE CKS (2017). Colic-Infantile. Available at https://cks.nice.org.uk/topics/colic-infantile/

3. Benninga MA and Nurko S. Childhood Functional Gastrointestinal Disorders:Neonate/Toddler. Gastroenterology 2016; 150: 1443-1455.

4. NHS. Colic. Available at https://www.nhs.uk/conditions/colic/

5. Daelemans S, Peeters L, Hauser B, Vandenplas Y. Recent advances in understanding and managing infantile colic. F1000Res. 2018 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134333/

6. Sung V, D'Amico F, Cabana MD, Chau K, Koren G, Savino F, Szajewska H, Deshpande G, Dupont C, Indrio F, Mentula S, Partty A, Tancredi D. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.)

7. Kanabar D et al. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Dietet 2001; 14: 359-363.

8. Chao et al. Therapeutic effect of Novalac-IT in infants with constipation. Nutrition 2007;23:469-473.

9. Infante et al. Modification of stool's water content in constipated infants: management with an adapted infant formula. Nutrition Journal 2011; 10:55-8.

10. Benninga MA; MENA Infant Constipation Study Group, Vandenplas Y. The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study. Pediatric Gastroenterology Hepatology and Nutrition 2019 May;22(3):270-281.

11. Billeaud C et al. Eur J Clin Nutr 1990;44:577-583.

12. Szajewska H, et al. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr 2013; 162:257-262

13. Savino F et al. Lactobacillus reuteri DSM 17 938 in Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial. Pediatrics 2010;126:e526–e533

14. Chau K, et al. Probiotics for Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial Investigating Lactobacillus reuteri DSM 17938. J Pediatr 2015; 166:74-8

15. NHS. Reflux in babies. Available at https://www.nhs.uk/conditions/reflux-in-babies/

16. NHS Start 4 Life. Breastfeeding Challenges. Available at
https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/reflux/#anchor-tabs

17. NICE (2015). Gastro-oesophageal reflux disease in children and young people. Available at https://www.nice.org.uk/guidance/ng1.

18. NICE CKS. GORD in children. Available at https://cks.nice.org.uk/topics/gord-in-children/management/management/

19. NICE CKS. Cow's milk allergy in children. Last revised Dec 2019. Available at
https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/

20. Fiocchi, A. et al. World Allergy Organ J. 2010; 3:57-161

21. Luyt, D. et al. Clinical & Experimental Allergy. 2014; 44, 642-672

22. Fox, A., Brown, T., Walsh, J. et al (2019). An update to the Milk Allergy in Primary Care guideline. Clin Transl Allergy 9 (40) 1-7. doi:10.1186/s13601-019-0281-8

23. Paediatric Specialist Group Position Statement: Use of Infant Formulas based on Soy Protein. The British Dietetic Association, Update April 2019.

24. Venter C, Brown T, Shah N, et al. Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy - a UK primary care practical guide. Clin Transl Allergy. 2013 Jul 8;3(1):23

25. Allergy UK Lactose intolerance Factsheet

26. NHS Start 4 Life. Healthy Breastfeeding Diet. Available at
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27. The GP Infant Feeding Network UK. The Milk Allergy in Primary Care (MAP) Guideline 2019. Available at
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Online references last accessed September 2022

IMPORTANT NOTICE

IMPORTANT NOTICE

We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organization’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age. We also recognise that breastfeeding is not always an option for parents. We recommend that healthcare professionals inform parents about the advantages of breastfeeding. If parents choose not to breastfeed, healthcare professionals should inform parents that such a decision can be difficult to reverse and that the introduction of partial bottle-feeding will reduce the supply of breast milk. Parents should consider the social and financial implications of the use of infant formula. As babies grow at different rates, healthcare professionals should advise on the appropriate time for a baby to begin eating complementary foods. Infant formula and complementary foods should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health. The product should be used only on the advice of independent persons having qualifications in medicine, nutrition, pharmacy, or other professionals responsible for maternal and childcare. ●SMA® Soya milk-free formula is intended to meet the nutritional needs of babies and children who are intolerant to cows’ milk protein, lactose or sucrose. Soya infant formulae are not recommended for preterm babies, those with kidney problems, or those with suspected or confirmed soya allergy, where medical guidance should always be sought. ●SMA LF® is a lactose-free milk-based formula for babies and young children who are intolerant to lactose or sucrose, or who are experiencing symptoms such as diarrhoea, tummy ache or wind caused by temporary lactose intolerance. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. The following products must be used under medical supervision. ●SMA® Comfort is a special formula intended for the dietary management of bottle-fed babies with colic and constipation. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 12 months of age. These products must be used under medical supervision. ●SMA® Anti-Reflux is a special formula intended for the dietary management of bottle-fed babies when significant reflux (regurgitation) is a problem. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 12 months of age. If the baby’s reflux does not improve within 2 weeks of starting SMA® Anti-Reflux, or if the baby fails to thrive, the family doctor should be consulted. ●SMA® Alfamino is a food for special medical purposes intended for the dietary management of severe cows’ milk allergy and/ or multiple food allergies. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 3 years of age. ●SMA® Althera is a food for special medical purposes intended for the dietary management of mild to moderate cows’ milk allergy. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 3 years of age. ●SMA® Xpert ProCol are not a substitute for breastmilk and do not replace a balanced diet. Please advise parents on the appropriate use of these dietary supplements to their child’s diet, particularly if there is a health concern or a known immune-compromised condition.

DENWHS016-2, DENWHSP122, NLNW031-2, USNS001, JU001, ACS02, ACS019

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