Academic journal article Canadian Journal of Public Health

Early Introduction of Non-Formula Cow's Milk to Southern Ontario Infants

Academic journal article Canadian Journal of Public Health

Early Introduction of Non-Formula Cow's Milk to Southern Ontario Infants

Article excerpt

ABSTRACT

Background: Early introduction of cow's milk is a risk factor for the development of anaemia and iron deficiency, which is associated with lower childhood developmental scores. The objective of this paper is to describe the incidence of the introduction of cow's milk before the recommended age of nine months and factors associated with early introduction.

Methods: Mothers of healthy term infants were invited to take part in the Infant Feeding Survey in 2002-2003. These mothers, from Southern Ontario, were interviewed by telephone at three and nine months postpartum to determine infant feeding practices.

Results: One in eight (12.7%) mothers completing the second interview indicated that they were feeding their infant non-formula cow's milk as the primary source of milk before nine months. Multivariate logistic regression analysis showed that mothers feeding cow's milk before nine months were younger, lived in households with lower annual incomes, and were less likely to have attended prenatal classes or to recall receiving information on the introduction of solid foods. They were also more likely to have introduced solid foods or skimmed milk before the recommended ages.

Conclusion: A substantial proportion of Southern Ontario infants are receiving cow's milk before the recommended age, putting them at increased risk for iron deficiency and the resulting sequelae. Further research into why guidelines are not followed is indicated.

MeSH terms: Infant nutrition; milk; health survey

A dequate nutrition in infancy is essential for optimal growth and development. The early introduction of non-formula cow's milk is associated with higher rates of anaemia and occult blood loss in stool.1 Several studies indicate that feeding cow's milk is a leading factor in iron deficiency in infancy and early childhood.2-5 Iron deficiency in infancy and early childhood may lead to lower developmental scores in young children, which appear to persist even after treatment.6,7

The joint statement of the Canadian Paediatric Society, Dietitians of Canada, and Health Canada recommends that infants be given breastmilk exclusively for the first six months. At six months, solid foods are to be introduced while continuing to breastfeed for up to two years or longer. Infants who are not breastfed, or who are weaned from breastmilk before nine months of age, are to be fed infant formula. After nine months, whole milk may be introduced. At no time in the first twelve months of life is the use of partly skimmed or skim milk or non-formula soya-based beverages recommended.1

Governments and health agencies in many other developed countries recommend the use of infant formula until twelve months.8,9 From the few studies looking at the introduction of cow's milk by nine months, as recommended in Canada, one multinational study done in Europe in the early 199Os determined that 18% of infants were fed cow's milk as their main drink at nine months.10 In 1992-93, 17% of Scottish infants were reportedly receiving cow's milk as their main drink by nine months.11

Even fewer studies describe the factors associated with the early introduction of cow's milk. Ummarino et al.12 report that the introduction of cow's milk by six months of age to Italian infants was higher in mothers with fewer years of education.

There are studies describing maternal factors associated with the introduction of solid foods before the recommended age. Factors associated with the early introduction of solid foods (not cow's milk) include younger, less educated mothers who smoke, live in less densely populated areas, who do not initiate breastfeeding or stopped breastfeeding before their child was one year of age.13,14

The objectives of this paper are to: a) determine the proportion of infants being fed non-formula cow's milk before the recommended age within a sample of Ontario mothers, and b) describe the maternal and household factors associated with the early introduction of cow's milk. …

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