>I have a friend [who]...has an eight month old bf baby girl...
>The pediatrician has advised "Jane" to give Baby 2 % cow's milk,
>not to "bother with" formula...
>When the EMB bottles are gone, the sitter has been giving the baby juice
>or water bottles.
>Baby is in 25th percentile for height/weight.


A) Whole fresh cow's milk is appropriate only after one year of age; 2%
milk is appropriate only after age two years; skim milk after age four
years.

B) Cow's milk formula (or if necessary, soybean juice formula) is the only
appropriate alternative to breastmilk under one year.  In a pinch, a
homemade formula can be constructed using canned evaporated milk (the heat
used in canning will reduce the curd tension) and corn syrup (which carries
a risk of botulism if the bottle has been opened previously).

C) Since the risk of allergic reaction to either cow's milk formula or
soybean juice formula is greater if the parents themselves have allergies,
she should consider using a protein hydrolysate formula if there is
familial history of allergies (including hay fever, asthma, etc.).

D) Juice and water are inappropriate substitutes for milk.  Water to
experiment with in drinking out of a cup is lovely, but not as a substitute
for milk.  Juice could better be replaced with strained fruit or
vegetables.

E) The baby's percentile for height and weight may well be appropriate.
People differ in size.  Has she always been at this percentile or recently
dropped significantly?

F) What can be done to make it easier for Jane to continue pumping?  Is her
recent breastmilk production decrease temporary, due to events that can be
manipulated ("cannot" pump--or has been arbitrarily told not to?  Can this
be changed?) or events that will resolve quickly (such as return of her
menses)?

Arly Helm, MS, BS, Nutrition and Food Sciences

[log in to unmask] (Arly Helm, LC)