I think it is very important that we understand some basics about the content of infant formulas. In the US formula is regulated by the Food and Drug Administration (FDA) who requires that all standard formulas contain 29 ingredients. They set minima and maxima for some of these. However, formulas from different manufacturers have different fat blends and fatty acid profiles and have a number of additives that vary as to what they are and where they come from. Many claim to cure normal infant behaviors with the addition or removal of ingredients. We should be able to counter the claims made by formula manufacturers so that mothers are not deceived into thinking that formula is equivalent to breastmilk.


We have all run into health providers who wish to unnecessarily use infant formula to treat a baby with any number of issues. I have been running into the issue of speech therapy providers in the NICU wanting many babies to be given thickened formula to treat reflux and disregarding the importance of breastmilk for these babies. Breastmilk provides:



 
Increased     brain ganglioside and glycoprotein sialic acid concentration in human     milk-fed infants enhances developmental outcomes compared with formula-fed     infants (Wang et al., 2003). Human milk oligosaccharides are an important     source of sialic acid. Formula-fed infants receive only 20% of the sialic     acid that a breastfed infant receives and are unable to synthesize the     difference.
 
Lactose     (galactose+glucose) in breastmilk ensures an abundant supply of     galactocerebrosides that are needed for myelinization of the brain.     Infants fed soy formula or lactose-free cow’s milk formula consume a diet     lacking particular brain growth nutrients.
Preterm infants are vulnerable to conditions associated with oxidative stresssuch as necrotizing enterocolitis, chronic lung disease, retinopathy ofprematurity, periventricular leukomalacia, and intraventricular hemorrhage.Breastmilk has a much higher antioxidative capacity than infant formula andhelps neutralize oxidative stress in young babies 
Any preterm or full term infant who has been oxygen deprived during birth has experienced an insult to the brain and the gut. We would want a source of brain nutrients for these infants as well as milk that will not increase the risk of necrotizing enterocolitis. We should be able to make the case regarding the importance of human milk for infants and why the use of infant formula may not always be in the best interest of the baby. 


We should also be aware of formula preparation guidelines. While the instructions may be on the can, many parents do not read them. In the US, Spanish language instructions for formula preparation appear on the inside of the can label, which means that to read formula preparation instructions in Spanish you have to peel off the label. Powdered infant formula is not sterile. Water should be at 158 degrees to reconstitute the formula to kill any intrinsic bacteria that may be present, them cooled to be fed to the baby. These instructions do not appear on all formulas. If this hot water is used to reconstitute formula with probiotics in it (live bacteria) it kills the bacteria. So manufacturers  instruct reconstitution with much cooler water which will not kill pathogenic bacteria if they are present.


Failure to provide instructions on formula preparation leaves infants vulnerable to food borne illness. See:
Labiner-Wolfe et al. Infant formula-handling education and safety. Pediatrics 2008; 122(Suppl):S85-S90.


Knowing something about the potential hazards of formula use may help keep more babies on breastmilk and reduce  inappropriate supplementation.


Marsha Walker, RN, IBCLC
Weston, MA




 

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