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Formula Feeding

Formula basics

Formula Feeding Many babies in the United States receive nourishment by way of infant formula, either in place of breast milk or in addition to it. Formula provides a certain element of freedom for parents and other caregivers, particularly because any adult is capable of feeding the baby at any time, precluding mom as the sole food source.

Formula is beneficial for other reasons, too.

• Some infants cannot tolerate the carbohydrate or protein in breast milk and depend upon specialized infant formula for survival.
• Moms who cannot breastfeed for one reason or the other (see Deciding to Breast-feed) rely on infant formula as a suitable substitute.
• Premature or low-birth-weight infants (under 5.5 pounds) and full-term babies who don't gain enough weight on breast milk alone often improve when infant formula is added to their diet.

Decision, Decisions
Infant formula makers try to come as close as possible to copying the composition of mother's milk. However, it's impossible to completely duplicate human milk, given its hundreds of different components. Even so, babies do thrive on infant formula. I did, and chances are, you did, too.

Still, there are some major nutritional differences between breast milk and formula. Generally speaking, formula contains more protein. Vitamin and mineral content can be higher, too, often to compensate for the possible lower rate of absorption of these nutrients from the formula.

Certain infant formulas are touted as low iron, yet there is rarely a medical need for low-iron formulas. In fact, inadequate iron intake can harm brain development and overall growth. That's why the AAP is against using low-iron infant formulas. Never feed your baby a low-iron formula without the approval of your pediatrician.

Form, Not Function, Is the Difference
Infant formula comes in three forms: ready-to-feed, concentrated liquid, and powder. Price and convenience, not nutrition, are what differentiates them from each other.

Convenience is costly. That's why powdered formulas are the cheapest of all. Aside from the price break, powdered formula has other advantages, particularly for breastfeeding moms who want to supplement their milk supply. You can mix as much of the powdered formula as you need, without waste. Powdered formula preparation is more time consuming than that of the other, costlier, forms. You must measure the formula carefully, as well as boil the water to mix with it. Powders have a thirty-day shelf life after opening.

The two types of liquid formula vary in concentration and cost. Concentrated liquid formula is meant to be mixed with an equal part of boiled water and delivered to baby in a clean bottle. Concentrated liquid formula is more expensive than powdered. To use ready-to-feed formula, just open and pour into a clean baby bottle.

Standard Formulas
Parents most often pick a cow's-milk-based formula to nourish their infants. And with good reason. Most children thrive on a cow's-milk formula fortified with iron. Milk-based formulas are available with little iron, or as iron-fortified, but only iron-fortified formula meets an infant's needs for this vital nutrient.

Manufacturers remove the butterfat from milk, replacing it with vegetable oil or a mixture of vegetable and animal fats. Changing the fat composition improves the digestibility and increases the concentration of essential fats needed to foster peak growth and development.

Common Brand Names: Good Start (Carnation); Enfamil with Iron and Enfamil Low Iron (Mead Johnson); and Similac with Iron (Ross)

Alternative formulasSoy Formulas
There are very few medical reasons why a baby would need soy formula, yet sales account for about 25 percent of the infant formula market. Obviously, parents see soy formulas as either beneficial or necessary, or both.

All soy formulas contain the necessary added iron and meet the requirements for vitamins and minerals set by the AAP and the FDA. They do not contain lactose. When comparing labels of cow's-milk formula and that of soy, don't be surprised to see higher levels of protein, calcium, and phosphorus. Soy formulas need more of these nutrients because they are not absorbed as well by the body as when they are found in cow's-milk formulas.

Soy-based formulas are just as nutritious for full-term, healthy infants as formulas made from cow's milk, but experts aren't so sure that premature babies should consume soy formula. If your baby was born before term, ask your doctor about using soy formulas.

When does a soy-based formula make sense? If you have a baby:

• With galactosemia, an inborn error of metabolism that prohibits him from breaking down the carbohydrate in milk and milk products;
• Who is lactose intolerant and cannot fully digest lactose, the primary carbohydrate in cow's milk;
• Who you want to raise as a strict vegetarian;
• Who is recovering from an intestinal infection.

Many parents switch their babies to soy formula because they are convinced that their baby's abdominal discomfort or allergy symptoms from drinking a cow's-milk-based formula will disappear. Yet, about half of all infants who are allergic to cow's-milk protein cannot tolerate soy protein, either. Before switching to soy, ask your pediatrician. If your child is allergic to milk and to soy, he may need a protein hydrosolate formula.

Common Brand Names: Alsoy (Carnation); Isomil (Ross); ProSoBee (Mead Johnson)

Lactose-Free Formulas
These cow's-milk-based formulas come free of lactose. Infants who cannot digest lactose, the carbohydrate in cow's milk, can still drink lactose-free cow's-milk formula.

Common Brand Names: Enfamil LactoFree (Mead Johnson); Similac Lactose Free Infant Formula (Ross)

Protein Hydrosolate Formulas
Lactose-free protein hydrosolate formulas contain protein that is broken down to prevent an allergic response. This type of formula may be attractive to parents of colicky babies and those with a suspected intolerance to lactose, the primary carbohydrate in milk.

Protein hydrosolates work well in babies that are allergic to both cow's-milk protein and soy protein, and for infants with certain conditions that hamper the proper digestion and absorption of nutrients, including cystic fibrosis and intestinal surgery. While protein hydrosolate formulas are costlier than cow- or soy-based options, they are a cheaper, less invasive alternative to feeding babies through a major artery.

Common Brand Names: Alimentum (Ross), Nutramigen (Mead Johnson), Pregestimil (Mead Johnson)

Follow-Up Formula
Your baby can begin taking follow-up formulas at six months as long as he's eating solid foods and growing normally. But are follow-up formulas necessary? No. Will follow-up formulas hurt your child? Another no. You can continue to decrease the amount of regular formula and increase solid foods until your child reaches the age of one. At a year, he or she can start drinking whole milk instead of formula.

Common Brand Names: Follow-Up (Carnation), Follow-Up Soy (Carnation)

When Milk Is Not the Beverage of Choice
Any type of formula is more expensive than breastfeeding. It's also costlier than regular cow's, goat's, canned condensed, and evaporated milk. But giving any type of milk to infants in place of commercial formula could cost your child in the long run.

Milk is not an option for any baby under the age of one, says the AAP. Milk cannot supply the nutrients babies need to thrive. For one, milk is low in iron. Using milk of any type instead of breast milk or iron-fortified formula promotes iron deficiency, which hampers brain development. To make matters worse, babies can be sensitive to the protein in milk (infants with milk allergies are often sensitive to soy as well), resulting in chronic blood loss from the intestinal tract. Bleeding is the primary route for iron loss from the body, so everyday blood loss further exacerbates an infant's low iron stores.

There are other reasons for babies to avoid milk. When infants drink milk in place of formula or breast milk, they risk consuming excess sodium, potassium, and chloride, which can strain their kidneys. Milk is also deficient in the type of fat that best fosters brain development, as well as vitamin E and zinc. What's more, infants fed reduced-fat milk risk consuming too much protein and inadequate calories and fat to fuel their growth.