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 and home-made formula can be harmful

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 of quality control requirements.

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

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.

What is the best practice of formula feeding?

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

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 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.

To ensure the formula is prepared correctly, remember to:

• use the right scoop (the one that came with the tin)
• use level, lightly packed scoops (not over or under filling it or packing it in tightly)
• add water first and then the powder
• it’s also important not to add anything else to the bottle.

Babies should be fed on demand

All babies, whether breast or formula-fed, should be fed “on-demand” in response to signs of hunger. (being awake and alert, mouth opening, sucking hand or fist) rather than by the clock. Crying can also be a late sign of hunger, but babies cry for many reasons, so this is not always a cue to feed.

Responding to signs of fullness () is another important part of responsive feeding. For bottle-fed babies, it’s important parents attend to signs of fullness (such as turning away and closing the mouth) t to avoid pressuring their baby to finish the bottle.

This may override a baby’s innate ability to self-regulate their intake and may even impact later eating behaviours.

Babies will vary in how often they want to feed. Parents shouldn’t worry if their baby does not drink as much or as often as suggested on the tin – as long as they’re producing plenty of wet nappies, and are growing and developing normally.

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.

It’s important for parents to hold their babies when feeding, them rather than ‘propping’ them up with the bottle or putting them into their cot with a bottle. This is not recommended as it can be a choking hazard, lead to tooth decay, ear infections, unhealthy weight gain and disturbed sleep.

Sippy or training cups

It’s also recommended parents introduce a “sippy” or training cup at six months and aim to phase out bottles by 12 months of age.

Prolonged bottle use is associated with a higher risk of later overweight and obesity, along with other problems including tooth decay, ear infections, iron deficiency and speech difficulties.

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}