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Introduction of fresh milk to infants

This question was posted the Infant and young child feeding interventions forum area and has 16 replies.

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Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

15 Mar 2022, 13:25

Greetings,  There is some contradicting information on how soon mothers/ caregivers can introduce fresh milk to children below one year

 Opinion 1: Fresh milk should be introduced to children when they are above one year

Opinion 2: Fresh milk can be introduced even when the child is below one year

Anyone with a clear factual information can kindly share on the correct age of introducing FRESH milk

Vicky Sibson

First Steps Nutrition Trust

Normal user

15 Mar 2022, 14:18

hello, in case it is useful this is from our First Steps Nutrition Trust infantmilks website (for use in the UK) (www.infantmilkinfo.org - Types of infant milk and ingredients - (infantmilkinfo.org))

Please note that FSNT recommends optimal infant and young child feeding practices as per WHO guidelines (and UK recommendations, which also promote immediate and exclusive BF for the first 6 months) and the following information is given in the context of information about formula use for formula fed babies (hence the refernce to formula here and there).

Why is it recommended that infants (under 12 months) are not given whole cows’ milk as the main milk drink?

Whilst the majority of infant formula in the UK are based on the protein from cows’ milk, unmodified cows’ milk is not suitable as the main milk drink for infants in the first year of life. The immature kidneys of infants are not able to manage the concentration of solutes in whole cows’ milk and the use of infant formula (pre 1970’s) based on unmodified cows’ milk is understood to have been responsible for some infants suffering from severe and even fatal hypernatraemia, hypocalcaemic tetany and convulsions. Legislation now ensures that all infant formula available in the UK contain safe levels of protein and minerals.

In addition, the iron in cows’ milk is poorly absorbed because it is complexed with ligands, principally phosphate. Introduction of cows’ milk to infants aged 6 months has also been associated with small losses of blood from the intestinal tract and observational studies have consistently shown negative associations of unmodified cows’ milk consumption with iron status indicators throughout infancy and early childhood.

At what age can cows’ milk be used as the main drink?

Most children do not need an infant formula after 1 year of age and cows’ milk can be the main milk drink from 1 year of age for most children who are not breastfed. Whilst cows’ milk is the most widely consumed animal milk in the UK, other pasteurised animal milks may provide a suitable alternative. You can find further information on the role of different animal milks in young children’s diets in our briefing paper: ‘Animal milks in the diets of children aged 1-4 years’.

Where there are concerns about the quantity and quality of food consumed, health professionals may recommend continued use of first infant milk into the second year, but this is rare, and food should be the main source of nutrients for toddlers. From 1 year of age children should get the majority of their energy and nutrients from food.

Best wishes

Vicky 

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

16 Mar 2022, 08:58

Thanks Vicky for the response.

Another question arises what happens in households where fresh milk is the main source of protein ( Africa set up)

Fabrizio Loddo

Normal user

16 Mar 2022, 12:42

Thanks for the interesting question and answer, to note that in UNICEF key message booklet, it's written on page 32: "A minimum of 2 cups of milk each day is recommended for all children under 2 years of age who are no longer breastfeeding.This milk can be either commercial infant formula, that is prepared according to directions, or animal milk, which should always be boiled for children who are less than 12 months old. It can be given to the baby as a hot or cold beverage, or can be added to porridge or other foods."

Ref: https://www.unicef.org/media/108411/file/Key%20Message%20Booklet.pdf

This is a message for non-breastfed children. The booklet is dated 2012, I didn't find a revised version online.

Surely, we have inconsistent messages...

Thanks

Marie McGrath

Emergency Nutrition Network

Frequent user

16 Mar 2022, 13:48

Dear Anon

WHO guiding principles for feeding the non-breastfed child aged 6m-24m states that from 6 months of age, full fat fresh milks can be used:

"Acceptable milk sources include full-cream animal milk (cow, goat, buffalo, sheep, camel), Ultra High Temperature (UHT) milk, reconstituted evaporated (but not condensed) milk, fermented milk or yogurt, and expressed breast milk (heat-treated if the mother is HIV-positive)" (page 12).

This is also reflected in the Operational Giudance on infant feeding in emergencies that states:

Clause 5.15. "Alternative milks may be used as a BMS in children aged six months and older, such as pasteurised or boiled full-cream animal milk (cow, goat, buffalo, sheep, camel), ultra-high temperature (UHT) milk, reconstituted evaporated (but not condensed) milk, fermented milk or yogurt".

Marie McGrath

Emergency Nutrition Network

Frequent user

16 Mar 2022, 13:52

Dear Anon

Regarding you second question in where fresh milk is a main source of nutrition (Africa context), the Ops Guidance on IFE states:

5.25 Where animal milk is a significant feature of child diets, such as in pastoral communities, it is important to establish how to safely include milk products as part of a complementary diet. Milk products can be used to prepare complementary foods for all children over six months of age. Recommend to breastfeeding mothers not to displace or substitute breastmilk with animal milk. Pasteurised or boiled animal milk may be provided to non-breastfed children over six months of age and to breastfeeding mothers to drink in controlled environments (such as where milk is provided and consumed on site (wet feeding)). Animal milk should not be distributed outside of such controlled environments (see 5.15 and 6.25).

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

16 Mar 2022, 15:54

Thanks Fabrizio for your response and input.

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

16 Mar 2022, 16:02

Thanks Marie for your response.

Mamdy

Nutritionist

Normal user

17 Mar 2022, 11:03

I agree  that we have inconsistencies between current research and WHO guidelines.

This also affects practice when working with different cadres handling the same child.

The rule is we follow WHO guidelines which are also well explained by UNICEF...but we need current WHO guidelines on the same..2012 is not current.

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

17 Mar 2022, 14:27

Thanks Mamdy, Absolutely

Michael Krawinkel

Prof.em.

Normal user

18 Mar 2022, 10:46

In Germany we recommend fresh milk to be given as drink to young children when they are one year old. But, (cows) milk can be utilized to prepare porridge to onfants beyond 6 months of age. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575031/)

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

18 Mar 2022, 14:07

Thanks Michael for your response.

Lucy Dominak

RN Project Lead

Normal user

21 Mar 2022, 20:22

Hello,

Thank you for your recent response to the Intro of fresh milk to infants. May I ask some clarification about your response, specifically - do you recommend fresh milk over human milk (thinking about the global infant feeding recommendation is to continue breastfeeding to two years and beyond)?

Thank you for clarifying.

Lucy Dominak

RN Project Lead

Normal user

21 Mar 2022, 20:33

Hi there, 

Apologies everyone, my last question re fresh milk to one year olds was intended for Michael K. who wrote about Germany's recommendations at one year olds. 

Mustafa

Nutrition officer

Normal user

22 Mar 2022, 04:59

Avez-vous un document qui indique combien de CTCE (centres thérapeuthiques de consultation externe), TSFP (alimentation complémentaire ciblée), SCs sont nécessaires par zone géographique ?

Michael Krawinkel

Prof.em.

Normal user

22 Mar 2022, 08:30

The German recommendation is not in conflict with the global breastfeeding policy. Ut, families are advised not to feed fresh milk as a drink to infants. This is relevant because only about 50% of all infants get breastfed at the age of 6 months for various reasons.

Muhammad Jaffar Ali MSNC PnD Punjab Pakistan

Sector Specialist

Normal user

23 Mar 2022, 06:41

How we can negate importance of Exclusive Breast Feeding?Question is quantity of the fesh milk which can be provided in after six month.

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