Formula not the only healthy way for kids

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."