Poisoned milk or mother's milk?

Poisoned milk or mother's milk?

24 Sep 2008

Dr Lisa Amir
Email: lisa.amir@latrobe.edu.au

First published in The Age on 23 September 2008

'YOU made that up!" exclaimed Richard Stubbs on 774 Melbourne radio recently when I was attempting to reframe the "benefits of breastfeeding" into the "risks of artificial feeding". He found it hard to believe that powdered infant formula was not a sterile product and that it may contain bacteria.

I'm not sure why breastfeeding advocates, such as me, need to be the ones explaining to parents how to safely feed formula to their children. But it seems the formula companies are not keen to do it. And neither government agencies nor medical bodies seem interested.

The crisis in China should be a warning to anyone complacent about the risks of artificial feeding of infants. The situation is still unfolding, but it is clear that the industrial chemical melamine - not a foodstuff but a component in plastic and counter-tops - has been added to cow's milk in order to make a profit. Nitrogen content is measured in milk as an indication of the protein present. Melamine, which is 66% nitrogen (by mass), has been added to watered-down milk to boost the nitrogen content and fool the buyer into believing the product is high in protein and therefore good quality milk.

This isn't a little backyard swindle - this has happened on a large scale. The vice-president of the infant formula company Sanlu has apologised and a recall of more than 8000 tonnes of product is under way but nearly 10% of samples taken from China's two largest dairies contained melamine.

Parents in China have been persuaded by extravagant advertising techniques that infant formula is more nutritious than breastfeeding. Mothers have been convinced of the convenience of infant formula when they have to return to the paid workforce and so the number of infants affected by this crisis is growing by the day. The latest estimate is 53,000 affected children, including at least four deaths.

At no other time in our lives, do humans double and triple our weight within a 12-month period. Vital organs such as the brain are developing rapidly in the first months of a child's life. Yet, infants are the only ones in our society who rely on a single food source - for six months they may consume nothing but one brand of infant formula. This puts them at incredible risk of ill-health if the formula is lacking an essential vitamin or mineral, such as the Remedia Soy Formula, produced by Humana (Germany) and exported to Israel in 2003, which lacked thiamine, or if the formula is contaminated with a chemical such as melamine.

Australian parents need to know that when they open the can of powdered infant formula, bacteria may already be present. Mostly these are harmless organisms. But some are life-threatening, particularly for preterm or unwell infants. For these reasons, neonatal nurseries are switching to liquid, ready-to-feed formula, which is less likely to be contaminated with bacteria.

The World Health Organisation released guidelines in 2006 for the preparation. Water should be boiled and then allowed to cool for less than 30 minutes, and then poured into the feeding bottle, before adding the powdered formula so that the temperature of the water is at least 70 degrees. The bottle should then be quickly cooled to feeding temperature. Unicef has also given clear instructions.

Parents might like to consider changing brands regularly in case one brand is faulty, and keeping a list of the serial numbers in case the companies announce a recall. If all this seems too complicated, why not just breastfeed? No middleman, no preparation and no recalls. Despite the benefits, there has been no change in breastfeeding rates in Australia over the past 15 years - and a growing gap between rich and poor.

Last year's parliamentary inquiry into the health benefits of breastfeeding received support from both sides of Parliament and came up with 22 recommendations. Breastfeeding advocates are still waiting to hear how the Federal Government plans to enact these recommendations. It would be timely for the State Government to start supporting breastfeeding in Victoria as well. This may well be a matter of life and death for an infant.

Dr Lisa Amir is a general practitioner and lactation consultant, and a senior research fellow at La Trobe University.

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