Baby Formula: What You Need to Know to Make Good Choices

The composition of infant formula is similar to breast milk, but it isn’t a perfect match. More than half the calories in breast milk come from fat, and thesame is true for today’s infant formulas. This may be alarming to many American adults watching their intake of fat and cholesterol, especially when high saturated fats, such as coconut oil are used in formulas. (High saturated fats tend to increase
blood cholesterol levels more than other fats or oils.)

The low-fat diet recommended for adults doesn’t apply to infants.

“Infants have a very high energy requirement, and they have a restricted volume of food that they can digest,” says Wallingford. “The only way to get the energy density
up is to increase the amount of fat.”HOMEMADE ISN’T BEST” Homemade formulas should not be used, says Nick Duy, assistant to the director in FDA ‘s division of regulatory guidance.

Homemade formulas based on whole cow’s milk don’t meet all of an infant’s vitamin and mineral needs.

In addition, the high protein content of cow’s milk makes it difficult for an infant to digest and may put a strain on the baby’s immature kidneys. Substituting evaporated milk for whole milk may make formula easier to digest,
but it is still nutritionally inadequate when compared to commercially prepared formula.

Use of soy drinks as an infant formula can actually be life-threatening .

Commercially prepared formulas are regulated by the Food and Drug Administration as a food for special dietary use. “Infant formulas are the most heavily regulated food that there is,” says Wallingford.

FDA regulations specify exact nutrient level requirements for infant formulas, based on recommendations by the American Academy of Pediatrics Committee on Nutrition.

What’s In Baby Formula?

The following must be included in all formulas:Protein, fat, linoleic acid, vitamin A, vitamin D, vitamin E, vitamin K, thiamine (vitamin B1), riboflavin (vitamin B2), vitamin B, vitamin B12 niacin, folic acid, pantothenic acid, vitamin C, calcium, phosphorous, magnesium, iron, zinc, manganese, copper, iodine, sodium,
potassium, and chloride.In addition, formulas not made with cow’s milk must include biotin, choline and inositol.

The safety of commercially prepared formula is also enhanced by strict quality control procedures that require manufacturers to analyze each batch of formula for required nutrients, to test representative samples for stability over the shelf life of the product, to code containers to identify the batch, and to make all records available to FDA investigators.

Baby Formula Choices

The most common sources of protein in infants formulas are either cow’s milk or soybeans. “For term infants, soy formulas appear to be as nutritionally sound as milk-based formulas, and their use is unlikely to expose infants to nutritional risk,” wrote pediatrician Samuel J. Foman in the American Journal of Clinical Nutrition. Baylor’s Schanler agrees, but says that there is some question about whether the minerals in soy-based formulas can be used by the infant’s body as well as those from
cow’s milk formula.

For a healthy, full-term infant, “cow’s milk formula would be the first choice,” Schanler says. “The only indication that I see for soy is for babies with lactose intolerance.”Lactose, also known as milk sugar, is the main carbohydrate in milk. Infants who don’t have enough enzyme lactase to digest may suffer from abdominal pain, diarrhea, gas, bloating, or cramps.

There is no lactose in soy formula. Schanler does not think soy formula is a good choice for infants with milk allergies, however. “If there is a real history of milk allergy in the family, the baby might be allergic to soy, too,” he says. Instead of soy, Schanler recommends special cow’s milk formula known as protein hydrolsates, which won’t cause allergic reactions because the proteins are already broken down.

“That way the chance of a cross reaction with the soy protein is eliminated,” he explains.Both milk and soy formulas are available in powder, liquid concentrate, or ready-to-feed forms. The choice should depend on “whatever the parents find convenient and can afford, “ says Schanler.

Whatever form is chosen, proper preparation and refrigeration are essential.

Opened cans of ready-to-feed and liquid concentrate must be refrigerated and used within the time specified on the can. Once the powder is mixed with water it should also be refrigerated, if it is not used right away.

Follow Directions Carefully

The exact amounts of water recommended on the label must be used. Under-diluted
formula can cause problems in the infant’s organs and digestive system. Over-diluted formula will not provide adequate nutrition, and the baby may fail to thrive and grow.Warming the formula isn’t necessary for proper nutrition, says William MacLean, M.D., a pediatrician at infant formula manufacturer Ross Laboratories.

What’s the Best Way to Warm a Baby’s Bottle?

“There is nothing magical about having [the formula] warmed up to body temperature,” he says. “But if it’s cold, some babies may refuse it. It’s the baby’s
preference.”Bottles should not be heated in the microwave oven because the
ovens do not heat evenly, MacLean warns. “The drop a mother tests on her wrist could be fine,” he says. But, he explains, undetected “hot spots” in the formula could seriously burn the baby.

The best way to warm a bottle of formula is by placing the bottle in a pot of water and heating the pot on the stove, according to Christine Watson, a nurse who specializes in maternal and newborn care at Shady Grove Adventist Hospital in Gaithersburg, MD. “You can also run hot tap water over the bottle, but that isn’t very
quick.

Vitamin Supplements for Baby?

The American Academy of Pediatrics says “the normal breast-fed infant of the well-nourished mother has not been shown conclusively to need any specific vitamin and mineral supplement. Similarly, there is no evidence that supplementation is necessary for the full-term, formula-fed infant and for the properly
nourished normal child.

“Many physicians recommend supplements, nevertheless–especially for breast-fed infants. “There is definitely some controversy here,” says Wallingford. The controversy on supplements usually revolves around the following:IRON–Although the amount of iron in breast milk is very low (0.3 milligrams of iron per liter), the infant absorbs almost half.

Iron is Important

In contrast, while iron-fortified formulas contain 10 to 12 mg per liter, babies absorb only 4 percent, amounting to 0.4 mg per liter to 0.5 mg per liter. In either case, those amounts of iron are adequate for the first 4 to 6 months, according to the
American Academy of Pediatrics.In the past, there was the concern that iron-fortified formulas could cause gastrointestinal problems such as colic,
constipation, diarrhea, or vomiting.

But based on several studies over the past 10 years, the American Academy of
Pediatrics does not believe there is any evidence connecting these problems to iron and recommends that iron-fortified formula be used for all formula-fed infants.

Vitamin D

Insufficient vitamin D can cause rickets, a disease that results in softening and bending of the bones. Although the amounts of vitamin D in breast milk are small, rickets is uncommon in the breast-fed term infant.

This may be because, like iron in breast milk, the vitamin D in breast milk is easily
absorbed by the baby.Sunlight is important for the formation of vitamin D, but
probably as little as a few minutes exposure a day is all the baby needs, say Schanler, and exposure to the whole body isn’t necessary–just the arms and face is enough.

Fluoride

No one knows for sure if giving fluoride during the first six months of life will result in fewer cavities. Reflecting the uncertainty surrounding fluoride supplements, the American Academy of Pediatrics recommends starting fluoride
supplements shortly after birth in breast-fed infants, but also says that waiting up to six months is acceptable. Because there is no fluoride in infant formula, the twofold recommendation also applies when ready-to-feed formula is used or when the water used for powdered or concentrated formula has less than 0.3 parts per million of fluoride.

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