Seunga (Jasmine) Han, PharmD Student
In a past article, we mentioned that it’s highly recommended for mothers to breastfeed infants for the first 6 months of their life and up to 2 years of age. However, some mothers, whether it’s due to a lack of breastmilk or personal preference, may be required to resort to baby formulas.
Fortunately, many manufacturers (Enfamil®, Good Start®, Similac®) produce infant formulas that contain micro- and macro-nutrients to mimic human breastmilk as close as they can (ratio of 40-45% carbohydrate, 8-12% protein, 45-50% fat). Due to these proportions, formulas can be used as the sole source of nutrition or as a supplement to breastfeeding. However, if you’ve ever walked down the aisle in search of baby formulas, you’ll have noticed that there are a large variety of infant formulas produced by different manufacturers. This can be quite overwhelming for some mothers and presents a challenge when trying to pick what is best for their baby. Today, we’ll discuss some of the different types of infant formulas available in the market and the details of each.
#1 Iron-fortified Infant Formulas
If a mother isn’t able to exclusively breastfeed in the first 6 months of the infant’s life, it’s recommended that they provide iron-fortified infant formulas until the infant is about 9-12 months of age. This is to ensure the infant is receiving enough iron to meet its nutritional needs.
#2 Cow’s Milk–based Formulas
Containing whey and casein, these formulas are the most commonly used substitution or supplement to breast milk. Most manufacturers try to create a ratio that reflects human milk. While there is no nutritional difference between the two proteins, whey-based formulas have been associated with fewer episodes of vomiting and gastroesophageal reflux (GERD). One thing to keep in mind is that it’s common for infants to have reflux, regurgitation, and vomiting several times a day in the first year of their life.
#3 Lactose-free Cow’s Milk–based Formulas
If you suspect that your infant’s gassiness or fussiness post-feeding is related to lactose intolerance, you could use lactose-free formulas. It’s important to keep in mind that there is a risk of residual amounts of lactose in the formula despite the labelling, and caution is always advised. While some mothers may be tempted to use lactose-free formula first, it’s important to weigh the risks and benefits of this decision since lactose plays important roles in mineral absorption and healthy bacterial growth in the gut.
#4 Soy Protein Isolate–based Formulas
If your infant has galactosemia or congenital lactase deficiency, soy-based formulas are recommended as they’re free of cow’s milk protein and lactose and are fortified with iron and added minerals to ensure that the infant receives all appropriate nutrients. This is also a good supplement to breastfeeding for infants of mothers who follow a vegetarian diet or who wish to feed them a non-animal protein based formula.
#5 Hydrolyzed Protein Formulas
Hydrolyzed protein formulas are available as partially or extensively hydrolyzed formulas:
- Partially hydrolyzed whey formulas: These contain lactose. In addition to being more palatable, they’re associated with fewer spitting up episodes and softer stools, likely due to their fast movement through the intestine. As a result, they may be beneficial in infants with GERD (gastroesophageal reflux disease).
- Extensively hydrolyzed protein containing formulas: They contain casein proteins and are lactose-free. Hence, they’re recommended for infants who are intolerant to cow’s milk protein and soy protein. The way the formulas are designed allows the formula to bypass the lymphatic system and use fewer pancreatic enzymes and bile salts for digestion and absorption. Due to this property, they’re also ideal for infants with malabsorptive disease (e.g. short bowel syndrome, liver disease, cystic fibrosis and intractable diarrhea), cholestasis and lymphangiectasia. Studies have also shown that giving extensively hydrolyzed protein formula can delay or prevent the occurrence of atopic disease and allergies if the infant is at high risk and can’t be exclusively breastfed.
#6 Amino Acid-based Formulas
Amino acid-based formulas are also known as “elemental” formulas. These are entirely made up of free amino acids and are designed for infants with severe milk protein hypersensitivity and/or with malabsorption-associated diseases who have persistent symptoms when receiving a partially hydrolyzed formula. These formulas are lactose-free and usually contain a combination of long- and medium-chain triglycerides (fats).
#7 Pre-thickened Formulas
Commercially available pre-thickened formulas are recommended for the treatment of regurgitation and vomiting compared to thickening up standard formulas with cornstarch or rice cereal. This is because thickening up standard formulas with infant cereal or cornstarch displaces nutrients and fluids and therefore, it’s not a recommended practice.
#8 Follow-up Formulas
Follow-up formulas are designed for infants between 6 and 24 months of age who are consuming some complementary foods and aren’t relying solely on formula to meet their nutritional needs.
Is it Safe?
There have been some concerns regarding the use of powdered infant formulas and their relationship to a number of serious disease, such as necrotizing enterocolitis and meningitis. Additionally, there have been some Enterobacter sakazaki outbreaks in infants linked to the consumption of powdered formula and the equipment used to prepare it. As a result, powdered formula should be used with caution in immunocompromised or premature infants.
Furthermore, steps must be taken to ensure proper hygiene, preparation, use, and storage of powdered infant formula. These steps may include:
- Bottles, nipples, caps and any other mixing equipment should be boiled for at least 2 minutes, and allowed to air dry and cool.
- Opened liquid concentrate formulas must be refrigerated and used within 48 hours.
- Reconstituted powdered formula must be used within 24 hours and within 2 hours once feeding is started.
- Opened powdered formula can be used for up to 1 month when stored in cool, dry place.
- Powdered formula must be mixed with boiled or commercially prepared, sterilized water.
- Cooled water that was previously boiled water may be used.
- Cold tap water must be boiled for at least 2-5 minutes.
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