Infant FormulasInfant Formulas

Which is better, breastfeeding or formulaWhich is better, breastfeeding or formula--feedingfeeding??

What is in an infant formula, and how do I choWhat is in an infant formula, and how do I choose the right oneose the right one

?? Can I make my own infant formulaCan I make my own infant formula??

•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

•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 ,

•gastroenteritis ,otitis media) ear infections( ,and other respiratory infections

in the infant .

•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 .

•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 .

•Remember also that the majority of breastfeeding infants end up on a

combination of breast- and formula-feedings before their first birthday.

•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-feeding allows exact

measurement.

•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 .

•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) .

.1Numerous 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

•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

•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.

•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.

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

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

premature infants, infants with metabolic diseases ,

•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

•In order to achieve appropriate growth and maintain good health, infant formulas must

include proper amounts of water, carbohydrate, protein, fat, vitamins, and

minerals .

•The three major classes of infant formulas are

•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.

•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 .

•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 .

•These formulas are not recommended for low-birth-weight or preterm infants or for

the prevention of colic or allergies.

.1special 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

•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

•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.

•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 .

•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 ".

•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

•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.

CarbohydratesCarbohydrates

•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

•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.

•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 .

•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

•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 .

•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).

•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 .

•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).

ProteinsProteins

•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

•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

•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.

•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

•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

•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).

•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 .

•The carbohydrates in soy-protein formulas are sucrose, corn-syrup solids, and

cornstarch or glucose polymers.

•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

•The decision to utilize one of these specialized formulas should be made in

consultation with the infant's pediatrician.

FatFat

•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.

•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.

•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 .

•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

VitaminsVitamins

•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.

•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

•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

•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.