Goat milk for infants: Yes or no?

Abstract

Two articles in this issue of the journal look at very distinct aspects of feeding different forms of goat milk to infants.1,2 The article by Grant et al. presents the results of a carefully conducted randomized controlled trial of goat milk infant formula versus cow milk infant formula which shows that growth at age 6 months was similar in each group. On the other hand, Ziegler et al.2 present a very concerning case history of an 11-month-old boy who was admitted with severe macrocytic anaemia secondary to folate deficiency which arose as a result of long-term feeding of a homemade formula based on goat milk. What messages about goat milk, and infant feeding in general, should clinicians take from these studies? The case history graphically highlights that fact that unmodified goat milk is not suitable as an infant formula as it is a poor source of folic acid.2 It has long been recognized that infants receiving goat milk as a major source of their diet are likely to develop megaloblastic anaemia as an expression of folate deficiency.3 Additional problems with raw goat milk include the potential for infections such as Q fever and toxoplasmosis.4,5 It is for these reasons that it is not recommended to feed unmodified goat milk, especially if unpasteurized, to infants.6 Why do people choose to use goat milk as an infant feeding? Often it appears to be in the mistaken belief that goat milk is more ‘digestible’ and will be less allergenic than cow milk. However, most infants who are allergic to cow milk are also allergic to goat milk.7 There is a safe alternative for those parents who choose to use goat milk, that is, the commercial goat milk infant formula which is supplemented with folic acid and, like all infant formulas, complies with the nutritional standards for infant formula.6 National infant feeding guidelines, such as that produced by the Australian National Health and Medical Research Council6 recommend infant formulas based on cow milk over those based on goat milk, presumably because there have been fewer studies evaluating the safety and efficacy of goat milk formulas, and also because of the lower cost of cow milk-based formulas. It is in this context that the study by Grant et al.1 appears, providing additional information on the safe effect on growth of a goat milk-based infant formula in healthy infants aged up to 6 months. What recommendations on infant feeding should clinicians be giving to pregnant women or mothers of newborns? There is ample evidence to show that exclusive breast-feeding, ideally until 6 months, provides optimal growth and health outcomes for infants, and that breast-feeding should be encouraged until 12 months and thereafter as long as mutually desired.6,8,9 Clinicians dealing with infants, new mothers and pregnant women can play a vital role in supporting and encouraging breast-feeding. In the case report,2 the mother is reported as having stopped breast-feeding at age 2 weeks after she developed mastitis. It is possible to speculate that more supportive management of the mastitis in those first 2 weeks might have enabled the mother to continue breast-feeding her child, with the result that the subsequent series of events could have been avoided.6 However, if mothers choose not to, or in very rare instances, cannot, breast-feed, then what recommendations on infant feeding can be given? As mentioned earlier, the first-line recommendation for a healthy term infant is that of a standard cow milk-based infant formula. Infant formulas based on soy milk or goat milk, or other more specialized formulas, are generally recommended ‘for medically diagnosed conditions’.6 There is, of course, no place for homemade formulas, as clearly illustrated by the case report. Unfortunately, it appears that misinformation on infant feeding is readily available to the general public, through such sources as old publications or even the Internet. Paediatricians and other clinicians dealing with infants have the opportunity to provide clear advice and support on infant feeding to mothers and other carers of young children.