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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
Human milk is the preferred feeding for all •
infants. This includes premature and sick
newborns, with rare exceptions.
Pediatricians generally advise that fullterm, 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 infectionfighting antibodies (immunoglobulins) that
,diarrhea may reduce the frequency of
ear ( otitis media ,gastroenteritis •
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
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
Examples of medications that are •
considered unsafe for the baby include
cyclophosphamide ,)Tagamet( cimetidine
,Lithobid), gold salts( lithium ,)Cytoxan(
,)Rheumatrex, Trexall( methotrexate
Flagyl), cyclosporine, and( metronidazole
.)Parlodel( bromocriptine
Numerous other medications have not .1
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
the because breast milk moves through
more quickly. Thus, digestive system
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
and/or delivery were especially pregnancy
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
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,
and ,vitamins ,carbohydrate, protein, fat
The three major classes of infant formulas •
milk-based formulas, which are prepared •
from cow milk with added vegetable oils,
vitamins, minerals, and iron. These
formulas are suitable for most healthy fullterm 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 •
protein with added vegetable oils (for soy
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 milkbased formulas or who are allergic to the
and milk-based cow milk whole protein in
The American Academy of Pediatrics •
recommends the use of soy formulas for
the above infants as well as for infants of
based diet -vegetarian parents seeking a
.for a term infant
These formulas are not recommended for •
low-birth-weight or preterm infants or for
.the prevention of colic or allergies
special formulas for low-birth-weight .1
(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-touse formulas can lead to water intoxication
.in the baby
In severe cases, water intoxication can •
,cause low blood sodium levels, irritability
and even permanent brain ,coma
damage. Conversely, failing to adequately
dilute the concentrates with water causes
the formulas to be too concentrated, or
diarrhea Hypertonic formulas can induce •
In extreme cases, .dehydration and
ingestion of overly hypertonic formulas can
of the gangrene ,kidney failure lead to
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
lactose, sucrose, ,glucose( Carbohydrates •
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
While most infants will thrive on a formula •
that contains lactose, some infants are
is Lactose intolerance .lactose intolerant
due to a lactase enzyme deficiency (low
levels of enzyme activity) in the small
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,
Lactase .gas and ,vomiting ,bloating
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 milkbased 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
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 milkbased formulas. (Immunoglobulins, a type
of protein unique to breast milk, provide
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 •
to the cow proteins that are in milk- allergy
based formulas. Infants with true cow milk
,abdominal pain allergy can develop
and ,rash skin ,rectal bleeding ,diarrhea
wheezing when given milk-based formulas
Allergy to cow-milk protein is different from •
lactose intolerance. Treatment of cowmilk-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 soyprotein 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- •
These .soy proteins milk proteins and
infants require a formula in which the cowmilk protein (casein) has been
"predigested" and specific amino acids
added to provide a formula that can
nutrition provide proper
The decision to utilize one of these •
specialized formulas should be made in
.consultation with the infant's pediatrician
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
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
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
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 •
B6 ,)niacin( (thiamine), B2 (riboflavin), B3
(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