Li Xiaokai died of kidney failure on the old wooden bed in the family farmhouse, just before dawn on a drizzly Sept. 10.
Her grandmother wrapped the 9-month-old in a wool blanket. Her father handed the body to village men for burial by a muddy creek. The doctors and family never knew why she got sick. A day later, state media reported that the type of infant formula she drank had been adulterated with an industrial chemical.
Yet the deaths of Xiaokai and at least four other babies are not included in China's official death toll from its worst food safety scare in years. The Health Ministry's count stands at only three deaths.
The stories of these uncounted babies suggest that China's tainted milk scandal has exacted a higher human toll than the government has so far acknowledged. Without an official verdict on the deaths, families worry they will be unable to bring lawsuits and refused compensation.
So far, nobody is suggesting large numbers of deaths are being concealed. But so many months passed before the scandal was exposed that it's likely more babies fell sick or died than official figures reflect.
Beijing's apparent reluctance to admit a higher toll is reinforcing perceptions that the authoritarian government cares more about tamping down criticism than helping families. Lawyers, doctors and reporters have said privately that authorities pressured them to not play up the human cost or efforts to get compensation from the government or Sanlu, the formula maker.
"It's hard to say how the government will handle this matter," said Zhang Xinkui, a Beijing-based lawyer amassing evidence of the contamination for a possible lawsuit. "There may be many children who perhaps died from drinking Sanlu powdered milk or perhaps from a different cause. But there's no system in place to find out."
In the weeks since Xiaokai's death, her father and his older brother have talked to lawyers and beseeched health officials, with no result.
"My heart is in pain," said her father, Li Xiaoquan, a short, taciturn farmer with hooded eyes. From a corner of his farmhouse courtyard in central China's wheat and corn flatlands, he pulls a worn green box that once held apples and is now stuffed with empty pink wrappers of the Sanlu Infant Formula Milk Powder that Xiaokai nursed on. "We think someone, the company, should compensate us."
In coal-mining country 450 miles to the northwest, Tian Xiaowei waits for his wife to leave the newly built house before removing five small photos of a wide-eyed baby boy from a brown plastic document folder. "She breaks down when she sees them," Tian said. The photos are the only mementos left of year-old Tian Jin, who died in August.
"I want these people who poisoned the milk powder to receive the severest punishment under law. I want an explanation and I want consolation for my dead child," said Tian, a broad-shouldered apple farmer and part-time truck driver. "I feel like we could die from regret. If we knew that it was contaminated, we would never have fed him that."
Since September, when the scandal was first reported, Beijing has said that Shijiazhuang Sanlu Group Co., the dairy, knew as early as last year that its products were tainted with melamine and that company and local officials first tried to cover it up.
The government has promised free medical treatment to the 50,000 children sickened, and unspecified compensation to them and families of the dead. The Health Ministry, which is coordinating the government's response, declined to answer questions about the compensation plan and whether it was investigating deaths and illnesses not yet counted by the government.
Melamine, a chemical used as a flame retardant and binding agent to make cooking utensils and industrial coatings, is rich in nitrogen. As such, it makes an attractive low-cost additive to milk and other foods; nitrogen registers as protein on many routine tests.
Though melamine is not believed harmful in tiny amounts, higher concentrations produce kidney stones, which can block the ducts that carry urine from the body, and in serious cases can cause kidney failure.
All eight babies who died were diagnosed with kidney failure, according to the families, medical records or state media accounts. All also supposedly drank Sanlu infant formula or powdered milk.
The fathers of Li Xiaokai and Tian Jin both wave inch-thick sheaves of medical reports and tests from their children's stays in hospitals. Xiaokai, a twin older than her sister Xiaoyan by three minutes, was fed with Sanlu formula while the younger girl nursed on breast milk because their mother did not have enough for both, family members said.
An ultrasound examination of Xiaokai's kidneys at the Zhengzhou Children's Hospital on Aug. 21 found a stone in each kidney that was about the size of a small marble and 2 1/2 times larger than what doctors consider a critical threshold.
Tian Xiaowei, the apple farmer, sent bags of Sanlu infant formula to a government laboratory in September. The Xi'an Product Quality Supervision Institute's report, dated Oct. 8, found melamine levels of 1,748 milligrams per kilogram, more than 800 times the government-set limit.
Then there's Wang Siyu, the daughter of an accountant and proprietor of an Internet cafe in the central city of Shangqiu. Siyu was fed Sanlu products from birth and developed recurring kidney problems in May last year, at age 3, said her mother, Li Songmei.
Twice hospitalized, she was taken off Sanlu milk and started to recover, only to fall ill again when the family began to give her Sanlu products, Li said. Sick for a third time and swollen, she died of kidney failure at the Zhengzhou Children's Hospital on May 2, said Li.
"Ever since she was born, she had been using Sanlu milk. Only when she felt sick and couldn't eat did she stop taking Sanlu," said Li.
Others among the five include an infant in far western Xinjiang province, whose story was posted on the provincial government Web site, and a 6-month-old boy in southeastern Jiangxi province, reported by the New Legal Daily. A reporter who worked on the article and would give only his surname, Liu, said the newspaper was careful not to blame Cai Cong's death on Sanlu formula because "the local government has not yet reached a verdict."
Medical experts say kidney stones in infants are rare. Doctors in several parts of China first noticed a rise in cases in the past two years. Pediatric urologist Feng Dongchuan tried to sound an alarm, posting an item on his blog in July about a spike in cases at his hospital in the central city of Xuzhou and in nearby Nanjing city. Feng pinpointed infant formula as the likely cause.
Feng at first refused requests for interviews, then responded in a terse e-mail: "The chance for infants or small children to come down with kidney stones is very small, and having stones that obstruct both kidneys is even more rare."
Like the others, the Li family grew distressed when Xiaokai started to become fussy in July. With their two-acre farm in Liti Village, her parents never had much money and already had a child, a son. But they wanted a larger family, bucking the one-child family planning limits. Xiaokai was "the more active" of the twins, said her 70-year-old grandmother, Li Xuan.
By August, Xiaokai was running a high fever, unabated by ever higher doses of medicine. Alarmed after she stopped eating and urinating, the family took her to the nearby Runnan county hospital on Aug. 18. The doctors diagnosed kidney failure and rushed her overnight by ambulance to Zhengzhou Children's Hospital, three hours away and the best in Henan province.
"They knew right away," said the father, Li. Xiaokai was run through tests and put on intravenous solutions to try to shrink the kidney stones. Unable to stay with her or afford a hotel, Li and his mother slept on the pavement outside the hospital. After five days, the hospital said it could do no more.
"The doctors wouldn't operate because they said 'she's too small,'" said Li. They suggested taking Xiaokai to Beijing or Shanghai. Hospital officials declined comment and refused to make Xiaokai's doctor available.
The hospital stay in Zhengzhou cost 7,331 yuan, or $1,070 — about a year's cash income for the family — and they had already borrowed money to pay for Xiaokai's care.
So Li brought Xiaokai home to die. They took her to a traditional medicine doctor in the village, who gave her an herbal medicine and confirmed the grim prognosis. "The old doctor told us 'the child will die in 10 to 18 days,'" Li said.
Early on Sept. 10 while it was still dark, the grandmother called Li into the side room where she and Xiaokai slept. "Her stomach was puffy" — a sign of kidney failure — "and she wasn't breathing," he said.
In many parts of north China, the death of a child is considered a misfortune that can bring bad luck on a family and is best suppressed. Accordingly, Li Haiqin, a cousin, and three other men took Xiaokai to a creek on the far side of the village fields. They put a brick in the blanket with the body and placed it in a shallow hole under a path between rows of poplar trees. Then they walked back in silence beneath a gray dawn and a light rain. No close family members were there and none was told where the grave is.
Xiaokai's family says Beijing had waived regular inspections of Sanlu because its quality controls were said to be excellent. "The government should shoulder its responsibility. This was a national brand, inspection-exempt products," said Xiaokai's uncle, Li Shenyi.
Since the death, Li Shenyi approached the Runnan county Health Bureau to classify Xiaokai's death as caused by tainted formula. "They said the upper levels (of government) were working on it," he said.
The county health bureau referred calls to its supervisors in Zhumadian city, who said ultimately it was up to Beijing.
"Right now, the Health Ministry has no clear explanation on how the victim's families should be compensated," said a Ms. Shang at the Zhumadian Health Bureau's medical affairs office. "Nobody knows."
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