Toddler Kester Lee has never tasted formula milk.
The two-year-old boy was fully breastfed until he was about 15 months old. When his mother Alethia Lee's breastmilk supply began dropping, she supplemented his milk intake with fresh milk.
Mrs Lee, 29, says: "He's never had formula. I don't see why I should be giving him chemically made nutrients."
She is among the minority of parents here who give fresh cow's milk or UHT (ultra-heat treatment) milk to their children, shortly after they turn one.
Many others, including some The Sunday Times spoke to, feed their children formula milk until the little ones are closer to three years old, before making the switch to fresh or UHT milk.
Medical experts also tell The Sunday Times that it is common practice here for toddlers to be on formula milk.
Milk becomes a supplement after a child passes his first birthday. Just as adults do not rely on milk as a main source of nutrition, as a child grows older, he should be consuming more food rather than milk.
DR ONG ENG KEOW, a paediatrician
A key reason for this is the perception among parents that formula milk is more nutritious than fresh or UHT milk. Many parents are also unaware that they can make the switch to cow's milk after their children turn one.
But amid rising public unhappiness over soaring milk powder prices here - there has been a 120 per cent increase in formula milk prices over the past decade - the authorities have assured parents that there is no need to feed their children pricey formula milk after they turn one. Fresh milk and a balanced diet are adequate for a child's nutritional needs.
While the average price of formula milk has more than doubled over the past decade to $56.06 for a 900g tin, a 1l carton of fresh milk costs between $3 and $3.50, and six 200ml packets of UHT milk cost about $4.
Formula milk is cow's milk that is fortified with additional nutrients such as vitamins, minerals and fish oils, but Dr Ong Eng Keow, a paediatrician at the International Child and Adolescent Clinic in Mount Alvernia Hospital, says "these extras should come from food rather than milk".
"Milk becomes a supplement after a child passes his first birthday. Just as adults do not rely on milk as a main source of nutrition, as a child grows older, he should be consuming more food rather than milk," he says.
Mrs Lee, who works at a luxury lifestyle magazine, already practises Dr Ong's advice.
"Powdered milk is said to be more nutritious, but I don't think fresh milk has any fewer nutrients," she says.
Another mother, sales executive Charlene Lee, 33, fully breastfed her daughter Ariel until she was about 20 months old before switching to formula milk. But when Ariel, now four, did not like the taste of it, she decided to give her fresh milk instead.
She subsequently switched to UHT milk after she found out that it was as nutritious as fresh milk.
"With UHT, there is no milk wastage. UHT milk has a much longer shelf life than fresh milk," she says.
Her other child, two-year-old Elijah, started on UHT milk when he was about 20 months old.
"Some people say UHT or fresh milk has fewer nutrients than formula milk, but I believe children can get those nutrients from their food," she says.
The Health Promotion Board's guidelines recommend children between six months and two years of age to consume about 750ml of milk daily.
Dr Ong says children whose milk intake exceeds the suggested amount can end up having constipation, fussy eating habits and poor weight gain.
Ms Natalie Goh, chief dietitian at Mount Elizabeth Novena Hospital, says minerals and nutrients added to milk formula can be obtained from food. For example, iron can come from meat, fish and spinach; and docosahexaenoic acid (DHA)from food sources such as fish.
But medical experts add that there are certain circumstances under which a toddler could benefit from formula instead of fresh or UHT milk.
Ms Tan Shiling, a dietitian at Mount Alvernia Hospital's nutrition and dietetics department, says toddlers should consume formula or special milk feeds if they have medical issues, including an iron deficiency, inflammatory bowel disease or liver disease.
There are also other parents who cannot make the switch because their children either do not like the taste of cow's milk or have allergies.
Civil servant Shirlene Tan, 36, gave her four-year-old son Nathan formula milk from the time he was 10 months old until he went to nursery school, when he was 21/2 years old. "I did not give him fresh or UHT milk as I believe formula milk has more nutrients. Besides, Nathan also liked the taste of formula milk," she says.
As for fresh and UHT milk, medical experts say the difference between the two is minimal.
Both types of milk are pasteurised - heat-treated to destroy pathogens and bacteria. The difference is in the way and temperature at which this process is done.
Dr Han Wee Meng, head of nutrition and dietetics at KK Women's and Children's Hospital, says: "Both fresh and UHT milk are equally recommended for children. The choice depends on individual taste preferences and practical considerations."
She adds that pasteurisation does not significantly alter the nutritional composition of the milk, in terms of energy, protein, calcium and phosphorous content.
While some vitamins may be lost, additional nutrients may sometimes be added back into the milk after pasteurisation.
Be it fresh or UHT milk, medical experts stress that parents should give full-cream milk to children under the age of two. "Toddlers have very high energy requirements and should not be taking low-fat or skimmed milk," says dietitian Derrick Ong, founder of Eat Right Nutrition Consultancy.
Dr Han says the fat from the milk is also important for a growing child, as it is essential for neurological development and brain function.
Parents may switch their children to low-fat milk after they turn two.
However, Dr Han suggests that if there is a concern with the child's growth and development, parents should continue their children on full-cream milk, as it provides additional energy.
Medical experts add that parents also need not opt for organic milk products over regular milk.
Dr Han says: "There is no significant difference in the nutrient content of organic milk compared with regular milk."
Mr Wesley Loh, 46, says both his sons grew up drinking fresh milk from the time they were about two years old. Benjamin is now eight, and Ethan, five.
Formula was a no-go for Mr Loh, the director of a photography company, after he examined the labels and found that manufactured sugars were high up on the list of ingredients in powdered milk.
He also observed that when he gave his older son formula milk when he was a toddler, his behaviour would change and he would "become a bit more hyper".
"My kids are fine. They can eat, read and socialise. I think it's more important to spend time nurturing our children than spend money on expensive milk," he says.