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If a baby can’t have the breast...

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Legislation against the marketing of baby formula has been in place in South Africa since December 2012.

Durban - Milk – it’s generally regarded as healthy stuff. But for new parents, it can be a minefield.

For vegan families, for babies with allergies or those who can’t be breast-fed for whatever reason, the formula floodgates open. Grocery store aisles have a vast and overwhelming array from which to choose.

And oddly, numerous international stories tell of families who have detrimentally and sometimes fatally switched from formula to their milk alternatives, such as from soy-based formula to soy milk: a big no-no in terms of optimal nutrition.

First of all, breast milk is the best for your baby, says Durban-based paediatrician Dr Ridwan Omar at Life The Crompton Hospital.

“There are very few indications where breast milk should be substituted (such as the HIV-infected mother who can choose to formula-feed her newborn baby to lessen the chances of HIV transmission through breast milk) but make no mistake, there are ample studies to show the superiority of breast milk over formula milk, and its excellence.”

However, when you cannot breast-feed it’s important to be fully aware of the other options available.

Dietician Danielle Roberts from The Life Healthcare Sharks Medical Centre says infant formula is better and safer than cow’s milk or evaporated milk because the formulas have been adjusted for baby’s specific needs.

“They have lower doses of protein and their fat levels have been adjusted to simulate human milk, whereas cow’s milk does not contain enough vitamin E, iron and other nutrients that are necessary for a baby’s development before the age of one.

“These days, formulas are made to be near exact to breast milk and would be the only alternative to breast milk.

She stresses, “Cow’s milk/ goat’s milk/ powdered milk should not be given to a child under the age of one.”

There are many babies, though, that battle on regular formula.

Abdominal pain, diarrhoea, nausea, flatulence and/or bloating after a feed can be signs of lactose intolerance, which needs to be diagnosed by a doctor before any changes are made.

Roberts explains that lactose is a disaccharide that is made of the monosaccharides glucose and galactose, and it is the primary carbohydrate found exclusively in mammalian milk. Absorption of lactose requires lactase in the small intestine. Milk intolerance may be attributed to either the lactose or the protein content of the milk.

“Lactose intolerance is a distinct entity from cow’s milk protein sensitivity, which involves the immune system and causes varying degrees of injury to the intestinal mucosal surface. “Cow’s milk protein intolerance is reported in 2 percent to 5 percent of infants within the first one to three months of life, typically resolved by one year of age.

“Lactose intolerance is a deficiency in lactase enzyme, and usually this lasts for life. These infants usually need to have a lactose-free or a soy-based formula.”

She says soy formula is a good option for parents who want to raise their child as a vegan, as there is no vegan formula.

Vegan moms – whose breast milk is said to lack docosahexaenoic acid, or DHA, the omega-3 fat found in fatty fish that is vital for eye and brain development – are often influenced to put their babies on a soy-based formula.

“Soy milk is becoming popular with older children, both for children with milk allergies and for parents who are simply trying to avoid cow’s milk. Soy milk is a good substitute for cow’s milk, but it is often reduced fat or low fat and so is not usually a good choice until a child is at least two years old.

“From birth to two years, an infant soy formula is a better choice. Like a milk-based formula, soy formula has all the correct proportions of protein and fat compared to soy milk.”

Omar says soy formulas can be tried in babies who are allergic to cow’s milk protein, but they may also be intolerant to the soy protein, in which case very specialised formulas such as amino acid formulas are used. Babies who are lactose-intolerant must be fed lactose-free formulas, and these do not have to be soy-based formulas. “There is a role for hydrolysed formulas, of which there are two types : partially hydrolysed and extensively hydrolysed,” he says.

“Partially hydrolysed formulas are sometimes indicated for babies who have a strong family history of eczema and whose mom’s cannot breast-feed them.

“Extensively hydrolysed formulas are used for infants who are confirmed allergic to cow’s milk protein. Very pre-term babies who have trouble absorbing the formula (such as those with severe gastrointestinal pathology) are also sometimes fed extensively hydrolysed formulas.”

Rice milk in particular is low in fat, which is not recommended for those under two years of age, and it is also low in (if not completely devoid of) protein.

It contains more carbohydrates compared to cow’s milk, but less protein and calcium and no cholesterol and lactose. Commercial brands are often fortified with Vitamins A and D, some B vitamins, calcium and iron.

If these products are used parents must be sure children are getting adequate fat and protein from other dietary sources.

To understand why rice milk is not recommended for infants, compare its ingredient list and Nutrition Facts label to that of infant formula. Rice milk contains only water, rice, oil and salt. It has no iron or other added minerals except calcium and the only added vitamins are D, A and B12.

It is also low in protein and essential fats.

Variety is not necessary a bad thing, says Omar.

“A walk down the grocery aisles will reveal a formula for almost every type of tummy trouble a baby may experience. It is important for parents to know that baby’s digestive system is immature and is designed to accept breast milk, a very gentle, easy-to-digest liquid. So, changing from breast milk to formula or from one formula to another can cause tummy problems. It always best to consult your doctor or clinic nurse before making any changes to baby’s diet. More often than not, specialty formulas are substantially more expensive and not significantly different in key nutritional value.

“Babies undergo tremendous adaptation of their gastrointestinal tract during the first six months of life, which is normal. There are very limited scenarios in which infants would require the more expensive formulas.”

Cow’s milk, introduced after the age of one, contains natural calcium that is more easily absorbed and bio-available than calcium from other sources.

It contains the “good” fats that are crucial to both infant and toddler development; this is why whole milk, and not low fat, is recommended for a minimum of the first two to three years of a child’s life.

Whole cow’s milk is also a great source of protein, another nutrient that is crucial in healthy development. Vitamins A and B12, along with some other B vitamins, are also found in whole milk and these vitamins are essential in sustaining proper growth.

Vegan babies…

Dietitian Danielle Roberts from The Life Healthcare Sharks Medical Centre provides the following advice for feeding vegan babies:

For the first four to six months, breast milk should be the sole food with soy-based infant formula as an alternative. Commercial soymilk should not be the primary beverage until after the age of one.

Breast-fed vegan infants may need supplements of vitamin B-12 if the maternal diet is inadequate; older infants may need zinc supplements and reliable sources of iron and vitamins D and B-12.

Timing of solid food introduction is similar to that recommended for non-vegetarians. Tofu, dried beans, and texturised vegetable proteins are introduced as protein sources at about seven to eight months.

Vegan diets can be planned with a dietitian to be nutritionally adequate and support growth for infants. Solid foods should not be introduced before four months of age.

Try to introduce one new food at a time, waiting two to three days before trying another. It is then easier to identify which food is responsible if any untoward reaction occurs.

First weaning foods might include rice-based dishes, pureed and sieved fruits such as banana, pear and apple, and vegetables such as carrot, potato and spinach.

At six months, wheat and oat-based cereals can be introduced.

Foods containing generous amounts of protein such as mashed cooked pulses, mashed tofu and soya yogurt are generally introduced at about seven to eight months. Children should progress from mashed or puréed foods to pieces of soft food. Smooth nut and seed butters spread on bread or crackers can be introduced after one year.

However, the American Academy of Pediatrics does not recommend nut butters under the age of three years.

As solid foods become a larger part of the diet, consideration should be given to foods that provide concentrated sources of calories and nutrients.

These include mashed tofu, bean spreads such as hummus, mashed avocado and cooked dried fruits.

Frequent meals and snacks help to ensure adequate energy intakes. The fat intake of healthy infants should not be restricted, and sources such as vegetable oils or soft vegan margarine should be included for the older infant.

To minimise the risk of choking, foods such as whole nuts, crunchy nut butters, vegan hot dogs, large chunks of hard raw fruits and vegetables, whole grapes, hard sweets, and popcorn should not be fed to infants and children under three.

By six months, iron stores in vegetarian and vegan infants will become depleted and it is important that iron-rich foods are included in the diet. Iron-fortified infant cereals are a good way to supply iron to vegan infants. Other good sources include whole grains, pulses, green leafy vegetables and dried fruits. To enhance iron absorption, add a source of vitamin C such as green leafy vegetables, citrus fruits, blackcurrants or orange juice to the meal.

Protein needs can be easily met if children eat a variety of plant foods and have an adequate intake of calories. Sources of protein for vegan children include pulses (peas, beans, lentils, soya), grains (wheat, oats, rice, barley, buckwheat, millet, pasta, bread), nuts, meat substitutes and nut butters.

Calcium is an important nutrient for growing bones and teeth. Good sources include fortified non-dairy milks and juices, baked beans and dark green leafy vegetables.

Vegan choices:

* Bagels with nut butter or hummus

* Bean burritos or wraps

* Fresh or dried fruit

* Mashed potatoes

* Oven-cooked chips

* Pancakes and waffles

* Pasta with tomato sauce

* Peanut butter and marmite sandwiches

* Pizza without cheese, topped with vegetables and pulses, tofu, or soya mince

* Raw vegetables with dips

* Shakes made with soya milk and fruit

* Spaghetti with tomato sauce

* Tofu/vegetarian dogs

* Veggie burgers. - The Mercury

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