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Although breastfeeding is the best option for an infant, cows’ milk based formula is recommended if breast feeding does not occur. Soy based formula is rarely indicated and is not necessary for an infant with a cows’ milk allergy or lactose intolerance. Hydrolysed cows’ milk formula and lactose-free or lactose-reduced cows’ milk formula can be used in these circumstances. View / Download pdf version of this article
While it is recognised that breastfeeding is the best option for mother and baby, some mothers cannot or choose not to breastfeed. General practitioners, practice nurses and other health professionals should have knowledge of infant formula so they can provide guidance for these mothers. Exclusive breastfeeding for around six months is ideal, at which time complementary foods can be introduced with continued breastfeeding until the infant is aged at least one year.1 All efforts should be made to encourage breastfeeding for as long as possible. Important considerations when infant formula is used:1
How does breast milk differ from formula milk?Breast milk is a complex nutritional food that contains antibodies, enzymes and hormones, all of which have significant health benefits. While the composition of formula milk is modelled on breast milk it cannot replicate it exactly.2 Breast is bestBreast milk is the preferred food for all infants. It is a nutritionally complete food and is all that is required for a baby's first six months of life. It has many beneficial effects for both mother and infant. See Table 1 for examples. Table 1: Beneficial effects of breast feeding for mother and infant1, 2
There are very few reasons not to breastfeedThere are only a few situations where breastfeeding is contraindicated such as infants with galactosemia, mothers receiving chemotherapy or mothers with HIV or uncontrolled tuberculosis. Prescribing for breastfeeding mothers2Maternal drug therapy should rarely constitute a reason to avoid breastfeeding. Caution should be used with the following drugs and the infant monitored:
Monitor the infant for evidence of adverse effects e.g. sedation, altered bowel habit. In New Zealand, the rates of breastfeeding do not reflect the vital role breastfeeding plays in an infant's development. Overall only 66% of infants are breastfed at six weeks and this decreases to only 25% by six months.1 Breastfeeding rates and use of infant formula among Māori1In 2006*, the rate of exclusive breastfeeding for Māori infants at six weeks of age was 59% compared with 66% of infants across all ethnic groups (70% for European infants, 55% for Asian infants and 57% for Pacific infants). Information from 2005* shows that the rates of infant formula use was highest for Māori infants across all age groups (25% at six weeks, 37% at three months and 49% at six months). "Whanau have the biggest influence on whether a mother breastfeeds or not, and provide the best support for the breastfeeding mother. The best way to improving breastfeeding statistics is through whanau, hapu and iwi development." - Raeleen de Joux, Māori Educator, New Zealand Breastfeeding Authority. Te Karaka 2008, Issue 39. Infant feeding definitions Infant formula - Formula intended as a substitute to breast milk for infants from birth to six months old. Follow-on formula - Formula that is marketed for infants aged from six months to 12 months. Complementary feeding - Foods fed to infants from around six months to complement breastfeeding or formula feeding. Types of formulaIn New Zealand, infant formula and follow-on formula must comply with the requirements of the Australia New Zealand Food Standards Code.3 This code contains standards for the composition of infant formulas so they meet the nutritional needs of a growing infant. Infant formulas differ depending on where the protein in the formula is derived. Infant formulas available in New Zealand are based on cows' milk, goats' milk and soy protein. Cows' milk-based formula is routinely recommended for feeding an infant who is not breastfedCows' milk-based formula is recommended as the first choice for feeding healthy infants who are not fully breastfed.4 The protein in cows' milk-based formula is derived from cows' milk. The carbohydrate component is generally provided by lactose, corn syrup solids and corn maltodextrin. Vegetable oil blends usually provide the fat component. Whey and casein are the two types of protein present in breast milk and cows' milk. Breast milk contains more whey than casein and this ratio changes over the course of lactation.1 Infant formulas vary in their composition and may be whey or casein dominant. There are many different commercially available cows' milk based formulas which are readily available from supermarkets and pharmacies. Some examples are S-26, Nurture Starter, Novalac 1, Nan 1 Gold Protect and Karicare Gold 1. Cows' milk formulas appropriate for infants aged up to six months often have "1" or "starter" in their name. Regular cows' milk is not suitable for infants aged less than one year Soy-based formula should not be used routinelyThere are only a few indications for the use of soy-based infant formula in place of cows' milk-based formula. These indications are: infants with galactosaemia, a rare inherited condition where infants are unable to metabolise galactose to glucose, or vegan infants who are not breastfed. The protein in soy-based infant formula is derived from refined soy protein isolate. Soy-based formula is free of lactose and cows' milk protein.1 However soy-based formula is not recommended for cows' milk allergy as 10-14% of infants with allergy to cows' milk protein will also have a soy protein allergy (see hydrolysed formula for recommendations).2, 4 Soy-based formula is not designed for or recommended for pre-term infants.14 Soy-based formula needs to meet defined standards for infant formula and requires fortification with the amino acid methionine. Soy-based formulas contain high concentrations of phytate, aluminium and phytoestrogens, for which the long term effects are unknown.4 Examples of soy-based formula are S-26 Soy and Karicare Soya. Goats' milk-based formulaGoats' milk formula is not suitable for infants with lactose intolerance, galactosaemia or allergy to cows' milk protein.1 It contains lactose and has cross-reactivity with cows' milk protein, which means that infants allergic to cows milk are also likely to be allergic to goats milk. The likelihood of cross-reactivity between cow and goat milk is approximately 90%.5 Specialised formula and additional ingredientsHydrolysed formula for cows' milk protein allergy There is some evidence for the use of hydrolysed formula for high risk infants (infants with at least one first-degree relative - parent or sibling - with diagnosed allergic disease) to prevent or delay the development of atopic dermatitis. Extensively hydrolysed formula may be more effective in preventing allergies than partially hydrolysed formula.1,7 The recently published German Infant Nutritional Intervention study confirms a preventive effect of hydrolysed infant formula persists until age six years.8 More research is needed into whether these benefits extend into late childhood and beyond. Hydrolysed formula carries a significant cost and referral to a paediatrician or allergy specialist is advised to obtain funding for them under special authority. Probiotics,
prebiotics and long chain polyunsaturated fatty acids Probiotics are live bacteria that colonise the gastrointestinal tract. When administered in adequate amounts they may improve gut barrier function and host immune response. There are many different strains of probiotics but the most common are Bifidobacterium or Lactobacillus species. Breastfed infants have been shown to have more Lactobacilli and Bifidobacteria in their intestines than formula fed infants. Prebiotics are food ingredients (usually oligosaccharides) that are resistant to digestion in the small intestine. They are fermented by beneficial bacteria in the large intestine selectively stimulating the growth of non-pathogenic bacteria in the colon such as Lactobacilli and Bifidobacteria. Breast milk contains oligosaccharides which have been shown to demonstrate a prebiotic effect in infants.9 Two systematic reviews in 2007 found that there was insufficient evidence to recommend the use of probiotics or prebiotics in infant formula for the prevention of allergic disease or food reactions.10 11 Long chain polyunsaturated fatty acids (LCPUFAs) are present in breast milk. LCPUFAs are important components of the phospholipids present in the retina and the brain and are also integral structural components of all cells in the body. Almost half the high lipid content of the brain is LCPUFAs. Since the mid 1990s LCPUFAs, have been the focus of much research. Early research suggested that infants fed a continuous supply of LCPUFAs, from either breast milk or a supplemented formula, may have improved visual functioning.12 For this reason LCPUFAs are now added to some infant formula. Although LCPUFA-supplemented infant formula seems safe, a 2007 Cochrane Systematic Review found that the results of most of the well conducted randomised controlled trials, have not shown beneficial effects of LCPUFA supplementation on the physical, visual and neurodevelopmental outcomes of infants born at term.13 Indications for switching formulaGenerally there is limited evidence for switching formula when infants experience symptoms such as vomiting, spilling, crying, diarrhoea or constipation.
Follow-on formulaFollow-on formula is designed for infants from 6-12 months. It is fortified with additional nutrients such as iron. However if an infant is thriving on the standard infant formula and eating a well-balanced complementary diet, switching to this formula is not usually necessary.2 Regular cows' milk is not suitable for infants aged less than one year. For infants weaned from breastfeeding after they are six months old and before 12 months old a follow-on formula may be an appropriate choice. When to refer to a paediatrician
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Make a comment:This article is 14 years and 3 months old.You may also like...What type of formula is available for infants with lactose intolerance?Two of their lactose-free formulas are Similac Sensitive and Similac Alimentum. These are milk-based formulas that are processed for lactose-intolerant infants.
What are the 3 types of baby formula?Three major types are available:. Cow milk protein-based formulas. Most infant formula is made with cow's milk that's been altered to resemble breast milk. ... . Soy-based formulas. Soy-based formulas can be useful if you want to exclude animal proteins from your child's diet. ... . Protein hydrolysate formulas.. Is Similac milk lactoseSimilac® Sensitive® Lactose Sensitivity is a milk-based formula designed for babies with lactose intolerance. We also offer Similac® Isomil®, a soy-based infant formula that is naturally lactose-free. As always, be sure to discuss with your health care professional before making changes to your baby's diet.
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