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Infant feeding

Is Aptamil less likely to cause allergies?

76 replies

barlow · 19/08/2003 12:52

I am breast feeding but would like to give the occasional bottle of forumula as sometimes I find expressing enough in order to go out and miss a feed extremely tedious. I have heard from a couple of people that Aptamil is best but they can't tell me exactly why and where they heard it. Any views on this?

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oliveoil · 19/08/2003 13:03

I used Aptimil on dd with no probs but only used this as it was the one given out free in hospital. Nurses said it was the best one as is closest to breastmilk. Not sure if this is one huge marketing ploy or not (cos they get it free?) but the ploy worked as I have used it since I stopped b/feeding at 5 months-ish.

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linzoid · 19/08/2003 13:10

I was also told that aptamil was the closest one to breast milk and it does look more like it too! I used it from birth and unfortuneatly my ds suffers pretty badly from allergies. I do think he would have done whichever i had used though.

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mears · 19/08/2003 13:12

There is no difference really in the differing formulas. Aptamil is a popular choice but it is no closer to breastmilk that any of the others. It is still made from cows milk which can be a trigger for allergies. Formula is best avoided in the first 6 months when trying to avoid allergies. It is better to express milk regularly nand bank it in the freezer so that you are prepared in advance. You don't have to express full feeds at a time - you can collect small amounts then combine them to make a full feed. Expressing batches of 2-4 oz. is probably a good way to do it so that not too much is wasted. HTH.

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JJ · 19/08/2003 22:34

Breastmilk, too, contains cows' milk if you're drinking milk or eating anything that contains dairy. You certainly won't avoid a dairy allergy by breastfeeding. Maybe if you don't have any dairy protein while breastfeeding (remember to avoid those peanuts and nuts, too, very allergenic -- that's how my son was exposed). Fish, too, I think is a problem and eggs. Anything you eat will expose your child to that food and you wouldn't feed that to him now would you?
(the above is to be read in a wholly sarcastic and bitter tone)

What I really believe is that if your child reacts badly to formula, you should think about what's causing it. My son couldn't have formula; it made him sick. But he could (kind of) handle breastmilk. If I had thought about it, I would have noticed much much earlier that he was allergic to milk. So try it, by all means and if he's ok, he's ok. If he has formula every once in a while who cares what it contains? Are you feeding your child? Yes? Ok, then.

Formula is best avoided in the first 6 months if you're eating a diet of rice. If you're eating a normal varied diet, don't worry about it. Any benefits you get from breastfeeding, you're still getting, even with the occasional formula feed. There's no evil allergy inducing substance in formula. (If anyone wants to argue statistics, please read what I've just written.. carefully, this time.)

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mears · 19/08/2003 23:13

JJ you are quite right that breastfed babies can be allergic to milk in their mothers diet. However, they may quite happily deal with cows milk protein in their mothers diet yet react to a bottle of formula. There is loads of evidence out there to say exclusive breastfeeding reduces risk of developing allergies. I have pasted an excerpt of an article below. I personally would not give an exclusively breast fed baby formula at all.


What is cow's milk (protein) allergy?

Regular milk is made up of protein, carbohydrates or sugar, fat, vitamins and minerals, and water. It's the milk protein that causes the allergic reaction in cow's milk allergy. Cow's milk protein allergy can develop in both breastfed and formula-fed children. However, breastfed children are usually less likely to develop food allergies of any sort. Occasionally, though, breastfed children develop cow's milk allergy when they react to the slight amount of cow's milk protein that's passed along from their mother's diet into her breastmilk. In other cases, certain babies can become sensitized to the cow's milk protein in their mothers' breastmilk, but don't actually have an allergic reaction until they're later introduced to cow's milk themselves.

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eidsvold · 20/08/2003 07:50

despite having access to a number of formulas when dd was in hospital - Aptamil was recommend as being the better one on the market by a hopsital paed - for our dd. Actually she started on pregestamil (?) with whatever I could manage to express then she was topped up with formula.

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JJ · 20/08/2003 08:56

The unattributed quote you pasted says "breastfed" not "exclusively breastfed". So it's not saying that the occasional bottle makes kids more susceptible to allergies. And it's certainly not saying that cows' milk "can be a trigger for allergies"; drinking cows' milk proteins won't trigger, for example, a shellfish allergy.

But, hey, let's think about if your claim is even reasonable. There are a number of things to consider and I'm going to go through some of them.. because the lack of critical thinking about things like this is one of my pet peeves.

First, why breastfeed? One of the big reasons for breastfeeding is that the maternal antibodies protect the child from infection and perhaps allergies. We'll take that as a given and I will fully agree here that "breast is best". Now, the question is, how long do those antibodies persist? Are they so transitory that skipping one feed makes a child appreciably more susceptible to infection and allergies? My guess is no. If that were true, many things need to be rethought about feeding (eg, an infant should be fed every x hours day and night and woken up if she is sleeping too long ). So skipping a feed is not going to effect the chances of having allergies.

The next question becomes, does formula in and of itself cause allergies? I'm only going to talk about the specific case of giving a bottle every now and then. The maternal antibodies, as mentioned before, are still in full force. Food allergies are mediated by IgE (for the immediate symptoms) and IgG (delayed symptoms); I say this like it's clear cut, but it's not. A child can have high levels of IgE and not react to a food (my son's RAST showed more chicken IgE than milk and he's fine with chicken). Your position seems to be that too much cows' milk (because, as I've previously mentioned, there is cows' milk in a woman's breastmilk if she has dairy) can cause an allergy (which is different than causing a reaction because a reaction does depend on amount, but it's mainly dependant on having the allergy in the first place). Let me emphasize the fact that exposure to the particular food protein is necessary for the allergy to develop.. a child is not going to be allergic to a food he hasn't been exposed to. Ok, rambling a bit, but you seem to be saying that too much cows' milk can cause a cows' milk allergy. Is this true? No. It's simply not. It's not the amount, it's the exposure that is necessary for the allergy. Repeated exposure builds up the allergy (a doctor explained it to me as "tickling" the allergy). Anyway, if you want to argue this point, that's fine.

To sum up: breastmilk is useful to help prevent allergies because it contains substances which do something to a child's immune system to make him less susceptible. These substances most likely don't disappear if the occasional feed is missed, so the child still has protection. Formula in and of itself won't cause an allergy. And to repeat myself again, I'm talking about the specific case of giving formula every once in a while.

Now, all that is not to say that formula won't cause more of a reaction if a child has an allergy, especially if it has more cows' milk than the mother's breastmilk. While a small amount of a food can provoke a horrible reaction, it's generally true that in each particular instance more of that food is worse. (It's more complicated than that, of course. Allergies are weird.)

So why do some studies say "exclusive breastfeeding" helps protect against allergies? Most likely it's because exclusive breastfeeding means just that : no formula whatsoever. Easy to measure, easy to control who gets put in what group: exclusive breastfeeders and formula feeders. The latter group would contain mothers like barlow, mothers who replace one feed a day with formula, mothers who breastfeed, but send their kids to nursery with formula and mothers who don't breastfeed at all. Each of those subgroups is different. Barlow's child will have effectively the same amount of maternal antibodies as the exclusive breastfeeders and she is not repeatedly exposing her child to cows' milk protein via the formula. The mother who replaces one feed a day with formula will have a child who has 1/6 less maternal antibodies than she would have if exclusively breastfed (that's making a number of assumptions, of course, the main two being that maternal antibodies go linearly with number of breastfeeds and that it actually will make a difference -- both are huge assumptions). And so on... So even studies that differentiate between full time formula feeders and those mothers that breastfeed some are inapplicable here.

So, in conclusion (finally!) I think it's just wrong to lay guilt on someone for this.

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mears · 20/08/2003 09:14

JJ - there is plenty of literature out there to support that even one bottle of formula given to an exclusively breastfed baby can be a potential allergen trigger. I am not just talking about food sensitivities but about asthma and exzema etc. It is not to make mothers guilty - it is a fact. Giving a bottle of formula is not going to cause a problem to every baby who has one. Sometimes babaies need formula when breastfeeding in not going well. The risk of not feeding then outweighs the risk of allergy. However, the point I am trying to make is that if your baby is exclusively breast fed, then it is an unnecessary risk to give a single formula feed. If there is no family history of allergies then perhaps you might be happy to take it. It is not related to the amount of formula given and that is why I would not give an exclusively breastfed baby formula at all. Here is a bit of info

here

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aloha · 20/08/2003 09:15

JJ, I think the tone of your posts is extremely confrontational. Mears is a senior and well respected medical professional who has helped so many people via this site you wouldn't believe. Someone asks for views, and Mears was kind enough to give her informed view. There is no need to be quite so aggressive, IMO.

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3GirlsMum · 20/08/2003 09:20

In answer to your original question Barlow..no Aptamil wont make any difference with regard to allergies. I know a lot of people that used it because it was recommended as the closest to breastmilk. I bottlefed my first two with Farleys which I had no problems with then breastfed my third who then later went onto Farleys, again no problems. Its all down to personal choice I think.

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aloha · 20/08/2003 09:25

Barlow, I don't know hold old your baby is, but a bit of regular expressing can build up quite a safety net of supply that can be whisked out of the freezer when needed. I also found expressing pretty tedious, but having a few Avent freezer bags full did give me a bit of reassurance. Sadly, my ds had formula at a few days old in hospital, so it was too late for exclusive breastfeeding by then so I did give formula from time to time so I'm not trying to 'lay guilt' on anyone. However, if I'd had a better start I personally would have delayed the introduction of formula - probably until 4months when I went back to work p/t. My very healthy son (23months) who I didn't think had any allergies recently had to go to A&E absolutely covered in massive hives literally from head to foot which he found pretty distressing and he had to be given steroids. Don't know what he was allergic to, though hopefully some tests will answer that question.

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mears · 20/08/2003 09:40

Sorry - you cannot say confidently that the introduction of formula milk will not cause allergies - it MIGHT.

Here is another refrenced link link

Parents need to make informed choices.

Can I say that our special care unit uses Aptamil when mothers do not know which one to use. In the ward the mothers are not advised one formula over the other - none of them are closer to breastmilk than any other. Aptamil seems to be digested better than some others though.

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robinw · 20/08/2003 12:02

message withdrawn

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aloha · 20/08/2003 12:16

Oh dear Mears. I hope all this doesn't put you off giving advice in future. I know how invaluable it has been to so many people on this site.

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GeorginaA · 20/08/2003 12:36

robinw: I couldn't get that link to work.

I'd like to second that mears advice is really very good and has been very helpful - she's definitely one of the best midwives I've come across - wish you were at my hospital when I gave birth, mears!

I can see where JJ is coming from though. I got myself in a real state at the hospital when ds was born as he wasn't feeding well. The midwives would wait until nighttime when my dh wasn't there to support me and would pressurise me to give ds formula to "top him up" as he was "obviously" hungry. I was convinced one bottle was going to poison him or something and would get very worked up every night. Would force them to do heal tests on him to prove that his blood sugar levels were fine and I spent most of the nights awake and in tears with no real support.

I discharged myself the afternoon of the second day as I couldn't take it anymore - the ward was too hot so ds was too sleepy to wake up and feed properly perpetuating the cycle.

Obviously there's two points here - if I'd been less religious about it (I doubt if 1 bottle would have done that much harm) I could have got me some sleep and reduced the stress I was under. Secondly, all midwives don't seem to be as supportive as mears - frankly what they did was horribly horribly wrong. I wonder how many people at that hospital just gave up and then told themselves they couldn't breastfeed?

It does put a tremendous amount of guilt on people for just wanting a bottle every now and then, or if they want to mix feed, let alone the people who for whatever reason end up bottle feeding completely.

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mears · 20/08/2003 12:37

Not a problem Aloha. I have absolutely no doubts about what I am saying just as JJ and robinw have no doubts about what they believe. We will have to agree to disagree.
Could you write the author and title of your reference and what journal it is in robinw because I have tried cutting and pasting but it won't work.
I am well aware of the different approaches and interpretation of data so am interested to read the article. Happy to make it into a link too.

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aloha · 20/08/2003 12:44

Funnily enough, I would have thought that references to seven peer reviewed studies published in respected medical journals and supported by Unicef is pretty bloody good evidence. I haven't seen anything like that from you JJ, despite your extremely rude tone.

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oliveoil · 20/08/2003 13:10

Ding ding, end of round one.

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mears · 20/08/2003 13:36

Here is another

link

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3GirlsMum · 20/08/2003 14:10

I wasnt saying that Aptamil wouldnt cause allergies what I meant was when comparing it with other formula milks there is no reason to suggest that there is a greater risk with others as opposed to Aptamil.

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JJ · 20/08/2003 19:09

Oh Mears, I'm so sorry for my horrible tone. You were the undeserving victim of the remnants of a discussion I had with a doctor and while you did absolutely nothing wrong (because expressing your opinion isn't wrong!), she made my son think he was going to die in one hour. That's not meant to be an excuse, because I really don't have one, but it is an attempt at explaining where that insane emotion came from. So please please accept my apologies for the tone and horridness of my posts.

This doesn't mean I agree with you. (Is it ok if I do a smiley face? I feel really bad about this...) Anyway, the book club is due at my house sometime between 8pm and 9pm and it's 8:07pm here right now, so I've got to post this before anyone gets here.

Again sorry. Feel free to email me and say mean and nasty things.... it might make me feel better, if nothing else. I certainly deserve them.

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aloha · 20/08/2003 19:20

JJ, I'm also sorry I got so annoyed. I have read something nice you posted to me on another thread and felt guilty. Just that Mears is a national treasure who would never be mean to anyone (don't say you would Mears, you'll just spoil my fantasy ) and whenever she posts it is just to help.

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mears · 22/08/2003 09:25

No problem JJ. I am sorry you had such a horrible encounter and there are certainly no hard feeling from me, even if we do disagree

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JJ · 22/08/2003 09:58

Aloha, no worries.

The main reason I don't think the occasional bottle doesn't do any harm is because, well, my sons' pediatrician told me so and their allergist agreed. My eldest son had a huge milk allergy and, when we moved to London from the US, I found a pediatrician who specialized in allergies. He turned out to be the nicest guy and, in addition to the allergies, helped me navigate the UK health care system (it's very different from the US). So when I was pregnant with my second, I signed him on with the same doctor. He was the one who did the check in the hospital when my son was born and at that time I asked him (I'm fairly sure I had asked him this before, but can't remember exactly) about formula. He told me that unless I was on a dairy free diet, the occasional bottle of formula was ok. My youngest turned out to be allergic to milk which became obvious days after his birth. (This is when the La Leche page Mears referenced became so helpful-- the HV said he couldn't possibly have an allergy because he hadn't ever had formula. Note: Mears, of course, is not saying this.) So I took him back in to see him. Anyway, the subject came up again in the course of talking about doing an elimination diet and he said that if a child is susceptible, it is the frequency of exposure that matters most in developing allergy, which is why he said an occasional bottle is ok. Later we discussed the difference between Neocate and Nutramigen and he wrote a prescription for both. My eldest also has allergic asthma and an allergy to peanuts. Again the advice, even with the hypoallergenic formula, was that the occasional bottle was ok; it was very important to mainly breastfeed if I could (and he did say that he knew a true dairy free diet was difficult and he completely understood if I couldn't do it) because of the maternal antibodies and it would be good to put off introducing solids for as long as possible.

The allergist was annoyed that I hadn't come to her at the moment of conception -- she would have had me eating only rice from the the very beginning (an exaggeration, but if you ever see a list of common allergens, those are the foods she thought I should have avoided...). So she was a little over the top and I didn't discuss that with her. But she also, prescribed a hypoallergenic formula saying to use it occasionally unless I couldn't do a completely dairy free diet, then I had to use the formula. Again, to introduce foods as late as possible and to do one per week or something like that. (I have to admit, I didn't follow that advice.)

So that's why I believe that there's nothing in formula that causes allergies except the proteins (cows' milk protein, soya protein, whatever) and that the occasional bottle doesn't do any harm.

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JJ · 22/08/2003 09:59

Mears, that just goes to show I am the slowest poster ever -- you wrote your post while I was writing mine (slowly and distracted by getting the boys off to the swimming pool with their babysitter).

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