Infant formula
No subject given Pushpa Acharya 25.03.99
infant formula George Fuchs 02.04.99
infant formulae Ali Maclaine 06.04.99
infant formulae -Reply Marion Kelly 06.04.99
infant formulae -Reply Rita Bhatia 07.04.99
Infant feeding in Emergencies - Kosovo Refugees Aileen Robertson 09.04.99
Kosovo Alison Tweeddale 09.04.99
no title Rafah Aziz 10.04.99
Re: infant formulae -Reply Pushpa Acharya 11.04.99
Infant feeding in Kosovo Michael Golden 16.04.99
infant formulae -Reply George Fuchs 16.04.99
Infant Formula - follow up Pushpa Acharya 16.04.99
infant feeding in emergencies Aileen Robertson 19.04.99
infant feeding in emergencies Elisabet Helsing 20.04.99
Re: infant feeding in emergencies Angela Berry 20.04.99
Re: infant feeding in emergencies Ludmila Lhotska 20.04.99
Re: Infant Formula - follow up Ali Maclaine 14.05.99


Date: Thu, 25 Mar 1999 12:45:27 -0500

From: "Pushpa Acharya"<acharyapatun.org>

Subject: Ngonut: No subject given

 

Dear All,

1. Is there any information regarding consequences of changing brands of Infant Formula frequently for children below one years of age?

2. What are the consequences of feeding Infant Formula meant for 6-12 months babies (Formula # 2) to 0-5 months babies?

Pushpa Acharya

World Food Programme - Iraq


Date: Fri, 02 Apr 1999 11:33:17 +0100

From: "George Fuchs" <gfuchsaticddrb.org>

Subject: Ngonut: infant formula

 

Dear Pushpa,

If they are standard commercial infant formulas and the child has no special needs, there should be no consequence of changing brands. Many formulas marketed for the 6-12 mo. old infants ("follow-up" or "follow-on" formulas) typically have a higher protein content and often lower fat content than standard infant formulas. While not the first choice for younger infants, it is my understanding they sustain growth well and could be used if there are no better alternatives. However, it will be interesting to see other views from other members of NGONUT. The only significant concern I would have is in the very young newborns given the higher renal solute load related to the higher protein concentration. In this regard, however, no problems or differences in U.S. infants as young as four months of age were observed in studies I have done comparing standard vs. follow-up formulas.

All the best,

 

George Fuchs, MD

ICDDR,B: Centre for Health and Population Research


Date: Tue, 06 Apr 1999 10:50:59 +0100

From: Maclainesataol.com

Subject: infant formulae

 

Dear Pushpa,

Some interesting questions you pose!

As far as I know there are no major consequences of changing brands of infant formula for infants. There is some debate about the relative merits of whey versus caesin formulas (with whey commonly accepted as the best early on as it is "more like breastmilk" with infants sometimes going on to caesin formulas later as they are for "hungrier babies") but while I would opt for whey formulas on the whole I don't think it matters that much. The infant formulas in the UK (and I presume elsewhere in the world) have to conform to guidelines about their constituents and as long as they do then I don't see this to be a major problem.

- As a matter of interest some health workers think that being seen to use a number of formulas is actually better as it stops the idea that you as the "expert" are endorsing a brand or company. (and thus may help to prevent breastfeeding being undermined)

As far as using follow-on formulas for infants between 0-5 months I would say IF AT ALL POSSIBLE DON'T (unless of course you have nothing else). Follow-on formulas were not made to provide a complete food for infants, you could imagine them, if anything, like a milk drink to go alongside other weaning foods. They are not a substitute for breast milk or infant milk formula.

The reason why follow-on formulas were made is debatable some see it as a way for companies to get around the Code on the Marketing of Infant Formula and as long as you give a wide range of weaning foods including iron, or you use an iron-fortified infant formula, you don't need follow-on formulas at all.

Others would say that it was made to give growing and developing infants extra protein, energy, vitamins and particularly iron (in order to prevent anaemia) without the problems associated by giving infants cows milk.

The main difference between follow-on milks and infant formula seems to be the increased amount of iron it contains. However, they also contain more protein and salts - for example calcium, phosphorous, sodium.

- Excess iron may be a problem as it may interfere with the infant's resistance to infection and the absorption of trace minerals such as zinc and copper. In at least one paper infants fed follow-on formula had lower plasma zinc levels (Lonnerdal & Chen, Effects of formula protein level and ratio on infant growh, plasma amino acids and serum trace elements. Acta Paediatr Scand 79:266-73, 1990) I think it's also the case that excess iron can be utilised by bacteria and therefore there is a greater risk of infection.

- It is known that formula-fed infants are also at a risk for neonatal hypocalceamic tetany, due to the high phosphate load in formula and the lower calcium retention in newborns fed formula - I do not know of any studies looking at this in the context of follow-on formulas however, I would surmise that new-born infants given follow-on formula are at higher risk of this due to the higher levels of phosphate.

- I do not know the long-term effect of high protein intake on kidney function in term infants, but there is no doubt that there will be increased metabolic stress on immature organs.

- These high amounts will also place the infant at higher risk of hypernatremic dehydration during common situations which reduce body water (eg fever, vomiting, diarrhoea, hot climate, reduced formula intake)

I hope this information is useful. I would be interested to know the situation in which you work and why you asked the second question - can you only get follow-on formula or something? I really think you should try and keep to normal infant formula for infants < 6 months of age as despite all the criticisms of it at least it is formulated with the aim to get it as close to breastmilk as possible, which is really what you want. I feel I must give a mention for breastmilk though. Like I said before I am not sure of your situation but remember breastmilk is always best! You might also be interested in a booklet which is about to come out called "Infant Feeding in Emergencies" by the ad-hoc UK group of the same name, which goes into breastfeeding in emergencies, the use of infant formulas and so on. Contact the Emergency Nutrition Network if you are interested e-mail: foreillyattcd.ie

I look forward to hearing other peoples comments on this subject.

Best wishes,

 

Ali Maclaine.


From: m-kellyatdfid.gtnet.gov.uk

Date: Tue, 6 Apr 1999 16:34:45 +0000

Subject: infant formulae -Reply

 

Ali and other ngonutters,

I read Ali's reply to Pushpa's query with great interest, and I agree with what she says.

I think I know a little about the context of Pushpa's query, as I worked in Iraq (both North and South) in 1991. At that time many of the paediatricians seemed to have incomplete or inaccurate information about infant feeding. Through no fault of theirs, most did not know how to help mothers breastfeed successfully, and most assumed that the effects of the war (which included changes in diet and psychological stress) would lead to lactation failure in any case (NB although there is every reason to try to prevent and/or mitigate both poor nutrition and stress, there is quite a lot of evidence to show that lactation is not greatly impaired by either of these factors). Many paediatricians and others in Iraq believed that changing brands of infant formula would be harmful to artificially-fed babies, though like Ali I'm not aware of any real evidence for this.

I understand that UNICEF and WHO have been working in Iraq to improve the protection, promotion and support of breastfeeding. Based on my experience there eight years ago, I think this is a very appropriate response which should help to prevent a great deal of suffering and death. I would be interested in learning of the progress and impact of this intervention, if anyone out there has information on it.

 

Marion Kelly


Date: Wed, 07 Apr 1999 20:48:23 +0100

From: Rita Bhatia <BHATIAatunhcr.ch>

Subject: infant formulae -Reply

 

Mike

How are you. It is me, appalled with the Kosovo situation. I wish to bring to the attention to NGONUT the following Quote Watching the media , it takes me back to Gulf Emergency of 1991 when Hundred of Thousands of Kurds were crossing the border and the mountains.

A Healthy population . Lot of babies and baby bottles. Wasting levels were very low Globally but when fine analysis of the data was carried out with age breakdown, high mortality and wasting was seen among under 2 years. 'cos Liberal use of Infant Formulas and Baby Bottles in very unhealthy environment.

I saw the same on the media now among Albanians crossing the border with Bottles and infant formulas.

I have just got a report from our Health coordinator in Kukes who reports "The water and sanitation situation is extremely cortical and requires an immediate intervention. A high potential for Outbreaks of water/food borne diseases exists. "

I just want Nutrition Community to be aware of this.

 

Rita Bhatia


From: "Robertson, Aileen (LSH-NIF)" <AROatwho.dk>

Subject: Infant feeding in Emergencies - Kosovo Refugees

Date: Fri, 9 Apr 1999 16:03:23 +0100

 

Dear ngonutters,

I have just returned from holidays and am horrified by the lastest disaster in the Former Yugoslavia. Having lived in Bosnia for 3 years from 1992 - 1995 I cannot believe what is happening. The stories that I am receiving are too horrific to even think about ..............

on top of the human tragedy it appears that the same situation is occurring regarding infant feeding and there is a great need for mothers to be supported to breastfeed and prevent them from having infant formula dumped on them.

The booklet - infant feeding in emergencies - a booklet for mothers - is available from our web-site (http://www.who.dk/tech/hp/breastfeed.pdf). UNICEF Belgrade translated into both Albanian and Serbian over 6 months ago. Any NGOs working in the Region may find this information useful.

Also we developed a short Policy Statement (UNHCR, UNICEF, WFP and WHO) on infant feeding in the Former Yugoslavia that might be useful. This is only in English

 

Aileen Robertson

Acting Regional Adviser for Nutrition, WHO Regional Office for Europe

Scherfigsvej 8, 2100 Copenhagen

Tel: 45 - 39 17 13 62, Fax: 45 - 39 17 18 54

Email: aroatwho.dk


Date: Fri, 09 Apr 1999 13:06:59 -0400

From: Alison Tweeddale <Alison_TweeddaleatWorldvision.CA>

Subject: Re: Kosovo

 

Dear Rita,

World Vision Canada, like many other NGOs, is involved in the emergency response to the Kosovo crisis. In providing input from a nutrition perspective our team would appreciate any advice you can share from lessons learned in the Iraq refugee crisis, as you have mentioned that the situation seems similar. I'm sure others on ngonut would appreciate your insights too.

Many thanks,

 

Alison Tweeddale, Nutrition Officer

World Vision Canada

6630 Turner Valley Road, Mississauga, ON

L5N 2S4

tel: (905) 821-3033 ext3402, fax: (905) 821-1825

alison_tweeddaleatworldvision.ca


Date: Sat, 10 Apr 1999 07:09:55 -0400

From: razizatunicef.org (Rafah Aziz)

Subject: Re:??????????????????????????s

 

Dear Aileen

Thanks for the information. This issue of abusing infant formuladuring emergencies , which make things even worse, must be taken seriously. May be some thing should be agreed on with international NGOs as well. Can we have copy of the short Policy Statement (UNHCR, UNICEF, WFP and WHO) mentioned in your message.

Best regards

 

Dr. Rafah S. Aziz

Health & Nutrition Officer UNICEF Iraq


Date: Sun, 11 Apr 1999 13:09:26 -0400

From: "Pushpa Acharya"<acharyapatun.org>

Subject: Re: infant formulae -Reply

 

Thank to all who have responded to the Infant Formula questions. Sorry I was out and could not respond to the question raised in the responses earlier because I was in the field.

You are aware that Iraq is under sanction. In order to respond to the food need of the population the Government of Iraq (GOI) established a public rationing system in 1991. The public rationing system included infant formula as Infant Ration. Till 1997 the infant formula ration was not adequate to fulfill the need of the infants. However, with the implementation of "oil for food" programme, the ration has increase to 3.6 Kg/month/child.

I understand that GOI removed the infant formula from the ration in 1994 and it created a public outcry. So, the government would not hear of removing the infant formula from the ration, despite WFP's and UNICEF's persistence recommendation to do so.

Breast-feeding practices in Iraq is said to have been low in pre-sanction period. After 1991 (sanction regime), some data reflected that rate of breast-feeding began to increase. The latest, UNICEF's survey's indicated that there is indication of increase in formula use after 1997. We do not know the reason, speculation is that because the ration of Infant Formula has increase, mother tend to opt for infant formula feeding.

The distribution of Infant formula however is complicated by different brands and the inability of the distribution system to distinguish between infants 0-5 months and 6-12 months.

Between April 1997 and March 1999, the government has distributed 18 different brands of Infant Formulas.

WFP conducts spot check on randomly selected 11,000 household every month. One of the major complaints of the beneficiaries is on the two questions I posed i.e. frequent change in the brand of Infant Formula (complaint about diarrhea with the change in brand each time) and receipt of follow - up formula by younger babies and start up formula by older babies.

We have established a nutrition - consultative group in Baghdad, where all agencies, local and International NGO and the Ministry of Health (MOH) meet to discuss outstanding issues regarding nutrition in Iraq. During our last meeting, a suggestion was made by a person from MOH that - why don't UN agency recommend the government to distribute only follow-up formula. Her reasoning was that mother tend not to feed follow up formula to younger children since she thinks it is not appropriate and hence breast feeding can continue. In such case there will be likelihood of continuation of breast-feeding after six-month as well. Furthermore, complimentary food is needed anyway after six months, introduction of Infant Formula at this stage may be lesser concern, child can be fed infant formula in cups etc.

I am trying to collect the nutrient composition of all brands of Infant formula to compare the difference between start up and follow up formula to see whether younger child can be fed follow-up formula. Ali's response gave me some thing to think about. I received some response personally which stated follow up formula may be better for younger infants because of Iron fortification. I would appreciate more discussion on this issue.

I would also appreciate, any suggestion regarding promotion of breast feeding and infant formula issues that can be applicable in the situation that we are working here.

Thanks

 

Pushpa


Date: Fri, 16 Apr 1999 17:52:33 +0100

From: Michael Golden <refugeesatabdn.ac.uk>

Subject: Infant feeding in Kosovo

 

The URL that Aileen Robertson was referring to is http://www.who.dk/tech/hp/breastfeed.pdf

For those who cannot connect to the web - the policy (taken from www.who.dk site) is as follows:

 

Policy on infant feeding in thecountries of former Yugoslavia

Joint UNICEF/UNHCR/WFP/WHO STATEMENT

 

1. BREASTFEEDING

Protect, support and promote exclusive breastfeeding for all infants until about 6 months and continue breastfeeding through the second year of life.

RATIONALE:An important way to prevent malnutrition and to reduce the risk of morbidity and mortality in infants is to encourage breastfeeding. Bottlefeeding is potentially harmful. The healthiest feeding practice for babies is to exclusively breastfeed to about 6 months of age and then introduce complementary foods with a cup and spoon while continuing to breastfeed through the second year of life.

In 1981, the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes which lays down strict regulations on the marketing and distribution of infant formula and other breastmilk substitutes, feeding bottles and teats. In 1990 the WHO/UNICEF Innocenti Declaration urged governments to adopt the code in its entirety as a minimal basis for national legislation by 1995. Many European countries are already following the Code's recommendations.

In 1989 UNHCR issued a policy related to the acceptance, distribution and use of milk products in refugee feeding programmes. UNHCR strongly discourages the use of breastmilk substitutes because of the negative effect on breastfeeding and serious implications for the health of infants.

Before the war, levels of breastfeeding in the former Yugoslavia were low and there was a high dependence on breastmilk substitutes. It was therefore recommended in October 1992 that as an emergency measure, baby milk formula could be temporarily distributed to war-affected areas. In the very limited circumstances where infant formula is still necessary (e.g. feeding of war orphans), the guidelines laid out in the Annex should be ahdered to.

The decision to distribute infant formula was only applicable until the reasons for failure to breastfeed could be identified and addressed. Results from nutrition surveys carried out in 1993 showed that advice from health care professionals was contributing to the low levels of breastfeeding.

Therefore UNICEF and WHO decided to provide training to health professionals in lactation management and counselling skills.

Commercial opportunities for marketing breastmilk substitutes will increase during the transitions from war to peace. Local authorities should be alerted to the danger this poses to breastfeeding and prevent manufacturers of baby milk formula from taking advantage of a vulnerable population. The International Code of Marketing of Breastmilk Substitutes should be adopted as widely as possible. In addition all subsequent resolutions of the World Health Assemblies should be followed, including the ending of free supplies of breastmilk substitutes to health care facilities.

UNICEF has promoted breastfeeding in the former Yugoslavia since the beginning of their mission. UNICEF/WHO seminars were held throughout the former Yugoslavia during 1993 and 1994. Local doctors and nurses were encouraged to attend. The clear messages delivered to local health care professionals were:

DON'T ACCEPT DONATIONS OF INFANT FORMULA DISPLAYING BRAND NAMES. LEARN HOW TO SUPPORT SUCCESSFUL BREASTFEEDING INSTEAD.

 

2. COMPLEMENTARY FOODS

Encourage parents to use local produce (such as fruit and vegetables) and basic food aid commodities (rice, beans and lentils) as complementary foods. Support and promote local food production.

Rationale: Dependence on commercial weaning foods should be avoided. Under war conditions, supplies may be unreliable and as food aid is phased out, local people will be unable to afford costly manufactured items. All agencies should encourage the use of local produce and basic food items, suitably prepared for infants older than 6 months rather than creating a dependency on expensive specialized manufactured weaning products.

In order to ensure that appropriate complementary foods are available, relief agencies could consider the procurement and distribution of local food produce such as fruit, vegetables and cereals. This would also help to stimulate the local economy.

 

3 SUPPLEMENTARY FOOD COMMODITIES

Reduce the distribution of supplementary food aid commodities and target only the extremely vulnerable.

RATIONALE: Supplementary food commodities such as dried milk powder and biscuits have been distributed to specific population groups (children aged 0-5 years, pregnant and lactating women, elderly aged over 65 years) within the former Yugoslavia as a means of protecting those groups most at risk during times of food shortage.

Joint UNHCR/WHO/UNICEF/WFP guidelines for the distribution of supplementary food were developed in 1993 which detail target populations, distribution and monitoring. Under no circumstances should dried skim milk be given to babies and very young infants.

Dried milk should be packaged displaying the following words in the local language:

'WARNING: DRIED MILK MUST NOT BE USED TO FEED INFANTS. BREAST MILK IS THE BEST FOOD FOR INFANTS. BREAST MILK PREVENTS DIARRHOEA AND OTHER ILLNESSES.'

Directions on how to prepare dried milk should also be displayed in the local language.

While food aid may have played a role in preventing widespread undernutrition in the war-torn areas of the former Yugoslavia, the situation is slowly changing with increased availability of locally produced and marketed food and improved distribution of food aid.

There is therefore no longer an urgent need to provide supplementary food commodities to infants in addition to basic foods provided through the general ration. Distribution should no longer be global but be targeted to the extremely vulnerable (eg. individuals at particular risk due to very poor economic circumstances). Stocks of supplementary food commodities should be kept in reserve for emergency situations.

 

ANNEX

1. In very exceptional circumstances baby milk formula provide in generic, non-brand packaging) should be prescribed to a mother only after she has received extensive counseling by specially trained health professionals skilled in the management of lactation.

2. An education component should be an integral part of every project where supplementary food commodities (especially baby milk formula and commercial weaning foods) are distributed. This should include: intensive training for health professionals in lactation management and counseling skills to ensure that all maternity and community practices are baby-friendly. special counseling for pregnant women to promote breastfeeding and attendance at antenatal clinics. special counseling for mothers of new-borns regarding the benefit of breastfeeding.

3. It is the responsibility of the Ministries of Health and local authorities to ensure that relief agencies comply with the International Code of Marketing of Breastmilk Substitutes. Moreover, each child receiving a donation of breastmilk substitutes must be assured a full supply for as long as is needed.

 

Prof. Michael H.N.Golden


Date: Fri, 16 Apr 1999 17:57:17 +0100

From: "George Fuchs" <gfuchsaticddrb.org>

Subject: RE: infant formulae -Reply

 

Dear Pushpa,

Just a quick reaction to your questions and then a comment on the iron issue. But perhaps I should first mention that I am a pediatric gastroenterologist. Of course breastmilk is preferred in young infants and should be vigorously promoted with use of commercial formula reserved for special cases, but I assume you have already considered this. My understanding is the same as Ali's (I believe), i.e. that all infant formulas, including follow-up formulas, have to meet specific coda/guidelines on content such that they could safely, if not as first choice, be consumed by all age infants. It would be important to confirm and should be fairly easily done. If this is confirmed as expected, then all the other reservations raised about using the follow-up formula will be addressed.

The iron issue is really a non-issue since the concentration in these formulas is not extreme and the physiologic regulation of iron absorption is such that there is absolutely no risk of iron overload in an otherwise normal infant/child. The risk of sepsis, bacterial infection, etc. has, to my knowledge, only been established in severely malnourished children in the very early phase of their rehabilitation and therefore, this is definitely not a reason to deter the use of the follow-up formula unless the child fits this description. As I mentioned earlier, unless there is a coexisting illness and the need for a specific formula type for therapeutic reasons, switching from one formula to another (providing they are standard commercial formulas) will not be a problem except in extremely few cases, so few that it is not really a practical problem in the context you describe. As mentioned earlier by someone, most of the differences (casein vs. whey protein, starter vs. follow-up, etc) between formulas sold for non-therapeutic reasons and for normal infants are based on companies trying to establish a market niche.

In summary, for the context you describe, breastfeeding is first choice. For infants 0-5 months, "starter" formulas are the second choice and changing from brand to brand is not a problem except in perception. If neither breastfeeding or starter formula is an option, then follow-up formula can be safely provided (IF the coda/guideline issue is confirmed). Switching from one brand to another, from starter to follow-up or vice-versa, admittedly is not esthetically pleasing to mother or health care provider or nutritionist but should not present a problem from a pathophysiologic point of view. Hope this helps.

 

George Fuchs, MD

ICDDR,B:Centre for Health and Population Research

Dhaka Bangladesh


Date: Fri, 16 Apr 1999 18:08:40 +0100

From: "Pushpa Acharya"<acharyapatun.org>

Subject: Infant Formula - follow up

 

Dear Ngonuters,

I have compared nutrient contents of eight different brands of infant formula distributed in Iraq and found following quantities of the nutrients. Could anybody provide any information regarding solute load that a new born baby can handle if the follow-on formula is fed to him/her based on these nutrient contents?

 

RANGE OF NUTRIENT CONTENTS IN EIGHT DIFFERENT BRANDS OF INFANT FORMULAS

Nutrients

Nutrient Contents
Formula # 1
Range

Nutrient Contents
Formula # 2
Range

  Minimum Maximum Minimum Maximum
Energy (Kcal) 491 510 466 474
Protein (g) 12 13.5 14.5 16
Vitamins        
A (IU) 1500 1800 1200 1900
D (IU) 280 310 250 420
E (mg alpa-TE) 3 6 3 5.6
K (mcg) 30 40 21 30
C (mg) 50 50 47 50
B1 (mg) 0.3 0.35 0.3 0.7
B2 (mg) 0.5 1 0.7 1.1
B6 (mg) 0.3 0.4 0.35 0.93
B12 (mcg) 1 1.5 0.93 1
Folic Acid (mcg) 40 46 25 140
Pantathenic Acid (mg) 2 2.3 2 3.3
Biotin (mcg) 11 15 10 16
Minerals        
Calcium (mg) 400 465 450 630
Phosphorus (mg) 320 375 360 450
Magnesium (mg) 41 50 48 60
Iron (mg) 6 6 8.5 8.5
Iodine (mcg) 30 75 25 98
Copper (mg) 0.3 0.3 0.3 0.56
Zinc (mg) 3 3.8 2.4 5.6
Maganese (mg) 0.03 0.036 0.03 0.034

 

Pushpa Acharya


From: "Robertson, Aileen (LSH-NIF)" <AROatwho.dk>

Subject: infant feeding in emergencies

Date: Mon, 19 Apr 1999 15:14:39 +0100

 

Dear All

Please note that the flashing message regarding infant formula has been added to the Kosovo page. <http://www.who.dk/cpa/Kosovo/welcome.htm>

 

Aileen Robertson, Acting Regional Adviser for Nutrition

WHO Regional Office for Europe

Scherfigsvej 8, 2100 Copenhagen

Tel: 45 - 39 17 13 62, Fax: 45 - 39 17 18 54

Email: aroatwho.dk


Subject: infant feeding in emergencies

Author: elisabet.helsingathelsetilsynet.dep.telemax.no

Date: 4/20/99 2:08 PM

 

Dear Aileen,

My congratulations on a job well done! Maybe all regional offices should get a copy for their use in regional emergencies.

I have only one small suggestion for improvement: I do not think it is generally known that re-lactation is almost always possible (the "almost" I put there for lack of sufficient experience). I know it is in the booklet, but it could perhaps also be in the screen text early on. A prominent sentence about this might do much to install confidence in mothers and relief workers and reduce the need for infant formula substantially.

 

Elisabet Helsing


From: aberryatunicef.org (Angela Berry)

Subject: Re: infant feeding in emergencies

Date: Tue, 20 Apr 1999 08:25:08 -0400

 

The model for relactation I have seen used with success was to establish a relactation clinic (tent) - provide the support and then have women who have successfully done it counsel others. Also, sewing materials and other child care etc. were provided to give a relaxed environment.

regards

 

Angela.


Date: Tue, 20 Apr 1999 09:11:38 -0400

From: llhotskaatunicef.org (Ludmila Lhotska)

Subject: Re: infant feeding in emergencies

 

Dear Elisabet,

I think more attention is now--very slowly--being given to relactation. We may now be in a better position to promote it since we have one more excellent publication "The Relactation: review of experiences and recommendations for practice", (WHO/CHS/CAH/98.14). It was produced under Felicity's supervision and is just out. UNICEF is sending it to all our offices with the April mailing. Copies were already sent to Macedonia with our people.

Regards.

 

Lida


Date: Fri, 14 May 1999 13:55:33 +0100

From: MaclainesatAOL.com

Subject: Re: Infant Formula - follow up

 

Dear Pushpa,

I note that no one has replied to your message and thought that I would. However, it seems from your previous note that some people have replied to you away from the Ngonut forum. Can I just say to everyone that I think this is a great shame? I, for one, would like to see other peoples replies and comments to the questions as this exchange of information is the only way we can learn from the experience of others. Moreover, if people think that my answer to something is wrong I would like to know so that I MAY change my opinion! So therefore can I make a general plea that people use the Ngonut forum when replying to people's queries? Thank you.

So anyway on to your problem. I don't really follow the values you put in your list so I can't really comment on them - are they per 100ml feed, per 100kcal or what?

There is a Briefing Paper called "Nutrition in Infancy" written by the British Nutrition Foundation, which has the EU and UK nutrient regulations (per 100kcal or 100ml feed) for feeding infants. It also has comparison tables, comparing the nutrient contents of breastmilk, different types of infant formula and follow-on formula as well. It might be quite useful for you. The British Nutrition Foundation can be contacted at:

High Holborn House
52-54, High Holborn
London WC1V 6RQ, UK
Tel: 171 404 6504, Fax: 171 404 6747

They may even have it on the web if you contact them and ask.

Alternatively Pushpa if you want I could fax parts of it directly to you, it's 43 pages long, so it's a bit much to fax it all but I could fax you a copy of the tables for instance, However, it is a good document, all in all, so I think it might be worth you getting a copy. Let me know. I'm sure that I should be able to attach it or something to an e-mail but I'm not too hot on this high-tech stuff so fax will have to do!

Regards,

Ali Maclaine. .