Literature review for - Flourish Paediatrics

infants were fed formula for 1 month and then pasteurized cow’s milk for 2 months. Infants
7.5 months of age showed a significant increase in stool Hb concentration after cow’s milk
feeding where-as 12 month old infants had no significant increase in the proportion of guaiacpositive
stools with cow’s milk. The results indicate that cow’s milk before the age of 12
months is associated with intestinal blood loss. As the response to cow’s milk had
disappeared in infants older than 12 months of age, Ziegler and colleagues concluded that the
gastrointestinal tract of healthy infants gradually loses its responsiveness to cow’s milk
(Ziegler, Jiang et al. 1999).
A cross sectional study conducted in Brazil on 98 infants did not find a statistically
significant difference in the presence of occult intestinal blood in breastfed infants compared
to infants who were fed with cow’s milk (p= 0.449). However serum ferritin was
significantly lower (p=0.004) in infants who received cow’s milk and they were positive for
occult faecal blood, implying that occult faecal blood loss is an aggravating factor of iron
deficiency in infants fed whole cow’s milk (Fernandes, de Morais et al. 2008). A case-control
study in Turkey assessed the cow’s milk intake of infants (4 months to 3 years old) who
experienced chronic constipation and anal fissure against the cow’s milk intake of infants
with no signs of these problems. In this study 25/30 cases were consuming more than 200 mL
cow’s milk compared to 11/30 controls OR 8.6 (0.23, 0.74). In summarizing their results the
author’s wrote that the delayed introduction of cow’s milk and a consequent increase in
breastfeeding duration may reduce chronic constipation and anal fissure in early childhood.
It has been suggested that cow’s milk intake can affect linear growth and later blood pressure
and risk of obesity, but the evidence is not convincing. A randomised trial carried out by
Larnkjaer and colleagues investigated the effects of high protein intake in the form of whole
milk (WM) on growth and insulin-like growth factor I (IGF-I) from 9 to 12 months of age.
Intake of WM significantly increased the protein energy percentage (PE%) of the infants.
When comparing WM to IF as the primary milk source for 3 months, the results did not show
WM had an effect on growth. However, the authors observed that positive effect of WM on
IGF-I in boys and the positive association between protein energy percentage intake and IGF-
I at 9 and 12 months is consistent with the hypothesis that a high milk intake stimulates
growth (Larnkjaer, Hoppe et al. 2009).
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