Infant Formulas

Infant formulas act as a nutritional source for infants less than one year of age. A variety of formulas are available for infants younger than 12 months of age if breast milk is not used. These formulas vary in caloric density, nutrient composition and ingredients, digestibility, taste, and cost. Guidelines for infant formulas and standards for normal infant feeding based on human breast milk have been provided by the American Academy of Pediatrics.

Specific types of formulas include:

• Standard milk-based formulas
• Soy protein formulas
• Formulas for premature infants
• Formulas for infants with metabolism problems

The standard milk-based formulas contain heat-treated cow's milk protein (at reduced concentrations), lactose and minerals from cow's milk, vegetable oils, minerals and vitamins. The amount of each nutrient is set to standards based on levels in breast milk. The American Academy of Pediatrics recommends iron-fortified formulas after about four months of age. Standard formulas contain 20 Kcal/ounce and .45 grams of protein/ounce. Additional vitamin supplements are not usually recommended. Consuming more than the daily requirement of vitamins is unnecessary and potentially harmful. Depending on the water supply, pediatricians may prescribe a fluoride supplement to help the infant develop strong teeth and bones.

Management of infants with metabolic problems should be discussed with an experienced dietitian and physician. Formula choices may be affected by the condition of the infants' gastrointestinal track and metabolism.

Disadvantages Of Infant Formulas

Improper mixing of infant formulas can cause gastrointestinal distress or other problems. Use of the wrong type of formula for infants with special needs can cause the baby's condition to become worse.

Other disadvantages of bottle feeding:

• Formula preparation and cleanup time
• Costs of formula and bottles
• Emotional conflicts for Mom regarding:
• Guilt over not breastfeeding
• Fear of depriving baby of breastfeeding experience
• Fear of depriving baby of advantages of breastfeeding
• Sense of depriving self of experience

Recommendations

Ideally, infants should be fed formulas for a minimum of 6 months. Cow's milk alone is not an appropriate diet for infants because the baby's kidneys may not work as efficiently as an adult's. Cow's milk also has too much protein (and in particular, too much casein--a special type of protein). The minerals are not easily absorbed, and there is an increased risk for sensitization to milk proteins. Low fat and skim milk are also inappropriate for use in the first year of life. They do not provide enough calories for growth nor enough of some nutrients needed for normal development.

Advantages Of Bottle Feeding

• Others can help Mom with feedings.
• Mom can occasionally sleep through the night.
• Mom may feel less restricted and isolated from other relationships and activities.

Milk-Based Formula is appropriate for full-term and pre-term infants having no special nutritional requirements. Common milk-based infant formulas include:

• Enfamil (Mead Johnson)
• Similac (Ross)
• SMA (Wyeth)
• Goodstart (Carnation)

Infants with lactose intolerance or a milk-protein allergy cannot drink standard cow's milk-based formula. Soy-based formulas do not contain milk protein; they use soy protein instead. Soy formulas include:

• Prosobee (Mead Johnson)
• Nursoy (Wyeth)
• Isomil (Ross)

Formulas for premature infants are designed to encourage rapid growth for low birth weight infants. These formulas should be used under a doctor's supervision:

• Enfamil premature formula (Mead Johnson)
• Similac special care (Ross)
• Preemie SMA (Wyeth)

Specialized Formulas

All specialized formulas should be used under a physician's supervision.

• Similac PM 60/40 is for infants that are predisposed to hypocalcemia and newborns with kidney or heart disease.
• Nutramigen (Mead Johnson) is for infants and children intolerant of food proteins or for infants with galactosemia.
• Pregestimil (Mead Johnson) and Alimentum (Ross) are for infants having malabsorption syndromes. They contain added vitamins and iron.
• Portagen (Mead Johnson) is for infants with an inability to digest and/or absorb certain types of fat.
• Lofenalac (Mead Johnson) is a specially designed formula for infants with phenylketonuria (PKU).

Mixing Formula

Improper mixing of formula is common and may harm the infant. Follow the instructions on the formula container carefully. To mix a single 4 ounce bottle, use two level scoops of formula powder and add water to the four ounce line, mix well. Be sure to add the formula first, it mixes better and is more accurate.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.


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