U.S. Study Shows Baby-Friendly Hospital Initiative Does Not Work

by Christie del Castillo-Hegyi, M.D.

On October 14, 2019, the Journal of Pediatrics published astonishing findings regarding the effects of the Baby-Friendly hospital certification on sustained breastfeeding rates as defined by the 2020 Healthy People Goals of: 

  1. any breastfeeding at 6 and 12 months
  2. exclusive breastfeeding at 3 and 6 months. 

They did so by measuring the relationship between statewide breastfeeding initiation rates data and the above breastfeeding rates. They then measured the contribution of Baby-Friendly hospital designation on these same breastfeeding outcomes.

According to the study authors, the increase in hospital designation in the Baby-Friendly Hospital Initiative (BFHI) began in 2011 when the U.S. Surgeon General issued a call to action for maternity care practices throughout the U.S. to support breastfeeding. The Centers for Disease Control (CDC) became involved in promoting the BFHI policies in hospitals and health facilities, as breastfeeding was thought to be associated with lower rates of childhood obesity. The assumption was that by increasing breastfeeding rates through the BFHI, there would be a concomitant decline in childhood obesity. Upon initiation of this program, the CDC initiated surveillance of state-specific data on breastfeeding outcomes after discharge including BFHI designation rates. This data is made available to the public through the CDC Breastfeeding Report Card, which provides annual reports from 2007 through 2014 and biennial reports from 2014.

As expected, they found that states with higher breastfeeding initiation rates had higher rates of these sustained breastfeeding outcomes. You cannot have high breastfeeding rates unless mothers are given education and successfully initiate breastfeeding. However, when they measured the effects of Baby-Friendly certification, this is what they found.

“Baby-Friendly designation did not demonstrate a significant association with any post-discharge breastfeeding outcome (Figures 1, B and 2, B). There was no association between Baby-Friendly designation and breastfeeding initiation rates.” Continue reading

World Health Organization Revised Breastfeeding Guidelines Put Babies at Risk Despite Pleas from Experts—Informing the Public “Not a Top Priority”

By the Senior Advisory Board of the Fed is Best Foundation

A key recommendation of the 1989 World Health Organization Ten Steps to Successful Breastfeeding which guides the Baby-Friendly Hospital Initiative (BFHI) is: “give infants no food or drink other than breast-milk, unless medically indicated.” This has led to serious complications from accidental starvation of babies, including dehydration, hyperbilirubinemia (jaundice) and hypoglycemia (low blood sugar) — known causes of infant brain injury and permanent disability. Last week, the WHO issued draft revised breastfeeding guidelines, failing to revise this recommendation. These guidelines define the standard of care for breastfeeding management in all healthcare facilities worldwide. Nearly 500 U.S. hospitals and birthing centers and thousands more worldwide that meet the criteria of the BFHI are certified as Baby-Friendly, adhering to the application of the WHO’s Ten Steps.

On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist from a leading U.S. tertiary care hospital and a pediatric endocrinologist, Dr. Paul Thornton, M.D, from Cook Children’s Hospital Fort Worth, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines, met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D., Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications arising from the BFHI Ten Steps and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation of exclusively breastfed newborns. The Foundation members who attended were 1) Christie del Castillo-Hegyi, MD, Co-Founder, 2) Jody Segrave-Daly, RN, IBCLC, Co-Founder, 3) Julie Tibbets, JD, Partner at Alston & Bird, LLP, Pro-Bono Attorney for the Foundation, 4) Brian Symon, MD, Senior Advisor, and 5) Hillary Kuzdeba, MPH, former quality improvement program coordinator at a children’s hospital, managing infant feeding projects and Senior Advisor.

Emails confirming meeting between the WHO and the Fed is Best Foundation available here.

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If I Had Given Him Just One Bottle, He Would Still Be Alive.

by Jillian Johnson with commentary from Dr. Christie del Castillo-Hegyi

Landon would be five today if he were still alive. It’s a very hard birthday–five. It’s a milestone birthday. Most kiddos would be starting kindergarten at this age. But not my little guy. I wanted to share for a long time about what happened to Landon, but I always feared what others would say and how I’d be judged. But I want people to know how much deeper the pain gets.

I share his story in hopes that no other family ever experiences the loss that we have.

Jarrod and I wanted what was best for Landon as every parent does for their child. We took all of the classes. Bought and read all of the books. We were ready! Or so we thought….every class and book was geared toward breastfeeding and how it’s so important if you want a healthy child. Landon was born in a “Baby-Friendly” hospital. (What this means is everything is geared toward breastfeeding. Unless you’d had a breast augmentation or cancer or some serious medical reason as to why you couldn’t breastfeed, your baby would not be given formula unless a prescription was written by the pediatrician.)

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How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital

Mothers who experienced delayed onset of milk production or experienced low milk supply with their first baby often contact us for support to try breastfeeding again. They typically have anticipatory anxiety, because they have lost trust in their lactation professionals and hospital staff and are unwilling to attempt breastfeeding again without supplementation. They want to know how to supplement their baby until their milk supply becomes sufficient to feed their baby safely while providing proper stimulation to their breasts for optimal milk production.

The most common concerns expressed:

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My Son’s Life was Forever Changed Due to Insufficient Feeding While Exclusively Breastfeeding

By Pam Floyd

I am the mother of a 28-year-old who is neurologically and physically disabled. My son Chaz, fell victim to severe dehydration called hypernatremia due to insufficient milk intake from exclusive breastfeeding in the first days of life. I read breastfeeding books, watched breastfeeding videos, and studied every page of What to Expect. Unfortunately, following the advice of our lactation consultant and pediatrician’s advice resulted in Chaz going 6 days with absolutely no milk intake, requiring admission to the ICU and a drug-induced coma. Chaz was eventually diagnosed with seizures, developmental delay, and cerebral palsy.

When Chaz was born, he was a healthy 10 pounds 4 ounces. I nursed him 20-30 minutes every 3 hours. Chaz produced the expected number of wet and dirty diapers. It didn’t take long for our routine to become feed, stop, make a smudged-up face. Grump a little. Then feed again.

When I mentioned my concerns about breastfeeding to the lactation consultant that visited us on day 3, she mentioned that he had a good stool. So, I must be doing something right. Stools meant that he was getting what he needed.

She added, “the colostrum that he gets now is enough for him until your milk comes in, which should be 4 to 5 days.” But whatever I do, do not supplement. No bottle. No formula.

It didn’t matter to her that I felt like something wasn’t right. That my gut was screaming that breastfeeding wasn’t working. I couldn’t shake the feeling that he wasn’t getting enough. By the time the weekend was over I had re-read my breastfeeding materials and re-watched my breastfeeding videos. We’d latched. But it got where he would feed for a minute or two then he’d turn his head away and fuss some more. The crying got louder each day. On day 3 the pediatrician’s office ensured me that everything was fine.

Don’t worry, he will eat when he gets hungry.

Breastfeeding takes.

I was asked if I had given him any formula. I said no. She said good…

Because baby formula is sweeter than breast milk and I might have a hard time getting him to breastfeed if I had given him formula.

By the 7th day, I was sure he hated me. He would take one look at my breasts and scream. He still had the correct number of diapers. I called the pediatrician again and was told…

You’re a new mother you don’t appreciate how much he is getting.

Besides with breastfeeding you never have to worry about how much he is getting.

When his eyes began zig-zagging an hour later. I called the pediatrician again to let them know he was having a seizure. I was told…

Newborns’ eyes sometimes do that. They tend to be unfocused. So they often wander.

My husband and I rushed him to the pediatrician despite their opinion of the problem. When we got there, we were told that he’d lost more than twenty percent of his birth weight.

I was so angry, not only had everyone ignored my concerns. But none of my baby books or videos mentioned the possibility of dehydration. Nor did the nurses, lactation consultants, hospital, or doctors tell me what to look out for.

My feelings of hopelessness and inadequacy were so strong and compounded with the stress of Chaz being in a drug-induced coma, I was infuriated because no one would listen to me. Not to mention it was preventing me from getting adequate sleep.

One thing I did know was that my mom instincts were spot on.

After I got out of my fog I took my story to our local paper, which was then picked up by The Wall Street Journal article, “Dying for Milk: Some Mothers, Trying in Vain to Breastfeed, Starve Their Infants,” as well as radio shows, and talk shows. I wanted to stop dehydration due to exclusive breastfeeding. 

That was 28 years ago. And it’s still happening. The medical community is still failing new moms. We’re told that if we don’t exclusively breastfeed then we’re bad people. I had several people tell me this when I purchased baby formula for Chaz.

I told this story to Fed is Best in a previous article. I’ve since written a detailed account of the experience in Mother Knows Best: A Memoir. According to Dr. Marianne Neifert, who was kind enough to write an Afterword for Chaz’s memoir. “Pam’s courageous conviction to share her story and highlight the controversial topic of breastfeeding tragedy has helped to spur many positive changes in hospital maternity care practices, to ensure the early follow-up and assessment of breastfed newborns, and to incorporate essential breastfeeding education in the training of health professionals.” I did what I could in 1993. But as I said it’s 28 years later and this is still going on. We need to continue to share our stories to prevent this from happening to other babies. And moms, always trust your instincts over others’ opinions. You may just save your child’s life.


Please support Pam Floyd in her mission to raise awareness about the dangers of newborn dehydration related to insufficient breast milk intake by purchasing her memoir, “Mother Knows Best,” by clicking on the link.

 

 

The New Seven Letter “F” Word

As soon as the word “formula” rolls off your tongue and leaves your mouth for everyone to hear, uncomfortable silence occurs. Parents are reluctant to talk about or admit freely they feed their babies infant formula. Most are suffering from the deeply entrenched shame and judgment that is associated with formula feeding; they have experienced it first hand in countless social media parenting groups, from friends, their health care professionals, WIC offices, and even in their hospitals.

How did we get to the place where talking about infant formula is profoundly divisive, shameful, and anxiety provoking for parents? 

 Let’s face it, infant FORMULA is the new seven letter F word. The scarlet letter F.  FAILURE. 

I frequently receive questions from anxious parents who want to know if everything they have been told about formula feeding is true. They often convey feelings of failing their baby and question their worth as a parent who could not provide exclusive human milk. The emotional suffering they carry is the foremost reason why I wanted to write about the topic of infant formula shaming.

Is the current breastfeeding advocacy responsible?

One of the problems of our current breastfeeding promotion is it has characterized infant formula as a substandard or dangerous form of nutrition, by providing false and misleading claims. The Just One Bottle campaign was intended to persuade parents to avoid formula citing risks of formula that are mostly speculative. But the message of this campaign continues to be taught to parents daily. Promoting false and confusing medical information is grossly unprofessional, unethical, and reckless, as this false information has put infants’ and mothers’ lives at risk.

Avery’s life was one of them. She writes: I had more than enough support for breastfeeding, but very little support for switching to formula when I knew it was best for my own mental health, and for my son. I can’t fathom telling a mom she’d better breastfeed or might as well be dead. But I was told this—and I believed them. I remember being in the basement bathroom and looking up at the tiny window and thinking that would be the last thing I saw before I died. I was ready to go. 

Let’s take a look at an example of exaggerated and false formula feeding information:

After reading this pamphlet from WIC, I can understand why parents are panicking. The formula risk brochure is grossly inaccurate and false and specifically says:

40–50% will develop asthma 

Greater chance of dying from SIDS

40% are likely to be obese

More likely to get leukemia and other cancers

Higher risk of dying from diarrhea and lung infections

This educational pamphlet is one example of what parents receive about formula feeding risks from WIC, in California. Up to 50 percent of US families receive nutritional benefits for their babies from WIC and will receive similar education.

This is an example of how formula is described as junk food by a lactation consultant  

 

 

Sara writes : The main reason I used formula was that I didn’t make enough breast milk, and my daughter was starving. They always leave that one off when they lie to women about how “everyone can breastfeed.” When people say fed is minimum or formula is junk food, they make me feel ashamed that I have a medical condition, which is so messed up. If I had continued to exclusively breastfeed, my daughter would be dead. Formula saved her life. But any time I bring this up, I get told I didn’t try hard enough, or I didn’t actually have a low supply. It’s ableist and abusive.

Human milk is depicted as magical

Social media has elevated the status of human milk from desirable nutrition for babies into pure magic! Human milk can cure everything they say. A Google search yields countless treatments using human milk to cure eye infections, stretch marks, ear infections, diaper rash, cancer, and even COVID. But it can’t and doesn’t. 

Human milk doesn’t have to be a magical elixir to be valuable. Do you know what is magical? Inclusive infant feeding support free of shame and judgment. And oh, a 6 month paid maternity leave.

However, shaming infant formula is oh so easy. Shaming infant formula is the easy way out.  It’s cruel to shame infant formula when parents are unable to push through the barriers that exist. The decision between breastfeeding and formula feeding is increasingly complicated by the barriers that exist in the United States. In fact, many times a mother doesn’t have a choice whether she can exclusively breastfeed for 6 months. We need to remove the many barriers FIRST before breastfeeding promotion saddles parents with the burden of exclusive breastfeeding, while receiving abysmal support. But formula shaming is so much easier.

 

 

This is an example of what formula shaming does.

Laura writes:  At first, I felt like a total failure and could not understand why my breasts would not do what they were supposed to. I would sob as I fed her formula. But over time I saw how much she was thriving and I started to forgive myself. I truly believe supplementing and then exclusively formula feeding saved me from hurting myself and allowed me finally to love my baby.

In the US alone, 75% of babies will receive infant formula before the first 6 months of life.  Parents who are formula feeding require education about how to safely prepare and feed their babies formula, during a period of time when their brain and body are rapidly growing, when formula is their sole source of nutrition. Formula feeding parents deserve to be treated with respect and without any kind of shame or judgment.

Did you know there are no unbiased educational resources for formula feeding parents readily available like there are for breast/chestfeeding parents? Not. one. Parents are forced to figure out how to formula feed their babies all on their own, searching the web for self-proclaimed formula experts, or using formula industry–created resources. 

The demonizing of the F word has now driven formula feeding parents who are seeking support and education straight into the arms of Big Formula!

Just this week, a study tells us that “It is important to understand the messages caregivers are receiving directly from formula companies, whose websites are targeting pregnant women and new parents with marketing claims disguised as feeding advice and support.”

The study, led by researchers at the NYU School of Global Public Health and published in the journal Public Health Nutrition, is the first to compare information and portrayals of breastfeeding with infant formula feeding on manufacturer websites directed at U.S. consumers.

This leaves a significant number of parents who are being supported only by formula companies. This is a problem, not only for exclusively formula feeding families, but also for those who want to keep breastfeeding while also adding some formula into their routine. While parents have access to the experience and insight of their pediatricians, well-baby check ups are relatively brief and infrequent. Facing a whole grocery store aisle filled with different brands and types of formula, and unstandardized prices per ounce, parents often feel paralyzed and helpless. Formula companies thrive on this confusion, because it enables them to sway parents towards their brand and charge more money for attributes that have not been proven to be necessary for infant health. This is especially problematic for WIC recipients. Since WIC typically provides only one brand of formula in quantities that are not enough to fully meet infants’ needs, parents are often under the impression that they must buy more of the same brand, instead of the equally nutritious generic equivalent.

Parents often ask me why infant formula is despised by breastfeeding zealots and I wish I had an answer for them. Is it because they hate Nestlé and formula company marketing tactics? I get it. I do. I have no love for Big Formula and their ruthless tactics to sell their product. The difference between me and them is that I don’t hate their product and would never, ever call it substandard nutrition—because it isn’t. 

We can easily support breastfeeding while supporting formula feeding parents. I have done this every day of my professional life for the past 30 years. 

Silence and shame have no place in health care, and I encourage all health care professionals to talk about infant formula, so that parents can trust you with their questions to keep their babies safe. Otherwise, they will resort to finding answers to their questions by unqualified people or those with a profit motive. I encourage parents to talk about formula too, because there is nothing shameful about feeding your babies with a safe, healthy, scientifically formulated milk. 

Stay tuned as I begin my blogging series about safe infant formula feeding in an unbiased manner. I will be interviewing pediatricians, neonatologists, and food scientists to talk about infant formula, and giving you accurate information straight from the experts.

Jody Segrave-Daly, MS, RN, IBCLC

If you need infant feeding support, please join us here.


An Evaluation Of The Real Benefits And Risks Of Exclusive Breastfeeding.

Breastfeeding Benefits: The Real, the Imagined, and the Exaggerated

The Shaming Began In My Hospital Breastfeeding Course And Never Stopped

Is Breast Milk Stealing The Spotlight Of A Novel Anti-Tumor Compound?

The Process of Healing from Infant Feeding Trauma, Guilt, and Shame: When You Wanted to Breastfeed, but Couldn’t

I Attempted Suicide From The Pressure Of Breast Is Best

I Was Having Suicidal Thoughts Because I Was Shamed For Not Making Enough Breast Milk For My Baby

Dear Chrissy Teigen, You Are Right; We Need To Destigmatize Formula Feeding Our Babies

What Happens When Mothers Are Told Being Fed Is The Bare Minimum?

I No Longer Judge Other Mothers; My Breastfeeding Challenges Have Absolutely Changed Me As a Mom, a Woman, And a Friend

 

 

I HAVE SO MUCH REGRET NOT QUITTING BREASTFEEDING EARLIER; WE SUFFERED AND FEEL VERY LET DOWN BY PROFESSIONALS AROUND ME FOR BEING SO ANTI-FORMULA

Knowing now how many babies have been lost or suffered injury due to insufficient nutrition and dehydration in those early days, I feel so much anger towards those staff who dismissed my concerns, as we could so easily have gone the same way. By this point, my son’s urine was like brick dust and barely meeting the minimum frequency—but home we went, away from any medical supervision. 

It has taken me nearly three years to put this story into writing; despite watching my son grow into a happy and healthy little man, I could not revisit the trauma of his early months in my mind for a very long time, without feeling such strong emotions that it might as well have happened yesterday. Despite my difficulty telling this story, I wanted other mothers to hear it because I suspect I’m not alone in my experiences; and the more people who come forward with similar trauma, the more likely things are to change.

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I Have So Much Regret Not Quitting Breastfeeding Earlier; We suffered And Feel Very Let Down By Professionals Around Me For Being So Anti-Formula

Knowing now how many babies have been lost or suffered injury due to insufficient nutrition and dehydration in those early days, I feel so much anger towards those staff who dismissed my concerns, as we could so easily have gone the same way. By this point, my son’s urine was like brick dust and barely meeting the minimum frequency—but home we went, away from any medical supervision. 

It has taken me nearly three years to put this story into writing; despite watching my son grow into a happy and healthy little man, I could not revisit the trauma of his early months in my mind for a very long time, without feeling such strong emotions that it might as well have happened yesterday. Despite my difficulty telling this story, I wanted other mothers to hear it because I suspect I’m not alone in my experiences; and the more people who come forward with similar trauma, the more likely things are to change. 

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My Breastfed Baby Starved While Under The Care Of Health Professionals For 5 Weeks

My beautiful baby girl Mary-Kate was delivered by emergency c-section, and although there were complications during labor, she was healthy on arrival. Having done a bit of research and listened to the advice of professionals, as well as the threat of the global pandemic posing a risk, I decided I would breastfeed my daughter, to provide her with passive antibodies for COVID-19 from my milk.

I began exclusively breastfeeding in the hospital and the midwife said Mary-Kate had the perfect latch. I loved being a mummy, I could not stop looking at this beautiful little human me and my partner had created, but Mary-Kate was becoming increasingly unsettled. She was almost always attached to my breast and would fall asleep soon after latching on. I spoke to the health visitors, and we were told her crying was colic.  We began giving Mary-Kate lots of colic-type remedies. 

Each time somebody came to weigh her whether it be the GP, HV, or Midwife, Mary-Kate was not gaining and was in fact losing weight. I could not understand, because she was ALWAYS feeding. Nobody seemed alarmed by this. I was told to just keep trying, she might be a ‘slow starter’. Never once did they check to see what my milk supply was or how much she was getting. The professionals would leave, and I would carry on as normal. Baby attached to the breast, me trying to maintain some sort of order in the home, taking care of my personal needs and sleep. Mary-Kate would just cry and cry and cry unless asleep at my breast.  I was exhausted, I was falling asleep whilst holding my baby and I knew this presented its own risks.  Continue reading

I Supplemented My Baby Until My Milk Came In And We Are Still Breastfeeding At 3 Months

My son will be three months old tomorrow, and I’m reflecting on our nursing journey with gratitude. I had infertility and recurrent pregnancy loss prior to having him, and (after two rounds of IVF and six embryo transfers), he was born at 35 weeks. So we had a lot working against us for successful breastfeeding, but I wanted to try breastfeeding and I was ready to advocate for myself and the baby if needed in the hospital, since I knew I had significant risk factors for delayed onset of milk. 

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Hospital Bag Packing Tips for You and Your Partner

by Josh Moore from Diaperdads.org

Image via Pexels

Packing your hospital bag can be one of the most exciting parts of preparing for your new baby. It’s getting real! But as exciting as it is, many first-time parents feel stressed about what to pack and bring. The Fed is Best Foundationprovides infant-feeding education and can help ease parental jitters. Then you can focus on the fun parts — packing your bag like a pro and visualizing your ideal birth. Read on for tips about how to get started.

Your baby’s first need is you.

The list of baby supplies can feel overwhelming, but try to remember that you are what your new baby needs most of all. The first hour of skin-to-skin contact with your baby has powerful physical and emotional benefits. The comfort and love that you provide your baby immediately after birth are more important than any supplies you bring to the hospital.

That said, there are a few things that you should pack for him or her, such as onesies (including a full body suit), a swaddle blanket, a beanie, and (most importantly) an installed car seat to take your little one home. Your hospital or birthing center usually provides diapers and wet wipes. But keep in mind that if you do forget anything, a friend or relative can bring it to the hospital for you, so there’s no need to pack your baby’s entire future wardrobe. Continue reading

Why Fed Is Best: From One Therapist’s Point Of View

Written by Sarah Edge

I am a Counsellor Psychotherapist, specialising in postnatal mental health in the United Kingdom. I am also a Mum of two small children. I recently wrote a guest blog on “The Process of Healing From Infant Feeding Trauma, Guilt, and Shame: When You Wanted To Breastfeed and Couldn’t” for the Fed is Best Foundation, and when I was asked to write again, I jumped at the chance. In this piece, I aim to examine the Fed is Best message through my therapist lens and discuss why the Fed is Best message is an essential part of healing and recovery. 

It is well known amongst those in the psychology field, whether it be researchers, psychologists, or therapists, that people are often drawn to study and work in a field where they have personal experience. The well-regarded and highly accomplished trauma academic Bessel Van Der Kolk has described his own research as “self-search.” And most have heard of the phrase “the wounded healer.” I am no different. I became interested in working therapeutically with postnatal mental health and infant feeding guilt due to my own experience of breastfeeding difficulties.

I personally have a complicated and emotional relationship with infant feeding. I experienced formula feeding my firstborn and breastfeeding with my second child. I have personally undergone my own therapy and recovery, meaning I am now able to work safely and supportively with other women experiencing psychological distress compounded by, or sometimes caused by, their infant feeding experiences. But that’s not to say my heart doesn’t ache when I hear a mother shares her raw and moving story of when breastfeeding didn’t work out. Continue reading

Do Parents Need To Boil Water For Powdered Infant Formula Preparation in the United States?

Written by Jody Segrave-Daly, MS, RN, IBCLC

Boiling water for powdered infant formula preparation is one of the most conflicting and confusing topics for parents. Our governing bodies such as the CDC, WHO, WIC, AAP, and FDA, all have varying recommendations for preparing formula. 

Seventy-five percent of infants in the US will receive some infant formula by 6 months of age. Safe infant formula preparation education is very important to ensure babies are fed safely for optimal growth and health outcomes.  Parents have shared some of the educational materials they received for formula preparation, and there were vast differences ranging from a one-page handout to a complete step-by-step instruction booklet. Most parents said they were not told to boil water.

Infant Formula Regulation In The United States

Infant formula products in the US have the most rigorous regulations in the world. In 1980 Congress passed the Infant Formula Act and the 1986 Amendment which, along with the current edition of the Infant Formula Program, established nutrient requirements for all infant formulas. The American Academy of Pediatrics’ Committee on Nutrition develops the nutritional standards and are used by the Food and Drug Administration to develop infant formula regulations. 

The Infant Formula Act of 1980 is one of the most specific and detailed acts ever passed by Congress. It establishes nutrient requirements, defines adulteration, provides for establishing nutrient and quality control procedures, prescribes recall procedures, and specifies inspection requirements.

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