Baby or toddler formula for malnourished 15 month old?

[Papaya]

Bit of an odd question here...

We live on the Thai-Burma border. DH is the manager of a community based health programme for HIV+ migrants, who don't have good (or any) access to local health systems. We don't have any trained medical staff ourselves, but aim to be advocates to help people access the right care from people with the right skills, while also providing support with things like finances, transport, budgeting....and providing infant formula for the babies of these HIV+ mums. So background: we have no medical training personally, but are trying to make sure these patients and their bubbas are able to get the care they need!

We have a mum with a 15 month old who was VERY malnourished when we found them five months ago, because mum knew she was + and shouldn't breastfeed, but couldn't afford formula. The local system really doesn't want to know or care about people in this situation. So we started paying for formula, and the LO is doing much better now - but he's still smaller than my 8 month old, can't crawl or move much, etc.

So he has been on infant formula, but it's time to get him a new supply and I thought he should probably be on toddler formula by now, for the extra nutrients - he is on solids also, but doesn't eat a lot (and what he gets is hardly the best nutrition - mostly rice). Does anyone know of any reason why his wee body might not be able to cope with toddler formula? Is it harder to digest than baby formula?

Thanks for the ideas, my LO is BF so don't know much about formula!

[Lolly]

Ok, we are not medically trained here either so I would really suggest that this LO needs to be seen by a Dr at the very least.

Toddler formulas are meant to be used as a supplement to a healthy diet, so if he's not even getting the basics I'm really not sure if it would be suitable for him . The also contain more of iron which can be constipating. My children were both on a reflux formula which was a first milk but we were told they could stay on it until they were 2 (and they did) so there shouldn't be a problem with having the baby milk for a bit longer. The only other thing I would suggest is that formula is very filling and not nutritionally right for a toddler so really it would be better to reduce it and work on getting him a better solids diet .

Poor baby though, I'm glad he's getting some help

Laura

[Mashi]

In principle I do agree with Laura, but at the same time I also understand the situation you are in (we've been in the Ranong area as well as other borders areas in Thailand) - it's much easier said than done and the reality is that giving him more rice, more rice, more rice really is not going to do him much better   

In terms of choosing one formula over the other, I would go for the higher calorie and higher fat formula, whichever one it is.  I would not worry about iron level, it is really not that much more to make a difference especially when he is probably not getting much iron in his diet as it is.  With solids is it "just" the access to food or is it that he is not willing to eat the foods he does get, as well? 

Sending loads of support to you and your DH and his team - and lots of vibes for this mom and her little boy xxxxx

[Papaya]

it's much easier said than done and the reality is that giving him more rice, more rice, more rice really is not going to do him much better   Undecided

Exactly Mashi - we would love for him to be referred to a nutritionalist etc etc...but the legal status of his parents is dubious so it's hard for them to get healthcare, they are sick and therefore have trouble holding down a fulltime job so they can barely afford rice for the family never mind anything else, and I doubt there is such a person in Ranong anyway - at least not for Burmese migrants.  I find myself in the terrifying position occasionally of being the only source of baby advice that these mothers have, as they are cut off from their families back in Burma, and therefore their traditional forms of support. So as a fairly well educated, though inexperienced, mother myself, I do what I can ("please don't give your LO condensed milk. And he really doesn't need solids at 2 months old no matter what your neighbour says, honestly").

You're right that's there's probably not much other iron in this wee lad's diet - mostly because there's not in the whole family's diet. Rice and a few veges, maybe a bit of fish, would be it most days. So I think we'll go for the higher calorie formula. I dream of running some simple nutrition classes for our mothers to try and improve their diet and that of their LOs on their limited budget, but so far time and language haven't made it possible. Still hoping though. Thanks for the support

[Shdef]

You can get high-calorie formulas for children who do not eat (Scotty got that when he was in a coma, he actually LOST weight on the formulas). I would strongly suggest to get your hands on those, have a company donate them, make appeals, I don't know, but the formula won't be enough at this age.

And I agree with mashi, until then, the higher fat one.

[Papaya]

Good idea about the high calorie formula, I will look into whether it's available here.

have a company donate them, make appeals,

That's actually something we've been talking about lately - will have to see what I can do. Our budget is pretty limited so it would be great if we could find a company willing to donate.

At the moment we only know of one baby in quite this bad a situation - there could well be others, but we're a small operation so they haven't come to our attention. Babies/people in general here often aren't what we would call well-nourished, but for mothers who are on our programme from the time the baby is born, we can at least help them to buy normal formula, so their babies get off to a much better start than this one did.

Also Laura, this LO has been to the local hospital to deal with his other health issues, but they're none too interested in the mechanics of how his family might actually manage to find food for him once he's home again, or to even give advice on what that food should be. Very frustrating.

On the whole though, we're thrilled that he can now hold his head up, smile, laugh and play with his mum - none of which he did a few months ago!

[*Kara*]

("please don't give your LO condensed milk

This was actually what was recommended in Canada into the mid-1970's... we have plenty of healthy adults who survived and did very well on it!  So, if formula is cost-prohibitive.. it would be better than nothing.

That said, of course an infant formula is totally preferred - I would for sure keep that little man on infant formula for quite some time yet.  Poor wee thing

[Papaya]

This was actually what was recommended in Canada into the mid-1970's... we have plenty of healthy adults who survived and did very well on it!  So, if formula is cost-prohibitive.. it would be better than nothing.

That's true, and the WHO does actually provide guidelines for modifying condensed milk (milk to water ratio), if there's nothing else available - as they do for modifying cows or goats milk. But when they've got the formula we provide, we'd rather they used that

[*Kara*]

Of course!

You must be so proud of DH, what a fantastic job... hard at times I am sure, but also so rewarding!

[Papaya]

Hang on, this has all got me thinking a bit more...I looked up those WHO guidelines a few months ago in case our funding just wasn't enough to meet demand (luckily not quite the case yet), so I knew what the next best thing to recommend was...but surely that's on the basis that sweetened condensed milk is, well, milk? Reduced, and with sugar added, but still milk?

I don't think it is here. Thai sweetened condensed 'milk' has some ridiculously low percentage of milk product, I'm talking single digit, and the rest is palm oil and sugar. Mostly palm oil. That's not the case with all sweetened condensed milk, is it? Hmmm... Don't expect answers from any of you lovely ladies, but it's given me a bit more homework to do

[Mashi]

No, you are right Papaya - there is condensed milk and evaporated milk.  One of them is sweetened and the other is strictly milk with the water removed.   Which one is called which varies by country/language.  At home (in Canada) I knew condensed milk to be the non-sweet one and evaporated milk to be the sweet version.  Here in Germany it is the opposite though.  I don't know which way it is in SE Asia, but yes I can imagine that there is quite a bit of palm oil in them to cheapen it up, regardless if there is sugar or not. 

Really, if you had the unsweetened one, that is just milk, it would be a substitute for his milk-intake, and drinking water could be added to it to make it more milk-like but it is not going to have the same nutrition make-up as his toddler formula. 

[Chicane]

Have been reading along...just wondering if an organisation like La Leche League might be able to give you some advice. I know they are advocates of breastfeeding but obviously in this situation thats not an option. I wonder if they may have some knowledge about working with HIV positive mums? The other organisation that may be able to help could be Medicins Sans Frontieres...they would surely have midwives, peadiatcricians etc on staff? I am sure you probably have thought of these things and may even have relationships with other organisations already

And finally - I reckon I could get quite a few of my Aussie mates together to send a shipment of formula over to you...what do you think? Let me know your thoughts and what kinds would be appropriate....

xo

[Shdef]

Just saying, instead of formula, pediasure or nutren would be the better option,

[kit-twigglet]

Hi Papaya,
just a thought, I don't know what you feel about this. How would you feel about pumping once a day and giving them that?  If you were ok with it. I live in India and so know what it is like not to have a choice of formula or have a dr who knows anything about children!!
Also, if the family soak the rice overnight and grind it, it will ferment and so give it more nutrients. they can make steamed cakes (savory) which can be eaten as they are or with veggies..