Formula not the only healthy way for kids

By Maria Kegel

JAKARTA (JP): The effects of the rupiah's fall in value have been far-reaching, but no one has been hit worse than low and modest income families with young children.

Among the household items whose prices have skyrocketed are imported milk formulas for babies and infants. For some families, the new price means the difference in what their baby will drink.

However, some doctors are also troubled about a heavy reliance on a product they consider unnecessary if proper nutritional requirements for infants are met.

"Aileen", a new mother, is disturbed about her daughter's dependency on an imported milk formula. On the one hand the formula is a blessing, allowing her to feed her baby while she continues to work at the office.

However, her daughter has grown dependent on that particular brand, and Aileen is having problems weaning her off it.

"After she's been sick, or during teething, she spits out her solid food, rejecting everything except that baby formula," she said, adding that "Dita" usually enjoyed eating soup, fish, carrots and melon.

Dita, aged one year and nine months, was breast-fed until three months.

When Aileen went back to work, she continued breast-feeding in the morning, and at night after she returned home, while the babysitter gave formula milk at midday.

But by the time Dita was nine months, Aileen had stopped producing milk.

"I tried another brand that was cheaper, but she had stomach aches and lost weight. I took her to the doctor, telling him I was confused about what brand would be suitable for her, and he switched her to this brand that she is on now, which is for sensitive stomachs."

Since then, that is all Dita will drink, and Aileen said her daughter's mind was made up -- she refuses to drink other kinds.

"Now I'm combining it with a local brand because it's just too expensive, but the one she is on now does have better ingredients," she said, adding that she hoped to eventually switch to the local product by the time Dita was two years old.

Each month Aileen buys eight 400 gram boxes of formula, totaling Rp 200,000. This is an increase of about Rp 30,000 from three months ago, due to the rupiah's fluctuation.

"I'm lucky because my husband is working, but think of the families who have a baby and can't continue buying milk. I don't know how they manage, because milk is so important if a mother can't breast-feed," she said.

Tini, a mother of two children, spends about Rp 500,000 a month on local infant formulas for her two boys, Maximilian, aged four and a half years, and Bertus, aged two.

But she said she was more concerned about the quality of the product than the price, and she always consulted her doctor first on the type to buy, changing the brand to meet their nutritional requirements.

Her complaint has been that her sons drink a lot of milk, and will continue to until they are eight years old, the age recommended on the package.

"Max drinks five glasses a day -- I can't stop him, while Bertus downs two or three glasses a day."

Max drinks a milk formula recommended for children aged four to eight years old, and Bertus drinks one for his age group. All packages come with the recommended ages printed on it.

Breast-feeding

Pediatricians Dr. Sri S. Nasar, Dr. Aryono Hendarto and Dr. Damayanti R. Sjarif from the Department of Children's Health at the University of Indonesia's Medical School and Cipto Mangunkusumo Hospital (RSCM) all agree that breast milk is best for babies. They advise mothers to breast-feed for as long as possible, or at least for the first four months.

"We don't recommend baby formula. It should only be given if there is insufficient breast milk, and since not all mothers produce enough, sometimes formula has to be used," Damayanti said.

Although manufacturers' advertising can be persuasive, all three pediatricians said moms could skip baby formula altogether if they started complementary feeding with breast-feeding from four months old.

"But that's the advertising (from formula manufacturers). 'Your child will be healthier, and don't you want them smarter? Then drink this'," Damayanti said.

Some mothers were unaware that while breast-feeding, complementary feeding with cereal, porridge or solid food, according to the age, was better than giving formula. Children's eating skills can also be improved this way.

"If all mothers knew that, then formula would not be that important anymore. Children can get all their protein and nutritional needs from other food, that's enough," Damayanti said.

But the pediatricians said they did not advise mothers to take their babies off formula milk if children were not getting enough nutrients in their diet.

Damayanti said formula was from the cow and meant for calves, a bigger mammal, and therefore was different in content with more electrolytes and protein. Baby formula manufacturers had adapted the milk for human consumption, she said.

However, all three doctors said formulas on the market were good substitutes for babies whose mothers could not supply them with breast milk.

"Breast milk is still superior as not only does it have energy, and micro and macronutrients, but also immunology factors, that are not present in formulas," Damayanti and Sri said.

Clinical studies have proven that breast-fed babies have fewer ear infections and colds, and less diarrhea and vomiting.

Breast milk is also easier to digest than formula, and is the optimum food to give babies aged under nine months.

How long a mother should breast-feed varies with each mother and child. However, the World Health Organization recommends that babies be breast-fed for the first year to help them resist infections and other diseases.

Disadvantages

Store-bought milk also has disadvantages, being high in saturated fat but low in essential iron and vitamin B, which is lost during the processing.

Damayanti said lactose intolerance, which happens more often with babies in Asia, could be handled differently depending on its severity.

Sri said: "If it's a mild intolerance, a mother can give a low-lactose milk, and if it's severe, the baby needs a lactose- free milk."

But the pediatricians warned not to cut milk out completely from the child's diet.

"Milk is a source of energy, and almost a complete source of nutrients, except for iron," Damayanti said, adding that mothers should think about giving iron in the form of liquid drops to preterm babies who were two months old.

Dairy substitutes such as soya milk earned a thumbs down for infants, because of several lacking ingredients. One of these was lactose, which facilitates calcium absorption.

Galactose, a sugar necessary in infants to help brain development, is also missing from soya milk and there is not enough methionine, which contains essential amino acids.

The doctors said Max was consuming too much formula, which is an enriched milk, for children over one year, fortified with more iron and vitamins than regular store milk.

"A child might not want to eat anymore after drinking so much as their stomachs would feel full, but he should continue drinking it as it is better than cow's milk. But it's not necessary to drink that amount (five glasses)," Damayanti said.

"Usually toddlers will have problems in consuming solid food, but we can't expect all children under five to get all the nutrients. One or two glasses of milk is good enough as a supplement."

As for Dita, Sri said her attachment to one brand of formula was a food preference.

Damayanti said: "Parents can teach a baby to try other tastes by introduce. At first the baby will refuse, but after repeated attempts she might like it and if not, just stop and try another one."