The topic of infant formula milk is often seen as a taboo topic for healthcare professionals due to the drive to improve breast feeding rates. Of course as a dietitian I think breast milk is the most wonderful “feed” available for babies and as far as possible this should be supported. The truth is though, that in spite of best efforts many mums are just not successful with breast feeding for numerous reasons. I get the impression from the mothers that I see in clinic, that they are made to feel guilty about this which is a shame.
Firstly, people think that the UNICEF Baby Friendly Initiative only includes guidelines on how to breast feed successfully and what hospitals need to do to achieve this status, but in 2014 further guidance was brought out by the UK UNICEF Baby Friendly Initiative which included the following points:
1. Mothers who give other feeds in conjunction with breast feeding are enabled to do so as safely as possible and with least possible disruption to breast feeding
2. Mothers who formula feed are enabled to do so as safely as possible
3. Mothers who bottle feed are encouraged to hold their baby close during feeds and offer the majority of the feeds the their baby themselves to help enhance the mother-baby-relationship
Nutritionally it is absolutely fine to combine breast and bottle feeding and for me as a dietitian it is crucial that parents get the correct information on how to make formula feed choices and how to prepare these formulas. First I would like to give some more information on formulas that are currently available. In the EU, the ingredients of formulas are strictly regulated for protein, energy, vitamins and mineral content, which need to be within ranges that are provided by the EU Directive. This means, that in general formulas will have a very similar content. All feeds by law also need to contain LCP – meaning long chain phospholipids (essential fatty acids) but there may be some slight differences in regard to prebiotic contents and some micronutrients.
In general you can divide feeds into 2 categories: whey or casein dominant. Whey protein is the main protein in breast milk, so first infant formulas (< 6 months or usually have the name followed by 1 or first) are whey dominant. This protein empties the stomach like a liquid and does not curdle. Now in theory you can continue on these formulas until your child is 1 year of age, because your breast milk remains the same protein throughout.
Then you get casein dominant formulas – these are also called formulas for “hungrier babies” or follow on formulas (number 2 or the tin says follow-up/growing up). These formulas should not be used < 6 months of age. Casein, is another cow’s milk protein, that curdles and it empties the stomach like a solid. That means it may keep your child more satisfied, not because of more calories in the feed, but because the protein remains in the stomach longer. This feed may in some cases make the stools much harder, so you should not be surprised if this happens. As mentioned before, in theory there is no reason why you need to change to this formula. The only aspect that I think make it worth-while in certain situations is when more iron and vitamins are required. Follow-on formulas outside of their different protein, have more iron and vitamin D in particular. There is some low level evidence that it may help with iron status in populations where iron intake is lower (i.e. vegans).
Infant formula milk is recommended as main drink for babies up to 1 year of age, because the introduction of cow’s milk before this age has been linked to the development of iron deficiency anaemia. You can from 6 months use cow’s milk for cooking, but please do not replace your formula until 1 year of age, when your child should have a nutritionally complete diet. I know there are now toddler formulas available that go up to 3 years of age. I rarely use these formulas in my practice as there is very limited evidence that they provide any benefit in a child where food intake is good.
I think this is enough for today’s blog entry, but will write next week on mixing of feeds and feed volumes…….
