Infant feeding when you are food insecure

Can I breastfeed my baby if I am not eating properly?

In the short term yes, but only to a point. Breastfeeding is a physiological process and requires a lot of energy.

On average, it takes 500 calories a day to make and eject milk for our babies. This equates to 25% of the recommended average calorie consumption for women of 2000 calories per day. The energy demand for breastfeeding can be met by eating extra nutrient rich foods, or from fat stores built up during pregnancy. When food intake is low, women who have built up fat reserves before and/or during pregnancy can use these stores. This means their milk supply will likely be maintained without the need for extra food. However, women who do not have adequate fat reserves will need a higher calorie intake (more than the recommended 300 extra calories a day for breastfeeding women) so will eventually need to eat more to maintain their milk supply.

Research shows women in food insecure homes often choose to initiate breastfeeding, but quickly switch to formula feeding for a variety of reasons. It's likely that if you are in this situation, you will need MORE support with breastfeeding from your Health Visitor. This is your right and you should ask for the extra support if it is not offered.

What foods will help with my milk supply?

You need energy to make milk and if you can, eating foods high in energy can support lactation. This includes things like nuts, bananas, eggs and meat.

It’s been suggested that oats, chickpeas, garlic, ginger, fenugreek, fennel and red raspberry leaf are galactagogues (substances that increase milk supply), although there is no scientific evidence to back up these claims.

You should aim to get enough calories from your diet to support breastfeeding, and to stimulate the breasts regularly enough to intitate the hormone cascade that results in milk production.

If you're struggling to access enough food you can reach out to your Health Visitor, Local Authority or other local organisations such as foodbanks, community larders or family support organisations.

Can stress affect my milk?

Potentially. Little research has looked into the effect of stress on breastfeeding in humans but we know from studying lactation in other mammals that stress impacts the quality and quantity of milk.

Stress leads to a rise in a hormone called cortisol. This hormone has been shown to impact lactation in some animals (namely dairy cows) so that the nutritional quality and volume of milk are reduced.

We can't control our cortisol levels but we can try to find ways to help relax and reduce stress, although we know this is easier said than done, especially because living in a stressful environment is sometimes unavoidable. It may help to remember that even in the most optimal situations, women report issues with milk supply.

Women in food insecure homes are far more likely to have high cortisol for a variety of reasons. Research has shown that women in food insecure environments need greater support with infant feeding. It is your right to ask for extra support.

Should we be taking supplements?

The NHS recommends that all breastfeeding women take vitamin D supplements, even if not exclusively breastfeeding. Free Healthy Start vitamin supplements are available from pregnancy until your baby's first birthday, or for the duration of breastfeeding; these contain folic acid, vitamin D and vitamin C. It's definitely worth asking your midwife or Health Visitor where to collect your supplements.

All exclusively breastfed babies should also be given vitamin D supplement daily from birth, even if their Mum is taking vitamin D supplements. Babies having more than around 500ml (roughly a pint) of formula every day will have their vitamin D requirements met through their formula milk and don't require additional supplementation.

If you qualify for Healthy/Best Start, you can get vitamin drops (with vitamins A,C AND D) for children age 0-3 years, as recommended by the deopartment of Health and social care - ask your midwife or health Visitor where you can collect them.

What is the best formula for my baby?

All first infant formula milks are nutritionally equal. The cheapest first infant formula has the same nutritional value as the most expensive. First infant formula milk (stage 1) is suitable for all babies from 0 to 12 months (unless medically advised otherwise). When your baby turns one, they can switch to full fat cow's milk.

Can I feed my baby follow on formula or growing up milks?

First infant formula milk - aka stage 1 - is suitable for all babies from 0 to 12 months (unless medically advised otherwise). When your baby turns one, they can switch to full fat cow's milk.

Marketing laws mean that first infant formula cannot be bought with coupons or on special offer, but because follow on and growing up milks are not restricted by the same laws they can sometimes be cheaper.

It's important to note that follow on formula is NOT suitable for babies under the age of 6 months due to their vitamin and mineral content. Only first infant formula milk (stage 1) is suitable from birth to six months of age.

If you are struggling to access formula, please speak to your Health Visitor or midwife for extra support as soon as possible.

Will hungry baby formula keep my baby fuller for longer?

There is no evidence that hungry baby milk keeps babies feeling fuller for longer, helps them settle or provides the magic ingredient for getting a bit extra sleep during the night (unfortunately)!

When money and food is scare, it can be tempting to opt for hungry baby milks in the hope that if your wee one feels fuller for longer, or that you might be able to eke out a tub of formula for a bit longer but, although hungry baby milk is in itself not harmful, any potential for underfeeding a baby poses a health risk.

If you are struggling to access formula, please speak to your Health Visitor or midwife for extra support as soon as possible.

Can I add cereal, rusks or baby rice to my baby's bottle?

In short, no. This is a common suggestion to help keep babies fuller for longer or help them sleep but there's no evidence to support this claim.

More importantly, adding food to your baby's bottle poses a significant choking hazard and should be avoided.

How can I safely make up a formula feed with no hot water?

Best practice guidelines for making up powdered formula is to add the relevant volume of boiled water cooled to 70 degrees. This is to ensure any bacterial contamination in the powder is killed before the baby drinks the milk.

Although not recommended, boiling the kettle once to make up multiple feeds at a time is an option, and the prepared formula can be stored for a up to 24 hours in the fridge. Your baby may prefer their milk warmed up before drinking and there are different methods of heating milk that will all require energy use. Regardless of which heating option you choose, it's important to gently mix the milk after heating by turning the bottle upside down a couple of times, to avoid hot spots and reduce the risk of scalding.

Ready-made formula offers an alternative to powdered formula that doesn't require heating, but the downside is that it's much more expensive per feed. Once opened, premade formula must be stored in the fridge but it should be disposed of after 24 hours so buying smaller bottles to avoid waste may also be your preference. The downside of reducing waste in this way is that the smaller bottles work out much more expensive per feed.

What is the cheapest way to sterilise my feeding equipment?

It's important to sterilise your feeding equipment - bottles, teats, pump parts etc - and the cheapest way to do this is by using cold water sterilising tablets or fluid. simply add the required amount of tablets to a basin or tub of cold water and submerge the items for a short time following the manufacturers guidelines.

Other options include microwave steam sterilising, using a plug in steriliser, or boiling your gear in a pan of water.

With all options you can do multiple bits of equipment at a time.

When can I safely start giving my baby foods other than milk?

Readiness for solid food is indicated by a number of factors and every baby is different. Most babies will be ready for solids at around 6 months of age, which is the age that the NHS recommends you start to look at introducing new foods.

Most babies only need breastmilk or first infant formula milk from birth to six months. However, if you feel your baby is signalling readiness for solid food before this, you can discuss your options with your Health Visitor.

Babies have small stomachs which means they need milk little and often. Their tummy's may fill up quickly, but as they are constantly growing, they are using all the energy up quickly and it can sometimes feel like they are constantly hungry.

While it's tempting to introduce solid food earlier than the recommended 6 months to offset the high cost of formula, or if you're concerned your wee one isn't getting enough milk, this can pose a choking hazard, so should always, always be discussed with your Health Visitor or GP first.

Is there anything I can do to make a tub of formula last longer?

As formula prices rise, the pressure on the family budget increases and many more families are finding it difficult to cover the costs.

Families struggling to afford formula report being forced to take drastic measures to try and make their formula stocks go further (see Feed Report, Feed Inquiry and APPGIFI Inquiry). These include; watering down formula (over diluting), increasing the time between feeds or feeding at fixed times, keeping/reheating formula ‘leftovers’, adding solid food (e.g rusks, baby rice) to bottles, early weaning and even using switching babies to cows milk.

It’s really, really important to be aware that diluting formula, reheating leftovers, delaying feeds or introducing solids or cows milk when it’s not developmentally appropriate carry significant risks for your babies health.

Formula must be prepared and discarded as per the manufacturer’s guidelines and responsive feeding - following your babies hunger cues and feeding on demand is ideal. This can be challenging when you are working to a tight budget; making smaller volumes of formula and feeding more often could help. You can also premake formula and decant small volumes per feed to reduce waste.

If you are struggling to access enough formula see below "I can't afford to buy infant formula, where can I get help". Getting support for you, so you can care for your baby is our priority.

Does breastfeeding cost less than formula feeding?

Like most infant feeding decisions, there's no straightforward answer to this question.

From a purely financial perspective, all infant feeding methods generally have an intial cost and an ongoing cost. The initial cost includes purchases such as bottles, teats, breast pumps, cleaning and sterilising equipment, breast pads, nipple cream, nursing bras and other equipment. To reduce this inital hit to your wallet, you can limit purchases to necessary items only and buy reuseable or preloved items. Cheaper, supermarket own brand items work just as well as the highly marketed branded products. Friends and family with wee ones are often keen to pass on stuff they no longer use which can really help out financially too.

The ongoing costs of infant feeding are mainly food costs - formula for the baby and food for the breastfeeding Mum - and costs of preparing and storing formula or expressed breast milk, plus small irregular costs for maintaining and replenishing your feeding equipment.

Formula is expensive; in January 2023, the cheapest formula in supermarkets was £10 a tub. This means that at peak intake (approx 4-6 months of age), it would cost a minimum of around £20 per week to exclusively formula feed your baby. If you're breastfeeding, you may need to increase your own food intake to meet the energy demads of lactation, so your food costs will increase slightly on a weekly basis too.

To our knowledge, there is no robust UK data quantifying the costs of formula feeding versus breastfeeding in the context of providing all members of the family with a basic nutritional diet (and especially not considering the current cost of living). Comparabale data from Canada suggests that exclusively breastfeeding will save a family the equivalent of approximately £17 per month compared to exclusive formula feeding, and that regardless of infant feeding method, families on low incomes are likely to be unable to afford to provide a basic nutritional diet (monthly deficit of the equivalent of approximately £100).

Women who are themselves food insecure often need more breastfeeding support so please reach out to your Midwife or Health Visitor; it's your right to ask for the support you need. Likewise, if you are struggling to access formula for your wee one, or food for any member of the family your Midwife, Health Visitor or Local Council are a good first port of call. You can also seek help at a local food or baby bank for immediate food provision, and support in finding longer term help.

I can't afford to buy infant formula, where can I get help?

Increasingly parents are struggling to afford to buy infant formula milk due to the rising costs of living. As a result, guidelines for local authorities advise ALL local authorities to have an emergency formula provision pathway in place. The best way for you to access this is via your midwife or Health Visitor.

If you need help outside of working hours, you can contact emergency social services. Whilst this may feel scary for some people, this service is there to help and support you so you can care for your baby.

Other charitable organisations also provide emergency formula. Feed has developed an interactive map to help you find local food and baby banks that can support families struggling with food insecurity by providing emergency food packages, including formula, and signpost you to local services that can help over the longer term.

At Feed, though we don't directly provide formula, we are always here to help and advise families and organisations where we are able.

Where can I find long term support with accessing food?

While more needs to be done to support families struggling with food insecurity, there are a number of existing initiatives that may help reduce the burden. Your Midwife and health Vistor is a great first port of call for advice and support with feeding,and they can point you in the direction of local services available.

For help understanding your basic rights, debt management and benefits you can contact Citizens Advice in (England), (Scotland), (Wales) or (Northern Ireland). They can give advice on maximising your income but be aware they are extremely busy and appointments can fill up weeks in advance.

To determine what financial support you might be entitled to you can use the Entitled To calculator. There are a number of benefits schemes available to families and it's worth checking to see if you are eleigible, even if you don't think you will be. The main supports include, but aren't limited to:

• Best Start Foods is a prepaid card available in Scotland that can be used in shops or online to buy healthy foods like milk or fruit.
• Healthy Start is prepaid card available in England, Wales and Northern Ireland that can be used in shops or online to buy healthy foods like milk or fruit
• Universal Credit is the primary benefits system in the UK. You can access funds if you meet certain eligibility criteria. The application process can take several weeks to process.

There are a variety of other benefits schemes for pregnant women and families with children that you maybe eligible for.