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t_Articles
t_Articles
July 19, 2005
In the first two years of life, milk is the
most important source of nutrition for a baby. Infant feeding experts agree that
breast feeding is always the best choice, and encouragingly the numbers of
mothers in Asia choosing to breast feed is on the rise. However, a significant
proportion of mothers elect to supplement or fully replace breast milk with
infant milk formula. So here are some important checks and guides to ensure that
babies receiving infant formula are receiving the infant formula of adequate
nutritional quality and equally importantly, that the prepared milk is safe and
free from bacterial contamination.
Breast is Best…
Breast milk is undoubtedly the best first food for babies. Not only is it
nutritionally balanced, easy to digest, cost-free, convenient and requires no
preparation, but it also helps to protect babies from many illnesses and
infections. There may also be additional benefits in later life such as better
weight management and reduced incidence of allergy.
As virtually all mums can breast-feed, the World Health Organization recommends
that infants be exclusively breast-fed (given breast milk with no other foods or
liquids) for the first 6 months of life and that, once complementary feeding
(solid or semi-solid foods) has begun, breast-feeding is continued up to the age
of 2 years or beyond alongside complementary foods.
The Next Best Options…
In Asia, although the trend to breast-feed has increased in recent years, fewer
than half of all infants are exclusively breast-fed up to four months of age.
Just over 80% are receiving breast milk at 12-15months of age.
Mothers may decide exclusive breast-feeding is not possible for a number of
reasons - health of the mother or baby, lack of family support, work or other
commitments may sometimes make exclusive or partial breast-feeding difficult. It
is extremely important that mothers who have concerns or difficulties breast
feeding seek help from qualified personnel such as a breast feeding counselor or
specialized nurse, before giving up, as breast feeding specialists may be able
to help them find a way to successfully breast feed.
Professor Fatimah Arshad of the Department of Nutrition & Dietetics, Universiti
Kebangsaan Malaysia comments, that "Both formula or breast feeding methods need
to be taught to parents. Even though breast feeding is considered a natural
process it is better if the new mother knows the ins and outs of breast feeding
at various stages, so she can gain confidence in the process and herself".
For those who choose to breast-feed partially or not at all, an important
question is which milk is the best for your infant? The only suitable
alternative to breast milk is commercial infant formula. Homemade formulas are
not recommended, as errors in selecting and combining ingredients for a formula
could cause severe nutritional imbalances, that are harmful to a baby's health.
Most infant formulas are made with cow's milk that has been extensively altered
so it closely resembles breast milk. This alteration makes the formula easy to
digest, nutritious and safe. Unmodified cow's or goat's milk should never be
given to children younger than 12 months of age, as the protein in these milks
cannot be easily digested. Additionally, milk from cows and goats is low in iron
and goat's milk is also deficient in vitamin B12, folate and vitamin D.
Select Infant Formulas with Care
Whether you use infant formula for some feeds or all feeds, it is important that
the brand selected is suitable - checking with medical or nursing personnel
should be the first move.
A formula that has been manufactured by a reputable company, and preferably one
for which the label provides details about how to contact the manufacturer with
concerns or complaints is a wise precaution. Reputable manufacturers adhere to
strict regulations, ensure the production of a nutritionally adequate and safe
formula and genuinely want feedback from customers.
Cow's milk-based infant formula is best for most full-term infants. However, a
small number of infants require different formulas. For example, a small number
of babies are allergic to cow's milk protein or are lactose intolerant. For
these infants, a soy-based formula or a protein hydrolysate formula, which is a
substantially modified cow's milk formula may need to be considered. Symptoms
that may indicate an adverse reaction to cow's milk protein include vomiting,
diarrhea, abdominal pain, and rash. With lactose intolerance, the most common
symptoms are excessive gas, abdominal distension and pain, and diarrhea.
However, don't be tempted to jump to conclusions about allergy or intolerance,
as these symptoms are common to many baby illnesses, and a proper diagnosis
requires specialized tests. For premature infants and babies with metabolic
disorders such as phenylketonuria more specialized formulas can be recommended
by a pediatrician or specialist nurse.
Extra Nutrients- Beneficial or Hype?
Manufacturers continue to strive to make infant formula as similar to
breast milk as possible. In recent years, research has focused more on some of
the nutrients present in breast milk at micro-levels which contribute to making
breast milk the perfect food for babies.
Some formulas are supplemented with special fats. Long-chain fatty acids called
docosahexanoic acid (DHA) and arachidonic acid (ARA) are added to some infant
formulas, as these are present in breast milk and have been found to have a
positive effect on the visual function and brain development of the infant over
the short term.
Probiotic and prebiotic formulas are also available and a number of studies have
reported a lower incidence of iron deficiency anaemia, dysentery and diarrhoeal
illnesses with these formulas.
Very recently, a study in Delhi, India found that infants receiving fortified
infant formula were better protected against diarrhoea, respiratory infections,
measles and moderate to severe anaemia than those on regular formula.
At about 6 months of age, when weaning foods are slowly introduced and nutrient
needs change, milk continues to be an important component of a baby's diet and
the recommendations are to continue to breast-feed. For those babies not
breastfed, a follow-on formula may be the next best choice. Follow on formulas
generally have more calcium and iron than infant formulas for younger babies, to
meet the increased needs of growing infants. Also, a number of studies have
reported that school children fed iron-fortified formula had better iron status
and performed better on standardized developmental tests than those children fed
with unfortified formula.
Ordinary cow's milk should only be introduced after one year of age. Reduced-fat
or non-fat milk is not recommended for infants and children below 2 years of
age, as these milk don't have enough fat and calories for a growing infant.
Professor Fatimah concludes that "whatever method of feeding preferred by
parents, they deserve every help available. Proper advice, the right information
and moral support can help mothers to make the right choice. Optimal care from
the mother, the feeling of satisfaction and strong bonding between mother and
child is the main objective."
Infant Formulas - Prepare with Care
New babies have few defenses against germs and it takes a while for them
to build immunity, so good hygiene practices during preparation and storage of
formulas are essential to prevent infections.
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Sterilize bottles and teats in a bottle
sterilizer or in a pot of boiling water for 5 minutes.
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Wash hands and all utensils required for
preparation, before preparing the formula. Fix the teat and bottle cap before
mixing the formula in a bottle. Do not use fingers to cover the teat while
shaking the bottle as this may contaminate the feed.
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Use only boiled tap water to prepare the formula.
Not all bottled waters are sterile, so the only safe source of water is water
that has been brought right up to the boil just before adding to the formula
powder (but be sure mixed formula has cooled to room temperature before
feeding).
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When preparing the formula, preparation
instructions on the formula container must be followed and both, the powder
and water, must be carefully measured. Too much water could deprive a baby of
adequate nourishment and too little water could strain a, baby's digestive
system and kidneys and lead to dehydration.
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If several bottles of formula are prepared and
filled at one time, it's important to refrigerate bottles that aren't for
immediate use straightaway. Discard unused prepared formula, if it hasn't been
used within 24 hours.
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Babies prefer formula at room temperature.
Refrigerated formula can be wormed by placing the bottle in a bowl or pan of
hot water and leaving to stand for a few minutes. A microwave is not
recommended for warming formula, as fluid heats unevenly, creating hot spots
that could burn a baby's mouth. Shake the bottle after warming it, turn it
upside down and allow a drop or two of formula to fall on the back of the hand
- it should feel comfortable and barely warm.
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Once a bottle has been warmed it is very
important to never put it back in the refrigerator, even if the baby goes back
to sleep before starting the bottle. The risk of bacterial contamination from
heating, cooling and then re-heating is too great.
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Always discard left over formula after the baby
has finished drinking.
Further Reading
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Global Strategy for Infant and Young Child Feeding
http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/gs_iycf.pdf
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UNICEF Breast-feeding and complementary feeding.
http://www.childinfo.org/eddb/brfeed/
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Efficacy of micronutrient foritification of milk on morbidity in
pre-school children and growth - a double blind randomized controlled trial. R
Juyal, M Osmamy, RE Black, U Dhingra, A Sarkar, P Dhingra, P Verma, D Marwah,
R Saxsena, V P Menon, S Sazawal. Asia Pacific Journal of Clinical Nutrition
(2004),
Vol 13; Supplement S1-S180 ISSN 0964-7058.
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