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  • Denise Scott

Breastfeeding and Formula Feeding

Whether to breastfeed or formula-feed your baby is your personal choice. The American Academy of Pediatrics and the World Health Organization promote breastfeeding exclusively for six months and up to a year or longer. Breastfeeding during the first few months passes antibodies and immunity to your newborn to protect them from illnesses until their immune system develops and they can be vaccinated.


Breast milk contains all the nutrients your baby needs for the first six months and is free and readily available. It promotes a healthy digestive system and may reduce the incidence of SIDS. Breastfeeding may also reduce the risk of certain diseases in the mother.

Young mother nursing her infant. Breast milk has all the nutrients an infant needs for the first six months.


That being said, and after many years of practice, I know that breastfeeding is not practical for many mothers. I even had some moms whose milk never came in. Even if you breastfeed, you may need to supplement with formula at some point. Formula exists for those who cannot or choose not to nurse. Breastfeeding does not work for everyone, and a baby will thrive whether fed breast milk or formula. The last thing anyone should do is cause a new mom to feel guilty regarding her choice of feeding her baby. That decision is the mother’s to make.


This article is to help sort through the plethora of infant formulas, as the choices are confusing. Just walk down the formula aisle at the grocery store, and you’ll understand. The selection is complicated for pediatricians and overwhelming for parents. There are too many variations available. I will pass on some guidelines for making your selection.

A woman looking at an infant formula label among the shelves of baby formulas. The choices are endless!


Some formula companies have researched infant nutrition; others have piggy-backed on what is already out there. The goal has been to make a formula that is closer and closer to breast milk in composition. There used to be far fewer companies and formulations available - now there are U.S.-based and European options; some are very similar while others are quite different.


Baby formula is 98% protein, carbohydrates, and fats (macronutrients). I will outline some differences based on the macronutrient components, highlight some micronutrients, and discuss organic selections. The choice is yours, but this will give you some knowledge in choosing.


Protein

Picture of a cow grazing (above) and a bowl of soybeans (below). Cow's milk or soybeans are the main sources of protein in formulas.


The primary differences in protein come either from the

source - cow or soybean

and the

size - intact or hydrolyzed (meaning the whole protein is broken down into smaller pieces).


What is designated as milk protein isolate, or soy milk isolate, is the whole, intact protein. These intact proteins are bigger than breast milk proteins. Most babies can digest these proteins fine, but for others, it can be hard on their digestive system. Only in specific diseases, such as galactosemia, can a baby not have any lactose from either breast milk or formula.


There are two types of milk proteins: whey and casein. Formulas often contain both of these in different ratios. The whey:casein ratio in breast milk is 60:40; in animal milk, it is around 20:80. Formulas add additional whey protein, so the whey to casein ratio to look for is 60:40 or 50:50. Whey protein stays liquid in the stomach, so will pass through the stomach more quickly than casein. Formulas that are developed for reflux usually contain only whey protein. Whey is not necessarily better than casein but may be easier to digest.


Young infant being bottle fed by parent. Most babies will tolerate most formulas.


Hydrolyzed or partially hydrolyzed formulas have the milk protein broken down into smaller pieces, making it easier to digest. This will be stated as “partially hydrolyzed” on the container.

Fully hydrolyzed protein formulas are considered specialty formulas and used for digestive issues after a doctor’s recommendation.


Carbohydrates


The primary carbohydrate in cow’s milk formulas is lactose which is also in breast milk. Most babies can digest this, so we usually start with a milk-based formula.

Soy formulas have several carbohydrates, including glucose, sucrose, maltodextrin, and corn syrup. Corn syrup, corn syrup solids, glucose syrup, brown rice syrup, and maltodextrin are all different types of glucose sugars that may be found in soy formula. Soy formulas are lactose-free and are considered vegan. I recommend minimizing corn syrup and corn syrup solids.


Fats


The fats in a formula consist of a blend, including palm oil, coconut oil, and high oleic sunflower oil or high oleic safflower oil. Even though palmitic oil is in breast milk, the palm oil used in formula is not the same as in breast milk. The palm oil in formula can decrease calcium and fat absorption in infants and may cause firmer stools.


Where to Start?


Typically, pediatricians recommend choosing a milk-based formula to start and one with intact proteins. If possible, we prefer staying with the same formula for at least two weeks unless there are significant issues. Simply existing from inside to outside the womb is a huge transition, so we don’t like to make changes too quickly. Any concerns regarding feedings should be discussed with your doctor.


If a change is needed, it makes sense to try a partially-hydrolyzed formula as the next step. This way, you keep the carbohydrate the same, and the protein is from the same source, only smaller.


What About Goat Milk Formula?


Recently the American Academy of Pediatrics expanded their formula recommendations to include goat milk-based formula. There are several formulas with companies based in other countries, such as The Netherlands and Australia, that have U. S. Food and Drug Administration (FDA) approval. The AAP first recommends either a cow's milk or goat's milk formula before soy formulas. Soy formulas are good choices for those with an allergy or intolerance to dairy.


Reportedly, goat milk casein is closer to human breast milk casein and goat milk contains more diverse prebiotics than cow's milk. Soon we will likely see more goat milk-based formulas available, but currently they are a more expensive option.


Other Additives


Further confusion is created by all the additional ingredients, supposedly to improve the formula and make it closer to breast milk, which is the gold standard. These extras may or may not make a difference and can be more expensive. The additions that make the most sense are DHA and ARA, which are omega-3 fatty acids that are good for the brain and exist in breast milk. Another good addition is HMOs (human milk oligosaccharides), which are prebiotics that can boost the beneficial bacteria in the gut microbiome.


These are not necessarily a deal-breaker, but if they exist in your formula of choice and are affordable, go for it.


All baby formulas marketed in the U.S. have to go through strict FDA approval. This includes minimum and maximum amounts of nutrients.


What about Organic?


For a formula to be certified organic, at least 95% of the ingredients must be organic. The nutrient components are the same, whether organic or not, but the source and processing of these components are different. Organic formulas are non-GMO and may not have some of the additives or preservatives that non-organic formulas contain. They offer less exposure to pesticides and chemicals but are more expensive, like other organic foods. Some organic formulas come from Europe and are not regulated by the FDA. There are several USDA-certified and FDA-approved organic formulas sold in the U.S.

The bottom line is that the protein, carbohydrates, and fats are more important than organic or non-organic.


Should I Buy a Formula with Iron?

The word iron spelled out in tiles on a red background. Iron is a vital nutrient added to infant formula.


Yes! Babies need iron, and there is no reason to buy formula without this vital mineral.


What about Generic Brands?


Many generic brands are fine and can be cost-saving. However, when it comes to the partially hydrolyzed formulas, some generics use a blend of full-size and partially hydrolyzed proteins, so look for the designation of 'partially hydrolyzed' on the label.


There have been three primary companies who have done the bulk of research on baby formulas - Enfamil, Similac, and Carnation - many of the other companies have based their formulas on the work these companies have achieved.


The Bottom Line


I am not here to endorse one brand over another, but I do recommend the following:

  • A cow’s milk-based or goat's milk-based formula with a whey-to-casein ratio of 60:40 or 50:50 (partially hydrolyzed formulas are fine but would not start with these)

  • Lactose as the primary carbohydrate (milk-based formulas all have this)

  • Formula with low or no palm oil or palm olein oil

  • Minimize corn syrup and corn syrup solids

  • Formula with iron

  • Formulas with DHA, ARA, and HMOs

  • Organic, if affordable, but only if corn syrup or its solids are not the main carbohydrate

Bottle of formula with a measuring spoon. Whatever formula you choose, be sure to mix correctly according to directions.


Discuss your decision with your pediatrician, who can give further guidance. Most babies will do fine on most formulas, but your doctor is a wonderful resource.


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1 Comment


kalasigler
Jan 10

Great review!

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