How much milk is needed for your child’s growth?

By Carol Aloysius

Milk – both powdered and liquid has been much in the news these past few weeks, triggering a wave of panic especially among parents of alleged contamination of some popular milk powders that could have adverse health impacts on their children.

Added to this, the question has been raised as to whether and how much milk is necessary for children once they start eating adult food.

Breastfeeding gives the most nutritious and complete meal

Emeritus Professor of Paediatrics , University of Colombo, Priyani Soysa who spearheaded the campaign for breast milk and succeeded in extending maternity leave for nursing mothers upto six months from the previous four months, talks about her favourite subject to the Sunday Observer.

Excerpts...

Question: You were a pioneer in promoting mothers to exclusively breast feed their babies in Sri Lanka. What memories do you have of those early days?

Answer : I have been a paediatrician for over 60 years and from the outset of my career as a paediatrician I have always said that breast milk is the most nutritious and a complete meal for the new born baby. I hold this view today as well and try to dissuade mothers from switching to formula milk foods until they complete six months at least and even longer. In my opinion every mother is capable of breastfeeding her baby.

Q: Are there any exceptions when infant formula has to be introduced?

A: Only if the mother dies while nursing her baby or in the case of an abandoned baby.

Q: How successful is the campaign for breast feeding which the Health Ministry is now vigorously promoting?

A: In the past, many mothers were reluctant to continue breast feeding after six months , and many working mothers began switching to formula milk fed with bottles (plastic and glass) to their infants, when they returned to work. This resulted in a decline in nutrition and diarrhoea when the bottles were not well washed.

But now due to awareness raising by the Health Ministry and child friendly non government organisations like UNICEF and WHO, the level of breast feeding for longer periods has reached a high level.

Q: You said that exclusive breastfeeding is sufficient for the baby in the first six months of life. What about the period after that?

A: After six months the child has to be introduced to other foods since he is growing. But breast feeding too must continue. Along with breast milk, the baby could be given rice conjee, mung kiribath with lentils well blended and vegetables.

All the protein he requires can be found in lentils and pulses. The baby must also be introduced to yellow fruits to give him the vitamin.

Q: If the baby is taking these complementary feeds how much of breast milk should he take?

A: About three feeds from the mother is sufficient. This should continue till his first birthday.

Q: And after that?

A: By the time he is one year old, the child should be eating adult food. If you fill his tummy with a lot of milk feeds, he will not be able to eat the normal food his growing body now requires. But milk especially mother's milk is important although the feeds can be less.

Q: Other than breast milk, what kind of milk should the child of this age be given? Fresh milk? Powder milk? Sterilised milk? Flavoured milk? Milk in packets?

A: The safest and most nutritious milk would be fresh milk straight from the cow. It is safe and there is no fear of tuberculosis bacillus in our local cows.

Q: Is milk important for a child's nutritional needs such as bone and teeth development and brain power?

A: A child’s nutrients don’t have to depend on milk alone. There are animal proteins like chicken, fish, dried fish, sprats, and vegetable proteins as well as leafy greens and yellow fruits. All of these natural foods will contribute to his overall development and growth.

Q: Do our mothers know this? Why are they still continuing to buy powdered milk foods and milk supplements as well as other protein and calcium supplements for their children?

A: I think the big multinational companies which operate here are to blame for this. Many of them advertise various brands of milk and other supplements for young children telling them they can raise their IQs or strengthen their bones by taking them. But the truth is they can get all the child needs for his growth with our locally grown foods and milk. It is a sheer waste of money as most of these mothers can ill afford to spend so much on these food supplements.

Q: There has been a claim by some paediatricians that water is a good replacement for milk. Your comments?

Fruits and vegetables play an important role in a child's development

A: Water is essential to us from with till we die. It is necessary to drink plenty of water in a tropical country like ours where you sweat a lot and can get dehydrated.

Q: What are the benefits of drinking water for the baby?

A: When a baby gets well hydrated his/her kidneys will function well and he will have easy bowel movements as water prevents constipation. These benefits apply to adults as well.

Q: When a child reaches his fifth year and starts going to school, how much of milk is needed to help his growth?

A: Between 2-3 glasses of milk (preferably fresh milk.) But less and less milk is needed as the child grows. School children also get a glass of milk these days free of charge.

Q: What about other dairy products like cheese and butter? Can they replace liquid milk or should they be taken along with milk?

A: If a parent can afford to give them these foods , there’s nothing wrong with taking them. But how many of our mothers can afford to give them butter and cheese when they are so expensive?

Q: Don’t adolescents also need a certain amount of milk?

A: Teenagers and even adults should have at least one glass of milk a day to give them calcium.

Q: What about pregnant women?

A: All mothers attending our maternal and child Health clinics are now given a nutritional supplement called Triposha. A pregnant woman should drink between 2-3 glasses of fresh milk, as she needs more milk at this stage for calcium. If she does not get enough of milk she can get osteomalacia (a disease like rickets). But this is rare in Sri Lanka today which shows our mothers are getting enough calcium in their bodies. Vitamin A deficiency which results in blindness is also rare these days.

Q: What about malnutrition? It is said that malnutrition among children is on the rise? Do you agree?

A: There may be some level of malnutrition among underprivileged sectors such as the estate sector. But overall we don't have severe malnutrition that leads to serious disabilities.

In the 70s when we had a major malnutrition problem because of poor education levels among parents, children were stunted and had vitamin a deficiency among other illnesses. Not today.

Q: What evidence do you have to back this claim?

A: Look at the children we have today. They are taller than before and getting taller. Whereas in the past they were stunted or averaging at five foot something, today we have healthy six footers. This is because of good healthy foods they are ingesting.

Q: So do they have to worry about any health problems at all?

A: They have to be careful about overeating junk foods and drinking sweet fizzy drinks. This can lead to obesity and early diabetes and other non communicable disease.

Q: Do you have a message for the future generation?

A: If you are hooked on junk food and sweet drinks, change your food habits. Drink natural fruit drinks . Eat your fruit rather than drinking it. And drink plenty of water.

Avoid starchy foods and foods dripping with oil. Try and eat some local lentils like cowpea, kadale if you get hungry, rather than munching on pies and hamburgers.

And take plenty of exercise. Go out and play in the garden and get some fresh air when you return home from school. A nutritious diet and plenty of outdoor exercise will keep you healthy.

Q: Any message for mothers?

A: For mothers I say, start breastfeeding your baby as soon as he /she is born, and exclusively breastfeed the baby for the first six months.

When starting the child on other foods, stick to locally grown vegetables and fruits, and animal foods to give the child his protein, calcium, vitamin A requirements. And give him fresh local cow milk.

CGPSL, a trailblazer in Family Medicine

By Dr. Ariyasena u Gamage

The College of General Practitioners of Sri Lanka(CGPSL) has come a long way since its humble inception in 1969 as the Independent Medical Practitioners Association. The College has a membership of over 460. Today, it has become a prestigious academic body that is widely admired in the medical profession for the standards it has set in the field of Family Medicine. Today, the CGPSL is acknowledged as a trail blazer and leader in promoting the practice of Family Medicine in South Asia.

The College publishes its own journal Sri Lankan Family Physician and has its own newsletter and website. The College also conducts its own course of training and subsequent qualifying examination the MCGP (Member of the College of General Practitioners) which is a diploma program recognised by the Sri Lanka Medical Council.

The general practitioner (GP) friendly weekend course is conducted for its members to keep them abreast of modern developments in the field of family medicine, many doctors in the state sector who are in part-time practice too follow it.

Highlights

The outgoing president Dr. Eugene Corea referred to the highlights of the college's work in the past year. They were:

The first island-wide awareness program on patient safety, the first postgraduate diploma of a College to be registered by the Sri Lanka Medical Council, the first College to have Acts of Parliament or amendments there of empowering it in 1974, 1980 and 2013, the first international workshop on research in general practice in Sri Lanka, the first certificate course in palliative medicine for doctors in Sri Lanka, the first research project on elderly care in Sri Lanka by the College which is currently in progress, the first year in history that the College became financially independent of its sponsors.

A nation that neglects primary health care is in peril. The United Nations - World Health Organisation (WHO), points out that, “Now, more than ever, there are opportunities to start changing health systems towards primary health care in all countries.

Although the challenges are different for countries with diverse income levels, there are commonalities. In this context General Practitioners in any country have a major role to play.”

The college set a task force for disaster management which implemented several projects of importance to the community when the country was struck by the tsunami in 2004.

The college played a pivotal role in setting up the North Colombo Medical College and in partnering with the Post Graduate Institute in Medicine (PGIM) in setting up diploma and degree programs, namely the DFM and the MD in Sri Lanka and in India.

The College is involved in mentoring program and the certificate course in palliative care both of which are the first of its kind for the medical profession in Sri Lanka.

The former is conducted to support budding general practitioners as well as to guide them in appearing for the MCGP program, while the latter is aimed at building and sustaining capacity among doctors working in a primary care/community setting in Sri Lanka to better understand and manage the growing demand for palliative care.

There is a necessity of continuing professional development programs (CPD) for members of the College to ensure that they can continuously improve the care they provide to their patients.

Descriptive

The Elderly Care Committee of the College is pioneering a descriptive cross sectional research study titled, “Profile of the elderly encountered in general/family/practice”.

The findings of the study, will help to identify the demographic and needs profile of the elderly encountered in general/family practice and ascertain critical requirements for their care. This in turn it would help primary care physicians to provide holistic and personalised care to our geriatric population.

The expectations of Sri Lankan society, with regard to medical care, continues to increase and general practitioners have to equip themselves with the necessary knowledge and networks to meet the aspirations of their patients and the community at large.

The desktop aide is yet another project to help the members of the College to be armed better with relevant details of important contacts and institutions so that they could provide holistic care to their patients.

The writer was inducted as the 16th President of the College of General Practitioners of Sri Lanka recently.

Breakthrough can revolutionise blood pressure treatment

Discovery will help patients who do not respond well to various treatment

Removing one of the smallest organs in the human body could dramatically reduce blood pressure in patients who do not respond to medicines, potentially revolutionising treatments for thousands.

Tiny organs, no larger than a grain of rice, called the carotid bodies, located near the artery that carries blood to the head and neck, were found to play a major role in causing and maintaining high levels of blood pressure.

Although the study, carried out by researchers at the University of Bristol and published in Nature Communications, looked at models of high blood pressure in rats, their findings were so significant that they have already led to a human clinical trial in 20 patients, which will be completed early next year.

High blood pressure, or hypertension, affects nearly a third of people in the UK and is known as “the silent killer” because thousands of patients do not know they have the condition. Large numbers of patients do not respond well to the various drug treatments, such as ACE inhibitors and Beta-blockers, that can be prescribed to keep blood pressure low, and still more find it difficult to keep up their medicines regime because of common side effects.

Professor Julian Paton, from Bristol’s School of Physiology and Pharmacology, said that the discovery of the carotid bodies’ role in causing high blood pressure was unexpected.

“We knew that these tiny organs behaved differently in conditions of hypertension but had absolutely no idea that they contributed so massively to the generation of high blood pressure; this is really most exciting,” he said.

The two carotid bodies are located at the point where the carotid artery, which carries blood from the heart, splits into two separate arteries that take blood to the brain and other parts of the head. Its function is to detect changes in levels of oxygen and carbon dioxide in the blood. If oxygen levels drop, for instance when you hold your breath, the carotid body acts as an alarm, sending a message to the brain, which stimulates a reflex nervous response, increasing the rate of breathing and raising blood pressure.

In cases of high blood pressure, it appeared that the carotid artery was over-active. Although the exact cause is not known, it may be that it is deprived of oxygen or inflamed in some way, Prof Paton said, leading to it sending a message to the brain to keep blood pressure constantly high. In human trials, only one carotid body would be removed, Prof Paton said. It is hoped this will reduce blood pressure, while also maintaining the carotid body’s function in regulating the body’s response to low oxygen levels in the blood.

Dr Tim Chico, senior clinical lecturer and honorary consultant cardiologist at the University of Sheffield and Sheffield Teaching Hospitals, said that the discovery could be “an important step towards a surgical procedure to be used alongside, or even replace drug treatment.”

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said: “For around one in fifty people with high blood pressure, taking pills does not help their condition…This breakthrough has already kicked-off a small trial to find out whether this treatment is safe and effective in people with high blood pressure resistant to medication.

This potential new treatment has real promise to help this hard-to-treat group of patients.”

- The Independent