Background: Excessive use of specialized formula for cow's milk allergy was reported in England, but complete analysis has not been undertaken and trends in other countries are unknown. Some specialized formula products, especially amino-acid formula (AAF), have high free sugars content. We evaluated specialized formula trends in countries with public databases documenting national prescription rates.Methods: Cross-sectional analysis of national prescription databases in the United Kingdom, Norway and Australia. Outcomes were volume and cost of specialized formula, and proportion of infants prescribed specialized formula. Expected volumes assumed 1% cow's milk allergy incidence and similar formula feeding rates between infants with and without milk allergy.Results: Prescribed volumes of specialized formula for infants rose 2.8-fold in England from 2007 to 2018, with similar trends in other regions of the United Kingdom.Volumes rose 2.2-fold in Norway from 2009 to 2020 and 3.2-fold in Australia from 2001 to 2012. In 2020, total volumes were 9.7-to 12.6-fold greater than expected in England, 8.3-to 15.6-fold greater than expected in Norway and 3.3-to 4.5-fold greater than expected in Australia, where prescribing restrictions were introduced in 2012. In Norway, the proportion of infants prescribed specialized formula increased from 2.2% in 2009 to 6.9% in 2020, or 11.2-to 13.3-fold greater than expected. In 2020, specialized formula for infants cost US$117 (103 euro) per birth in England, US$93 (82 euro) in Norway and US$27 (23 euro) in Australia. Soya formula prescriptions exceeded expected volumes 5.5-to 6.4-fold in England in 1994 and subsequently declined, coincident with public health concerns regarding soya formula safety. In 2020, 30%-50% of prescribed specialized formula across the three countries was AAF. Conclusions:In England, Norway and Australia, specialized formula prescriptions increased in the early 21st century and exceeded expected levels. Unnecessary specialized formula use may make a significant contribution to free sugars consumption in young children.

Background: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy. Methods: Delphi study involving two rounds of anonymous consensus building and anopen meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe,

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Background:The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years.Methods: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years