Nutrition - Infant
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Infant Formula FAQs
WHICH FORMULA BRAND SHOULD I CHOOSE?
Remember that all infant formulas sold in the US have met FDA approved nutritional standards. The most widely popular brands on the market today are:
· Enfamil Neuropro - contains MFGM proteins and DHA fats which are important components that naturally occur in human breast milk, and that support neurodevelopment. This formula most closely mimics breast milk. It has an average annual cost of $1400.
· Similac Advance – Tends to be the more affordable option with an average annual cost of $1350. The formula includes a second oligosaccharide sugar compared to Enfamil, which can make it tastier for babies. Similac may be preferable if price or taste tolerance are inhibitory.
· Gerber good start – Unlike similac, it does not contain DHA or carotenoids that support brain and eye development. This brand also tends to be pricer than the other two at an average annual cost of $1500. Some consumers may opt for Gerber for its larger variety of vegan options.
Each brand also has options for fussier babies who are more prone to gas and spit up. The respective sub-brands are Enfamil Neuropro Gentlease and Similac Sensitive.
ARE SOY-BASED OR HYPOALLERGENIC FORMULAS BETTER FOR MY BABY?
Breast milk remains the optimal source of nutrition for all babies in the first six months of life, regardless of risk for food allergies. After six months, studies comparing soy formula over conventional cow’s milk formula have not shown a significant benefit for preventing allergies. Studies comparing the benefits of hypoallergenic protein hydrolysate formulas over conventional cow’s milk formula have been weak and inconclusive. Nevertheless, almost all fomular brands offer soy-based and hypoallergenic options. Some examples of the latter are Enfamil Neutramigen Hypoallergenic and Similac Alimentum Hypoallergenic. For babies who still exhibit symptoms on an extensively hydrolyzed formula, the next line of hypoallergenic options is an amino-acid formula, which are expensive and unpalatable.
DOES MY BABY NEED ORGANIC FORMULA?
Many parents question whether organically grown food is safer when it comes to pesticide use and hormone exposure. Research shows that the risk of pesticide contamination that exceeds the maximum-allowed safety limits is small in organic and non-organic foods, as pesticide use is strictly regulated by the FDA. Organic formula has not been shown to be related to changes in health benefit compared to non-organic formulas. In the evaluation of cow’s milk, organic milk has levels of bovine growth hormone comparable to conventional versus organic milk, as in both cases, 90% of the hormone is destroyed during pasteurization. Furthermore, the hormone is inactive in humans, so would not be expected to have hormonal effects. In meat consumption, sex steroid treatments used in livestock have not been shown to trigger early puberty children.
DOES MY BABY NEED VITAMIN SUPPLEMENTS?
Yes, infants should receive the following vitamin supplements:
· Vitamin D – 10mcg daily for all breastfeeding infants daily. For formula-fed infants, supplement vitamin D until the infant is drinking at least 1 liter of vitamin-D fortified formula daily
· Iron – 1 mg/kg for all full term breastfed infants starting at 4 months of age and until iron-rich foods are introduced into diet; 2mg/kg for premature and low birth-weight infants
· B12 supplementation is required for infants on strictly vegan diets
CAN I SUBSTITUTE COW’S MILK IN PLACE OF BREASTFEEDING OR FORMULA FEEDING?
No. Cow’s milk and other milk alternatives should not be introduced until 12 months of age. Cow’s milk lacks the necessary nutrients which infants need, and also has proteins that may put young infants at risk for FPIES intestinal bleeding. When it comes time to introduce cow’s milk at age 1, whole milk is advised because it supplies adequate fat content which is necessary for healthy brain development. Two cups of dairy daily are recommended.
HOW DO I KNOW MY BABY IS EATING ENOUGH?
Full term infants require 110 kcal/kg daily. The calorie content of breastmilk and standard formulas is 22kcal/oz. Thus, in order to provide adequate caloric nutrition, feed volume should be 5oz/kg daily (~2.5 oz/lb). So an 8lb baby should be eating 20 oz of formula daily.
WHEN SHOULD I START GIVING MY BABY SOLID FOODS?
Complementary foods can be optimally introduced at 4-6 months, as this is the time period when infant’s dietary requirements surpass what can be provided solely through milk and formula. For exclusively breastfed infants, breast milk provides enough caloric and nutritional content for infants until 6 months of age, and there has been benefit shown in delaying until this time point to preventing GI infections.
References
1. Centers for Disease Control and Prevention. National Center for Health Statistics. Growth charts. http://www.cdc.gov/growthcharts. Accessed March 20, 2022
2. Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011
3. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary guidelines for Americans 2015–2020. Eighth edition. http://health.gov/dietaryguidelines/2015/guidelines/. Accessed March 20, 2022
4. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012
5. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012
6. American Academy of Family Physicians. Breastfeeding, family physicians supporting (position paper). https://www.aafp.org/about/policies/all/breastfeeding-support.html. Accessed March 20, 2022
