Breastfeeding is undoubtedly the best for your baby. Both the World Health Organization (WHO), as well as the Australian government’s Department of Health advocate exclusive breastfeeding for the first six months to nourish the baby. Breastmilk contains, apart from the essential nutrients, active substances that provide immune protection for the infant.
While breastfeeding is the first natural choice, there are many instances where it is not an option. The Australian Medical Association (AMA) states that an infant formula is an option for those unable to breastfeed for any reason.
HIV, severe illnesses such as sepsis, Herpes simplex virus and syphilis lesions on the breast are some of the medical reasons that mandate avoiding breastfeeding. Other conditions could be substance addiction in the mother, inflammation of breasts, active tuberculosis and treatment for breast cancer.
Certain health conditions in the infant such as metabolic conditions including phenylketonuria and galactosemia need special dietary infant formula that needs to be used under medical supervision. There could be other reasons as well, such as the infant not gaining adequate weight for age or other concerns.
The Australian National Health and Medical Research Council has formed “Infant Feeding Guidelines” to highlight the importance of educating the parents regarding the advantages of breastfeeding before they make an informed decision on using infant formula. The guidelines advocate using a formula based on cow’s milk till 12 months.
Preparing the formula
The Infant Nutrition Council states that water used for preparing the feed should not be hotter than 37°c to prevent risks of scalding and also to prevent losses of nutrients.
- Before preparing feeds, washing of all surfaces and hands with warm water and soap and then drying with clean towel is mandatory
- All utensils, bottles, and equipment need to be sterilised before using each time
- Handle sterilised bottles or equipment with sterilised tongs
- Make fresh formula for each feed
- Follow instructions on the formula tin.
Storage of prepared formula
- Store formula in the coldest place in the fridge for no longer than 24 hours.
- To use the stored formula, remove just when needed and warm by placing in a heated container for fifteen minutes. A commercial warmer can also be used.
- It is not recommended to microwave the formula for heating.
- Any unused formula should be discarded if not used within two hours
The Australia New Zealand Food standards code regulate and mandate the nutrition and quality requirements in all infant formula available in these regions
Factors to remember when choosing the infant formula
Energy content: As per regulatory mandates, a litre of infant formula should provide 597 to 848 kilo-calories. This is close to the energy provided by one litre of breast milk at 700 kilo-calories on an average.
Has adequate protein: Studies have found that there is no particular benefit of using a formula with higher protein content. The ideal ratio of whey to casein in the formula needs to be as close to that present in the breast milk, which is between 60 to 80% whey and 40 to 20% casein. Human breast milk contains 1–1.1 g protein per 100 ml while most infant formula in Australia provides 1.3–2.0 g protein in 100 ml.
Most brands of infant formula contain between 11 to 24.8 grams of protein in a litre of formula or 0.45–0.7 grams of protein per 100 kJ that meets the amino acid requirements. Check the ratio of whey to casein to ensure easy digestion.
Source of fat: Breast milk contains all three types of fats, including polyunsaturated, monounsaturated and saturated fats. Most available infant formula uses a combination of vegetable oils including sunflower, soy oil, canola, coconut and sustainable palm oil. The organic formula such as Bellamy’s uses 100% soy oil while Holle uses a combination of organic palm, sunflower and canola. It may be important to check if Genetically Modified (GM) crops are the sources of these vegetable oils. Most of the canola grown is GM and if that is something you wish to avoid, check for labelling that says non-GMO.
Pre or probiotics: Breast milk naturally contains prebiotics. There is no evidence that added pre or probiotics in infant formula provide the same benefits as breast milk and regulations do not recommend these.
DHA or ALA: Docosahexaenoic acid (DHA) is a type of polyunsaturated fatty acid that offers many health benefits to the infant including brain development, vision, learning, cognition and so on. Alpha-linolenic acid (ALA) is usually obtained from plant sources and is later converted in the body to DHA. Almost all infant formula available in Australia have DHA. But, it is important to check the source of DHA to ensure it is safe for the infant.
Vitamins and minerals: The infant formula available have added iron and vitamins such as D, A, B complex, K and E. Iron is required to be added as per regulations.
Cost: While both regular and “Gold” formula has to meet the standards and regulations regarding nutrition, the latter may be more expensive. It is not necessary to choose the most expensive one on the shelf to meet the nutritional requirements of the infant. The Gold formula contains additional nutrients that are permitted by national regulations and these include pre or probiotics, DHA and nucleotides. While these are generally considered as safe in infant formula, there is not enough evidence to support that they offer additional health benefits.
The “Infant Feeding Guidelines” also highlight the below on choosing an infant formula:
- No evidence exists that any one formula is better than the other if the baby is full-term and is healthy
- Using the formula recommended or used in the hospital is not an indication that the particular formula is the “best”
- Frequent changing of formula although is optional may result in confusion and increases the chances of wrong preparation or dosing.
- Follow-on formula for infants between six and 12 months of age is not recommended or necessary as there is no evidence of any added benefits over the regular infant formula
- Formula with a lower protein content is preferable