Formula feeds contain a host of vitamin and minerals, as well as trace elements (zinc, mangnese, copper, iodine) and electrolytes. In formula feeds vitamin K is added in higher levels than in breast milk to reduce the risk of hemorrhagic diseases in new born. So, vitamin K deficiency can never be a complication of formula fed babies. Now let’s see what Ghai 6/e, p 164, 331, 177 has to say on the rest of options. Option “a” i.e. Necrotizing enterocolitis “Almost all patients of neonatal necrotizing enterocolitis (NEC) are artificially fed prior to the onset of illness. Breast milk is protective for NEC.” —Ghai 6/e, p 164 Option “b” i.e. Otitis media “Otitis media is one of the most common infections of early childhood. Anatomic features which make this age group particularly susceptible to ear infection include shorter, more horizontally placed and compliant eustachian tube, which permits reflux of nasopharyngeal secretions into the middle year. A high incidence of bacterial carriage in the adenoids may also contribute to the frequency of otitis media in children. Other risk factors include exposure to cigarette smoke, over crowding, bottle feeding, cleft palate, allergic rhinitis, Down’s syndrome and disorders of mucocilliary transport.” —Ghai 6/e, p 331 Option “c” i.e. Hypocalcemia “In the neonatal period there is transient hypoparathyroidism. As a result, less phosphate is excreted in the urine. Human milk is low in phosphate, but cow’s milk is rich in phosphate. Immature parathyroid in the neonates can not easily cope with excess phosphate in cow’s milk leading to hypocalcemia in top fed babies”. —Ghai 6/e, p 177