All About Infant Formulas

Myth: In case lactation fails, infant formulas of different makes for different age groups are the best alternatives.

Fact: Lactation nearly never fails. Breastfeeding, however, may fail, if the infant is not initiated to suckling properly. Mammary glands are modified eccerine glands, similar to tear glands and sweat glands. Breast milk is secreted only if the infant suckles properly. The more the 'emptying' in the previous feeding, the more the refilling. Breast milk also changes in composition if the baby is born prematurely, to fulfill the needs of the premature baby. Good lactation counselors are able to re-initiate breastfeeding even after gaps due to illness of the mother or other such reasons.

Let us proceed to see as to what are the ingredients of infant formulas. Most of the parents that I have met during my 35 years of practice seem to believe that these formulas are "special". The fact is, that all of them are processed from cows' and buffaloes' milk. The first step is to separate cream/fats and sell it separately at a high price. The remaining milk is called 'skimmed milk', which for many rich milk producing countries is a by-product. This milk is spray-dried and made into skimmed milk powder (SMP), which is very cheap. My research showed that all different formulas have SMP as a base ingredient. Now, inexpensive vegetable oils (some of them suspected to be from GM seeds) are mixed with the SMP base. Many of them have maltodextrins and some micronutrients . When we taught nutrition in our M.D., these additive ingredients were not mentioned anywhere. They are propagated only by the formula industry and are not proven to have any beneficial effects.
Many young parents simply believe the formulas to be beneficial simply because of the name of the multinational attached without ever having read the ingredient label!
Recommendations: The IYCF program in India recommends the following priority order for neonates and infants:
1. Own mother's milk
2. Other mother's milk (Human Milk Bank/Wet Nurse)
3. Fresh boiled bovine milk
For complimentary feeding after six months of age, home cooked multi ingredient food should be used as it is far more nutritionally superior to packaged cereals.

For reference of ingredients of some popular infant formulae, please visit the links here:
https://www.amazon.in/Nestl%C3%A9-Starter-Infant-Formula-Probiotics/dp/B00I4SZJUG

https://www.amazon.in/Nestle-Nan-Pro-Infant-Formula/dp/B00HQFRQRC

https://www.google.com/imgres?imgurl=https%3A%2F%2Fbrucebradley.com%2Fwp-content%2Fuploads%2F2012%2F11%2FFormulaGerber.jpg&imgrefurl=https%3A%2F%2Fbrucebradley.com%2Ffood%2Fbabys-first-encounter-with-big-food%2F&docid=gfTeXXED-KXXDM&tbnid=sA2Q2DhZbMN1TM%3A&vet=10ahUKEwiXn9fRzbfmAhXi7HMBHRbMCMQQMwhsKAEwAQ..i&w=1024&h=768&bih=625&biw=1280&q=infant%20food%20ingredients&ved=0ahUKEwiXn9fRzbfmAhXi7HMBHRbMCMQQMwhsKAEwAQ&iact=mrc&uact=8

https://www.arlafoodsingredients.com/industries/early-life-nutrition/early-life-nutrition-ingredients/ingredients--concepts/infant-nutrition/

For further information on breastfeeding and complementary feeding, please visit: http://www.bpni.org/

For risks involved with formula feeding and bottle feeding, please visit: http://www.infactcanada.ca/RisksofFormulaFeeding.pdf

Please do not buy into the marketing tactics and feed a sub standard product to your child. In poor tropical countries like India, another concern is about sterility of baby food. While fresh milk is usually boiled before feeding and thus made sterile, formulas are not boiled after reconstitution and run a risk of infection. Complementary foods made at home are not only cheaper, but superior in all aspects. 

Doordarshan News: BPNI experts talk about breastfeeding scenario in India

Please see the full report from DD News here: https://www.youtube.com/watch?v=HZrMqZlzi2g&feature=youtu.be

We continue to urge mothers to breastfeed their new born baby within an hour of being born.

Melinda Gates says Breast Milk is a miracle potion

Hindustan Times recently published this interview with Melinda Gates in which she quotes the benefits of breastfeeding your child. It is ironical that WABA (World Alliance for Breastfeeding Action), the organisation which started the whole concept of breastfeeding promotion week, gets no mention. Neither does BPNI(Breastfeeding Promotion Network of India) or IBFAN (International Baby Food Action Network). These organizations have been promoting and educating people about the benefits of breastfeeding for a good thirty years now. But of course, it takes an American billionaire to be heard! This is a bittersweet moment. I am thankful that Mrs. Gates has taken up the right statistics and is making and effort to educate people. But I am disgusted that our media houses refuse to publish the exact same thing when it comes out of Indian agencies!
However, the facts are out- breast milk IS the best food for your newborn.

All about vaccinations

Vaccinations are essential preventive medicines, which have greatly reduced infant mortality rate. India has been proud to be polio-free because of government policies to make the polio vaccination essential for every child under five years of age.
However, there is now a plethora of vaccinations available and this post is an attempt to the guide the parents to make a good choice. Here are the facts:

1. Manufacturers claim efficacy figures (say, 85% with one dose or 93% with two doses etc.) and also report side effect figures (say, 1 in 10000 patients report a side effect). These figures are not easily understood by the consumer into their own context.

2. Vaccinations are effective only if more than 85% of a large sample set (e.g. an entire nation) benefits from taking the vaccination over a long period of time. (For example, if a vaccination was tested on only 200 people claims an efficacy of 90% for one year, it does not mean anything). They are not individual treatment drugs (except the Rabies vaccination).

3. The usual cry of "if you can afford it, why not take it?" is  fraudulent method of pushing non-essential expensive (and in many cases, inadequately tested) vaccines to rich parents. The immunization acquired due to large-scale immunization (called "herd immunization") cannot be achieved by immunization of a select few of the population.

4. Vaccinations are drugs, and require a clinical trial. The only licensing authority in India is the Drug Controller General of India(DCGI). Imported vaccinations also need to be re-licensed by the DCGI. "WHO Prequalification" is NOT an adequate license to sell in India.

5. Ministry of Health (Government of India) is the only authority that notifies inclusion of a vaccinations in the Indian Immunization Programmes. In case of epidemics like Swine Flu, please visit a government hospital. Do not blindly take individual vaccination. A few months ago, there was much hue and cry about a swine flu breakout. Many of those cases turned out to be common cold/ flu. The only beneficiary of this public scare were the vaccine manufacturers, who got rid of their near-expiry stock.

In conclusion, please stick to the immunization schedule listed by the health ministry. Mission Indradhanush lists the seven vaccinations which are absolutely essential : diphtheria, whooping cough, tetanus, polio, tuberculosis, measles, HIB and hepatitis B. In addition to these, tetanus and rabies vaccinations may be administered in case of accidents and mammal bites respectively.  Do not fall prey to powerful MNCs pushing unnecessary expensive vaccinations under the garb of philanthropy. Exclusive breastfeeding is proven to boost immunity against many types of pneumonia and against many viruses and bacteria that cause diarrhoea, leading to the hypothesis that breastfed children may not require a rotavirus vaccination.  

Update: GOI has announced four more vaccinations to included in Indradanush programme soon.

Maggi and the trend of unhealthy snacks

Recently, Maggi has been thrown into the news for having high MSG content. MSG(Mono Sodium Glutamate) is the Sodium salt of Glutamate proteins- a common flavour enhancing additive that has many ill effects on health and many studies have linked it to diabetes. (some facts here: http://www.msgtruth.org/whatisit.htm)

Even without MSG concerns, Maggi/instant noodles are NOT a healthy snack, not even the "atta" or "oats" variants. They are highly processed foods that are carbohydrate-heavy: they do not provide the essential vitamins, minerals or  fibre required for a growing child. Nor do they have significant amounts of protein. It is much better to use grain which are less processed- like wheat and rice, as found in any Indian home, to make fresh healthy food for your children. Even other snacks, like biscuits, wafers and chips are over processed and have a lot of fats and carbohydrates and not enough nutritional value. No wonder our cities have shown such an increase in the number of overweight children!

Nestle products have come under questioning worldwide many, many times. But these are multinational corporations that have the wealth and power to get away with it most of the time. Even the Indian government policy advocates fresh home-cooked food for children. Keep your child's snacks simple and fresh- a well washed apple or a home cooked soup is any day a better snack than the over marketed, well-advertised packaged food that tries to lure us in.

Wasteful Expenditure on Child Health: Skincare

Skincare for Newborns

Scenario: The massage of newborns has been practised since time immemorial. It is believed that massage helps strength of muscles and bones. This wrong belief led to mushrooming of tens of brands of baby oils and baby cosmetics. To the contrary, in tropical countries, pediatricians have been observing more and more allergic dermatitis and seborrhoeic dermatitis.

Fact: A multicentric review article on neonatal skincare published Indian Pediatrics July 2010 issue clearly states that neonatal skin should not be rubbed at all because of loose connection between upper layer of skin (epidermis) and the lower layer of skin (dermis), as friction can cause blisters. Oil application on scalp can lead to blockage and hence swelling and infection of natural oil glands (sebaceous glands) and lead to seborrhoeic dermatitis. The crusty itchy deposit that you may have noticed on an infant's head is a result of excessive oiling of scalp. All baby soaps or shampoos are synthetic detergents, disguised under the label  'syndets'. But the consumer should notice that they claim only about having a pH matching that of human skin (balanced pH). They don't at all mention allergenic potential of all the chemicals in the ingredients.

For the consumer's interest, an MLA of Maharashtra, many years ago, had admitted a single line PIL against a big MNC asking “please tell us as to what is 'baby' in your product”? (http://articles.economictimes.indiatimes.com/2005-03-16/news/27489620_1_fda-commissioner-the-fda-baby-product) Till today, there has been no answer. Recently Maharashtra FDA terminated the license of a famous company as carcinogens and allergens were found in its baby talc. (http://www.mumbaimirror.com/mumbai/others/Johnson-Johnsons-licence-for-cosmetics-cancelled/articleshow/19760664.cms). The aforementioned article in Indian Pediatrics concluded by cautioning against the use of any synthetic detergents or baby oils. Only coconut oil is recommended, that too, only in winter, never in hot and humid weather (which prevails for a long time in a large part of our country). It is sad that even this very scientific article was supported by a grant from Johnson and Johnson. No funding was received for writing this blogpost though!

In summary, neonates need to be bathed (splashed) only with plain clean water. No rubbing should be done on skin. Wrap and dry them in plain cotton sheets (preferable over rough towels). No soap, detergent, talc or oil should ever be used during first couple of months. Skin health is maintained by internal nutrition, i.e. Exclusive breastfeeding for first six months and thereafter adequate complementary feeding with home cooked foods. Benefit of “kinesthetic stimulation” can be achieved by gently pressing leg and arm muscles while feeding.

Baby oils, talc, soaps and other cosmetic products are wasteful expenditure worth thousands of rupees. They cause discomfort to the newborn and take another couple of thousand rupees for treatment, all of which is completely avoidable.

Child Friendly School Initiative Program (CFSI) under IAP Action Plan- 2011

Children spend an immense amount of time in school. It is our duty to make this wonderful place of learning safe and enjoyable for them. To do the same, Indian Academy of Pediatrics had formulated a 5 point action plan, which was published in March 2011, Volume 48, Number 3 issue of the Indian Pediatrics journal.

These are the 5 points of action, as given by Dr. T.U. Sukumaran, President of IAP-2011:

1. No physical punishment in school: The physical punishment may do more harm than benefit. However in unavoidable situations, the child may be punished by other non-physical methods.

2. Avoid excess baggage: Excess weight of the school bag may lead to backache, neck pain, school phobia etc ("The School Bag Syndrome"). The ideal weight of the bag should be less than 10% of the child's body weight. Bag weight can be reduced by many methods: (a) The age of admission for KG class should be 4 years and first standard 6 years, (b) in lower primary classes bag weight can be reduced by having a provision for keeping books in the school (c) for different terms we can have separate textbooks (d) a file system is an effective method in higher classes.

3. Provision for adequate number of toilets: There should be at least one urinal per 60 students and one latrine per 100 students, with provision for daily cleaning.

4. Provision for safe travel: Travel to and from the school should be safe. Travel in two and three wheelers should be discouraged and overcrowding to be avoided.

5. Well equipped class rooms and adequate play grounds: The number of students in a classroom should be limited to 40. The class room should have enough space (10 square feet/student or 400 square feet/classroom) and there should be appropriate furniture and proper ventilation. The school should have an adequate playground and a minimum of 4 hours per week to be allotted for sports and cultural activities.

These five simple provisions are still not provided in many of our schools. Schools play a major role in the successful upbringing of a child and should facilitate a healthy childhood.

Disclaimer: These 5 action points are published in the journal Indian Pediatrics as cited above. I do not have the copyright to them. I am merely trying to popularize them among more people.