Child Care: What to Feed a Neonate?

There are three types of milk feeds for a newborn:

i) Breast-feeds.

ii) Bottle-feeds with powdered infant formulas (marketed in 2 forms; one for 0-6 months and the other for infants more than 6 months. A third type is also available meant only for preterm babies).

iii) Cow’s milk.

Breast milk is the ideal nutrition for a baby. It is the gold standard against which all infant formulas are compared. It is compulsory for all infant formulas to mention on the tin that breast milk is best for the baby. If for some reason, breast milk is not available for the baby there remains two options: a) Infant formulas b) Cow’s milk.

Which is preferable? Medical evidence suggests that formulas are better as they are better tolerated and less allergenic. But there is nothing against cow’s milk. In fact the Standard Textbook of Paediatrics clearly mentions that the rate of growth and development with cow’s milk is comparable to that with the infant formulas.

The formulas are costly. A 1-month-old baby can finish a milk tin in 3-4 days and the cost translates to approximately Rs. 700-800/month (even more as the child gets older). In comparison, cow’s milk costs only Rs. 200-250/month (1/3 to 1/4 the cost of infant formulas). Can an average middle-class salaried person (who may be earning Rs. 4000-5000/month) afford to spend 20% of his income only on buying tins? The milk tins have become so popular in India because of our tendency to follow the western culture and also because of the commercial blitz.

Thus today every layman knows about them and goes for them (I have encountered daily labourers, vegetable vendors, villagers i.e. the poor people who can hardly make their two ends meet, purchasing milk tins so as to give the best to their child). For such people, initially the cost may be low as the baby (few days old) may finish one tin in 15 days, but as it grows older and its demands increases, the baby may consume 1 tin in 3-4 days. That’s the time when the person starts feeling the pinch and is no longer able to afford it. So they may over-dilute the milk (normal dilution for the formulas is 1 scoop in 1 ounce = 30 cc of water).

I have seen parents putting 1 scoop or even less in 100 cc of water, which is not correct. The baby is made satisfied with a “white water” diet. Initially it may cry as it receives less nutrition to satisfy its hunger, but over a period of time, the child’s metabolism and the body adjusts to the “over dilution” and the child becomes satisfied with whatever is offered to it. But this has disastrous consequences for the baby. It fails to gain weight (being fed only 1/3 to 1/4 of its caloric requirements) and starts becoming “skin and bones.” These babies are very vulnerable to infections, chronic diarrheas, vitamin deficiencies etc. and sadly, a large number of them succumb to malnutrition and die.

In fact malnutrition is a leading cause of infant deaths in India and the infant formulas are much responsible for this malnutrition. In fact when one sees a case of infantile malnutrition in the paediatric ward, the doctors, even without asking the parents, have got a resigned feeling in their minds that the mother must have been giving diluted infant formula, which on asking, more often than not, is correct.

This problem is so common, and the condition of the “skin and bones” infant looks so miserable and hopeless, that the infant formulas have been aptly termed as “white poison” by the doctors, particularly paediatricians. In fact there is a strong feeling amongst doctors that the infant formulas should be banned or at least OTC (over the counter) sale, without a doctor’s prescription, should be prohibited.

One should also be aware of the danger in under-dilution (i.e. making concentrated feeds). Frequently it is due to ignorance about the “scoop of the powder.” The scoop, which is included in the tin, should not be heaped but should be levelled off at the top by rubbing the scoop at the side of the tin so that the extra powder falls off and thus the scoop becomes levelled at the top.

Another reason is that the mother may think that if she feeds the baby more powder (i.e. more concentrated milk); it will become stronger and gain weight faster. Whatever the reasons are, it is dangerous for the baby, so avoid it. The reason is that the child is getting more solid as compared to water. Thus his body becomes “water deficient” over a period of time. This leads to a combination of dehydration along with increased sodium levels of the blood, both of which are dangerous.

Parents who cannot afford infant formulas can give undiluted cow’s milk to the baby. The cost is 1/3 to 1/4 of milk tins and as stated above, over dilution of powdered milk is done so that the child gets 1/3 to 1/4 of the calories. So if the parents give cow’s milk, they can afford to give it undiluted. Thus the child gets the required calories making him grow at a normal pace. Fears that the cow’s milk is hard to digest, child may suffer from diarrhoea or allergies are largely unfounded. An occasional child, who the parents feel is unable to tolerate the cow’s milk, should seek a doctor’s opinion.

Parents who can afford infant formulas can go for the infant tins, provided for some reason they are not having breast milk, which always is the nutrition of choice for all babies. They should follow the proper procedure in preparing milk from the powdered form (i.e. proper dilution is used, the bottles are properly washed and sterilised etc.)

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