Feeding Baby : Formula Choices, Vitamins

by Food and Drug Administration (FDA)

(Page 2 of 3)

Formula Choices

The most common sources of protein in infants formulas are either cow's milk or soybeans. "For term infants, soy formulas appear to be as nutritionally sound as milk-based formulas, and their use is unlikely to expose infants to nutritional risk," wrote pediatrician Samuel J. Foman in 1987 in the American Journal of Clinical Nutrition. Baylor's Schanler agrees, but says that there is some question about whether the minerals in soy-based formulas can be used by the infant's body as well as those from cow's milk formula.

For a healthy, full-term infant, "cow's milk formula would be the first choice," Schanler says. "The only indication that I see for soy is for babies with lactose intolerance."

Lactose, also known as milk sugar, is the main carbohydrate in milk. Infants who don't have enough enzyme lactase to digest may suffer from abdominal pain, diarrhea, gas, bloating, or cramps. There is no lactose in soy formula.

Schanler does not think soy formula is a good choice for infants with milk allergies, however. "If there is a real history of milk allergy in the family, the baby might be allergic to soy, too," he says. Instead of soy, Schanler recommends special cow's milk formula known as protein hydrolsates, which won't cause allergic reactions because the proteins are already broken down. "That way the chance of a cross reaction with the soy protein is eliminated," he explains.

Both milk and soy formulas are available in powder, liquid concentrate, or ready-to-feed forms. The choice should depend on "whatever the parents find convenient and can afford, " says Schanler.

Whatever form is chosen, proper preparation and refrigeration are essential. Opened cans of ready-to-feed and liquid concentrate must be refrigerated and used within the time specified on the can. Once the powder is mixed with water it should also be refrigerated, if it is not used right away. The exact amounts of water recommended on the label must be used. Under-diluted formula can cause problems in the infant's organs and digestive system. Over-diluted formula will not provide adequate nutrition, and the baby may fail to thrive and grow.

Warming the formula isn't necessary for proper nutrition, says William MacLean, M.D., a pediatrician at infant formula manufacturer Ross Laboratories. "There is nothing magical about having [the formula] warmed up to body temperature," he says. "But if it's cold, some babies may refuse it. It's the baby's preference."

Bottles should not be heated in the microwave oven because the ovens do not heat evenly, MacLean warns. "The drop a mother tests on her wrist could be fine," he says. But, he explains, undetected "hot spots" in the formula could seriously burn the baby.

The best way to warm a bottle of formula is by placing the bottle in a pot of water and heating the pot on the stove, according to Christine Watson, a nurse who specializes in maternal and newborn care at Shady Grove Adventist Hospital in Gaithersburg, MD. "You can also run hot tap water over the bottle, but that isn't very quick.

Vitamin Supplements — Yes Or No?

The American Academy of Pediatrics says "the normal breast-fed infant of the well-nourished mother has not been shown conclusively to need any specific vitamin and mineral supplement. Similarly, there is no evidence that supplementation is necessary for the full-term, formula-fed infant and for the properly nourished normal child."

Many physicians recommend supplements, nevertheless — especially for breast-fed infants. "There is definitely some controversy here," says Wallingford.

The controversy on supplements usually revolves around the following:

IRON — Although the amount of iron in breast milk is very low (0.3 milligrams of iron per liter), the infant absorbs almost half. In contrast, while iron-fortified formulas contain 10 to 12 mg per liter, babies absorb only 4 percent, amounting to 0.4 mg per liter to 0.5 mg per liter. In either case, those amounts of iron are adequate for the first 4 to 6 months, according to the American Academy of Pediatrics.

In the past, there was the concern that iron-fortified formulas could cause gastrointestinal problems such as colic, constipation, diarrhea, or vomiting. But based on several studies over the past 10 years, the American Academy of Pediatrics does not believe there is any evidence connecting these problems to iron and recommends that iron-fortified formula be used for all formula-fed infants.

VITAMIN D — Insufficient vitamin D can cause rickets, a disease that results in softening and bending of the bones. Although the amounts of vitamin D in breast milk are small, rickets is uncommon in the breast-fed term infant. This may be because, like iron in breast milk, the vitamin D in breast milk is easily absorbed by the baby.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.