The Health Promotion Board (HPB) will be kicking off a multi-year campaign aimed at educating parents on the nutritional needs of children by the end of the month. The move comes amid a public debate over the high prices and the nutritional value of formula milk.
HPB chief executive Zee Yoong Kang told The Straits Times that $1 million has been set aside a year for the next five years. It will go towards advertising, brochures for hospitals and social media efforts, among others.
HPB will also be working with organisations such as the National Trades Union Congress and Singapore National Employers Federation to encourage more employers to create breastfeeding-friendly workplaces for mothers.
While the health authority has traditionally focused on encouraging breastfeeding, it will also ramp up education efforts on the nutritional composition of formula milk, to help parents who rely on it to make more informed decisions, said Mr Zee.
"While breast milk is best, we recognise that parents have good reasons to resort to formula milk. In that context, we have to reassure them that standard milk is sufficient, and provide more information on how to build a strong dietary foundation for kids, including weaning," he said.
An estimated 95 per cent of formula milk sales in 2015 comprised sales of "premium" and speciality milk, with just 5 per cent of sales for "standard" milk - which costs less than half the price, showed a report released by the Competition Commission of Singapore last week.
The average price of formula milk has more than doubled over the last decade to $56.06 for a 900g tin, leading the Government to announce measures to address the issue.
BALANCED DIET KEY
Rather than focusing on which (formula) brand is the best, parents should look towards building a balanced and nutritious diet for their children.
DR ANNIE LING, director of HPB's policy, research and surveillance division.
The authorities have said that all infant formula sold here meets safety standards and nutritional requirements, and urged against using price as a proxy for quality.
Dr Annie Ling, director of HPB's policy, research and surveillance division, analysed the nutritional labels of eight Stage 2 formula brands on shelves here. Stage 2 formula is for babies older than six months.
She concluded that there is little difference in the key nutrients between them, with differences found, for example, in levels of docosahexaenoic acid (DHA), an omega-3 fatty acid important for the development of the brain, nervous system and eyes.
It is present in varying amounts in breast milk and formula milk, but there is no recommended dietary intake level.
While some brands seek to differentiate themselves by adding supplemental nutrients such as higher levels of DHA, the evidence for its added benefit is inconclusive, said Mr Zee.
Further, not all of the more expensive brands have higher levels of DHA than the cheaper ones.
Dr Ling said there are lower-cost weaning foods that can be introduced at six months that contain more DHA than "premium" formula brands, along with protein and other nutrients needed by growing children.
"While milk is still important for key nutrients after six months, the focus should shift towards complementary food," she said.
Proper weaning is crucial, as delaying the introduction of food can lead to fussy eating and developmental issues.
"Rather than focusing on which (formula) brand is the best, parents should look towards building a balanced and nutritious diet for their children," she said.
Follow-on formula not enough for infant nutrition: Paediatrician
Follow-on formula or growing-up milk is inadequate on its own to meet the nutritional needs of infants aged between six and 12 months, said Dr Chua Mei Chien, head of KK Women's and Children's Hospital's Neonatology Department.
It is important to start introducing weaning foods after six months to meet the changing nutritional needs of the growing infant, particularly of iron, she said.
Failure to introduce nutrient-rich weaning foods and an over-reliance on formula milk can lead to poor eating habits, she cautioned.
The World Health Organisation recommends exclusive breastfeeding for the first six months of a child's life, followed by the introduction of semi-solid foods.
The frequency of feeding with solids as well as the variety of weaning foods should increase as the infant develops from six to 12 months, with a corresponding decrease in milk intake, said Dr Chua.
Cup feeding can be introduced from six months, with an aim to stop feeding from the bottle by 12 months to 18 months, facilitating the transition to fresh milk.
The use of infant formula milk is only recommended to supplement breast milk, and babies have varying tolerance levels to different brands, she said.
Constipation is a common problem encountered in formula-fed infants as the casein in cow's milk- based formula is difficult to digest, she said. The iron and calcium in formula are also less well absorbed and can contribute to hard stools.
Conversely, some infants may have diarrhoea due to the fat blends in formula milk, which are mainly derived from a blend of vegetable oils with a simpler composition than that of lipids in breast milk.
While all infant formulas comply with international food standards and are nutritionally complete, none contains antibodies, growth factors, hormones, probiotics, live cells and other protective substances present in breast milk, said Dr Chua.