Infant nutrition-
The first year
A brief report on two symposia organised for health visitors
in London and Glasgow
'The only perfect science is
hindsight,' commented Profes-
sor Gavin Arneil of the Royal
Hospital for Sick Children, Glas-
gow. He was chairing a sympo-
sium entitled, 'Infant Physiology
& Nutrition the First Year',
sponsored by Cow & Gate, and
attended by several hundred
midwives and health visitors in
London on 29th January.
'Looking back we can see we
have progressed enormously in
the field of infant nutrition over
the past decade,' he continued,
'but we can certainly expect re-
search to tell us a great deal
more in twenty years' time.'
Enlarging on this point, Pro-
fessor Thomas Opp, of St
Mary's Medical School, London,
emphasised the need for more
research into the components of
the infant diet. 'Do the amounts
of fats or salt, for example, eaten
in early childhood, affect the la-
ter pattern of diseases? We
must be able to move forward on
the basis of knowledge, not just
opinion,' he asserted.
And he suggested that health
professionals have now told
women the good reasons why
they should breastfeed and
should spend more time helping
them with any problems in doing
so. This is especially important
in poorer sections of the com-
munity.
Professor Opp went on to
make the point that although
breastfeeding is seen as the
optimum method of feeding in-
fants, infant milk formulae have
improved immeasurably in com-
position over the last ten years.
Growth rates of babies on the
highly modified formulae (eg
Cow & Gate Premium) are very
close to those of breast fed
babies and this he saw as a
good sign. Furthermore, dis-
eases such as neo-natal hypo-
calcaemia and hypernatraernic
May/June 1985
dehydration have become much the infant diet was examined by
rarer. Professor Donald Naismith of
At the second symposium in Queen Elizabeth College, Lon-
Glasgow on February 27th, Pro- don University. 'Human milk is a
fessor Belton speaking on the very strange food,' he com-
same subject, made the point mented, 'differing in composi-
that health visitors should dis- tion in almost every respect from mins and nutrients remained in
courage mothers from switching the type of diet now recom- the infant's diet during the vital
to cow's milk too early. Asian mended for adults.' He pointed first year of development.
children, particularly, would be- out that this is because while the The point was made that
nefit from more extended use of infant's diet is designed for opti- cow's milk is not designed for
infant milk formula to help re- mum growth, the adult diet human babies unlike both breast
duce the risk of vitamin defici- merely 'prevents premature milk and inflant milk formula, and
ences. death'. He warned against de- its balance of nutrients is not
parting too far from this com- therefore as suitable for the
position without further know- young infant.
Support ledge. The revelation that skimmed
The next speaker, Anne Cowell, Like Professor Opp, Profes- milk was sometimes being given
director of nursing services sor Naismith noted that infants to infants, made at the London
(community) for Redbridge, fed on highly modified babymilks symposium, provoked Profes-
spoke on postnatal care of have a rate of growth very simi- sor Naismith to show in his talk
mother and baby. She dwelt on lar to that of breast fed babies. at Glasgow that skimmed milk is
the subject, already touched With the old higher protein totally unsuitable for infants hav-
upon by Professor Opp, of national dried unmodified form ing ten times the sodium content
more continuous care from the with high levels of protein, of breast milk, a very high pro-
health visitor, even perhaps the growth in early infancy seemed tein content, and much less vita-
setting up of a 24 hour service to be accelerated by as much as min A than human milk.
for mothers. 'After all, it is at 30%. The lasting effects of this Dr H a r v e y , c o n s u l t a n t
night, that many mothers feel are unknown. Professor Nais- paediatrician at Queen Charlot-
most isolated and inadequate,' mith cited various unexplained te's Maternity Hospital, London,
she pointed out. She urged results of experiments which spoke on the subject, 'Inflant
health professionals to be more combined to demonstrate clear- malnutrition in the UK'. He re-
sensitive to parents' anxieties ly Professor Arneil's point that minded the audience that mal-
and lack of confidence. 'Each there is still a lot to find out about nutrition was 'imperfect or faulty
time you take a crying baby from infant feeding and the best diet feeding' not simply underfeed-
a new mother and soothe it, you for babies. ing. By this definition, he said
may simply be reinforcing her some infants in the UK are mal-
own feelings of inadequacy.' nourished. Because of this he
Mrs Cowell suggested that Cow's milk emphasised the importance of
health visitors should concen- The paper provoked questions regular weighing and measuring
trate upon improving rela- about the suitability of door step of infants. In this way, variations
tionships between mother and cow's milk (containing much can be spotted before a baby
baby, and that this can be higher levels of protein) for becomes too thin or obese. 'We
achieved through raising a babies from six months. It are all bad about measuring
mother's confidence by discus- emerged that many mothers are length, but proper equipment
sing her anxieties and reassur- anxious to hurry their babies on costs no more than a pair of
ing her that she is the best per- to cow's milk as soon as possi- scales' he said, 'and length is as
son to look after her baby. The ble. Professor Arneil suggested important in gauging condition
mother should be reassured that in discussion that the safest as weight.'
she knows her baby's moods advice health visitors could give Dr Harvey made the point that
and characteristics better than would be to continue the use of care must be taken in not having
anyone else very soon after the breast milk or infant milk formula a too rigid attitude as this might
birth. until 12 months, thus ensuring
continued overleaf
The role of protein and fats in that a satisactory level of vita-
15

Infant nutrition-
Thefirstyear
continued
be detrimental to breastfeeding.
An instance of this he cited was
an experiment showing that
mothers told to time their babies
breastfeeding were more likely
to become discouraged and give
up than those allowed to take
what time they liked. However,
Dr Harvey did warn the audience
that some babies did fail to thrive
at the breast and such babies
were not always fretful, but could
appear content and yet be
underfed. In such instances
growth charts would be useful in
detecting the problem and
sometimes it might prove advis-
able to take a baby off the breast
onto infant milk formula.
Alternative milks
The widespread increase in
the use of soya milk prepara-
tions for babies was another
area of concern. 'While satisfac-
tory for vegetarian mothers who
do not wish to breastfeed, there
is no evidence to support its use
for children of parents with aller-
gies. Indeed babies can become
allergic to soya milk just as they
can to cow's milk.' Dr Harvey
also made the point that goafs
milk, an increasingly popular
'health drink' is not as strictly
controlled as cow's milk and
may therefore even be danger-
ous for babies.
In his talk at Glasgow, Profes-
sor K Cockburn, Professor of
Child Health, Royal Hospital for
Sick Children, Yorkhill, Glas-
gow, emphasised the import-
ance of pre-conceptual care and
of the mother's diet during pre-
gnancy. He also pointed out that
for pre-term infants breast milk is
not a 'natural food' and may
prove inadequate.
Sue Goodley, Family Care
Sister, was applauded for her
a c c o u n t of t h e h u m a n e
approach adopted by the Not-
tingham City Hospital Neonatal
unit. 'Parents need a great deal
of support to cope with pre-term
babies,' she emphasised. 'In
fact most have not even started
attending ordinary parentcraft
classes, which usually begin
around 28 weeks. And on top of
feelings of fear, anxiety, guilt
and helplessness which usually
attend a premature birth, there is
16
confusion at all the sophisticated
technology, which can so easily
come between the baby and its
parents.'
The unit sees its role as sup-
porting parents to care for their
own babies, not only to encour-
age bonding but also to dispel
feelings of inadequacy. 'We
have no restrictions on visiting,'
she explained. 'Parents, sibl-
ings, relatives and friends are
welcome at any time and we
have areas where families can
relax and children play.' Each
parent is provided with a photo
of the baby and there is a pa-
rent's handbook to reinforce the
many verbal explanations that
staff are prepared to give at any
time.
There is also a parents' sup-
port group to overcome the
isolation that many such parents
feel. 'A family communications
chart alerts us to those families
who are failing to visit, so that we
can then find out the reasons
and perhaps offer help. And
finally we try to maintain con-
tinuity of care by encouraging
the community midwife or health
visitor to come to the hospital,
and visit the babies' homes after
discharge.'
Ethnic groups
In discussing the care of the
infant from ethnic minority
groups, the final speaker, Dr
Sundara Lingam, consultant
paediatrician from St George's
Hospital, Ilford, stressed the
need to understand the prac-
tices in such groups in order to
dispel the misconceptions. 'In
Asian families, who often live in
extended family situations, for
example, it is particularly impor-
tant to convince the in-laws and
especially the father figures
husband and father-in-law of
the need for any change since
he is the person whose advice
the young mother will take.' He
emphasised the importance of
health professionals visiting
such families in their own homes
and of leaflets and perhaps
videos in the relevant lan-
guages.
He also talked about the tradi-
tions of certain ethnic minority
groups which, though long-
established, were not of particu-
lar benefit and in some cases
could be harmful to the babies.
For example, the belief among
Asian mothers that colostrum is
not good for baby which pre-
vents them from suckling their
babies for the first three days
after birth. Another example of
this was the habit of boiling
cow's milk a handover from
practices in homelands where
milk was not pasteurised and
giving babies the highly concen-
trated residue which can be
damaging. Health education for
these ethnic minorities is there-
fore vital.
Delegates' questions
Several interesting points
emerged in the final discussions
between the panel of speakers
and members of the audience.
Speakers from the floor
showed concern at the recent
introduction of a follow-on milk.
There were worries that mothers
were using it too early. The
panel felt that such milks, if used
properly might be acceptable
from six months, but could see
no other particular advantage.
It was agreed that the way to
influence mothers to adopt good
feeding practices was often
through the grandparents. A
Nottingam speaker mentioned
successful grandparent classes
held in her area.
It was felt by several members
of the audience that special
videos on feeding practices
might be an effective means of
communicating with ethnic
minority groups and poorer sec-
tions of the community. But as
Professor Arneil pointed out,
'they should be a supplement,
not a substitute for personal con-
tact with the midwife or health
visitor.'
There was a general plea for
health visitors to make time for
health education in schools and
agreement with Professor
Arneil's statement 'that if as
much time were spent on infant
nutrition and the father's role as
on sex education, there would
be widespread benefits.'
Nutrition and Food Science