Infant Formula

Introduction

Human milk is the preferred source of nutrition for almost all neonates and infants, including those born prematurely.

Major infant formula companies continuously change their products to more closely mimic the composition of human milk and to improve nutrient delivery to infants with a variety of medical conditions.

• Formula choice depends on many factors including age, GI function, previous tolerance or intolerance to ingredients, nutritional requirements and various disease or conditions present.

Ideally, infant formula should be given to an infant only when there is a medical indication such as clinical evidence of insufficient intake (especially excessive weight loss) or the mother is infected HIV or has active tuberculosis.

Formula Selection

Preterm infants have higher protein and calorie requirements. In addition, they need more calcium, magnesium, and phosphorus (minerals transferred in utero during the third trimester).

• These special requirements led to the development of enriched and preterm formulas designed to facilitate "catch-up" growth.

Some infants will require formula with altered macronutrients, such as extensively hydrolysed protein (semi-elemental) or free amino acids (elemental) formulas, due to cow milk and soy protein sensitivities or other conditions.

• Goats' milk formulas are NOT suitable for infants with cows' milk allergy, as the proteins they contain are very similar.
• Use of soy formulas in patients with cow milk protein allergy is controversial. Sensitivity to soy protein is present in 30% to 50% of infants with enteropathy or enterocolitis associated with cow milk allergy.

For further reading, there is a very well written eChapter in Pharmacotherapy: A Pathophysiologic Approach, 2020: Oral Nutrition and Rehydration of Infants and Children.

Additives

Many infant formulas are fortified with iron and infants receiving on of these formulas usually do not require additional iron supplementation.

At birth, a large amount of long chain polyunsaturated fatty acids (DHA and ARA) are required as brain maturation continues, including maternal and cognitive development (learning, memory, behaviour) and visual acuity.

Some infant formulas are now supplemented with pre- and probiotics and marketed for infants with colic or to regulate bowel movements.

Key Reminder

When changing between formulas, check the correct scoop and dilution as these can vary significantly between brands.

External Links

• Infant Formula, 2009
• NHS - Types of Formula, 2019
• StatPearls - Cow Milk Allergy