Infant Formulas

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Infant Formulas

• Which is better, breastfeeding or
  formula-feeding?
• What is in an infant formula, and how do I choose
  the right one?
• Can I make my own infant formula?

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• Human milk is the preferred feeding for all
  infants. This includes premature and sick
  newborns, with rare exceptions. Pediatricians
  generally advise that full-term, healthy infants
  exclusively breastfeed when possible for the
  first 12 months of life and, thereafter

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• for as long as mutually desired. Advantages of
  breastfeeding include (1) breast milk is
  nutritionally sound and easy to digest (2)
  breastfeeding is believed to enhance a close
  mother-child relationship and (3) breast milk
  contains infection-fighting antibodies
  (immunoglobulins) that may reduce the frequency
  of diarrhea,

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• gastroenteritis, otitis media (ear infections),
  and other respiratory infections in the infant.

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• Some parents choose formula-feeding either
  because of personal preference or because medical
  conditions of either the mother or the infant
  make breastfeeding ill-advised. Parents need not
  feel guilty for choosing formula-feeding. Infant
  formulas are a time-tested, perfectly acceptable
  alternative to breastfeeding.

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• Even though formula-fed babies do not receive
  infection-fighting antibodies from the breast
  milk, they still will have received a four- to
  six-month supply of these antibodies through the
  maternal bloodstream prior to delivery.

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• Remember also that the majority of breastfeeding
  infants end up on a combination of breast- and
  formula-feedings before their first birthday.

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• There is an inadequate supply of maternal breast
  milk.
• The baby is sucking inefficiently.
• Parents are unable to quantify the amount of
  breast milk received by the baby. Some parents
  want to know exactly how much their baby is
  receiving at each feeding, and formula/bottle-feed
  ing allows exact measurement.

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• A significant reason for not breastfeeding is
  concern about transferring certain drugs the
  mother is taking due to a medical problem through
  the breast milk to the infant.

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• Examples of medications that are considered
  unsafe for the baby include cimetidine (Tagamet),
  cyclophosphamide (Cytoxan), lithium (Lithobid),
  gold salts, methotrexate (Rheumatrex, Trexall),
  metronidazole (Flagyl), cyclosporine, and
  bromocriptine (Parlodel).

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1. Numerous other medications have not yet been
   adequately studied in the context of
   breastfeeding and the possible effects on the
   baby. Mothers may choose bottle-feeding rather
   than risk any potential effect on the baby

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• An increasing number of mothers must return to
  work shortly after their baby's delivery.
  Formula-feeding offers a practical alternative
  for mothers who may not be able to breastfeed due
  to work schedules

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• Formula-fed babies often need to eat less
  frequently than do breastfed babies because
  breast milk moves through the digestive system
  more quickly. Thus, breastfed babies may become
  hungry more frequently.

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• A benefit of bottle-feeding is that the entire
  family can immediately become intimately involved
  in all aspects of the baby's care, including
  feedings. The mother can therefore get more rest,
  which can be critically important, especially if
  the pregnancy and/or delivery were especially
  difficult.

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• What is in an infant formula, and how do I choose
  the right one?

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• A small percentage of newborn infants will
  require a specialized formula (for example,
  premature infants, infants with metabolic
  diseases,

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• or infants with intestinal malformations). These
  children's unique dietary requirements should be
  an item of individual discussion between the
  parents and the infant's pediatrician

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• In order to achieve appropriate growth and
  maintain good health, infant formulas must
  include proper amounts of water, carbohydrate,
  protein, fat, vitamins, and minerals.

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• The three major classes of infant formulas are

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• milk-based formulas, which are prepared from cow
  milk with added vegetable oils, vitamins,
  minerals, and iron. These formulas are suitable
  for most healthy full-term infants and should be
  the feeding of choice when breastfeeding is not
  used, or is stopped before 1 year of age.

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• soy-based formulas, which are made from soy
  protein with added vegetable oils (for fat
  calories) and corn syrup and/or sucrose (for
  carbohydrate). These formulas are suitable for
  infants who cannot tolerate the lactose (lactose
  intolerant,) in most milk-based formulas or who
  are allergic to the whole protein in cow milk and
  milk-based formulas.

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• The American Academy of Pediatrics recommends the
  use of soy formulas for the above infants as well
  as for infants of parents seeking a
  vegetarian-based diet for a term infant.

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• These formulas are not recommended for
  low-birth-weight or preterm infants or for the
  prevention of colic or allergies.

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1. special formulas for low-birth-weight (LBW)
   infants, low-sodium formulas for infants that
   need to restrict salt intake, and "predigested"
   protein formulas for infants who cannot tolerate
   or are allergic to the whole proteins in cow milk
   and milk-based formulas

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• Water
• Water is an important part of a baby's diet
  because water makes up a large proportion of the
  baby's body. When properly prepared, all infant
  formulas are approximately 85 water

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• Infant formulas are available in three forms
  liquid ready-to-use, liquid concentrate, and
  powder concentrate. Liquid ready-to-use formulas
  do not require the addition of water, while the
  liquid and powder concentrates require the
  addition of water.

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• It is of prime importance for parents to read,
  understand, and follow the manufacturer's
  directions when adding water to liquid and powder
  concentrates. Adding too much water to these
  concentrates or adding water to ready-to-use
  formulas can lead to water intoxication in the
  baby.

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• In severe cases, water intoxication can cause low
  blood sodium levels, irritability, coma, and even
  permanent brain damage. Conversely, failing to
  adequately dilute the concentrates with water
  causes the formulas to be too concentrated, or
  "hypertonic."

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• Hypertonic formulas can induce diarrhea and
  dehydration. In extreme cases, ingestion of
  overly hypertonic formulas can lead to kidney
  failure, gangrene of the legs, and coma

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• Therefore, parents should not adjust the amount
  of water that is added to concentrates to either
  "fatten the baby up" or "put the baby on a diet."
  Instead, parents should discuss their concerns
  regarding the baby's calorie intake with his/her
  pediatrician.

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Carbohydrates

• Carbohydrates (glucose, lactose, sucrose,
  galactose, etc.) are sugars or several sugars
  linked together. Carbohydrates provide energy
  (calories) for the brain tissues, muscles, and
  other organs

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• Lactose is a carbohydrate consisting of glucose
  linked to galactose. Lactose is the major
  carbohydrate in human breast milk, cow milk, and
  in most milk-based infant formulas.

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• While most infants will thrive on a formula that
  contains lactose, some infants are lactose
  intolerant. Lactose intolerance is due to a
  lactase enzyme deficiency (low levels of enzyme
  activity) in the small intestine.

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• Lactase enzymes are necessary for "digesting"
  lactose by breaking the link between glucose and
  galactose. The intestines can then absorb the
  smaller glucose and galactose molecules

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• In infants who are lactase deficient, the
  undigested lactose cannot be absorbed. This, in
  turn, can cause diarrhea, cramps, bloating,
  vomiting, and gas. Lactase deficiency is more
  common in premature infants than in full-term
  babies.

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• Lactase deficiency can also develop temporarily
  during recovery from viral gastroenteritis
  (commonly referred to as the "stomach flu").
  Finally, lactase deficiency can be inherited
  (rarely).

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• For infants with lactose intolerance, formulas
  that contain no lactose can be used. Lactofree is
  an example of a milk-based formula that contains
  corn-syrup solids rather than lactose as its
  carbohydrate calorie source.

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• Many soy-protein formulas also do not contain
  lactose and are suitable for lactose intolerant
  infants. In addition to corn-syrup solids, other
  examples of carbohydrates contained in
  lactose-free formulas include sucrose (table
  sugar), tapioca starch, modified cornstarch, and
  glucose polymers (short chains of glucose
  molecules).

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Proteins

• Proteins contain different amino acids that are
  linked together. Proteins provide both calories
  and the amino-acid building blocks that are
  necessary for proper growth. The protein in human
  milk provides between 10-15 of an infant's
  daily caloric need

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• Casein and whey are the two major proteins of
  human milk and most milk-based formulas.
  (Immunoglobulins, a type of protein unique to
  breast milk, provide infection-fighting

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• immunity and are not considered as a nutritional
  source and are not efficiently metabolized.)
  While formulas from different manufacturers may
  vary slightly in the relative proportion of these
  two proteins, healthy babies generally thrive on
  any milk-based formula brand.

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• Some 0.5-7.5 of infants have a true allergy to
  the cow proteins that are in milk-based formulas.
  Infants with true cow milk allergy can develop
  abdominal pain, diarrhea, rectal bleeding, skin
  rash, and wheezing when given milk-based formulas

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• Allergy to cow-milk protein is different from
  lactose intolerance. Treatment of
  cow-milk-protein allergy involves using formulas
  that contain no cow milk or using formulas that
  contain "predigested" casein and whey proteins

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• The predigesting process breaks the whole
  proteins into smaller pieces or into amino acids.
  The amino acids and smaller protein pieces are
  hypoallergenic (do not cause allergy).

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• Soy-protein formulas contain no cow milk and are
  reasonable alternatives for infants with true
  cow-milk allergy. Since most soy-protein formulas
  also contain no lactose, they are also suitable
  for infants with lactose intolerance.

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• The carbohydrates in soy-protein formulas are
  sucrose, corn-syrup solids, and cornstarch or
  glucose polymers.

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• Certain infants have allergy to both cow-milk
  proteins and soy proteins. These infants require
  a formula in which the cow-milk protein (casein)
  has been "predigested" and specific amino acids
  added to provide a formula that can provide
  proper nutrition

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• The decision to utilize one of these specialized
  formulas should be made in consultation with the
  infant's pediatrician.

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Fat

• Fat in human milk and formula provides a
  significant percentage of the total daily caloric
  needs for a growing infant. Formula manufacturers
  utilize many different vegetable oils for fat,
  including corn, soy, safflower, and coconut oils.

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• Some formulas contain "predigested" fats known as
  medium chain triglycerides (MCT). These are
  analogous to the "predigested proteins" discussed
  above. Because of their unique application,
  formulas containing MCT are not routinely
  recommended for healthy infants and children.

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• There is a significant amount of research into
  determining the ideal concentration and ratios of
  fatty acids such as arachidonic acid (ARA) and
  docosahexanoic acid (DHA) for infant nutrition.

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• Some studies have suggested that these may have a
  positive effect on short-term cognitive function.
  More research is needed to clarify this issue,
  and you should discuss this with your infant's
  pediatrician before supplementing

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Vitamins

• Vitamins are organic substances that are
  essential in minute quantities for the proper
  growth, maintenance, and functioning of the baby.
  Vitamins must be obtained from food because the
  body cannot produce them.

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• The exception is vitamin D, which can be produced
  by the skin when it is exposed to the sun. There
  are four fat-soluble vitamins (A, D, E, and K)
  and several water-soluble vitamins

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• These include the B vitamins, B1 (thiamine), B2
  (riboflavin), B3 (niacin), B6 (pyridoxine), and
  B12 (cobalamin), as well as folate and vitamin C
  and pantothenic acid, and biotin

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• These vitamins have been added to infant formulas
  to ensure proper nutrition. Unless otherwise
  directed by their pediatricians, routine vitamin
  supplementation is not necessary for healthy
  full-term infants taking formulas.