Infant formula
Breast milk
Breast milk is recommended as
the main milk for all children until age 12 months or longer if the mother
chooses.
Infant formula is an alternative when breast milk is not available. Infant
formulas have been developed to contain a similar amount of nutrition to
breast milk, however no formula can supply the unique ingredients that breast
milk does, such as live immunological factors, or a change in composition
depending on the age or the infant or the time of day.
Which infant formula is appropriate?
There are many different infant
formulas available today, most often described in terms of the protein content
of the milk.
If given in suitable quantities infant formula alone is nutritionally adequate
for infants until the introduction of solids at around 6 months of age.
Many parents feel that a change in infant formula may be necessary for infants
who sleep or feed badly, or who may be unsettled or ‘colicky’. There is
little evidence to suggest that this is helpful in the majority of infants,
and the advice of a health professional should be sought before too much
unnecessary ‘formula swapping’ takes place.
Starter or first formula
Starter or first formula based
on cow’s milk protein (either whey or casein dominant) is suitable for children
from birth until 12 months of age. These formulas are available in soy and
goat milk also.
Included in this group are some products that contain additional very long
chain polyunsaturated fatty acids to more closely mimic the fat composition
of breast milk.
Soy formula
Soy formula have increased in
popularity over recent years, however while these formula meet the nutrient
and growth requirements of infants, recommendations are for their use to
be limited to situations with a clear medical purpose such as cow milk protein
intolerance.
Follow on formula
Follow on formula are available
for all of the 3 major protein types i.e. cow milk, soy and goat milk. These
are marketed for children over 6 months of age, as they have a relatively
higher protein and mineral and lower carbohydrate content than human milk.
Parental choice rather than nutritional need largely dictate their use.
Specialised infant formula
Specialised infant formula refer
generally to a group of formula used largely for infants with specific medical
conditions such as severe allergy or intolerance, fat or carbohydrate malabsorption
or maldigestion. This group includes formula with:
● Modified carbohydrate content used for lactose
intolerance and sucrose intolerance, or severe carbohydrate intolerance.
● Modified protein content including hydrolysed
whey and casein protein, and amino acid based formula used for severe dietary
protein allergy and intolerance and malabsorption and maldigestion disorders
such as short gut syndrome and severe failure to thrive. This group of formula
may have specific amino acid manipulation such as those used for metabolic
conditions such as phenylketonuria and Tyrosinemia
● Modified fat content including formula with high
concentration of medium chain triglycerides and lower levels of long chain
fatty acids required for cardiac conditions such as chylothorax, or gastrointestinal
disorders such as liver disease and protein losing enteropathy.
Premature infants also require additional energy and minerals, and human
milk fortifier or pre-term formulae are available to supply their nutritional
needs.
New developments
New developments in infant formula
are largely dictated by greater understanding of the role of unique ingredients
in human breast milk. This has seen the addition of a variety of new ingredients
in infant formula or breast milk substitutes over recent years. This includes
the addition of specific carbohydrates, fatty acids such as Docosahexaenoic
acid “DHA” and Arachadonic acid “AA”, and biologically active compounds
with immune enhancing effects.
Human milk is a rich source of
nucleotides: low molecular building blocks of DNA and RNA that have shown
to play a modulatory role in immunity, which has led the interest in fortification
of infant formulas. Nucleotides are prominent in the non-protein nitrogen
component of human milk, and previously have been virtually absent from
infant formula.
Nucleotides are believed to be
of benefit for the development of the gastro-intestinal tract and the immune
system. While nucleotide supplementation has been allowed in some countries
prior to its inclusion in formula available in Australia, there has been
inconclusive evidence that supplementation has led to a significant benefit
in well term infants. The type and amount of nucleotides in human milk varies,
ongoing research may help to determine the optimal land safe level of supplementation
in formulas.
