Choosing the most suitable baby formula

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

The end result of the many studies on infant growth and nutrition has been the production and vast improvement in infant formula. So today, the number of safe and practical alternatives to breast milk available seems limitless.

Formula is monitored for safety and the manufacturers must test each batch of formula to make sure it has the required nutrients. It is also tested to guard against inadvertent contaminants such as lead or pesticides.

There are three main types of infant formula, which are cow's milk, soy-based and protein hydrolysate. Most infants are given one of these types. However, there are special formulas for premature babies or special disease, which we will not talk about today.

Let's start with cow's milk formula. Most infant formula is based on cow's milk that closely mimics breast milk. The process ensures that the formula has the right amount of carbohydrates and the right percentages of protein and fat.

Infant formula, like breast milk, is designed to be an energy- rich food because infants have very high energy requirements. More than half its calories are from fat. Many different types of fatty acids make up fat, and those that go into infant formula are specifically selected because they are similar to those found in breast milk. These fatty acids help in the development of the brain and nervous system as well as in meeting your baby's general energy needs. The butterfat naturally found in cow's milk is replaced with certain vegetable oils to provide essential fats.

Standard cow's milk formulas contain many vitamins, but most are relatively low in iron. Infant formulas are available with and without supplementary iron.

Iron deficiency is generally not a risk in the first few months, but it can occur later in the first year. Many physicians recommend starting formula-fed infants right off with iron- fortified formula. Others prefer to begin iron supplementation after a few months.

Soy-based formula is an alternative for babies with lactose intolerance.

Lactose is a sugar naturally present in milk. The ability to digest lactose depends on the presence of an enzyme called lactase. A small percentage of infants are born without the ability to digest lactose, the symptoms of which are abdominal cramps, bloating, watery diarrhea and excessive gas if they drink more than a small amount of milk. For these babies, soy formula is the food of choice.

Parents sometimes consider switching to soy formula when a baby has colic, spits up or is fussy. But the truth is some fussiness and irritability is normal for newborns.

If you choose to give your baby a soy product. Be sure to choose a soy infant formula, not soy milk. Soy milk is not nutritionally adequate for infants. Some parents will switch from cow's milk because of an allergy to soy-based formula, which is not the right choice because a large number of infants allergic to cow's milk are also allergic to soy proteins. That is why we have other kinds of formula, such as protein hydrolysate formula.

For infants who come from families with a strong history of milk allergy, an alternative to standard formulas is a special cow's milk formula known as protein hydrolysate formula. Protein hydrolysate formula is less likely to cause allergic reactions because the proteins in it have been broken down in a process that mimics digestion. Unfortunately protein hydrolysate is quite expensive.

Cow's milk should never be given to young infants as a substitute for breast milk or formula. Although it has about the same number of calories as breast milk, it has about three times as much sodium and three times as much protein. The protein in the milk is foreign to the baby and can cross through the immature, highly permeable intestine into the baby's circulation, potentially leading to allergic conditions.

Additionally, cow's milk may not contain sufficient fat. Infants have a need for fat. It is especially important for the developing brain and it is an important source of calories.

Breast milk is still the best choice. Next week we will talk about how to prepare a water supplement in bottle-feeding.