Most brands of formula milk for babies lack certain special fats believed to be essential for the optimum development of the brain in the first weeks of a baby's life. They lack a particular component of breast milk called long chain polyunsaturated fatty acids, or LCPs.
It is these that are thought to be the "brain food" giving children who were breast-fed a higher IQ and better eyesight than those who were bottle- fed.
The most recent piece of the LCP jigsaw was published in the Lancet in November last year, when researchers at University Hospital, Groningen, in the Netherlands, found that children who had been bottle-fed were twice as likely as those who had been breast-fed to suffer some degree of brain dysfunction, causing movement abnormalities.
It is possible to add LCPs to formula milk. But, as the authors pointed out, in spite of the growing evidence about the importance of LCPs in babies' cognitive development, most milk manufacturers have not updated their products for full-term babies to include these nutrients.
The failure of most manufacturers to add LCPs to their products in the teeth of mounting evidence of their necessity is "outrageous", says Professor Michael Crawford, head of brain metabolism and nutrition at the Institute of Brain Chemistry and Human Nutrition in London, and an internationally renowned expert in infant nutrition and formula milks.
He points out that most baby formulas are made from cows' milk and some are based on soya protein. "Cows' milk is designed to rapidly grow an animal with a large body and a small brain whereas human milk is designed to grow a small body but a large and rapidly developing brain," he says. Human babies are born more helpless and physically less developed than other animals, in order for their comparatively huge brains to be safely delivered.
Doctors now understand that premature babies have special feeding needs. Without a supplement, they would be at particular risk of deficiency. In a study carried out last year by Dr Susan Carlson, of the University of Tennessee, premature babies given formula milk supplemented with LCPs were found to have better eyesight and to perform better on tests of mental development at one year old than babies who had had ordinary formula milk.
As a result of this and other research from around the world, most baby milk manufacturers are now adding LCPs to their special formula milks for premature babies.
But what about the majority of babies, who are not born prematurely? Many experts in this field believe that these babies too - if they can't be breast-fed - should have formula with added LCPs.
In 1992 the British Nutrition Foundation published a report recommending that manufacturers put into their formula milks amounts of LCPs which replicate those in human milk. But so far only a single manufacturer, Milupa, has done so: Aptamil, with the special fat blend called Milupan, was launched in 1993.
The rest of the formula milk industry has not yet added LCPs to milks for full-term babies, claiming that the evidence is still inconclusive.
Professor Crawford deplores this lack of action. "There are now very few experts who would disagree about the need for LCPs in formula milk for full-term as well as pre-term babies. As early as 1978 a committee of experts from the World Health Organisation and the United Nations stated that formula milk should follow the composition of human milk with respect to LCPs.
"On the basis of present knowledge, you cannot justify leaving them out and I fail to understand why the manufacturers are doing so. Why is it taking them so long?"
A possible answer, according to Joe Eastwood, Milupa's scientific director, lies in commercial considerations. "The bigger companies will only change if they are forced to. But they will have to find another source of LCPs because we have the process patent on using egg lipids - and developing new sources could take some time."
The new milk costs an extra £12 for the first three months, the period over which LCPs are thought to be important.
Dr Peter Willatts, of Dundee University's psychology department, and consultant paediatrician Stewart Forsyth, of Ninewells Hospital, Dundee, are convinced that LCPs are vital. They have been using tests of babies' early cognitive development to investigate the effects of different types of feeding.
They have found that at three months the way a baby is fed has an effect on learning ability. In a test of habituation (the decrease in attention a baby pays to a stimulus when it is repeatedlv presented), the breast- fed babies perform best. Of the babies who are slower to learn about the stimulus, those having milk supplemented with LCPs do better than those having standard formula milk. "The new formula has a significant effect on half the bottle-fed babies - those with poorer control of their attention," says Dr Willatts.
At nine and 10 months of age the babies are given a problem-solving task involving a toy, and the differences between babies in their ability to concentrate are still present. "The babies who seemed to have better control of their attention at three months are also the ones who examine the toy in a very controlled way and learn about it quickly. What we are finding here is new and we are excited about it - it may be one of the important factors determining a child's intelligence," says Dr Willatts.
His research, funded by Milupa, is still at an early stage; he hopes to test more babies and be able to publish conclusive results next year.
Because formula milk manufacturers are not allowed to advertise to the public, parents remain largely unaware of the LCPs issue. It is a complex and controversial subject, with claims and counter-claims about the scientific evidence that many health professionals would be hard put to explain to parents.
For babies born at term, so far there is no evidence that leaving out LCPs is harmful in the long term. But for mothers who want to do right by their babies, the message is clear. Breast-feeding is not just the best way to make sure your baby gets his LCPs - it also protects him against illnesses and allergies, it's free, it doesn't involve going down to a cold kitchen at dead of night, and it only ever gets a good press.
Additional research by Jackie Cowhig.
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