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Use of Food for Special Medical Purposes in Areas of Paediatric Dietetics: A Double-Edged Sword?

Elements of enteral tube feeding in paediatric dietetics have vastly changed over several decades, from the labour-intensive practice of blending eggs, milk and chicken in the early days, to the introduction of commercial formulations in the 80s. The extensive range of commercial formulations including oral nutrition supplements and tube feeds available today (known as food for special medical purposes (FSMPs)), have been developed from extensive research into the functional properties of ingredients and nutrient profiles for specific patient groups. As a result, dietetic management of faltering growth became more effective, precise, safe and allowed easier provision of nutrition support. For many children born prematurely, diagnosed with acute or chronic illness, or inborn errors of metabolism, FSMPs form part of lifesaving treatment and ensure adequate growth, nutritional status and quality of life, and their use is written into several disease-specific clinical guidelines, including NICE guidelines on faltering growth1. Sick children who require nutrition support and are breastfed are encouraged to continue supplementary feeds as breastmilk has many physiological and psychological advantages for the child and mother.

Large efforts to improve child health in the UK through active promotion of breastfeeding, as part of the UNICEF Baby Friendly Initiative (BFI), outline that healthcare professionals (HCPs) should not be enabled to attend study days sponsored by companies who manufacture breastmilk substitutes (BMS) 2. UNICEF define BMS as any product which replaces breastmilk for children up to the age of three years, including FSMPs. As a result, some professional bodies have outlined measures to decline sponsorship from BMS manufacturers. In view of the legislative laws that govern general infant formula, alongside BFI, the application of FSMPs in paediatrics is contained within a contentious space for some HCPs who manage both breastfed children (able to achieve nutritional requirements and have adequate growth) and sick children requiring nutrition support.

Due to perceptions about the influence of BMS manufacturers and varied interpretations of BFI, HCPs tread tentatively across areas that provide opportunity to attend study days or collaboration, in fear of peer-to-peer judgement and breaching guidelines (perhaps poorly understood). Remaining clinically up to date about changes to paediatric FSMPs may already be challenging for some due to stark clinical pressures, little study time and low resource. Some local areas have taken measures against staff accepting sponsorship to attend scientific conferences, as well as attending industry-own and industry-sponsored events.

A lack of understanding may exist about FSMPs across the sector and its stakeholders, and the role of paediatric dietitians who make decisions based on best practice and evidenced-based guidelines. Dietitians have a duty of care for all patients and adhere to the HCPC and BDA code of conduct which is underpinned by placing the needs of the patient first, by practicing safe and effective care with integrity, honesty and openness. The BDA recently published guidelines for dietitians working with industry or promoting products, which are supportive of these activities within the code of conduct (HCPC, BDA and Advertising Standards Authority), and their recommendations include details on transparency and ethical decision making3.

The BDA Paediatric Specialist Group want to champion the force who work tirelessly to help better the lives of sick children which may often involve the use of FSMPs. The BDA Paediatric Specialist Group also recognise the great work of BFI and are engaging in collaborative work to develop better guidelines around the management of sick breastfed babies with increased requirements, and breastfeeding training that is built into the core of dietetics, that is continued throughout career.  

The BDA Paediatric Specialist Group welcomes any views on this matter from clinicians on the front line who feel challenged by local interpretations of policy so we can guide and support those in need to practice with confidence and without inappropriate challenge; a position statement is to be published by the group in due course.   

 

References:

  1. NICE: Faltering growth: recognition and management of faltering growth in children. https://www.nice.org.uk/guidance/ng75/resources/faltering-growth-recognition-and-management-of-faltering-growth-in-children-pdf-1837635907525. Accessed 7th September 2021.
  2. UNICEF: Working within the international code of marketing of breast-milk substitutes. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/02/Health-Professionals-Guide-to-the-Code.pdf. Accessed 5th September 2021.
  3. BDA: Working with industry or promoting products – considerations for dietitian. https://www.bda.uk.com/resource/working-with-industry-or-promoting-products-considerations-for-dietitians.html. Accessed 8th September 2021.