The World Health Organization (WHO) recommends mothers to exclusively breastfeed infants for the first six months of life. After six months, other liquids and foods are given to the infants and the frequency of breastfeeding is reduced. However, breastfeeding up to two years of age is recommended.

Though breast milk is superior to infant formula, some parents choose formula-feeding, either because of medical conditions or because of personal preferences. Infant formulas are an alternative to breast milk for infants from 1-12 months.

Reasons for choosing formula-feeding include:

  • Inadequate supply of breast milk by the mother.
  • The difficulty with latching on or sucking.
  • Working mothers who need to return to their work shortly after the delivery.
  • The entire family who want to be a part of the baby’s feedings.
  • Mothers who are weak and need more rest after delivery.

How to Choose the Right Infant Formula

Various types of infant formulas are available in the market. Some infants require specialized formula, for example-

  1. Infants with intestinal malformations.
  2. Infants with metabolic diseases.
  3. Premature infants.

The nutritional requirement for every infant is different, therefore, parents must carefully choose the right type of infant formula for their little one.

Types of Infant Formulas

Here are types of infant formulas available in the market:

Milk-Based Formulas

Cow milk formula is one of the commonly used formulas for your little one. It is made from the proteins of cow’s milk and these proteins are modified in such a way that it is easier to digest for the babies. The composition of this formula is similar to the breast milk. Hence, the majority of the babies thrive on cow’s milk formula.

Nonmilk-Based Milk Formulas

For infants who are intolerant to cow milk-based formulas can opt for soy-based formulas. In 1929, the first soy formulas were made commercially available. These formulas were made with soy flour.

These soy-based formulas were not accepted by parents and they complained about loose stools, diaper rash and stained clothing. Vitamin K deficiency was reported in infants who were fed soy-based formulas. This is because soy protein eliminates most of the vitamin K in soy.

Mixing Infant Formula

Hydrolyzed Formulas

Whey protein hydrolysate formulas are specially designed for infants who are intolerant to cow milk protein or soy protein. Symptoms of gastrointestinal intolerance to the protein in infants include:

  • Vomiting.
  • Diarrhea or loose stools.
  • Colic.
  • In severe cases, failure to thrive.

Hydrolyzed formulas provide a complete and well-balanced nutrition to infants who cannot digest the intact protein.

In these formulas, proteins are broken down into smaller pieces so that they are easily digested. They do not add an extra pressure on the baby’s stomach.

Extensively hydrolyzed formulas are hypoallergic and are also useful in some cases of malabsorption. Amino acid-based formulas, also known as elemental formulas are designed for infants who cannot tolerate extensively hydrolyzed formulas.

Formulas for Preterm Infants

Preterm infants are usually underweight and weak. Therefore, their nutrient requirements are higher. They are also at an increased risk of allergies or intolerances.

According to research, a preterm formula is intended to provide nutrient intakes to match intrauterine growth and nutrient accretion rates.

These formulas are enriched with energy, macronutrients (carbohydrates, protein and fatty acids), vitamins, minerals and trace elements as compared to term infant formulas. Preterm infants need higher amounts of certain nutrients like:

  • Calcium.
  • Phosphorus.
  • Zinc.
  • Sodium.
  • Potassium.
  • Protein.
  • Iron.
  • Copper.

The infant’s growth and development are closely monitored by a pediatrician. If the baby is healthy, the pediatrician may shift the infant from the special formula to a standard one.

Forms of Infant Formulas

In What Forms are Infant Formulas Available

Infant formulas are available in three different forms:

  1. Powder.
  2. Ready-to-feed.
  3. Concentrate.

Instructions on how to prepare the formula are mentioned on the formula bottle or packet.

When preparing a powder formula, one scoop of the powder needs to be added to one or two ounces of water, as mentioned on the pack and shake it well in a bottle.

While making a concentrate, mix equal parts of the formula and water and mix thoroughly.

Ready-to-feed as the name suggests is ready to use. You do not need to add anything to it.

Once the formula is prepared, do not keep it at the room temperature for more than an hour.

Once heated, the formula can be stored at the room temperature for an hour. Re-heating it may lead to harmful bacterial growth.

Any leftover formula milk should be discarded and should not be re-used or stored.

The composition of Infant Formulas

Breastfeeding is an ideal form of infant feeding. The main aim of the industry is to prepare infant formulae that meet the nutritional requirements and to promote normal growth and development of the infants for whom they are intended.

Research suggests that the composition of the human milk of a well-nourished and healthy woman can provide guidance for the composition of the infant formulae.

Infant formulae should contain only those components that serve a nutritional purpose or provide health benefits to the infant. The inclusion of unnecessary components or improper amounts of components may add an additional pressure on the metabolic and physiologic functions of the baby.

100 ml of an infant formula should provide minimum 60 calories and maximum 70 calories. Besides macro and micronutrients, other ingredients are added to provide benefits similar to the breastfed babies. Here is what an infant formula contains:

Proteins

  • Cow’s milk.
  • Soy milk.
  • Hydrolyzed cow’s milk protein.

Lipids

  • Linoleic acid.
  • Alpha-linoleic acid.
  • Lauric + myristic
  • Trans fatty acids.
  • Erucic acid.

Carbohydrates

  • Lactose.
  • Glucose.
  • Starches.

Vitamins

  • Vitamin A.
  • Vitamin D3.
  • Vitamin E.
  • Vitamin K.
  • Thiamin or vitamin B1.
  • Riboflavin or vitamin B2.
  • Niacin or vitamin B3.
  • Pantothenic acid or vitamin B5.
  • Pyridoxine or vitamin B6.
  • Biotin or vitamin B7.
  • Folic acid or vitamin B9.
  • Cobalamin or vitamin B12.
  • Vitamin C.

Minerals and trace elements

  • Iron.
  • Calcium.
  • Phosphorus.
  • Magnesium.
  • Sodium.
  • Chloride.
  • Potassium.
  • Manganese.
  • Fluoride.
  • Iodine.
  • Selenium.
  • Copper.
  • Zinc.

Other substances

  • Choline.
  • Myo-inositol.
  • L-carnitine.
  • Docosahexaenoic acids.
  • Phospholipids.
  • Immunoglobulins.

In the 1900s, mothers who were unable to breastfeed their infants chose alternative sources of milk to feed their infants, for example- cow’s milk.

Research has found that as general sanitation measures improved and the differences in composition between human milk and that of other mammals were defined, feeding animal milk became more successful.

The birth of the infant formula industry took place in the 1920s. The modern commercially prepared formulas were introduced with nonfat cow milk, lactose, vegetable oils, iron, calcium and phosphorus.

The protein content is diluted because of the immature renal tubular system of the infant. Iron was first added in 1959 to reduce the risk of iron-deficiency in formula-fed infants. Long chain fatty acids were recently added to these formulas in an effort to improve visual and cognitive development in infants.

It was believed that the quality of cow’s milk protein was far inferior compared to human milk protein. Therefore, high level of protein was added to infant formulas to meet the infant requirements.

However, this increased the additional load on the immature kidneys of the infants.

Furthermore, it was recognized that whey protein is predominant in human milk, whereas caseins are higher in cow’s milk.

In the year 1962, formulas with a whey : casein ratio similar to human milk were introduced. Whey-predominant formulas began to gain popularity by 2000.

Nucleotides, the basic structural unit of DNA became an important component of infant formulas. According to research, nucleotides may act as growth factors and may have immunomodulating effects on the immune defenses.

Home-Made Formula Feeds or Kitchen Feeds

Some parents want to prepare their own organic formula feeds for their little one. But, buying a commercial formula feed is better because it is approved by FDA and it is nutritionally balanced.

On the other hand, home-made formula feeds are less expensive and healthier because parents know what it is exactly made up of.

However, experts recommend that home-made feeds are not nutritionally balanced and the risk of contamination is high. But, if some parents still prefer home-made feeds, they can consult their pediatrician and go ahead with it.

Bottle Feed

How to Start with Formula Feeds

Infants must be fed formula feeds up to one year of age. Initially, these feeds must be given every 2-3 hours. Start with 60-90 milliliters of formula at one go. In an entire day, an infant must consume 480-720 milliliters of the formula.

Similar to breastfeeding, as the baby grows older, the number of feedings decreases. But, the quantity of formula given at one go will increase.

After 6 months of age, other liquids and solid foods are introduced and the quantity of formula feeds is further reduced.

Hygiene

Formula feeds are more prone to bacterial growth as compared to breastmilk. Therefore, parents need to be more careful while preparing and feeding their little one.

During the first six months, the bottles in which the feeds are given should be sterilized before and after use.

Parents or whoever is feeding the infant should wash their hands with hot soapy water before preparing the feed and before feeding the little one.

Water used to prepare the formula feeds should be boiled properly and then strained. This water is then safe to use for your baby.

Summary

Formula feeds are a healthy alternative to breastmilk. Mothers who cannot breastfeed their infants can easily depend upon the formula feeds. Parents should carefully prepare the formula and feed their infant from time to time. Ask your pediatrician before starting with any type of formula feed. As your little one grows old, your pediatrician may change the formula feed to meet his/her requirements.

References

  1. Hernell, Olle. (2011). Human Milk vs. Cow’s Milk and the Evolution of Infant Formulas. Nestlé Nutrition workshop series. Paediatric programme. 67. 17-28. 10.1159/000325572. (https://www.researchgate.net/publication/49850216)
  2. Institute of Medicine (US) Committee on the Evaluation of the Addition of Ingredients New to Infant Formula. Infant Formula: Evaluating the Safety of New Ingredients. Washington (DC): National Academies Press (US); 2004. 3, Comparing Infant Formulas with Human Milk. https://www.ncbi.nlm.nih.gov/books/NBK215837/
  3. Mendonça MA, Araújo WMC, Borgo LA, Alencar EdR (2017) Lipid profile of different infant formulas for infants. PLoS ONE 12(6): e0177812. https://doi.org/10.1371/journal.pone.0177812
  4. Koletzko B, Baker S, Cleghorn G, Neto UF, Gopalan S, Hernell O, Hock QS, Jirapinyo P, Lonnerdal B, Pencharz P, Pzyrembel H, Ramirez-Mayans J, Shamir R, Turck D, Yamashiro Y, Zong-Yi D. Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group. J Pediatr Gastroenterol Nutr. 2005 Nov.(https://www.ncbi.nlm.nih.gov/pubmed/16254515)
  5. Lönnerdal B. Infant formula and infant nutrition: bioactive proteins of human milk and implications for composition of infant formulas. Am J Clin Nutr. 2014 Mar. (https://www.ncbi.nlm.nih.gov/pubmed/24452231)
  6. Tudehope DI, Page D, Gilroy M. Infant formulas for preterm infants: in-hospital and post-discharge. J Paediatr Child Health. 2012 Sep. (https://www.ncbi.nlm.nih.gov/pubmed/22970671)
  7. Merritt RJ, Carter M, Haight M, Eisenberg LD. Whey protein hydrolysate formula for infants with gastrointestinal intolerance to cow milk and soy protein in infant formulas. J Pediatr Gastroenterol Nutr. 1990 Jul. (https://www.ncbi.nlm.nih.gov/pubmed/2388135)
  8. Antonio Alberto ZuppaEmail, Piero Catenazzi, Riccardo Riccardi and Costantino Romagnoli, Specific formulas for preterm infants, how and when, Italian Journal of Pediatrics 201541 (Suppl 1): A46 https://doi.org/10.1186/1824-7288-41-S1-A46