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Human milk is the preferred feeding for all infants: This includes premature and sick newborns, with rare exceptions. Pediatricians generally advise that full-term, healthy infants exclusively breastfeed when possible for the first 12 months of life and, thereafter, for as long as mutually desired. Advantages of breastfeeding include: (1) breast milk is nutritionally sound and easy to digest; (2) breastfeeding is believed to enhance a close mother-child relationship; and (3) breast milk contains infection-fighting antibodies (immunoglobulins) that may reduce the frequency of diarrhea, gastroenteritis, otitis media (ear infections), and other respiratory infections in the infant. Please see the Breast Feeding article for more information.

Some parents choose formula-feeding either because of personal preference or because medical conditions of either the mother or the infant make breastfeeding ill-advised. Parents need not feel guilty for choosing formula-feeding. Infant formulas are a time-tested, perfectly acceptable alternative to breastfeeding. Even though formula-fed babies do not receive infection-fighting antibodies from the breast milk, they still will have received a four- to six-month supply of these antibodies through the maternal bloodstream prior to delivery. Remember also that the majority of breastfeeding infants end up on a combination of breast- and formula-feedings before their first birthday. Some common reasons for choosing formula-feeding include:

There is an inadequate supply of maternal breast milk: A significant reason for not breastfeeding is concern about transferring certain drugs the mother is taking due to a medical problem through the breast milk to the infant. Examples of medications that are considered unsafe for the baby include cimetidine (Tagamet), cyclophosphamide (Cytoxan), lithium (Lithobid), gold salts, methotrexate (Rheumatrex, Trexall), metronidazole (Flagyl), cyclosporine, and bromocriptine (Parlodel). Numerous other medications have not yet been adequately studied in the context of breastfeeding and the possible effects on the baby. Mothers may choose bottle-feeding rather than risk any potential effect on the baby.

An increasing number of mothers must return to work shortly after their baby's delivery. Formula-feeding offers a practical alternative for mothers who may not be able to breastfeed due to work schedules. Formula-fed babies often need to eat less frequently than do breastfed babies because breast milk moves through the digestive system more quickly. Thus, breastfed babies may become hungry more frequently. A benefit of bottle-feeding is that the entire family can immediately become intimately involved in all aspects of the baby's care, including feedings. The mother can therefore get more rest, which can be critically important, especially if the pregnancy and/or delivery were especially difficult.

In order to achieve appropriate growth and maintain good health, infant formulas must include proper amounts of water, carbohydrate, protein, fat, vitamins, and minerals. Each of these components is discussed below. The three major classes of infant formulas are milk-based formulas, which are prepared from cow milk with added vegetable oils, vitamins, minerals, and iron. These formulas are suitable for most healthy full-term infants and should be the feeding of choice when breastfeeding is not used, or is stopped before 1 year of age. Soy-based formulas, which are made from soy protein with added vegetable oils (for fat calories) and corn syrup and/or sucrose (for carbohydrate). These formulas are suitable for infants who cannot tolerate the lactose (lactose intolerant, see below) in most milk-based formulas or who are allergic to the whole protein in cow milk and milk-based formulas. The American Academy of Pediatrics recommends the use of soy formulas for the above infants as well as for infants of parents seeking a vegetarian-based diet for a term infant. These formulas are not recommended for low-birth-weight or preterm infants or for the prevention of colic or allergies.

 

Notice to Human milk compared to Infant formula milk powder

 

Water: Water is an important part of a baby's diet because water makes up a large proportion of the baby's body. When properly prepared, all infant formulas are approximately 85% water. Infant formulas are available in three forms: liquid ready-to-use, liquid concentrate, and powder concentrate. Liquid ready-to-use formulas do not require the addition of water, while the liquid and powder concentrates require the addition of water.

It is of prime importance for parents to read, understand, and follow the manufacturer's directions when adding water to liquid and powder concentrates. Adding too much water to these concentrates or adding water to ready-to-use formulas can lead to water intoxication in the baby. In severe cases, water intoxication can cause low blood sodium levels, irritability, coma, and even permanent brain damage. Conversely, failing to adequately dilute the concentrates with water causes the formulas to be too concentrated, or "hypertonic." Hypertonic formulas can induce diarrhea and dehydration. In extreme cases, ingestion of overly hypertonic formulas can lead to kidney failure, gangrene of the legs, and coma. Therefore, parents should not adjust the amount of water that is added to concentrates to either "fatten the baby up" or "put the baby on a diet." Instead, parents should discuss their concerns regarding the baby's calorie intake with his/her pediatrician.

Carbohydrates: Carbohydrates (glucose, lactose, sucrose, galactose, etc.) are sugars or several sugars linked together. Carbohydrates provide energy (calories) for the brain tissues, muscles, and other organs. Lactose is a carbohydrate consisting of glucose linked to galactose. Lactose is the major carbohydrate in human breast milk, cow milk, and in most milk-based infant formulas.

Proteins: Proteins contain different amino acids that are linked together. Proteins provide both calories and the amino-acid building blocks that are necessary for proper growth. The protein in human milk provides between 10%-15% of an infant's daily caloric need. Casein and whey are the two major proteins of human milk and most milk-based formulas. (Immunoglobulins, a type of protein unique to breast milk, provide infection-fighting immunity and are not considered as a nutritional source and are not efficiently metabolized.) While formulas from different manufacturers may vary slightly in the relative proportion of these two proteins, healthy babies generally thrive on any milk-based formula brand.

Some 0.5%-7.5% of infants have a true allergy to the cow proteins that are in milk-based formulas. Infants with true cow milk allergy can develop abdominal pain, diarrhea, rectal bleeding, skin rash, and wheezing when given milk-based formulas. These symptoms will disappear as soon milk-based formula is removed from the diet. Allergy to cow-milk protein is different from lactose intolerance. Treatment of cow-milk-protein allergy involves using formulas that contain no cow milk or using formulas that contain "predigested" casein and whey proteins. The predigesting process breaks the whole proteins into smaller pieces or into amino acids. The amino acids and smaller protein pieces are hypoallergenic (do not cause allergy).

Soy-protein formulas contain no cow milk and are reasonable alternatives for infants with true cow-milk allergy. Since most soy-protein formulas also contain no lactose, they are also suitable for infants with lactose intolerance. The carbohydrates in soy-protein formulas are sucrose, corn-syrup solids, and cornstarch or glucose polymers.

Fat: Fat in human milk and formula provides a significant percentage of the total daily caloric needs for a growing infant. Formula manufacturers utilize many different vegetable oils for fat, including corn, soy, safflower, and coconut oils. Some formulas contain "predigested" fats known as medium chain triglycerides (MCT). These are analogous to the "predigested proteins" discussed above. Because of their uniqueapplication, formulas containing MCT are not routinely recommended for healthy infants and children.

There is a significant amount of research into determining the ideal concentration and ratios of fatty acids such as arachidonic acid (ARA) and docosahexanoic acid (DHA) for infant nutrition. Some studies have suggested that these may have a positive effect on short-term cognitive function. More research is needed to clarify this issue, and you should discuss this with your infant's pediatrician before supplementing.

Vitamins: Vitamins are organic substances that are essential in minute quantities for the proper growth, maintenance, and functioning of the baby. Vitamins must be obtained from food because the body cannot produce them. The exception is vitamin D, which can be produced by the skin when it is exposed to the sun. There are four fat-soluble vitamins (A, D, E, and K) and several water-soluble vitamins. These include the B vitamins, B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), and B12 (cobalamin), as well as folate and vitamin C and pantothenic acid, and biotin. These vitamins have been added to infant formulas to ensure proper nutrition. Unless otherwise directed by their pediatricians, routine vitamin supplementation is not necessary for healthy full-term infants taking formulas. High doses of certain vitamins can have adverse effects. For example, high doses of vitamin A can cause headaches, vomiting, liver damage, brain swelling, and bone abnormalities. High doses of vitamin D can lead to high levels of calcium in the blood and kidney and heart damage. Therefore, high doses of vitamins should not be given to infants and young children without supervision by their pediatricians.

Minerals: Minerals (calcium, phosphorus, magnesium, iron, iodine, copper, and zinc) and trace elements (manganese, chromium, selenium, and molybdenum) are included in most formulas. Therefore, there is no evidence that mineral supplementation is necessary for healthy formula-fed, full-term infants.

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