30/05/2020
Which infant formula is the right one?
As previously discussed breastfeeding is the best option available for any baby. However, not every mother is able to produce sufficient amounts of breastmilk or lifestyle (e.g. having to go back to work) interferes with the possibility to provide ongoing breastfeeding. For many mothers expressing breastmilk and leaving it in the fridge or freezer is a good alternative to breastfeeding at times when they cannot be around their infant.
Expressed breastmilk will last you up to 6 months in the freezer (avoid placement in the door) and once completely unfrozen has to be used up within 24 hours. If after expressing the breastmilk it is put into the back of the fridge it lasts you for 3-5 days. Preparation of expressed breastmilk is easy as all it takes is warming it up in a water bath or bottle warmer to room temperature and swirling the container or stirring it. Some infants are fine to drink even the cold milk directly from the fridge, but rewarming it is recommended.
There are also the rare occasion where breastfeeding is not recommended (see blog from 06 November about “some breastfeeding info”). In these cases or if breastfeeding is not an option for other reasons infant formula milk is required. There are quite a number of cows milk formulas on the market: NAN, Similac, Infacare, S26, Lactogen just to name a few. Most brands also have different ranges for different infant problems. It can get quite confusing which formula to chose. Here are some guidelines:
In general it does not matter which formula you choose at first. Try a small tin initially in case your infant does not like the formula, in which case you haven’t wasted a lot of money (the same applies when changing form one stage of formula to the next stage). Some formula gives infants constipation with hard stools. Which formula does this differs from infant to infant and occasionally parents have to try a few before finding the one that works. In general breastfeeding stools are relatively pleasant smelling, but once formula is added the colour changes often from yellow to grey-green and the stools smell rather badly. This is not an indication to change the formula, but an expected side effect.
Formula fed children tend to gain much more weight than their breastfed counterparts. Often they become too heavy and this may result, if continued unchecked, in childhood and adolescent obesity. It is therefore useful with most formulas to reduce the amount of scoops by one from what is indicated on the tin using the same mixing volume. This reduces the caloric intake with formula to a more appropriate level.
There are some standard infant formulas and then a wide range of specialized formulas. If your infant is formula fed and has some of the issues below the following formulas might be helpful. If you are breastfeeding first consult with your healthcare provider before considering changing over to one of the specialized formulas below, as there are other ways of addressing these issues in breastfed infants.
Specialized formulas:
If your infant is prematurely born or weights very little your doctor might recommend preterm formula which is richer in calories than the standard term formulas.
For infants that struggle a lot with reflux (bringing up of milk) an anti-reflux formula (AR) can be quite helpful. These formulas have thickeners that make the milk thicker once it hits the warm stomach and prevents or reduces the refluxing of the milk.
If there are high allergy risks in the family the formula industry provides hydrolyzed formula. Hydrolization splits the milk protein in much smaller pieces so our body does not recognize it as foreign protein. The problem is that these formulas are very expensive and only really useful if your child has a proven severe cows milk protein allergy. In this case extensively hydrolyzed formula like Alfare, Pepticate or Neocate are required and sometimes even amino acid formulas. They taste vile but if required are very useful. The industry also provides an about
10% hydrolyzed formula known as HA. This used to stand for “hypoallergenic”, but since this has been disproven it stands now for “hydrolyzed and adapted”. They also taste much worse than normal formula and according to the Allergy Society of South Africa (ALLSA) consensus have no real useful function. They also cost much more than the normal formula.
Most brands of cows milk formula have a “gold” range. The only significant difference is the addition of oligosaccharides which are very useful for brain development. Breastmilk is very rich in oligosaccharides and if formula is only required to top up after breastfeeding, additional oligosaccharides are probably not needed. For exclusively formula fed infants the gold range might have an extra benefit for brain development and can be useful.
Lactose-free cows milk formula is useful if lactase deficiency (known as lactose intolerance) is suspected. This might be likely if your baby has persistent diarrhoea every time you feed cows milk formula. However, such formula should be suggested only by your healthcare provider after investigations have been done.
There are also some non-cows milk formulas available. Most of them are soya based. They should not be used without the assistance of your healthcare provider or dietician.
Goats milk as a substitute is not recommended as it has a high salt content and is deficient in vitamins like folate, vitamin B6 and in iron, plus its protein content is too high for an infants kidneys to deal with.
In short:
Breastfeeding is the best available nutrition for your infant. However there are situations when it might not be possible, advisable or feasible to breastfeed and cows milk formula must be used instead. There are many options and unless there are some issues with your baby either the normal standard formula or the gold range of such formula should be used. HA products are not useful and costly. For any other formula product consult your healthcare provider or dietician before use.
