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Page 1: Everything That You Wanted to Know About Infant Formula ... · PDF fileEverything That You Wanted to Know About Infant Formula, ... •Galactosemia ... Everything That You Wanted to

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Everything That You Wanted to Know About Infant Formula, But Did Not Know Who to Ask

Adrienne Z. Udarbe, MS, RDN

Overview

•Review of Infant Feeding Hierarchy

•Regulation of Infant Formula

•Navigating the Options

•Responding to Caregivers Concerns

Page 2: Everything That You Wanted to Know About Infant Formula ... · PDF fileEverything That You Wanted to Know About Infant Formula, ... •Galactosemia ... Everything That You Wanted to

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First and Foremost

“Breast milk is the optimal source of nutrition for the infant but, when breast milk is not available, iron‐fortified infant formula is an appropriate alternative for the infant’s 

first year of life.”

Hierarchy1. Mother’s own milk/colostrum

2. Pasteurized donor banked human milk

3. Hypoallergenic infant formula

4. Elemental infant formula

5. Bovine milk based infant formula

6. Soy infant formula

7. Water/Glucose Water

Regulation of Infant Formula

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The Food, Drug, and Cosmetic Act

• Mandates all infant formulas marketed in the US provide the same nutrition for healthy, full‐term infants

Formulation

In comparison to breastmilk:

• Lower in fat

• Higher in carbohydrate, protein, and minerals

48‐50% Fat

40‐45% CHO

9% PRO

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Iron‐Fortified

DHA/ARA

• In breastmilk

• Added to infant formula in the US early 2002

• No official position by AAP

• Long‐Chain Polyunsaturated Fatty AcidsoARA = Arachidonic Acid (n‐6)

oDHA = Docosahexanoic Acid (n‐3)

• Major fatty acids in the brain and retina

Nucleotides, Prebiotics, Probiotics

• Nucleotides:oBuilding blocks of RNA, DNA, and ATP

o Present in breast milk

oMay enhance immune function and healthy development of GI tractwhen added to formula

• Prebiotics support growth of good bacteria in the intestine

• Probiotics  = nonpathogenic bacteria

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Navigating the Options

Forms• Powders

o Least expensive

o Important to follow mixing directions (water to powder)

• Liquid concentratesoMore expensive than powders

oAlso important to follow mixing directions (water to concentrate)

• Ready‐to‐useo Typically most expensive

oNo mixing

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Formula Preparation

Special Concerns

• Powdered infant formulas are not commercially sterileoHeat‐treated during processing, but unlike liquid products, not subjected to high temperatures for sufficient time to make the final product commercially sterile

• FDA Alert (2002) ‐ Enterobacter Sakazakii (E. Sakazakii)oMicroorganism

oMay cause sepsis, meningitis, or necrotizing enterocolitis

o Premature infants or medically compromised at highest risk

Water

• Ensure safe water source

• If in doubt about water supply or in case of water contamination in community find alternative clean water source

• Sterilize water by bringing to boil, boil 1‐2 minutes, then cool

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Milk‐Based Formulas

Examples:

oSimilac Advanced

oEnfamil

oGood Start

• Most common

• Casein is predominant protein (vs whey in human milk)

o Some altered to contain more whey

• Iron‐Fortified

Soy‐Based Formulas

• Examples:

o Isomil

o Prosobee

oGoodstart Soy

• Developed for infants who cannot tolerate cow’s milk formula

• Ingredients:

o soybean solids (protein)

o vegetable oils

o carbohydrates (usually sucrose and/or corn syrup solids)

o vitamins and minerals 

Soy‐Based Formulas, Cont.

May be indicated for:

• Galactosemia

• Parents seeking a vegetarian diet for their full‐term infant

• IgE‐mediated allergy tocow’s milk protein

Not recommended for:

• Acute gastroenteritis

• Infants with colic

• Prevention of allergy

• Non‐IgE‐associated allergy symptoms: Diarrhea, malabsorption, colitis, esophagitis

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Lactose‐Free Formulas

• Lactose is major carbohydrate in cow’s milk based infant formula

• Very small number of infants produce insufficient amounts of lactase, the enzyme needed to break down lactose

Hypoallergenic/Elemental Formulas

Examples:

o Alimentum

o Elecare

o Gentlease

o Nutramigen

o Pregestimil

o Neocate

• Partially or Extensively hydrolyzed protein

• Infants with non‐IgE‐associated symptoms

• Strong family history of allergy

• May also use elemental formula (free amino acid‐based formula)

• Some are lactose‐free

• Significantly more expensive

• Altered taste

Increased Calorie Prep

• Only if prescribed by healthcare provider

• Help mom to get information:

oHow long

oWhen to follow up withprovider

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Responding to Caregivers Concerns

Changing Formulas

• See healthcare provider for any of the following:oVomiting

oDiarrhea

oAbdominal Pain

oRash

oBlood in the Baby's Stools

• Changing formulas should be done under the supervision of healthcare provider or Registered Dietitian

Feeding Frequency and Amount

• Newborns 8‐12 feedings/24‐Hours

• Start with 2 ounces every 2‐3 Hours

• Partially breastfed/formula‐fed infant may consume less

• Frequency and amount will shift at 6 Months

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Organic?

• AAP No Position

• FDA recognizes sucrose as‘safe and well established’

Your Turn

Questions?

[email protected]