Thursday, October 7, 2010

Which Infant Formula?

Of course we all suggest that breastmilk is best when feeding a newborn child, but what happens when you cannot breastfeed or express milk and now you have to look at the infant formula market? Which formula is better for your baby?

The latest information from the American Academy of Paediatrics (2009) suggests that certain formulas should be used for certain types of child. It is important to note any familial allergies, current symptoms of fussiness, reflux, gas and type of stool (soft, hard runny, bubbly) when taking into consideration each type of infant formula. The AAP suggests that all children under 12 months should be breastfed or be fed using an iron-fortified infant formula. They suggest that the child older than 12 months should be given whole milk, not skimmed or semi-skimmed.

The typical infant formula that is suggested to be the routine in all babies is the Standard milk-based formula. These formulas have been derived from cows-milk protein and changed to be similar to breast-milk. Lactose and minerals from the cow's milk, as well as vegetable oils, minerals, and vitamins are also in the formula. The American Academy of Paediatrics suggests that the majority of children will do well on this formula. They advise that fussiness and colic symptoms are typically not related to the infant formula, and it is not necessary to switch to a different formula in such cases.

Commonly, from my experience, it is usually the action of changing the infant formula that tends to be the issue than the actual formula itself. It seems to take the child’s digestive system approximately a week to normalise after the change of a formula, which during this time will commonly entail a shift between loose stools through to hard through to soft again. It is usually 2 or 3 days into the change that the parents see that ‘oh no, the child is constipated now’ with the harder stools and then go and change the formula yet again...creating another cycle of issues. If you are not sure whether this is the right formula for the child, wait for a week. Unless you get frothy, extremely pungent stools, which in this case, it’s probably lactose intolerance and best to ask the advice of your medical practitioner.

If your child has been diagnosed with galactosemia, or congenital lactase deficiency, then the soy based formulas are suggested. These formulas are derived from soy and do not contain lactose. They are also designed for the family who does not want their child to consume animal-derived protein. For the baby who may be allergic to cow’s milk it is not always that they will not be allergic to soy as well. Soy based formulas have not been shown to be helpful for milk allergies or colic. Most of the time soy based formulas are used as an alternative, due to the high expense of the hypoallergenic formulas. Research suggests that the evidence is still out there on the effect of the phyto-oestrogen content of the soy products. These increase the isoflavone serum levels (in the blood) which when administered directly to animals can cause decrease in fertility. However,clinically relevant adverse effects of soy formulas in infants are not reported. 

Hypoallergenic formulas are designed for the true allergy to milk protein baby, or wheezes, or skin rashes from allergies. They contain extensively hydrolysed proteins that are less likely to stimulate antibody production in the child, hence aiming to decrease the allergic reaction to the formula.

Lactose-free formulas are ones that are specifically for congenital or primary lactase deficiencies, or galactosemia children. Please take note that lactase deficiency can only be diagnosed when the child is over 12 months old using special tests.
A child who has an illness with diarrhoea does not necessarily need a lactose-free formula. Though, a temporary lactase deficiency can arise after an acute bout of gastroenteritis, soy and lactose-free formulas shorten the bout of diarrhoea, but do not change the overall recovery or weight gain in the following 2-week period.

Anti-Reflux formulas are thickened with rice starch and are designed to be used for the reflux child who is not gaining weight or who is very uncomfortable. They are shown to decrease vomiting/regurgitation, but have not been shown to affect growth or development.

There are also special premature and low birth weight formulas that are designed for the premie. These contain extra calories and minerals to aid the child who needs to put on weight.

Interestingly, the formulas designed for Toddlers who are picky eaters, have not been shown to be any better than whole milk and multivitamins.

Reference:

O'Connor NR (2009). Infant formula. Am Fam Physician.79:565-570.

Vandenplas Y (2010). Soy infant formula: is it that bad? Acta Paediatrica. Sept 22.