Cheap Milk Substitutes Endanger Babies

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An 8-month old baby girl, Noor, arrived at a public hospital in Lahore, Pakistan. With a history of frequent watery diarrhea for more than a month, the baby was severely undernourished.

Interviewing the mother revealed that the child was taking in sufficient food; weaning foods had been started and the child was getting enough milk. The mother’s food preparation technique was satisfactory. She reported the use of packaged milk locally called ‘dabbay ka doodh.’ No dietary reason of undernourishment could be determined, and we shifted our focus toward the social and medical history of the child. Data regarding every possible determinant of watery diarrhea was taken including the personal, food and bottle hygiene practices. Still, no significant contributory factor was revealed.

The mother reported that she stopped breastfeeding about 2 months ago. Guessing that packaged milk did not suit the baby, we decided to shift her to infant formula milk. The parents balked, citing the expense of formula milk. In helping them compare the cost of packaged milk vs. formula, we asked the brand of milk being given to the child.

Their response shocked me, and I told them “That is not milk.” They looked strangely at me and tried to convince me by showing the package, and said that they had seen it advertised on TV for use with tea. It proved difficult to convince them, to explain that they had been feeding their child something for almost 2 months that was in no way related to milk. Most importantly, they were not willing to accept that the cheap milk was saving their money at the expense of their child’s health.

After this, I started to collect data about the brand of milk being fed to the children—deviating from my research objectives. To my surprise, Noor was not the only child being fed artificial tea whitener; rather, this practice was quite common. Finding a total of 5 tea creamer-fed children during three months period, I was convinced that poverty, lack of knowledge and advertising can play a significant role in child feeding practices.

Many health practitioners might not probe deep into the feeding practices of child and therefore may overlook this root cause of undernourishment. But it must be highlighted. Not only can it have an impact on child’s health, it can also improve the efficiency of diagnostic interventions. Convincing the pediatric health practitioners to start asking the type/ brand of milk being given to the patient and intervening accordingly is a small investment compared to its potential benefits. Moreover, the tea whitener manufacturers must be pressed to put a clear pictorial explanation in their advertisements and on packages that it must not be used for feeding children. This issue must also be included in the community-based nutrition campaigns for promoting healthy feeding practices during formative early years of life.

Afifa Tanweer Nutritionist, MSc., M.Phil., won an honorable mention in this year’s Untold Global Health Stories Contest, co-sponsored by NPR’s Goats and Soda Blog and the Consortium of Universities for Global Health.

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