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