Wednesday, 15 May 2013

Goat's Milk for Infants

What About Goat's Milk?

Using goat’s milk before 6 months or regular use between 6 and 12 months is not recommended. Goat’s milk is no more appropriate to give baby than cow’s milk. If you need to supplement and breastmilk is not available, formulas are a more nutritionally complete product. There are several comparisons of goat vs. cow vs. human milk in the links below. Using this information, goat milk is much closer in composition to cow milk than human milk. Goat’s milk is high in sodium (like cow’s milk) and is very high in chloride and potassium, which makes the renal solute load too high for babies. This can cause gastrointestinal bleeding and can result in anemia and poor growth (these problems are usually undetected until months later). Goat milk is also deficient in folic acid, which can lead to megaloblastic anemia. Also, infants who are allergic to cow’s milk protein are often allergic to goat’s milk too.

While it’s true that whole goats milk (and whole cow’s milk) was commonly used prior to the advent of infant formulas it is also true that the infant mortality and morbidity rate during the times of such substitutions was very high.

The developing digestive system of a young infant is specifically designed to digest mother's milk during the first 12 months. If breastfeeding is not possible, the next best choice is iron-fortified infant formula. Solid food should not be introduced until four to six months of age, at minimum.

Unfortunately, parenting advice shared by well-meaning family,  friends and sometimes even doctors, is not necessarily healthy advice for tiny tummies. The most common diversions from recommended feeding practices for infants include giving:

Cow's milk before age one.
Goat's milk as an alternative to formula.
Infant cereal to very young babies.

Any one, or more of these situations are quite common in households across the U.S. and beyond. However, parents should ponder more current medical findings and recommendations before deciding to practice them. Here's why.

According to G. F. W. Haenlein Ph.D. and R. Caccese, on the "Differences of Cow and Goat Milk," over 10 million cows are raised in the U.S. to provide more than 125 billion pounds of milk annually. Yet on a world wide basis, there are more people who drink the milk of goats than from any other single animal.

In his Agriculturally geared report, Haenlein suggests that goat's milk is a sufficient alternative for those with milk allergies. Yet, numerous other resources render this disputable.

While it is more easily digested, the basic composition of goat's milk is actually quite similar to cow's milk. It's feasible, that various constituents of cow's milk that cause an allergic reaction may also be present in goat milk. Studies by a group of European researchers, led by Dr. Luisa Businco of the University "La Sapienza," in Rome, concluded that goat's milk can trigger serious allergic reactions in infants who are known to be sensitive to cow's milk.

Goat milk is also touted as having exceptional nutritional value over cow's milk. For developed digestive systems there may be benefits, but for tiny tummies it just doesn't measure up. Though goat's milk has greater levels of vitamin A, riboflavin, calcium, potassium and niacin, the down side is less iron, zinc, B6, and B12, which among other considerations, makes it an insufficient alternative to formula.

Undoubtedly, there are numbers of children throughout the years that have thrived on goat's milk, however, Parents Place Nutritionist, Sue Gilbert, warns us that, "There is a real danger of dehydration if it is used exclusively for very young infants because of the solute load and the subsequent stress that it puts on the baby's kidneys."

Goat's milk is not indicated for use in infancy. Here is some rationale:

  1. Goat's milk is deficient in folic acid and vitamin B6.
  2. Goat's milk is higher in protein than human milk (1.0 gm pro/100 ml) and infant formula (1.4 gm/100 ml). It actually has 3.6 gm pro/100 ml, which puts an infant at risk for dehydration and a higher renal solute load.
  3. The reason many of the "recipes" for goat's milk for infants call for dilution (usually the recommendations are to dilute it to 2/3 strength, but in this case, it appears to be for half strength) is to decrease the renal (kidney) solute load. When it is diluted, however, nutrients including energy, are diluted. With this comes the risk of hyponatremia or water intoxication, which can result in seizures. Dilution of goat's milk to half-strength supplies about 10 calories per ounce. This means to meet the energy needs (98 kcal x 8.25 kg, which is the 50th percentile for a 7 month old boy), 80 ounces per day of goat's milk would be required.
  4. Goat's Milk Acidosis has been reported in the literature most likely secondary to the high protein level.
  5. It may be appropriate to try a formula that has no intact protein, milk, casein or soy and gradually introduce individual foods rather than rely on goat's milk which is not recommended for infants."

Maybe you know an infant who thrived and grew well on a goat's milk based infant formula recipe and we know that many infants have thrived. However, it is also true that as science evolves, we know that goat's milk is not the optimal nutrition solution for infants between the ages of 0-12 months old.

Fresh Goat's Milk for Infants: Myths and Realities—A Review

Many infants are exclusively fed unmodified goat's milk as a result of cultural beliefs as well as exposure to false online information. Anecdotal reports have described a host of morbidities associated with that practice, including severe electrolyte abnormalities, metabolic acidosis, megaloblastic anemia, allergic reactions including life-threatening anaphylactic shock, hemolytic uremic syndrome, and infections. We describe here an infant who was fed raw goat's milk and sustained intracranial infarctions in the setting of severe azotemia and hypernatremia, and we provide a comprehensive review of the consequences associated with this dangerous practice.

"The infant in this report presented with severe hypernatremia and azotemia in addition to other electrolyte abnormalities. Goat's milk contains 50 mg of sodium and 3.56 g of protein per 100 mL, approximately 3 times that in human milk (17 mg and 1.03 g per 100 mL, respectively).6 The estimated requirements of sodium and protein for infants <6 months old are 100 to 200 mg/day and 9 to 11 g/day, respectively.7 The infant described here was receiving ∼500 mg/day of sodium and 30 g/day of protein, with a total intake of 32 oz of goat's milk per day. The immature kidneys in very young infants have difficulty handling the byproducts of foods with a high renal solute load.8 Sodium excretion capacity matures more slowly than glomerular filtration rate and does not attain full capacity until the second year of life.9 Therefore, infants fed fresh goat's milk are at substantive risk for hypernatremia and azotemia, particularly in the face of dehydration (as in the case described here), which may in turn result in major central nervous system pathology, including diffuse encephalopathy, intraparenchymal hemorrhage, or thromboses10 as manifested in our patient...

...The main benefit claimed by proponents of fresh goat's milk for infants is that it is less allergenic than cow's milk and is a suitable substitute for infants who are allergic to the latter. However, evidence shows that most infants who are allergic to cow's milk are also allergic to goat's milk. In vitro studies have shown that there is an extensive cross-reactivity of sera from individuals who are allergic to cow's milk with proteins found in goat's milk.17,–,19 In 1 study, 26 children with immunoglobulin E–mediated cow's milk allergy also had positive skin test responses to goat's milk, and 24 of 26 had positive double-blind, placebo-controlled, oral food challenges with fresh goat's milk.20 There have been case reports of severe life-threatening anaphylactic reactions after the ingestion of commercial goat's milk preparation in infants with documented cow's milk protein allergy.21 Furthermore, infants and young children may have signs, symptoms, and serology positive for goat's milk without being allergic to cow's milk.22,–,25 In a retrospective study, children presented with severe allergic reactions, including anaphylaxis, after consumption of goat's milk products but tolerated cow's milk products.26

Folate deficiency with anemia in infants fed homemade formula based on goat's milk has been described.27,28 In fact, “goat's milk anemia” was the name given to the macrocytic hyperchromic megaloblastic anemia observed in infants fed goat's milk in Europe during the 1920s and 1930s.29 The anemia was thought to be more severe than that associated with exclusive cow's milk feeding and was cured by giving supplements of liver extracts. The concentration of folate in goat's milk is 6 μg/L in comparison to human breast milk, which contains 50 μg/L.30 Infants younger than 6 months of age need 65 μg/day of folate, and the recommended daily allowance increases with age.30

There have been reports of infections such as Q fever, toxoplasmosis, and brucellosis associated with feeding raw goat's milk.31,–,33 Consumption of unpasteurized goat's milk has also been implicated in the development of Escherichia coli O157:H7–associated hemolytic uremic syndrome.34,35 Although raw goat's milk is a proven vehicle for pathogen transmission, the belief persists that raw dairy products are healthier and that pasteurized products are less beneficial and even harmful.5" - Reference

Cow's Milk

A number of studies, indicate that the early introduction of cow's milk may contribute to the development of IDDM (insulin-dependent diabetes mellitus). Among these, was a report regarding "Infant feeding practices and their possible relationship to the etiology of diabetes mellitus," by the American Academy of Pediatrics Work Group on Cow's Milk Protein and Diabetes Mellitus (Pediatrics 1994;94:752-4), which states that, "avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals." Susceptible individuals are those in families with a strong history of IDDM, and particularly when a sibling has diabetes. The report concludes that, "Breastfeeding and avoidance of commercially available cow's milk and products containing intact cow's milk protein during the first year of life are strongly encouraged."

another policy statement (Pediatrics Volume 89, Number 6 June Part 1, 1992, p 1105-1109) by the AAP, extensive studies reflect that babies given WCM (whole cow's milk) take in lower levels of iron, linoleic acid, and vitamin E, and excessive levels of sodium, potassium, and protein. Infants who were fed breastmilk or iron-fortified formula during the first year, generally maintained healthy iron levels. 

Additionally, the studies indicate that the high levels of calcium and phosphorus, and low levels of Vitamin C in whole cow's milk actuallydecreases absorption of iron from infant cereals and other dietary sources.

The CDC (Centers for Disease Control) Guidelines for Prevention, Detection and Treatment of Iron Deficiency takes the stand against cow's milk a bit farther, by recommending children aged one to five years don't consume more than 24 oz. of cow's milk (or soy and goat milk) each day.

Another consideration focuses on infants who are at high risk for food allergies. According to nutrition professionals from the Manitoba Milk Producers site, the prevalence of cow's milk allergy is highest in infancy. A predominate factor leading to food allergy is the early introduction of food allergens, therefore, feeding an infant cow's milk before three to four months places the child at greater risk for intolerance.

Freezing and Thawing Goats Milk

"My friend has been having trouble when thawing her frozen (raw) goats milk. It appears curdled and is sometimes in thick, tough lumps that won't separate when shaken. Blending it breaks up the lumps but does not make it smooth. It won't go through her baby's bottle nipple. I tasted it and it tastes ok. The texture was like the cheese we make by putting vinegar into hot milk and curdling before straining. We've tried bleaching the jars and plastic bottles we freeze it in, we've tried thawing slowly and thawing quickly. Nothing seems to make a difference. Does anyone know what causes this and how to avoid it? She's been using the thawed milk for cereal and it seems ok and tastes ok but it's not pleasant to drink with all the curds. I don't freeze milk very often so I haven't had the problem except with milk that's been pasturized for the kids in the spring, which I never drink. This problem is with raw milk. Is it how it's frozen or how it's thawed? Any suggestions?" Thanks, Ann

Raw milk does not stay fresh very long, especially if it's not cooled in a water bath quickly after milking.

The fat solids and the liquids freeze and thaw at different temperatures and are then separated.

After taking it from the freezer, leave it on the kitchen counter (not in the sun) for a while until about half of it is melted and then finish thawing it in the refrigerator. Goats milk just thaws that way.

It also depends on how long it has been frozen. Milk put in the freezer to cool quickly thaws out without separating, even when frozen solid. Milk not thawed out for a month or more always separates, but only little tiny curds or cream globules.

If one puts it in a warm water bath to thaw, it will separate. Shaking it very vigorously or putting it in a blender before warming it will restore the milk to its original form.

Fresh Goat's Milk for Infants: Myths and Realities—A Review

Further reading

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