Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study

BMJ 1999;318:693-698 ( 13 March )

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J Williams, consultant community paediatrician, ^a A Wolff, consultant community paediatrician, ^a A Daly, senior paediatric dietitian, ^a A MacDonald, head of paediatric dietetic services, ^a A Aukett, consultant community paediatrician, ^b I W Booth, professor. ^c

^a Birmingham Children's Hospital NHS Trust, Birmingham B4 6NH, ^b Northern Birmingham Community Trust, Carnegie Institute, Handsworth, Birmingham, ^c University of Birmingham, Institute of Child Health, Birmingham B4 6NH

Correspondence to: Professor Booth i.w.booth{at}bham.ac.uk

Objective: To compare the effect of unmodified cows'milk and iron supplemented formula milk on psychomotor developmentin infants from inner city areas when used as the main milksource.
Design: Double blind, randomised interventiontrial.
Setting: Birmingham healthcentre.
Subjects: 100 infants, mean age 7.8 months (range 5.7to 8.6 months), whose mothers had already elected to use unmodifiedcows' milk as their infant's milksource.
Intervention: Changing to an iron supplemented formula milkfrom enrolment to 18 months of age, or continuing with unmodifiedcows'milk.
Main outcome measures: Developmental assessments using Griffithsscales at enrolment and at 18 and 24months.
Results: 85 participants completed the trial. Therewere no significant differences in haemoglobin concentration betweenthe two groups at enrolment, but by 18 months of age 33% of theunmodified cows' milk group, but only 2% of the iron supplementedgroup, were anaemic (P<0.001). The experimental groups had Griffithsgeneral quotient scores that were not significantly differentat enrolment, but the scores in both groups declined during thestudy. By 24 months the decrease in the mean scores in the unmodifiedcows' milk group was 14.7 whereas the decrease in the mean scoresin the iron supplemented group was 9.3 (P<0.02, 95% confidenceinterval 0.4 to 10.4). Mean subquotient scores were considerablylower in the unmodified cows' milk group at 24 months; significantlyso for personal and social scores (P<0.02, $-$ 5.4 to 17.2).
Conclusion: Replacing unmodified cows' milk with an ironsupplemented formula milk up to 18 months of age in infants frominner city areas prevents iron deficiency anaemia and reducesthe decline in psychomotor development seen in such infants fromthe second half of the firstyear.

Key messages

Iron deficiency anaemia is common in infants from inner cities who are given unmodified cows' milk in the first year of life
Giving an infant iron supplemented formula milk instead of cows' milk not only prevents anaemia but reduces the decline in developmental performance observed in those given only cows' milk
An iron supplemented formula milk rather than cows' milk should be provided free of charge for infants up to the age of 18 months who are living in inner cities and who are not receiving breast milk

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