Health: How to keep a hungry baby happy - Daily Mail
I didn't like Sarah Stacey's answer in the Daily Mail on the link above to the question below. So I decided to reply myself.
Q: I am a first-time mum and don’t produce enough milk for my hungry six-week-old baby boy at night, which makes us both stressed. I want to avoid using formula if possible so the health visitor advised expressing milk with a pump in the mornings – when I have plenty – but I find a manual pump very difficult to use.
A. What makes you think you don't produce enough milk at night? During the evening it's very normal for babies of this age to cluster feed, which is when they take multiple feeds with shorter spacings in between, sometimes back to back.
In the early days, hunger is driven partly by a hormone called CCK - the same hormone that induces relaxation and sleep. After a feed baby has a high level of CCK, which tells him he’s full, but it drops after another 10 or 20 minutes, so he thinks he’s hungry again. He may go through this loop several times, in what’s known as cluster feeding, before dropping into a solid, longer sleep. This is thought to allow baby to fill their whole digestive system, so excess hunger doesn't occur during a longer sleep spell.
The other thing to consider is that babies often have something called a "growth spurt" at 5-6 weeks ish (sometimes termed "fussy spell"), which can last anywhere from a couple of days to a week or so. This is when a previously settled baby has a sudden increase in appetite and wants to feed feed feed, sometimes appearing insatiable and generally fussy. It's a normal developmental step seen in both breast and bottle fed infants and they may have a few days sleeping lots after the spurt, which is when some suggest the growing (physically or mentally) occurs.
Therefore the first thing to ascertain is whether you really are not producing enough, or whether you actually have a perfectly normal supply and your baby is just doing what babies do (but which many "experts" fail to tell parents about).
You mention you have plenty in the mornings, enough to express - which wouldn't suggest a shortage of milk? It is though totally normal for milk volume to be greatest in the morning and fall gradually as the day progresses, which can leave mums concerned there isn't enough. But it's also worth knowing that if we measure the fat content of feeds this increases during the day as volume decreases - magic!
Really you need to look at the big picture. Does baby pee, poop and gain weight as expected, was he previously settled after feeds and you felt things were going well prior to this point? Is feeding pain free? If you answer yes to the above, following your baby's lead and feeding on cue is the quickest way through a fussy spell without using formula (which you mention you would like to avoid using).
If not and your baby remains unsettled or you're experiencing any pain or discomfort, there is specialist help out there. From Lactation Consultants to Breastfeeding Counsellors there are lots of options if you know where to look. Ask your Midwife or Health Visitor for details of local groups and breastfeeding counsellors, find out who is your local Infant Feeding Advisor or call one of the helplines. If you prefer there are also private Lactation Consultants who charge for their one to one services. Keep hunting for effective support, with which the vast majority of mums can make enough milk to satisfy even the hungriest of babies.
Showing posts with label Ask The Armadillo. Show all posts
Showing posts with label Ask The Armadillo. Show all posts
Ask The Armadillo - Does Breastfeeding Cause Tooth Decay?
Q. Dear Armadillo
My dentist has warned me to cut nightfeeds now my daughter has some teeth, as it will cause decay. This is proving easier said than done, is it true breastfeeding at night rots teeth?
Sarah
A. Hi Sarah
I contacted Dr Brian Palmer DDS about your question, as a world respected dentist who has extensively studied anthropological evidence surrounding normal oral development, infant feeding and decay - who better?
The upshot?
No, breastfeeding is not thought to cause tooth decay - it's another one of those old breastfeeding myths. It is widely recognized as being the main cause of dental caries (cavities) is caused by bacteria such as streptococcus mutans, which feeds on food sugars producing an acid that causes decay. It's estimated that around 20% of the population have increased levels of this bacteria (predisposing them to decay) and it can be passed from parent/caregiver to baby via saliva eg a parent sucking baby's pacifier, sharing spoons etc. A researcher called Berkowitz concluded that "caries is an infectious and transmissible disease".
I think the confusion about breastfeeding and teeth comes from two sources; firstly many don't understand the difference between breastmilk and substitutes and their effect on teeth. A 1999 study by Erikson demonstrated that some infant formulas dissolve tooth enamel, significantly reduce pH, and cause dental caries. In addition bottle feeding causes milk to pool around the teeth, because it is delivered much further forward in an infant's mouth.
Secondly whilst an extracted tooth soaked in lactose (the sugar in breastmilk) decayed, infant teeth exposed to breastmilk as a whole producted react quite differently. Breastmilk has antibacterial properties, with lactoferrin as a major consituent - and lactoferrin actively helps to neutralise strep mutans. Furthermore unlike other sugars, lactase enzyme splits lactose into glucose and galactose in the intestines, rather than in the mouth. When teeth were exposed to breastmilk, it did not cause enamel decalcification even after 12 weeks exposure; furthermore breastmilk did not cause a significant drop in plaque pH when compared to rinsing with water.
In 1999 a study published in Pediatric Dentistry stated:
There are 4,640 species of mammals, all of whom breastfeed their young. Lactose is present in most of the breastmilk of these species, yet humans are the only species with any significant decay in deciduous teeth. Modern Homo sapiens have been around for 30,000 to 35,000 years, but dental decay, however, did not become a significant problem until about 8,000 to 10,000 years ago. Anthropologists believe the increase in decay was primarily due to the advent of the cultivated crops. (Brian Palmer DDS)
To support this, there are numerous studies demonstrating no link with decay:
If lactoferrin helps destroy strep mutans, how can brestfed infants still suffer decay?
Small enamel defects can occur when teeth are forming in utero, sometimes due to exposure to medicines eg specific antibiotics. or insufficient calcium intake (Torney 1992). These defects make the teeth more vulnerable and breastmilk is not sufficient to counteract high levels of bacteria.
According to Dr Brian Palmer, the following are the most common causes of dental decay:
1. Sugar intake is the primary cause of decay. This includes sugar in otherwise nutritious foods such as juices, cereals, breads, raisins, etc. It also applies to sweetened medications. It is very important to understand that it is not the amount of sugar or carbohydrates to which the teeth are exposed, but rather the frequency of exposure that is the key to the development of decay.
2. The timing of introduction and the number of decay causing bacteria that are introduced into the infant’s mouth.
3. Xerostomia or dryness of the mouth (lack of saliva flow).
4. Illnesses of, or stress to, the mother or fetus during development.
5. Poor dietary habits of the family.
6. Poor oral and overall hygiene of the family.
7. Family genetics (minor contributor).
I've also seen increased rates in infants who have a tight or thick labial frenulum (the little tag of tissue in the center of the upper and the lower lip that attaches the lip to the gums) - perhaps because the area is sensitive it's harder to brush and thus more prone to stray food particles remaining.
You can read Brian's own presentation on breastfeeding and tooth decay here - WARNING, the link contains graphic images within a medical context.
Things you CAN do to help prevent or deal with decay:
Further Reading:
Breastfeeding & Infant Caries - No Connection.
My dentist has warned me to cut nightfeeds now my daughter has some teeth, as it will cause decay. This is proving easier said than done, is it true breastfeeding at night rots teeth?
Sarah
A. Hi Sarah
The upshot?
No, breastfeeding is not thought to cause tooth decay - it's another one of those old breastfeeding myths. It is widely recognized as being the main cause of dental caries (cavities) is caused by bacteria such as streptococcus mutans, which feeds on food sugars producing an acid that causes decay. It's estimated that around 20% of the population have increased levels of this bacteria (predisposing them to decay) and it can be passed from parent/caregiver to baby via saliva eg a parent sucking baby's pacifier, sharing spoons etc. A researcher called Berkowitz concluded that "caries is an infectious and transmissible disease".
I think the confusion about breastfeeding and teeth comes from two sources; firstly many don't understand the difference between breastmilk and substitutes and their effect on teeth. A 1999 study by Erikson demonstrated that some infant formulas dissolve tooth enamel, significantly reduce pH, and cause dental caries. In addition bottle feeding causes milk to pool around the teeth, because it is delivered much further forward in an infant's mouth.
Secondly whilst an extracted tooth soaked in lactose (the sugar in breastmilk) decayed, infant teeth exposed to breastmilk as a whole producted react quite differently. Breastmilk has antibacterial properties, with lactoferrin as a major consituent - and lactoferrin actively helps to neutralise strep mutans. Furthermore unlike other sugars, lactase enzyme splits lactose into glucose and galactose in the intestines, rather than in the mouth. When teeth were exposed to breastmilk, it did not cause enamel decalcification even after 12 weeks exposure; furthermore breastmilk did not cause a significant drop in plaque pH when compared to rinsing with water.
In 1999 a study published in Pediatric Dentistry stated:
"It is concluded that human breast milk is not cariogenic."What the study did find was that when a small amount of sugar was added to the breastmilk, it caused more decay than a sugar solution alone - emphasising the importance of tooth brushing and good dental hygiene to ensure all food particles are removed. (Investigation of the role of human breast milk in caries development, Pediatr Dent. 1999 Mar-Apr;21(2):86-90)
There are 4,640 species of mammals, all of whom breastfeed their young. Lactose is present in most of the breastmilk of these species, yet humans are the only species with any significant decay in deciduous teeth. Modern Homo sapiens have been around for 30,000 to 35,000 years, but dental decay, however, did not become a significant problem until about 8,000 to 10,000 years ago. Anthropologists believe the increase in decay was primarily due to the advent of the cultivated crops. (Brian Palmer DDS)
To support this, there are numerous studies demonstrating no link with decay:
No correlation found between caries and breastfeeding among children who were breastfed up to 34 month
Alaluusua 1990
There is not a constant relationship between breastfeeding and the development of dental caries. Mothers should be encouraged to breastfeed as long as they wish."
Valaitis 2000.
Prolonged demand breastfeeding does not lead to higher caries prevalence
Weerheijm 1998
Breastfeeding may act preventively and inhibit the development of nursing caries in children
Oulis 1999
If lactoferrin helps destroy strep mutans, how can brestfed infants still suffer decay?
Small enamel defects can occur when teeth are forming in utero, sometimes due to exposure to medicines eg specific antibiotics. or insufficient calcium intake (Torney 1992). These defects make the teeth more vulnerable and breastmilk is not sufficient to counteract high levels of bacteria.
"Human milk alone does not cause dental caries. Infants exclusively breastfed are not immune to decay due to other factors that impact the infant's risk for tooth decay. Decay causing bacteria (streptococcus mutans) is transmitted to the infant by way of parents, caregivers, and others"
Palmer 2002
According to Dr Brian Palmer, the following are the most common causes of dental decay:
1. Sugar intake is the primary cause of decay. This includes sugar in otherwise nutritious foods such as juices, cereals, breads, raisins, etc. It also applies to sweetened medications. It is very important to understand that it is not the amount of sugar or carbohydrates to which the teeth are exposed, but rather the frequency of exposure that is the key to the development of decay.
2. The timing of introduction and the number of decay causing bacteria that are introduced into the infant’s mouth.
3. Xerostomia or dryness of the mouth (lack of saliva flow).
4. Illnesses of, or stress to, the mother or fetus during development.
5. Poor dietary habits of the family.
6. Poor oral and overall hygiene of the family.
7. Family genetics (minor contributor).
I've also seen increased rates in infants who have a tight or thick labial frenulum (the little tag of tissue in the center of the upper and the lower lip that attaches the lip to the gums) - perhaps because the area is sensitive it's harder to brush and thus more prone to stray food particles remaining.
You can read Brian's own presentation on breastfeeding and tooth decay here - WARNING, the link contains graphic images within a medical context.
Things you CAN do to help prevent or deal with decay:
- Good teeth brushing is essential - any food particles mixed with breastmilk can cause decay. Some parents find an electric or musical/novelty toothbrush can distract reluctant brushers enough to quickly get the job done.
- Investigate Xylitol - it has been shown to stop strep mutans being able to "do their thing" and comes in various forms. You can get crystals to dissolve in water to use in a spray bottle, as a mouthwash or in a water bottle to sip (check suitable dosage!) a study also found reduced decay for infants if mum chewed xylitol gum.
- Decay initially may look like small chalky white patches, usually seen on front surfaces of incisors, often close to gumline - many recommend "flipping your baby's top lip once a month for a good look! These patches then turn golden brown and eventully black as decay advances.
- If you spot something get it checked out, ignoring it because they will fall out anyway in a few years isn't a good plan - statistics show infants with decay are 3 x more likely to suffer as an adult. This condition can progress very rapidly due to the enamel of primary teeth being thinner than that of permanent teeth - resulting in pain, infection and premature loss of baby teeth.
- Teeth can be remineralised and decay arrested given the right care (and at the white patch state is often completely reversible)
- Products such as Tooth Mousse or MI paste may be suitable to remineralise teeth within 2-3 months - always check with your dentist.
- If the decay is more advanced, other products are available to use short-term alongside such as curasept toothpaste and gel - always check with your dentist.
- The NHS seems to only offer tooth removal in cases of severe decay - yet experts urge parents to seek alternative opinion and treatment where possible, because baby teeth need to remain in the mouth for lots of other reasons; chewing on well-formed teeth helps the jaw bones to grow and develop properly, provide spacing for permanent teeth, allow normal chewing of food important for digestion and are also necessary for the development of sounds and proper speech development. As certain molars are expected to be in the child's mouth until 12-13 years of age - early removal may have significant impact.
- Other options may include infant crowning.
Further Reading:
Breastfeeding & Infant Caries - No Connection.
Ask The Armadillo - How Frequently Should Baby Feed?
Q. Dear Armadillo
My nine week old feeds every two hours during the day, everything feels very chaotic and I'm wondering when I can expect her to go longer?
Thanks
Emma
A. Hi Emma
Chaotic is a great way to describe life with a newborn, life is suddenly so different than before - with everything focusing around this tiny being. Many mums have expectations their baby will go 3 1/2 - 4 hours between feeds, and of course be sleeping through the night by six months! As the vast majority of infants are not breastfed after the first few weeks - these expectations are based on what is normal for infants fed a breastmilk substitute, which is often different to normal behaviour for a breastfed baby.
Breastmilk is what a young baby's digestive system is built to digest, therefore it quickly and efficiently does so within an hour and a half to two hours. Breastmilk substitutes are based on cows milk (generally) and thus a lot harder work for baby to digest. The amounts consumed are also different - formula is a static unchanging product, each the same as the last. Breastmilk changes not only in composition, but also the amount taken at each feed.
On top of this whilst mothers can make roughly the same amount over a 24 hour period - the amount available at each "sitting" varies mum to mum, so some infants will need feeding much more frequently than others. How effectively baby feeds is also a factor - some power feed whilst some feed much more slowly; often infants who feed very frequently during the day will have a longer stretch at night, and vice versa, but there's really no rules. Some babies will only take one side per feed, others will take two - generalising how much and how often baby should eat simply doesn't work.
Breastmilk is also about much more than food - it's emotional and psychological comfort, pain relief, has hormones to relax and get baby to sleep, contains a massive range of anti-viral, anti-infective, anti-microbial, anti-bacterial properties; providing it's own immune system. This means babies often want to feed more when unwell, teething or hitting a developmental milestone. Young infants also have a need to suck for appropriate neurological development - scheduling feeds deprives baby of all but nutrition. All this means that baby can have phases of frequent feeding, combined with phrases of sleeping a little longer - it really is not the case that once they can sleep through (defined as 5 hours) they do every night!
Even sleep patterns are different depending upon how an infant is fed, with some experts suggesting it is the longer and deeper levels of sleep that increase risk of SIDS.
Unfortunately - much of this natural behaviour is a big clash with expectations and cultural norms. Modern mums are used to structure, routine and predictability. In response mothers often try and stretch out or schedule feed - for a small percentage breastfeeding will still work. For many more problems with supply/insufficient weight gain in baby, or both will occur - sometimes not apparent until around 4 months when prolactin levels drop.
But let's look at what's involved with feeding. When you consider the guidelines for formula preparation - you can see why mothers are tempted to try and encourage baby to "finish the bottle", hoping for a decent gap before the next feed. In comparison breastfeeding involves simply picking baby up - is it really a biggie if it's more frequently?
Instead of battling to regain structure - why not just go with the flow and take each day at a time? your baby is still so young and within a very short period of time your baby WILL go longer between feeds and before you know it they are too busy to feed, not every need can be met by the breast and long lazy snuggly feeds become a distant fond memory; all without you doing anything at all. It can be easy for mums to feel they are doing something wrong if they don't have a set routine or pattern, it's simply not so and mums often find taking things as they come can make young babyhood so much more enjoyable.
Hope this helps
My nine week old feeds every two hours during the day, everything feels very chaotic and I'm wondering when I can expect her to go longer?
Thanks
Emma
A. Hi Emma
Chaotic is a great way to describe life with a newborn, life is suddenly so different than before - with everything focusing around this tiny being. Many mums have expectations their baby will go 3 1/2 - 4 hours between feeds, and of course be sleeping through the night by six months! As the vast majority of infants are not breastfed after the first few weeks - these expectations are based on what is normal for infants fed a breastmilk substitute, which is often different to normal behaviour for a breastfed baby.
On top of this whilst mothers can make roughly the same amount over a 24 hour period - the amount available at each "sitting" varies mum to mum, so some infants will need feeding much more frequently than others. How effectively baby feeds is also a factor - some power feed whilst some feed much more slowly; often infants who feed very frequently during the day will have a longer stretch at night, and vice versa, but there's really no rules. Some babies will only take one side per feed, others will take two - generalising how much and how often baby should eat simply doesn't work.
Breastmilk is also about much more than food - it's emotional and psychological comfort, pain relief, has hormones to relax and get baby to sleep, contains a massive range of anti-viral, anti-infective, anti-microbial, anti-bacterial properties; providing it's own immune system. This means babies often want to feed more when unwell, teething or hitting a developmental milestone. Young infants also have a need to suck for appropriate neurological development - scheduling feeds deprives baby of all but nutrition. All this means that baby can have phases of frequent feeding, combined with phrases of sleeping a little longer - it really is not the case that once they can sleep through (defined as 5 hours) they do every night!
Even sleep patterns are different depending upon how an infant is fed, with some experts suggesting it is the longer and deeper levels of sleep that increase risk of SIDS.
Unfortunately - much of this natural behaviour is a big clash with expectations and cultural norms. Modern mums are used to structure, routine and predictability. In response mothers often try and stretch out or schedule feed - for a small percentage breastfeeding will still work. For many more problems with supply/insufficient weight gain in baby, or both will occur - sometimes not apparent until around 4 months when prolactin levels drop.
But let's look at what's involved with feeding. When you consider the guidelines for formula preparation - you can see why mothers are tempted to try and encourage baby to "finish the bottle", hoping for a decent gap before the next feed. In comparison breastfeeding involves simply picking baby up - is it really a biggie if it's more frequently?
Instead of battling to regain structure - why not just go with the flow and take each day at a time? your baby is still so young and within a very short period of time your baby WILL go longer between feeds and before you know it they are too busy to feed, not every need can be met by the breast and long lazy snuggly feeds become a distant fond memory; all without you doing anything at all. It can be easy for mums to feel they are doing something wrong if they don't have a set routine or pattern, it's simply not so and mums often find taking things as they come can make young babyhood so much more enjoyable.
Hope this helps
Ask The Armadillo - what's in breastmilk?
I've seen lots of things that talk about ingredients in breastmilk that are not in formula, could you give me some more details please?
Lisa
A. Hi Lisa
I will try! although it's always a difficult one to pitch in terms of how sciency to go - giving enough information without overloading people.
It's quite interesting to talk about constituents because when it comes to research outcome of breast v formula, many will argue "x" wasn't taken into account, or "y" skews the study or suchlike; even if there are numerous studies all indicating a similar outcome, if there's one that isn't as conclusive, people will say "ah but there's conflicting evidence". Looking at what may cause the different outcome tackles things from another angle - as the question becomes what is the impact of depriving a child of a particular constituent?
Breastmilk contains around a hundred constituents that cannot be replicated in formula, with more still regularly being found as science advances. What's also worth bearing in mind is that it's not just about each element working alone to influence something specific - many properties can impact in more than one area, and a combination can also work together to affect something else entirely. Furthermore the basic makeup protein, carbs, fat etc are all different because every mammalian milk is species specific.
As an example the protein in breastmilk does a whole host of things; it contains all required essential amino acids, it provides protective factors (which I will come onto more in a moment) and it carries hormones and vitamins. Protein isn't about obtaining calories for growth, in fact it's a minimal source of energy in breastmilk.
It's also not just about the milk, but the delivery method. Mum creates antibodies specifically tailored to protect against pathogens acquired from her baby’s immediate surroundings. New antibodies are produced whenever she comes in contact with harmful microbes, or when baby breastfeeds, passing into mother’s body via saliva on her nipple. This signals her immune system to provide or produce the antibodies, which are passed back at subsequent feedings. If baby is not breastfeeding, he has only his own very low antibody levels support him; this, compounded by an immature immunological system, make him extremely vulnerable to infection, which can quickly spread.
I will try and cover some of the main constituents we know most about in terms of "defenses against illness/disease".
Interesting Constituents:
αlpha lactalbumin: the main protein in human milk, making up 10-20% of total protein. Perhaps the most exciting discovery of 2010 is that researchers discovered it causes cell suicide in over forty types of cancer. The team were exploring the antibiotic properties of breast milk when a researcher noticed that cancerous lung cells in a test tube died on contact with breast milk. They discovered that when alphalactalbumin was mixed with acid (as also found in breastmilk and the stomach of breastfed infants) a compound named HAMLET was formed (human alphalactalbumin made lethal to tumour cells) Researchers gave a period of 5 days treatment to patients with bladder cancer and discovered patients urinated dead cancer cells after each treatment. Studies with rats showed that after just seven weeks a highly invasive brain cancer called glioblastoma was seven times smaller in those treated with HAMLET. The most important factor is that the substance has no side effects, it only eliminated cancer and does not harm healthy cells. Karlsson predicted that this therapy would be widely used for adult cancer patients in 5 years. a-lactablumin also binds calcium and zinc, and during digestion forms antibacterial and immunostimulatory properties.
Stem Cells: Have a remarkable ability to develop into many different cell types in the body, serving as a sort of internal repair system. Evidence suggests these cells remain in the body long after cessation of breastfeeding. Stem cells from other sources are already being used to treat leukaemia and could soon help treat eye conditions. Scientists are also researching their potential in the longer term for treating conditions such as spinal injuries, diabetes and Parkinson’s disease.
Lymphocytes: kill infected cells directly or send out chemical messages that mobilise other components of the immune system (see T cells).
T cells: are a sub-group of lymphocytes that play an important role in establishing and maximizing the capabilities of the immune system. These cells are unusual in that cannot kill infected host cells or pathogens, and without other immune cells they would usually be considered useless against an infection. However they have an important role to play activating and directing other immune cells.
Macrophages and neutrophils: are amongst the most common leukocytes in human milk, and they surround and destroy harmful bacteria. The macrophages also manufacture lysozyme, an enzyme that destroys bacteria by disrupting their cell walls. Macrophages in the digestive tract can rally lymphocytes into action against invaders
Immunoglobulins: IgA, IgG, IgM and IgD are all found in human milk. Of these the most important is IgA, which is both synthesised and stored in the breast. It ‘paints’ baby's tract and gut, covering the mucosal surfaces to prevent the entry of pathogenic bacteria and enteroviruses. It affords protections against E. coli, salmonellae, shigellae, streptococci, staphylococci, pneumococci, poliovirus and the rotaviruses.
Lysozyme: Enhances the ability of IgA and attacks E. coli along with with lactoferrin and sIgA.
Lactoferrin is a protein that binds to iron, preventing disease-causing bacteria from consuming it. It also kills various bacteria including E coli and also helps prevent the immune system from overreacting. Lactoferrin is currently being investigated as a treatment for auto-immune conditions such as rheumatoid arthritis, multiple sclerosis and septic shock.
Mucin: Attaches to bacteria and viruses that enter the baby’s body. When this happens, other cells in the immune system will destroy the disease-causing substance.
Cytokines are believed to play a significant role in the immune-modulation and immune-protection of breast milk. Most of the cytokines that are known to be deficient in the neonate have been found in significant amounts in breast milk.
Anti-infective factors: During the first 10 days there are more white cells per ml of human milk than there are in blood.
Milk lipids (fats): Milk lipids damage the outer surface of certain types of viruses. When the viruses are damaged, they are unable to replicate and cause an infection in the baby.
Linoleic acid: Associated with anti-cancer properties, can reduce the risk for cardiovascular disease and help fight inflammation.
IL-7: is linked to the size of the thymus, the central organ in the immune system. It has been found to be up to half the normal size in artificially-fed infants. IL-7 also has an important role in promoting the production of B lymphocytes, the antibody producing cells.
Growth factors: including epidermal, insulin-like and transforming growth factor; these promote gastrointestinal maturation in the infant. Epidermal growth factor leves are highest in the milk of mums who have premature infants, which dramatically reduces the rate of necrotising enterocolitis (NEC) & intestinal inflammation. There is also theory these factors may play a role in "early life programming" which suggests that the adult individual's physiology (eg obesity) and potential morbidity (eg cancer) is predetermined early in life.
This list is by no means exhaustive;
Breastmilk contains a myriad of other factors that work to protect and enhance the development of the breastfed child. These include:What is interesting is that as we are discovering more about what the constituents do, it supports what research has been highlighting in terms of outcome. Studies have long linked not breastfeeding with higher rates of ear infections, cancers, diabetes, meningitis, respiratory illness, rheumatoid arthritis (and other diseases of the immune system) gatrointestinal illness and NEC to name just a few from a long list. As we begin to understand more about which part of breastmilk does what, it gives more understanding as to why non breastfed infants are more susceptible - not just as infants but in terms of life long health. What's perhaps the most worrying is that science has hardly scraped the surface yet and so potentially massess of other diseases could also be intricately linked eg researchers are currently exploring links with a number of conditions including multiple sclerosis and chronic fatigue syndrome.
- nucleotides
- defensins
- hormones
- anti-inflammatory components
- soluble CD14 and soluble Toll-like Receptor (health-e-learning)
Full list of what's in Breastmilk V Formula
BREASTMILK - bear in mind some are plural and that new constituents are still being identified and their function understood within breastmilk
Water
Carbohydrates (energy source)
Lactose
Oligosaccharides (see below)
Carboxylic acid
Alpha hydroxy acid
Lactic acid
Proteins (building muscles and bones)
Whey protein
Alpha-lactalbumin
HAMLET (Human Alpha-lactalbumin Made Lethal to Tumour cells)
Lactoferrin
Many antimicrobial factors (see below)
Casein
Serum albumin
Non-protein nitrogens
Creatine
Creatinine
Urea
Uric acid
Peptides (see below)
Amino Acids (the building blocks of proteins)
Alanine
Arginine
Aspartate
Clycine
Cystine
Glutamate
Histidine
Isoleucine
Leucine
Lycine
Methionine
Phenylalanine
Proline
Serine
Taurine
Theronine
Tryptophan
Tyrosine
Valine
Carnitine (amino acid compound necessary to make use of fatty acids as an energy source)
Nucleotides (chemical compounds that are the structural units of RNA and DNA)
5’-Adenosine monophosphate (5”-AMP)
3’:5’-Cyclic adenosine monophosphate (3’:5’-cyclic AMP)
5’-Cytidine monophosphate (5’-CMP)
Cytidine diphosphate choline (CDP choline)
Guanosine diphosphate (UDP)
Guanosine diphosphate - mannose
3’- Uridine monophosphate (3’-UMP)
5’-Uridine monophosphate (5’-UMP)
Uridine diphosphate (UDP)
Uridine diphosphate hexose (UDPH)
Uridine diphosphate-N-acetyl-hexosamine (UDPAH)
Uridine diphosphoglucuronic acid (UDPGA)
Several more novel nucleotides of the UDP type
Fats
Triglycerides
Long-chain polyunsaturated fatty acids
Docosahexaenoic acid (DHA) (important for brain development)
Arachidonic acid (AHA) (important for brain development)
Linoleic acid
Alpha-linolenic acid (ALA)
Eicosapentaenoic acid (EPA)
Conjugated linoleic acid (Rumenic acid)
Free Fatty Acids
Monounsaturated fatty acids
Oleic acid
Palmitoleic acid
Heptadecenoic acid
Saturated fatty acids
Stearic
Palmitic acid
Lauric acid
Myristic acid
Phospholipids
Phosphatidylcholine
Phosphatidylethanolamine
Phosphatidylinositol
Lysophosphatidylcholine
Lysophosphatidylethanolamine
Plasmalogens
Sphingolipids
Sphingomyelin
Gangliosides
GM1
GM2
GM3
Glucosylceramide
Glycosphingolipids
Galactosylceramide
Lactosylceramide
Globotriaosylceramide (GB3)
Globoside (GB4)
Sterols
Squalene
Lanosterol
Dimethylsterol
Methosterol
Lathosterol
Desmosterol
Triacylglycerol
Cholesterol
7-dehydrocholesterol
Stigma-and campesterol
7-ketocholesterol
Sitosterol
β-lathosterol
Vitamin D metabolites
Steroid hormones
Vitamins
Vitamin A
Beta carotene
Vitamin B6
Vitamin B8 (Inositol)
Vitamin B12
Vitamin C
Vitamin D
Vitamin E
a-Tocopherol
Vitamin K
Thiamine
Riboflavin
Niacin
Folic acid
Pantothenic acid
Biotin
Minerals
Calcium
Sodium
Potassium
Iron
Zinc
Chloride
Phosphorus
Magnesium
Copper
Manganese
Iodine
Selenium
Choline
Sulpher
Chromium
Cobalt
Fluorine
Nickel
Metal
Molybdenum (essential element in many enzymes)
Growth Factors (aid in the maturation of the intestinal lining)
Cytokines
interleukin-1β (IL-1β)
IL-2
IL-4
IL-6
IL-8
IL-10
Granulocyte-colony stimulating factor (G-CSF)
Macrophage-colony stimulating factor (M-CSF)
Platelet derived growth factors (PDGF)
Vascular endothelial growth factor (VEGF)
Hepatocyte growth factor -α (HGF-α)
HGF-β
Tumor necrosis factor-α
Interferon-γ
Epithelial growth factor (EGF)
Transforming growth factor-α (TGF-α)
TGF β1
TGF-β2
Insulin-like growth factor-I (IGF-I) (also known as somatomedin C)
Insulin-like growth factor- II
Nerve growth factor (NGF)
Erythropoietin
Peptides (combinations of amino acids)
HMGF I (Human growth factor)
HMGF II
HMGF III
Cholecystokinin (CCK)
β-endorphins
Parathyroid hormone (PTH)
Parathyroid hormone-related peptide (PTHrP)
β-defensin-1
Calcitonin
Gastrin
Motilin
Bombesin (gastric releasing peptide, also known as neuromedin B)
Neurotensin
Somatostatin
Hormones (chemical messengers that carry signals from one cell, or group of cells, to another via the blood)
Cortisol
Triiodothyronine (T3)
Thyroxine (T4)
Thyroid stimulating hormone (TSH) (also known as thyrotropin)
Thyroid releasing hormone (TRH)
Prolactin
Oxytocin
Insulin
Corticosterone
Thrombopoietin
Gonadotropin-releasing hormone (GnRH)
GRH
Leptin (aids in regulation of food intake)
Ghrelin (aids in regulation of food intake)
Adiponectin
Feedback inhibitor of lactation (FIL)
Eicosanoids
Prostaglandins (enzymatically derived from fatty acids)
PG-E1
PG-E2
PG-F2
Leukotrienes
Thromboxanes
Prostacyclins
Enzymes (catalysts that support chemical reactions in the body)
Amylase
Arysulfatase
Catalase
Histaminase
Lipase
Lysozyme
PAF-acetylhydrolase
Phosphatase
Xanthine oxidase
Antiproteases (thought to bind themselves to macromolecules such as enzymes and as a result prevent allergic and anaphylactic reactions)
a-1-antitrypsin
a-1-antichymotrypsin
Antimicrobial factors (are used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses.
Leukocytes (white blood cells)
Phagocytes
Basophils
Neutrophils
Eoisinophils
Macrophages
Lymphocytes
B lymphocytes (also known as B cells)
T lymphocytes (also known as C cells)
sIgA (Secretory immunoglobulin A) (the most important antiinfective factor)
IgA2
IgG
IgD
IgM
IgE
Complement C1
Complement C2
Complement C3
Complement C4
Complement C5
Complement C6
Complement C7
Complement C8
Complement C9
Glycoproteins
Mucins (attaches to bacteria and viruses to prevent them from clinging to mucousal tissues)
Lactadherin
Alpha-lactoglobulin
Alpha-2 macroglobulin
Lewis antigens
Ribonuclease
Haemagglutinin inhibitors
Bifidus Factor (increases growth of Lactobacillus bifidus - which is a good bacteria)
Lactoferrin (binds to iron which prevents harmful bacteria from using the iron to grow)
Lactoperoxidase
B12 binding protein (deprives microorganisms of vitamin B12)
Fibronectin (makes phagocytes more aggressive, minimizes inflammation, and repairs damage caused by inflammation)
Oligosaccharides (more than 200 different kinds!)
FORMULA
Water
Carbohydrates
Lactose
Corn maltodextrin
Protein
Partially hydrolyzed reduced minerals whey protein concentrate (from cow’s milk)
Fats
Palm olein
Soybean oil
Coconut oil
High oleic safflower oil (or sunflower oil)
M. alpina oil (Fungal DHA)
C.cohnii oil (Algal ARA)
Minerals
Potassium citrate
Potassium phosphate
Calcium chloride
Tricalcium phosphate
Sodium citrate
Magnesium chloride
Ferrous sulphate
Zinc sulphate
Sodium chloride
Copper sulphate
Potassium iodide
Manganese sulphate
Sodium selenate
Vitamins
Sodium ascorbate
Inositol
Choline bitartrate
Alpha-Tocopheryl acetate
Niacinamide
Calcium pantothenate
Riboflavin
Vitamin A acetate
Pyridoxine hydrochloride
Thiamine mononitrate
Folic acid
Phylloquinone
Biotin
Vitamin D3
Vitamin B12
Enzyme
Trypsin
Amino acid
Taurine
L-Carnitine (a combination of two different amino acids)
Nucleotides
Cytidine 5-monophosphate
Disodium uridine 5-monophosphate
Adenosine 5-monophosphate
Disodium guanosine 5-monophosphate
Soy Lecithin
Related Posts: Over 101 reasons to breastfeed
Carbohydrates (energy source)
Lactose
Oligosaccharides (see below)
Carboxylic acid
Alpha hydroxy acid
Lactic acid
Proteins (building muscles and bones)
Whey protein
Alpha-lactalbumin
HAMLET (Human Alpha-lactalbumin Made Lethal to Tumour cells)
Lactoferrin
Many antimicrobial factors (see below)
Casein
Serum albumin
Non-protein nitrogens
Creatine
Creatinine
Urea
Uric acid
Peptides (see below)
Amino Acids (the building blocks of proteins)
Alanine
Arginine
Aspartate
Clycine
Cystine
Glutamate
Histidine
Isoleucine
Leucine
Lycine
Methionine
Phenylalanine
Proline
Serine
Taurine
Theronine
Tryptophan
Tyrosine
Valine
Carnitine (amino acid compound necessary to make use of fatty acids as an energy source)
Nucleotides (chemical compounds that are the structural units of RNA and DNA)
5’-Adenosine monophosphate (5”-AMP)
3’:5’-Cyclic adenosine monophosphate (3’:5’-cyclic AMP)
5’-Cytidine monophosphate (5’-CMP)
Cytidine diphosphate choline (CDP choline)
Guanosine diphosphate (UDP)
Guanosine diphosphate - mannose
3’- Uridine monophosphate (3’-UMP)
5’-Uridine monophosphate (5’-UMP)
Uridine diphosphate (UDP)
Uridine diphosphate hexose (UDPH)
Uridine diphosphate-N-acetyl-hexosamine (UDPAH)
Uridine diphosphoglucuronic acid (UDPGA)
Several more novel nucleotides of the UDP type
Fats
Triglycerides
Long-chain polyunsaturated fatty acids
Docosahexaenoic acid (DHA) (important for brain development)
Arachidonic acid (AHA) (important for brain development)
Linoleic acid
Alpha-linolenic acid (ALA)
Eicosapentaenoic acid (EPA)
Conjugated linoleic acid (Rumenic acid)
Free Fatty Acids
Monounsaturated fatty acids
Oleic acid
Palmitoleic acid
Heptadecenoic acid
Saturated fatty acids
Stearic
Palmitic acid
Lauric acid
Myristic acid
Phospholipids
Phosphatidylcholine
Phosphatidylethanolamine
Phosphatidylinositol
Lysophosphatidylcholine
Lysophosphatidylethanolamine
Plasmalogens
Sphingolipids
Sphingomyelin
Gangliosides
GM1
GM2
GM3
Glucosylceramide
Glycosphingolipids
Galactosylceramide
Lactosylceramide
Globotriaosylceramide (GB3)
Globoside (GB4)
Sterols
Squalene
Lanosterol
Dimethylsterol
Methosterol
Lathosterol
Desmosterol
Triacylglycerol
Cholesterol
7-dehydrocholesterol
Stigma-and campesterol
7-ketocholesterol
Sitosterol
β-lathosterol
Vitamin D metabolites
Steroid hormones
Vitamins
Vitamin A
Beta carotene
Vitamin B6
Vitamin B8 (Inositol)
Vitamin B12
Vitamin C
Vitamin D
Vitamin E
a-Tocopherol
Vitamin K
Thiamine
Riboflavin
Niacin
Folic acid
Pantothenic acid
Biotin
Minerals
Calcium
Sodium
Potassium
Iron
Zinc
Chloride
Phosphorus
Magnesium
Copper
Manganese
Iodine
Selenium
Choline
Sulpher
Chromium
Cobalt
Fluorine
Nickel
Metal
Molybdenum (essential element in many enzymes)
Growth Factors (aid in the maturation of the intestinal lining)
Cytokines
interleukin-1β (IL-1β)
IL-2
IL-4
IL-6
IL-8
IL-10
Granulocyte-colony stimulating factor (G-CSF)
Macrophage-colony stimulating factor (M-CSF)
Platelet derived growth factors (PDGF)
Vascular endothelial growth factor (VEGF)
Hepatocyte growth factor -α (HGF-α)
HGF-β
Tumor necrosis factor-α
Interferon-γ
Epithelial growth factor (EGF)
Transforming growth factor-α (TGF-α)
TGF β1
TGF-β2
Insulin-like growth factor-I (IGF-I) (also known as somatomedin C)
Insulin-like growth factor- II
Nerve growth factor (NGF)
Erythropoietin
Peptides (combinations of amino acids)
HMGF I (Human growth factor)
HMGF II
HMGF III
Cholecystokinin (CCK)
β-endorphins
Parathyroid hormone (PTH)
Parathyroid hormone-related peptide (PTHrP)
β-defensin-1
Calcitonin
Gastrin
Motilin
Bombesin (gastric releasing peptide, also known as neuromedin B)
Neurotensin
Somatostatin
Hormones (chemical messengers that carry signals from one cell, or group of cells, to another via the blood)
Cortisol
Triiodothyronine (T3)
Thyroxine (T4)
Thyroid stimulating hormone (TSH) (also known as thyrotropin)
Thyroid releasing hormone (TRH)
Prolactin
Oxytocin
Insulin
Corticosterone
Thrombopoietin
Gonadotropin-releasing hormone (GnRH)
GRH
Leptin (aids in regulation of food intake)
Ghrelin (aids in regulation of food intake)
Adiponectin
Feedback inhibitor of lactation (FIL)
Eicosanoids
Prostaglandins (enzymatically derived from fatty acids)
PG-E1
PG-E2
PG-F2
Leukotrienes
Thromboxanes
Prostacyclins
Enzymes (catalysts that support chemical reactions in the body)
Amylase
Arysulfatase
Catalase
Histaminase
Lipase
Lysozyme
PAF-acetylhydrolase
Phosphatase
Xanthine oxidase
Antiproteases (thought to bind themselves to macromolecules such as enzymes and as a result prevent allergic and anaphylactic reactions)
a-1-antitrypsin
a-1-antichymotrypsin
Antimicrobial factors (are used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses.
Leukocytes (white blood cells)
Phagocytes
Basophils
Neutrophils
Eoisinophils
Macrophages
Lymphocytes
B lymphocytes (also known as B cells)
T lymphocytes (also known as C cells)
sIgA (Secretory immunoglobulin A) (the most important antiinfective factor)
IgA2
IgG
IgD
IgM
IgE
Complement C1
Complement C2
Complement C3
Complement C4
Complement C5
Complement C6
Complement C7
Complement C8
Complement C9
Glycoproteins
Mucins (attaches to bacteria and viruses to prevent them from clinging to mucousal tissues)
Lactadherin
Alpha-lactoglobulin
Alpha-2 macroglobulin
Lewis antigens
Ribonuclease
Haemagglutinin inhibitors
Bifidus Factor (increases growth of Lactobacillus bifidus - which is a good bacteria)
Lactoferrin (binds to iron which prevents harmful bacteria from using the iron to grow)
Lactoperoxidase
B12 binding protein (deprives microorganisms of vitamin B12)
Fibronectin (makes phagocytes more aggressive, minimizes inflammation, and repairs damage caused by inflammation)
Oligosaccharides (more than 200 different kinds!)
FORMULA
Water
Carbohydrates
Lactose
Corn maltodextrin
Protein
Partially hydrolyzed reduced minerals whey protein concentrate (from cow’s milk)
Fats
Palm olein
Soybean oil
Coconut oil
High oleic safflower oil (or sunflower oil)
M. alpina oil (Fungal DHA)
C.cohnii oil (Algal ARA)
Minerals
Potassium citrate
Potassium phosphate
Calcium chloride
Tricalcium phosphate
Sodium citrate
Magnesium chloride
Ferrous sulphate
Zinc sulphate
Sodium chloride
Copper sulphate
Potassium iodide
Manganese sulphate
Sodium selenate
Vitamins
Sodium ascorbate
Inositol
Choline bitartrate
Alpha-Tocopheryl acetate
Niacinamide
Calcium pantothenate
Riboflavin
Vitamin A acetate
Pyridoxine hydrochloride
Thiamine mononitrate
Folic acid
Phylloquinone
Biotin
Vitamin D3
Vitamin B12
Enzyme
Trypsin
Amino acid
Taurine
L-Carnitine (a combination of two different amino acids)
Nucleotides
Cytidine 5-monophosphate
Disodium uridine 5-monophosphate
Adenosine 5-monophosphate
Disodium guanosine 5-monophosphate
Soy Lecithin
Courtesy of http://www.bcbabyfriendly.ca (reproduced with permission)
Book your visit with AA at Milk Matters Infant Feeding Solutions here
Book your visit with AA at Milk Matters Infant Feeding Solutions here
Related Posts: Over 101 reasons to breastfeed
Ask the Armadillo - making up infant feeds, what's the deal?
Q. Dear Armadillo
Would you consider an article about making up infant formula please? I've read you have to use water hotter than 70 degrees and make the feeds up as required, but a lot of mums I speak to don't do this as it's quite new information and babies have been fine for years without it and over cleaning is just as bad. Who is right?
Sarah
A. Hi Sarah
You are correct that Department of Health guidelines are to use water of at least 70 degrees and discard a bottle after two hours (some sources suggest one if baby has been drinking from it) but there does generally seem to be quite a lot of confusion over the guidelines and whether they are applicable to countries such as the UK & US where water contamination is not an issue. I wanted to answer this question as for mums not breastfeeding, it's important to make the alternatives as safe as possible. I should add at this point that I generally had quite a laissez-faire attitude to sterilisation of things when mine were little - I mean once they were crawling on the floor and chewing things that had been on it, I didn't really see much point ensuring toys were sterilised. I do also think generally that over use in the home of things like antibacterial sprays on every surface, bleaching floors constantly etc carries more risk than the germs they protect from. Breastmilk substitutes however are a little bit different.
Unlike ready to feed liquid milk, a tin of powder is not sterile and there are risks of contamination all the way through the process - starting with the raw ingredients, during production after pasteurisation and thirdly in the reformulation or in the can at home. Because of this there are different problems associated with reconstituting incorrectly.
Let's start with the most serious risks.
Without a doubt these are are Enterobacter sakazakii and Salmonella. The first is a bit of an interesting one as it is found in the gut of healthy humans (probably as an intermittent guest) as well as in the gut of animals and in the environment. A 2005 study found the prevalence in infant formula varied from 0 to 12% in samples from five different companies. To give more of an idea of frequency, a 2010 study found 9 out of 149 samples were contaminated with E Sakazakii.
When it strikes it can be extremely nasty, and there are strong links with meningitis, septicemia, and necrotizing enterocolitis. In the outbreaks reported 50-70% of the infants who contracted the disease died; for those who survive, severe lasting complications can result in various problems including neurological disorders
The trouble with breastmilk substitutes is that they provide the perfect environment for bacteria to grow and thrive, and in 50-80 % of cases powdered infant formula is both the vehicle and the source (direct or indirect) of E. sakazaki induced illness, whilst no exclusively breastfed infants have to date been reported to have Enterobacter sakazakii infections (WHO).
Because of the high mortality rate, when links with disease were made investigations immediately began as to how to best minimise risks; scientists discovered boiling water at 70 degrees resulted in a more than 4-log reduction in E. sakazakii levels. Furthermore, not leaving the made product to sit around prevented any remaining pathogens from increasing to dangerous levels, a risk that increases further once the enzymes from baby's saliva have entered the mix. This is really important as in the above mentioned study, 8 of the 9 cases of contamination were low and therefore mixing with water of an adequate temperature and using immediately is likely to reduce this risk to a nominal level. However using water that is too cool, then leaving the milk to sit around can very quickly lead to high levels of harmful bacteria.
Although found less frequently in breastmilk substitutes, more people have heard of Salmonella; it can cause anything from mild diarrhoea, vomiting and cramps to the rarer Salmonella bacteremia which can result in septicemia and meningitis. Again using water at 70 degrees minimises risks.
Because formula contamination rarely hits the news unless it's a large "official outbreak" which is less common, many people are under the impression that the risk of formula contamination is negligible; but WHO feel differently:
Sue Battersby, a midwife stated in a 2009 report:
For people who say they didn't do it with other children and theirs have always been fine, I always think that given the advancements in what we know about bacteria and how to reduce the risks of it - why ignore this?
Is it hard to do in practice?
Guidelines suggest using water that has been boiled and left for no more than around 30 minutes. For a couple of pounds it's worth buying a thermometer and checking the temperature of your water a couple of times to get a feel for how fast it cools. It is just as important not to add boiling water to the powder as manufacturers suggest this may damage vitamins/nutrients.
If baby has a rough feeding routine, you can then build in cooling time when at home. If going out and about, carrying the powder in a sterilised container, water in a flask and then combining the two when required works - again worth checking the temperature a few times if there's risk it could have cooled. I've heard a lot of mums do this at night too! Another option is to keep cooled boiled water in the fridge, and work out how much needs to be added to the boiling water to get an appropriate temperature. If you decide to use thermal bags for carrying ready made bottles, it's even more important to check temperatures after storage as many mums report large differences in how long milk remains at temperature.
Hope that answers your question - it also neatly dispels the myth infant formula is a handy, convenient alternative!
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_084165.pdf
Would you consider an article about making up infant formula please? I've read you have to use water hotter than 70 degrees and make the feeds up as required, but a lot of mums I speak to don't do this as it's quite new information and babies have been fine for years without it and over cleaning is just as bad. Who is right?
Sarah
A. Hi Sarah
You are correct that Department of Health guidelines are to use water of at least 70 degrees and discard a bottle after two hours (some sources suggest one if baby has been drinking from it) but there does generally seem to be quite a lot of confusion over the guidelines and whether they are applicable to countries such as the UK & US where water contamination is not an issue. I wanted to answer this question as for mums not breastfeeding, it's important to make the alternatives as safe as possible. I should add at this point that I generally had quite a laissez-faire attitude to sterilisation of things when mine were little - I mean once they were crawling on the floor and chewing things that had been on it, I didn't really see much point ensuring toys were sterilised. I do also think generally that over use in the home of things like antibacterial sprays on every surface, bleaching floors constantly etc carries more risk than the germs they protect from. Breastmilk substitutes however are a little bit different.
Let's start with the most serious risks.
Without a doubt these are are Enterobacter sakazakii and Salmonella. The first is a bit of an interesting one as it is found in the gut of healthy humans (probably as an intermittent guest) as well as in the gut of animals and in the environment. A 2005 study found the prevalence in infant formula varied from 0 to 12% in samples from five different companies. To give more of an idea of frequency, a 2010 study found 9 out of 149 samples were contaminated with E Sakazakii.
When it strikes it can be extremely nasty, and there are strong links with meningitis, septicemia, and necrotizing enterocolitis. In the outbreaks reported 50-70% of the infants who contracted the disease died; for those who survive, severe lasting complications can result in various problems including neurological disorders
The trouble with breastmilk substitutes is that they provide the perfect environment for bacteria to grow and thrive, and in 50-80 % of cases powdered infant formula is both the vehicle and the source (direct or indirect) of E. sakazaki induced illness, whilst no exclusively breastfed infants have to date been reported to have Enterobacter sakazakii infections (WHO).
Because of the high mortality rate, when links with disease were made investigations immediately began as to how to best minimise risks; scientists discovered boiling water at 70 degrees resulted in a more than 4-log reduction in E. sakazakii levels. Furthermore, not leaving the made product to sit around prevented any remaining pathogens from increasing to dangerous levels, a risk that increases further once the enzymes from baby's saliva have entered the mix. This is really important as in the above mentioned study, 8 of the 9 cases of contamination were low and therefore mixing with water of an adequate temperature and using immediately is likely to reduce this risk to a nominal level. However using water that is too cool, then leaving the milk to sit around can very quickly lead to high levels of harmful bacteria.
Although found less frequently in breastmilk substitutes, more people have heard of Salmonella; it can cause anything from mild diarrhoea, vomiting and cramps to the rarer Salmonella bacteremia which can result in septicemia and meningitis. Again using water at 70 degrees minimises risks.
Because formula contamination rarely hits the news unless it's a large "official outbreak" which is less common, many people are under the impression that the risk of formula contamination is negligible; but WHO feel differently:
Is the risk similar in all regions and countries?Another condition heavily linked with incorrect preparation of infant formula is gastroenteritis, often called stomach flu. Symptoms include diarrhoea, sickness and stomach cramps - in people able to consume enough fluids it is generally not serious; however infants and young children are at risk from loss of fluids and may need to be hospitalised for treatment to correct or prevent dehydration.
There have been reported cases of Enterobacter sakazakii infections due to contaminated infant formula in only a few developed countries. It is likely that there is a significant under reporting of infections in all countries. The absence of reports is probably due to a lack of awareness of the problem rather than an absence of illness. In general, the limitations of current surveillance systems in most countries would add to the explanation for the lack of reported cases. Since infant formula is widely used, the presence of Enterobacter sakazakii in infant formula and its potential effects in infants could well be a significant public health problem in most countries.
Sue Battersby, a midwife stated in a 2009 report:
Formula is not sterilised and bacteria can be present. When it is made up or stored incorrectly there is a big risk that it could cause gastroenteritis. "Formula fed babies are five times more likely to be admitted to hospital with gastroenteritis, which in the majority of cases is preventable."It's as usual all about risks rather than certainties - not every baby who drinks milk prepared incorrectly will become ill and nor is meticulously following the guidelines a guarantee baby will remain well; but for the sake of the extra few minutes is it really worth the risk? Of course good hygiene such as sterilisation of bottles and other equipment (domestic dishwashers usually are not hot enough), effective hand washing and careful storage all contribute too . My personal experience is that gastroenteritis is still common at 9-24 months, when many parents relax a little - whilst this may be ok for other items such as toys, things that come in contact with breastmilk substitutes are still prime breeding ground.
For people who say they didn't do it with other children and theirs have always been fine, I always think that given the advancements in what we know about bacteria and how to reduce the risks of it - why ignore this?
Is it hard to do in practice?
Guidelines suggest using water that has been boiled and left for no more than around 30 minutes. For a couple of pounds it's worth buying a thermometer and checking the temperature of your water a couple of times to get a feel for how fast it cools. It is just as important not to add boiling water to the powder as manufacturers suggest this may damage vitamins/nutrients.
If baby has a rough feeding routine, you can then build in cooling time when at home. If going out and about, carrying the powder in a sterilised container, water in a flask and then combining the two when required works - again worth checking the temperature a few times if there's risk it could have cooled. I've heard a lot of mums do this at night too! Another option is to keep cooled boiled water in the fridge, and work out how much needs to be added to the boiling water to get an appropriate temperature. If you decide to use thermal bags for carrying ready made bottles, it's even more important to check temperatures after storage as many mums report large differences in how long milk remains at temperature.
Hope that answers your question - it also neatly dispels the myth infant formula is a handy, convenient alternative!
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_084165.pdf
Ask The Armadillo - follow on formula con linked to impaired development
Q. Hi Armadillo,
I've got a Q for you! I'm confused (and so are a lot of mums I speak to) about this claim by follow-on milk producers that breastfed babies and those weaned onto cows milk are going to be short of iron. Can you shed any light?
Many thanks,
Jude
A. Hi Jude
Ah the giant marketing machine that is follow on milk, and it's huge iron count. Yes, how did the human race manage before it?
An interesting fact you may or may not be aware of, is that until the 1980's/90's there was no such thing as "follow on milks". They were developed partly because the market for young baby infant formula was saturated (s'always about the money), and partly to dodge the new regulations that were starting to appear which banned the promotion of young baby infant formula.
Follow on milk (for infants over 6 months) was not restricted in these regulations, because it did not exist! So manufacturers then moved to advertise their similarly packaged and branded follow on milk, because parents very often mistake these adverts for young baby formula. There have been numerous follow on adverts banned because they used infants that were too young or because they used misleading statements. In fact, when a 2005 survey asked 1,000 new mothers and pregnant women, two thirds (60%) said they had seen or heard advertising for young baby infant formula in the past year. Worryingly more than a third of women who had seen formula advertising said that the message conveyed was that infant formula is 'as good as' or 'better than' breastmilk. Clever huh?
The "very large iron scam" as I fondly like to term it, is almost as clever - but not quite...
Because obviously pre the 80's babies weren't all wandering round iron deficient. No mammal biologically needs the milk of another species to survive and thrive, otherwise the human race would have died out long before follow on milk was around. Even babies not having breastmilk after twelve months, don't need cow's milk or follow on formula to remain healthy. Some babies are more at risk of deficiency, such as those born preterm, or if mum has diabetes - if you are unsure, check with your healthcare provider.
Before I go any further, it's important to understand the different types of iron we can consume. Heme iron is found in animal foods that originally contained haemoglobin, such as red meats, fish, and poultry; iron in plant foods such as lentils and beans is arranged in a chemical structure called non-heme iron, and it's this form of iron that is added to iron-enriched and iron-fortified foods. Heme iron is better absorbed and more bioavailable than non-heme.
Now, the recommended daily iron allowance (RDA) for a child 1-3 years is around 6 mg/day.
So take the advert with the giant cup of milk, and wow imagine having to drink all this to give your baby the RDA - gosh yes, mammoth! But hang on, infants at 6 months plus aren't reliant solely on milk - at this point they are starting to consume solids and take iron in their diet too, by twelve months most are eating a good varied diet - so their intake is a combination of iron in milk + iron in food. If their daily iron requirements are met in just a couple of beakers of "high iron formula", isn't baby very quickly at risk of being well over the daily recommended allowance if they eat much?
Nowhere in this marketing plan does anyone mention the risks of too much iron, but many source suggest that too much is just as bad as too little.
A study published November 2011 found infants who received iron fortified infant formula have poorer long-term developmental outcomes.
I've got a Q for you! I'm confused (and so are a lot of mums I speak to) about this claim by follow-on milk producers that breastfed babies and those weaned onto cows milk are going to be short of iron. Can you shed any light?
Many thanks,
Jude
A. Hi Jude
Ah the giant marketing machine that is follow on milk, and it's huge iron count. Yes, how did the human race manage before it?
An interesting fact you may or may not be aware of, is that until the 1980's/90's there was no such thing as "follow on milks". They were developed partly because the market for young baby infant formula was saturated (s'always about the money), and partly to dodge the new regulations that were starting to appear which banned the promotion of young baby infant formula.
Follow on milk (for infants over 6 months) was not restricted in these regulations, because it did not exist! So manufacturers then moved to advertise their similarly packaged and branded follow on milk, because parents very often mistake these adverts for young baby formula. There have been numerous follow on adverts banned because they used infants that were too young or because they used misleading statements. In fact, when a 2005 survey asked 1,000 new mothers and pregnant women, two thirds (60%) said they had seen or heard advertising for young baby infant formula in the past year. Worryingly more than a third of women who had seen formula advertising said that the message conveyed was that infant formula is 'as good as' or 'better than' breastmilk. Clever huh?
The "very large iron scam" as I fondly like to term it, is almost as clever - but not quite...
Because obviously pre the 80's babies weren't all wandering round iron deficient. No mammal biologically needs the milk of another species to survive and thrive, otherwise the human race would have died out long before follow on milk was around. Even babies not having breastmilk after twelve months, don't need cow's milk or follow on formula to remain healthy. Some babies are more at risk of deficiency, such as those born preterm, or if mum has diabetes - if you are unsure, check with your healthcare provider.Now, the recommended daily iron allowance (RDA) for a child 1-3 years is around 6 mg/day.
So take the advert with the giant cup of milk, and wow imagine having to drink all this to give your baby the RDA - gosh yes, mammoth! But hang on, infants at 6 months plus aren't reliant solely on milk - at this point they are starting to consume solids and take iron in their diet too, by twelve months most are eating a good varied diet - so their intake is a combination of iron in milk + iron in food. If their daily iron requirements are met in just a couple of beakers of "high iron formula", isn't baby very quickly at risk of being well over the daily recommended allowance if they eat much?
Nowhere in this marketing plan does anyone mention the risks of too much iron, but many source suggest that too much is just as bad as too little.
A study published November 2011 found infants who received iron fortified infant formula have poorer long-term developmental outcomes.
Betsy Lozoff, M.D explored long-term developmental outcomes after ten years for infants who were given iron-fortified formula. In a randomised controlled trial they followed up 473 children after ten years. Between 6-9 months of age 244 were in the iron-fortified group and 229 in the low-iron group
Researchers gathered data on their IQ, arithmetic skills, VMI (visual-motor integration), motor functioning, visual perception and spatial memory.
At the age of ten the researchers detected no significant differences in the iron status in the children of both groups. 4.1% (9) of the infants and 6.9% (17) of the ten-year-olds were diagnosed with iron deficiency in the iron-fortified group.
The children in the iron-fortified group scored lower in every outcome measured at ten years, with statistically significantly lower scores in spatial memory and VMI, compared to those in the non-iron group. They showed suggestive trends that did not reach statistical significance in arithmetic skills, motor coordination, visual perception and IQ.
Furthermore:
At the age of ten the researchers detected no significant differences in the iron status in the children of both groups. 4.1% (9) of the infants and 6.9% (17) of the ten-year-olds were diagnosed with iron deficiency in the iron-fortified group.
The children in the iron-fortified group scored lower in every outcome measured at ten years, with statistically significantly lower scores in spatial memory and VMI, compared to those in the non-iron group. They showed suggestive trends that did not reach statistical significance in arithmetic skills, motor coordination, visual perception and IQ.
Furthermore:
The lowest ten year follow-up scores were found among the infants with the highest hemoglobin scores who had been given iron-fortified formula. However, the highest scores were among the iron-fortified formula infants whose hemoglobin levels at six months of age were the lowest.
The authors wrote:
"In conclusion, this study indicates poorer long-term developmental outcome in infants with high hemoglobin concentrations who received formula fortified with iron at levels currently used in the United States. Optimal amounts of iron in infant formula warrant further study."
The authors wrote:
"In conclusion, this study indicates poorer long-term developmental outcome in infants with high hemoglobin concentrations who received formula fortified with iron at levels currently used in the United States. Optimal amounts of iron in infant formula warrant further study."
So this considers US levels - I decided to investigate how things stood in the UK.
In the study fortified formula was mean 12.7 mg/L and non fortified was mean 2.3 mg/L
SMA Stage 2 Follow On Milk - 12 mg/L
Aptamil Follow On Milk - 10 mg/L
Cow & Gate Follow On Milk - 10 mg/L
Hipp Organic - 10 mg/L
Any unabsorbed iron sits providing the perfect environment for harmful pathogens to live and feed and for cancer cells to thrive. Excess iron also creates free radicals, which have been linked with everything from heart disease to ageing. Someone who feels very strongly about this issue and probably presents "worst case scenario" is Ray Peat - but a quick google of "iron causes free radicals" or "risks of too much iron", finds this is not a new concern to many.
Add to this the risks of aluminium from follow on tins - and it's hardly appealing....
Those who don't know very much about breastmilk will tell you how low it is in iron compared to breastmilk substitutes (which as the above study shows is likely to be a good thing!) Something further to consider is only 7-12% of the total amount in substitutes is absorbed to be used by baby - compared to at least 50% in breastmilk. The result from larger amounts in formula is a lot of excess iron that can't be used by the body.
The iron in breastmilk (NOT related to maternal intake during lactation), isn't just "any old iron", and it's not just wildly floating around. It's bound with a glyco protein called lactoferrin.
Human lactoferrin carries the iron and as it is also bactericidal and antiviral to many harmful pathogens including E coli, protecting the iron by reacting with the cell membrane of bacteria it comes in contact with; it is also an effective anti fungal against Candida. Breastmilk also contains high levels of lactose and vitamin C, further aiding absorption. There is never any spare iron sitting round to cause problems.
As mentioned above, iron is obviously also found in foods. Red meat is a fantastic source of heme iron for young children as it also contains the essential B vitamins and zinc- I always find it very confusing when parents use the 6 month guideline to introduce solid foods, and then use foods such as baby rice (irk!) or plain veg - which are from an introduction plan aimed at prematurely weaned infants and offer little nutritionally.
If a baby is having plain doorstep milk from a year instead of formula (and really, why line their pockets a moment longer than you need to?) ensuring you offer other iron rich foods instead is recommended. Chicken livers are very high at 12.8 mg per 3 1/2 oz serving, beef tenderloin offers approx 3mg per 3oz and dark turkey approx 2mg. Good non heme sources include soya beans at around 8.8mg per cup (although some debate this claiming some proteins found in soybeans can also inhibit absorption), followed by pumpkin seeds (4mg per 30g) lentils, beans, potatoes, broccoli, spinach, mushrooms, raisins and wholewheat bread (see all the sources of iron that creep in?) plus of course fortified cereals.
It is important to ensure baby doesn't consume too much doorstep milk ie to the detriment of solids intake. Cows milk is very low in iron naturally, so if baby is filling up on that and refusing foods, there is increased risk of deficiency. In addition too much calcium is also known to inhibit iron absorption, whilst offering foods rich in vitamin C alongside iron rich foods, assist.
Hope this answers your question?
AA
UPDATE - The Advertising Standards Authority have banned the "iron count advert" as misleading.
SMA Stage 2 Follow On Milk - 12 mg/L
Aptamil Follow On Milk - 10 mg/L
Cow & Gate Follow On Milk - 10 mg/L
Hipp Organic - 10 mg/L
Any unabsorbed iron sits providing the perfect environment for harmful pathogens to live and feed and for cancer cells to thrive. Excess iron also creates free radicals, which have been linked with everything from heart disease to ageing. Someone who feels very strongly about this issue and probably presents "worst case scenario" is Ray Peat - but a quick google of "iron causes free radicals" or "risks of too much iron", finds this is not a new concern to many.
Add to this the risks of aluminium from follow on tins - and it's hardly appealing....
Those who don't know very much about breastmilk will tell you how low it is in iron compared to breastmilk substitutes (which as the above study shows is likely to be a good thing!) Something further to consider is only 7-12% of the total amount in substitutes is absorbed to be used by baby - compared to at least 50% in breastmilk. The result from larger amounts in formula is a lot of excess iron that can't be used by the body.
Human lactoferrin carries the iron and as it is also bactericidal and antiviral to many harmful pathogens including E coli, protecting the iron by reacting with the cell membrane of bacteria it comes in contact with; it is also an effective anti fungal against Candida. Breastmilk also contains high levels of lactose and vitamin C, further aiding absorption. There is never any spare iron sitting round to cause problems.
As mentioned above, iron is obviously also found in foods. Red meat is a fantastic source of heme iron for young children as it also contains the essential B vitamins and zinc- I always find it very confusing when parents use the 6 month guideline to introduce solid foods, and then use foods such as baby rice (irk!) or plain veg - which are from an introduction plan aimed at prematurely weaned infants and offer little nutritionally.
If a baby is having plain doorstep milk from a year instead of formula (and really, why line their pockets a moment longer than you need to?) ensuring you offer other iron rich foods instead is recommended. Chicken livers are very high at 12.8 mg per 3 1/2 oz serving, beef tenderloin offers approx 3mg per 3oz and dark turkey approx 2mg. Good non heme sources include soya beans at around 8.8mg per cup (although some debate this claiming some proteins found in soybeans can also inhibit absorption), followed by pumpkin seeds (4mg per 30g) lentils, beans, potatoes, broccoli, spinach, mushrooms, raisins and wholewheat bread (see all the sources of iron that creep in?) plus of course fortified cereals.
It is important to ensure baby doesn't consume too much doorstep milk ie to the detriment of solids intake. Cows milk is very low in iron naturally, so if baby is filling up on that and refusing foods, there is increased risk of deficiency. In addition too much calcium is also known to inhibit iron absorption, whilst offering foods rich in vitamin C alongside iron rich foods, assist.
Hope this answers your question?
AA
UPDATE - The Advertising Standards Authority have banned the "iron count advert" as misleading.
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