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Is infant formula a substitute for breastmilk?

When breastmilk is not an option, infant formula is the only suitable alternative.

Historically, parents have been advised to make up their own infant formulas using a range of products.

For example, Dr Benjamin Spock, a famous and respected US paediatrician, advised parents in the 1940s and 50s to make their own infant formulas using combinations of milk, sugar and water.

While the intentions here may have been good, this was not an appropriate substitution for breastmilk.

Why can’t an infant just drink regular cow’s milk or evaporated cow’s milk?

Overall, cow’s milk (or evaporated milk) is simply too different to human breast milk to be suitable for human infants. It contains three times the protein of human milk, less carbohydrate and lower levels of a range of vitamins (eg vitamins A, C, D, E, niacin) and iron.

The very different composition of cow’s milk puts a baby’s growth and kidney function at risk. For these reasons, cow’s milk is not recommended as a major source of nutrition until a child turns one.

Infant formulas are usually derived from cow’s milk, but have been altered in many ways to better copy human breastmilk. Regulated infant formulas are the only suitable substitute for breastmilk but they must meet stringent standards if they are to be safe substitutes for breastmilk.

Are there any global standards and regulations that I can refer to?

At the global level, the Codex Alimentarius Commission has developed a widely regarded minimum standard for infant formula which includes a list of required ingredients and outlines a number quality control requirements.

In Australia, infant formula composition and labelling are regulated through the Food Standards Code.

This push for regulation reflects the fact that the substitution/replacement of a mother’s breastmilk with a home-made alternative can, if not regulated, be detrimental to a child.

Is infant formula equivalent to breastmilk?

Apart from the nutritional differences between infant formulas and breastmilk, there are two very important additional considerations.

Firstly, infant formulas lack the distinct bioactive molecules that protect humans against infection and inflammation and contribute to immune maturation, organ development and healthy microbial colonisation.

Secondly, infant formula is homogenous in composition, meaning the last sip the baby takes is the same as the first sip. In contrast, breastmilk is a dynamic, bioactive fluid that changes in composition from the colostrum produced at birth to the milk produced in later lactation.

Breastmilk composition also varies during feeds and across the day.

Are there problems associated with using infant formula?

When it comes to introducing infant formula, there are few important things to keep in mind.

Microbial contamination

The risk of infection among formula-fed babies is greater than among those who are breastfed. This is partly due to the absence of a mother’s antibodies and partly due to the risk of the infant formula being contaminated by the water added to it. To reduce the risk of infection from infant formula, it must be made with cool boiled water and then be refrigerated. Pre-prepared infant formula should not be kept for longer than 24 hours.

Incorrect preparation

Incorrect preparation of feeds can lead to an intake of too many or too few kilojoules (energy). The number of scoops required and the size of the scoops vary between brands, and this can cause confusion. Given this, it is important to follow the manufacturer’s advice as printed on the label.

Consuming more food than is required

While breastfed infants can regulate their milk intake, formula-fed babies are likely to be encouraged to finish the amount of milk that’s been prepared, that is, to finish the bottle.

While there is only a small amount of research comparing intakes, it appears that breastfed infants tend to consume less milk than formula-fed, and this may affect their risk of becoming overweight.

Most infant formulas contain substantially more protein than breastmilk and it’s considered that this increased protein content may promote increased rates of overweight and obesity in formula-fed children. Human breastmilk contains 1–1.1g protein per 100mL compared to 1.3–2.0g protein per 100mL in infant formulas available in Australia (NHMRC, 2012).

The Australian Infant Feeding Guidelines recommend parents choose an infant formula with a lower protein level.

Your task

Join the conversation to share your thoughts about the use of infant formula. For example:

  • When do you think it’s appropriate to include infant formula in a baby’s diet?
  • What do you think about the use of homemade infant formulas?
  • What questions, tips or advice do you have about overcoming some of the problems associated with the use of infant formula?

Reference

National Health and Medical Research Council. (2012). Infant feeding guidelines: Summary. Canberra: National Health and Medical Research Council. Retrieved from https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/170131_n56_infant_feeding_guidelines_summary.pdf

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Infant Nutrition: from Breastfeeding to Baby's First Solids

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