In 2017, French baby formula milk makers Lactalis recalled nearly 7,000 tonnes of their product after 26 infants in France fell ill with salmonella poisoning. The babies had reportedly consumed contaminated milk produced in the company's Craon factory in northwestern France.
If you are a formula-feeding parent, you may have come across the news and felt terribly worried about your baby's health and safety. How would you be able to identify contaminated formula milk and protect your little one from poisoning?
Read on to find out more about the causes of contamination of formula milk, and explore the ways to prevent it at home and protect your baby.
Contamination of formula milk: How and when could this happen?
Formulated to emulate a mother's natural milk, baby milk formula is available in organic, cow's milk-based, soy-based as well as DHA-fortified forms.
Despite this huge range, however, formula milk has yet to match the natural ability of breast milk to adapt and change with the needs of a growing baby.
While formula milk manufacturers do have stringent quality control systems in place to ensure their product is safe for consumption, there is a risk that contamination can occur.
When it does happen, the contamination of formula milk most often takes place during the manufacturing and handling stages. In other words, it could happen either when it is being made in the factory, or when we prepare it at home.
Now, let's take a look at common contaminants and what you can do to prevent contamination of formula milk.
Some studies have uncovered that formula milk contains fungal toxin aflatoxin. This is a well-known carcinogen and can cause cancer in babies. | Image source: Dreamstime
1. Heavy metals
Source of heavy metals. Formula milk is prepared in factories, which use metallic machines for processing. Sometimes this processing can lead to the addition of heavy metals, such as mercury, cadmium, aluminium, lead and plasticisers, in baby formula.
Recent studies found traces of heavy metals in samples of formula milk – mostly within approved limits of toxic heavy metals in consumables. But, levels of mercury, cadmium and aluminium were found over the acceptable limits in a few samples.
Effects of heavy metals. Plasticisers can disrupt the hormones and can cause cancer, cadmium can cause damage to the kidneys, while aluminium can interfere with information dissemination by the DNA and cellular metabolic processes.
A collaborative study published in PubMed uncovered that sometimes, formula milk may also contain the fungal toxin aflatoxin. This is a well-known carcinogen that can cause cancer in babies.
How to prevent heavy metal contamination of formula milk. For consumers, it is impossible to prevent heavy metal contamination. This occurs during the manufacturing stages.
For the manufacturers, the researchers at the Yeditepe University, Turkey, have categorically made this recommendation: "Considering that infants who are not breast-fed are especially dependent on formula diets, and that infants are potentially more susceptible, toxic metal contamination and essential metal limits should be regularly monitored during manufacturing."
However, for formula-feeding parents, preventing the consumption of contaminated milk is doable. So if you have already zeroed in on a particular brand of formula, doing a quick online search on the brand for any past cases of contamination is the first step. Confirm its suitability as well with your doctor/paediatrician. Or ask for a better alternative.
2. Neuro-toxic chemicals
Source of neuro-toxic chemicals. A few commercial soy-based infant formulas may contain manganese. Studies show that manganese is a neuro-toxin. These are chemical agents that affect the dissemination and transmission of information between neurons.
Effects of neuro-toxic chemicals. Its exposure in early childhood may lead to behavioural disorders like ADHD in kids.
A study by the Nassau County Medical Center, New York, US, reveals that "soy-based formula milk contains about 80 times more manganese than breast milk." This later led to learning disabilities in children. Similarly, formula made from animal proteins has a 30 percent elevated rate of manganese as compared to breast milk.
Most infants are unable to digest or excrete manganese, especially during the early months of their lives. Therefore, you must consult with your doctor before giving your baby any kind of formula.
How to prevent neuro-toxic contamination of formula milk. Try to avoid soy-based formula milk. Such formula milks usually contain about 0.2-0.3mg of manganese per litre. Cow's milk formula may contain around 0.030-0.050mgs of manganese.
Remember that the recommended intake of manganese for an infant between zero and six months is 0.3mg. And it is 0.6mg for those between seven and 12 months. So if your baby needs 10 servings of formula, it is well within the range. To prevent any excess, check the ingredients and their amount stated on the can.
Source of carcinogens. Unfortunately some formula milks also reportedly contain carcinogens like glutamic acid (MSG) and aspartic acid. An International Baby Food Action Network (IBFAN) report states that the highest levels of these carcinogens are present in hypoallergenic formulas.
These carcinogens are often given names such as "enzymatically hydrolysed reduced minerals," "maltodextrin," "casein hydrolysate," "carrageenan," "soy protein isolate," and "modified cornstarch" among others.
Effects of carcinogens. You may be aware that an infant's blood-brain barrier (this prevents materials from the bloodstream entering the brain and spinal cord) is not completely developed.
Therefore, if carcinogens are present in a baby's bloodstream, they can easily leech into the brain and spine.
How to prevent carcinogenic contamination of formula milk. Based on guidelines by food and drug authorities of various countries, manufacturers of baby formula must reveal all ingredients – especially, if they contain glutamic acid (MSG) and aspartic acid.
So make sure to check the ingredients before you make the purchase. If you read words like "enzymatically hydrolysed reduced minerals," "whey protein concentrate," "soy protein isolate," "modified cornstarch," and "carrageenan," you should be concerned.
4. Endocrine disruptors
Source of endocrine disruptors. Another type of contamination of formula milk is due to the presence of endocrine disruptors like phytoestrogens. Soy formula milk is especially known to contain these phytoestrogens.
Effects of endocrine disruptors. A study published in the Lancet journal reveals, "The daily exposure of infants to isoflavones in soy infant-formulas is 6-11 fold higher on a bodyweight basis than the dose that has hormonal effects in adults consuming soy foods. Circulating concentrations of isoflavones in the seven infants fed soy-based formula were 13,000-22,000 times higher than plasma oestradiol concentrations in early life, and may be sufficient to exert biological effects, whereas the contribution of isoflavones from breast-milk and cow-milk is negligible."
What this means is that soy-based infant formulas may have a high concentration of endocrine disruptors. This can lead to hormonal imbalance and influence of gonadal functions.
One study published by the Korean Pediatric Society has also proved that soy-based formula can also lead to premature breast development in infants as well as girls under the age of eight.
How to prevent endocrine disruptor contamination of formula milk. Try not to opt for soy-based baby formula. Consult with your doctor before you make a purchase and discuss all the ingredients.
When you add warm or hot formula to the bottle, BPA can easily leach into the formula from the container. | Image source: Flickr
5. Phthalates and Bisphenol-A
Source of Phthalates and Bisphenol-A (BPA). Both Phthalates and Bisphenol-A (BPA) are also endocrine disruptors. Phthalates are testicular toxins and are used as a popular plasticisers to make the product flexible, easy to handle and resilient.
BPA is used to produce polycarbonate plastic. It may be common in baby bottles (though some companies sell BPA-free bottles). So when you add warm or hot formula to a bottle that contains BPA, the chemical can easily leech in to the formula from the container.
Since it is also used as a lacquer on some metal cans – including those that contain formula milk – and has an an affinity to fatty acids (such as those present in the milk powder), it may also seep into the canned formula milk powder.
Effects of Phthalates and Bisphenol-A (BPA). Collaborative studies from Asia, Europe, and the US were published in PubMed recently. They reveal that early childhood exposure to phthalate may "increase the risk of allergic diseases including asthma and eczema."
On the other hand, the Food and Drug Administration (USA) reveals that there might be a link between BPA and slower development of neurological and endocrine systems in infants.
How to prevent Phthalates and BPA contamination of formula milk. To prevent BPA from leaching into the formula, avoid boiling the bottles in hot water. Also do not place them in dishwashers, microwaves or anything that uses warm and/or hot water. That's because heat forces the chemicals to detach from plastic and enter the item placed in them.
Instead, use warm soapy water to clean the bottles. Rinse them well and dry them off in a clean place. Alternatively, you can use glass bottles or look for the "BPA-free" sign on plastic bottles before you buy them.
Source of lead. Dirty or unfiltered water is often the most common source of lead in households. Unfortunately, you cannot smell or taste lead. The only way to identify its presence is to ask your water provider to share how they filter water to your home.
For homes that get water from public water systems, you may want to check your community water providers' websites for more information.
Effects of lead. As per the Florida Lactation Consultants Association (FLCA), "Lead in water used to reconstitute formula can cause elevations in blood lead levels if used from the hot water tap or boiled. Boiling concentrates lead. There is a six point IQ drop for every 10ug increase in blood lead levels."
The Centre for Disease Control (CDC) on the other hand says, "Infants who drink formula prepared with lead-contaminated water may be at a higher risk because of the large volume of water they consume relative to their body size."
How to prevent lead contamination of formula milk. The contamination of formula milk with lead can happen due to unfiltered and dirty water. So your best bet is to use filtered water and keep the baby bottles washed properly and clean and dry.
Source of nitrates. The FLCA also explains that nitrate can also contaminate formula milk. This nitrate also comes from water provided locally at homes.
Effects of nitrate. Absorption of nitrate can lead to methemoglobinemia (baby blue syndrome) in infants – in other words, nitrate poisoning.
This is a condition wherein the red blood cells contain more than one percent of methemoglobin (a type of heomoglobin). This prevents baby's blood from getting properly oxygenated, resulting in a bluish tinge on his or her skin.
The Global Burden of Disease project, coordinated by the World Health Organization (WHO), revealed more details about the effects of methemoglobinemia in children.
"Nitrate has been implicated in methemoglobinemia and also a number of currently inconclusive health outcomes. These include proposed effects such as cancer (via the bacterial production of N-nitroso compounds), hypertension, increased infant mortality, central nervous system birth defects, diabetes, spontaneous abortions, respiratory tract infections, and changes to the immune system," the study reveals.
How to prevent nitrate contamination of formula milk. To prevent contamination of formula milk with nitrate, make sure you only use boiled and filtered water to prepare the formula.
Source of atrazine. As per the Environmental Working Group (EWG), atrazine is a herbicide and is a hormone disruptor in both men and women. It is also commonly found in water.
Effects of atrazine. The apex agency (EWG) also shares that its presence in water and subsequently in the formula can reportedly lead to cancer in young children.
Although most formula manufacturers have to use clean water, especially to prepare liquid concentrated formula, slips are possible. So before you purchase formula, consult with your doctor and share all the ingredients listed on the label.
How to prevent to prevent contamination of formula milk with atrazine. You must use only filtered water. Do this to clean the bottles as well as in formula preparation.
Source of bacteria. Bacterial contamination is possible in powder formulas. In addition, if formula is stored in the fridge for more than 24 hours, that can lead to bacterial contamination. It can also happen if your baby has leftover milk and you stored it in the fridge.
Effects of bacteria. Bacterial infection in leftover formula is due to your baby's saliva. It may contain bacteria that enters and contaminates the leftover milk.
A study published in PubMed also supports this claim.
So in order to avoid bacterial contamination, make sure that you focus on cleanliness while handling the formula. Ensure proper washing of your baby’s bottles. Sterilise and clean them before you use them to fill formula.
Read here to know more about how to wash baby bottles.
How to prevent bacterial contamination. Before you prepare the formula, make sure to wash your hands properly. Remember to always maintain hygiene in the area of preparation.
Keep the can of formula clean as well. Wash its lid and its outside area before you open it. Most of all, whenever you open the can, inspect the powder for any foreign particles like glass or hair.
Mums and dads, the purpose of this article is not to scare you about the use of infant formula. After all, it exists for a very good reason. And that reason is to nourish your child should you not be able to breastfeed for some reason.
However, at the same time, it is crucial that parents are informed and educated about what they give their children – especially very young babies – in terms of nourishment. This is so you can always give priority to your baby's health.
We hope this article has empowered you in terms of knowledge. At the same time, always speak to your child's paediatrician if you have any concerns about their health and/or nutrition.
Sources (in addition to those mentioned through the article): Momsandpopsproject, Department of Health, WA, WebMD
Also read: How to spot fake formula milk from Johor Baru