FORMULA FEEDING

Dr.sabah alatwani

Cow's Milk-Based Formulas The alternative to human milk is iron-fortified formula, which permits

adequate growth of most infants and is formulated to mimic human milk.

No vitamin or mineral supplements (other than possibly fluoride after 6 months) are needed with such formulas.

Cow's milk formulas are composed of reconstituted, skimmed cow's milk or a mixture of skimmed cow's milk and electrolyte-depleted cow's milk whey or casein proteins.

The fat used in infant formulas is a mixture of vegetable oils, commonly including soy, palm, coconut, corn, oleo, or safflower oils.

The carbohydrate is generally lactose, although lactose-free cow's milk-based formulas are available.

The caloric density of formulas is 20 kcal/oz (0.67 kcal/mL), similar to that of human milk.

Formula-fed infants often gain weight more rapidly than breastfed infants, especially after the first 3 to 4 months of life. Formula-fed infants are at higher risk for obesity later in childhood; this may be related to differences in feeding practices for formula-fed infants compared with breastfed infants.

Cow's milk-based infant formulas are used as substitutes for breast milk for infants whose mothers choose not to or cannot breastfeed or as supplements for breastfeeding.

Soy Formulas Soy protein-based formulas provide an alternative to cow's milk-

based formula when intolerance occurs from immune reactions to cow's milk proteins.

A significant proportion of infants allergic to cow's milk protein also are allergic to soy protein, however. The soy formulas are nutritionally safe alternatives to cow's milk-based formulas.

The soy protein is supplemented with methionine to improve its nutritional qualities. The carbohydrates in soy formulas are glucose oligomers (smaller molecular weight corn starches) and sometimes sucrose.

The fat mixture is similar to that used in cow's milk formulas. Caloric density is the same as for cow's milk formulas.

Soy protein formulas do not prevent the development of allergic disorders in later life, and clinical intolerance to soy protein or cow's milk protein occurs with similar frequency.

Soy protein formulas can be recommended for use by 1-Vegetarian families choosing not to serve animal protein formulas. 2-In the management of galactosemia. 3-Primary and secondary lactose intolerance.

Soy formulas should not be used indiscriminately to "treat" poorly evaluated patients with colic, formula intolerance, or more serious diseases.

Soy protein-based formulas are not recommended for premature infants with birth weights less than 1800 g.

Therapeutic Formulas

The composition of specialized infant and pediatric formulas is modified to meet specific therapeutic requirements.

Therapeutic formulas are designed to treat digestive and absorptive insufficiency or protein hypersensitivity.

Semielemental formulas include protein hydrolysate formulas.

The major nitrogen source of each of these products is a casein or whey hydrolysate, supplemented with selected amino acids.

These formulas contain an abundance of essential fatty acids from vegetable oil.

Certain brands also provide substantial amounts (25% to 50% of total fat) of medium chain triglycerides, which are water soluble and are more easily absorbed than long chain fatty acids; this is a useful feature for patients with malabsorption resulting from such conditions as short gut syndrome, intestinal mucosal atrophy or injury, chronic diarrhea, or cholestasis.

Elemental formulas also are available that contain synthetic free amino acids and varying quantities and types of fat components. These are especially designed for patients with protein allergy or sensitivity.

The carbohydrate content of these specialized formulas varies, but all are lactose free; some contain glucose oligomers and soluble starches.

Formula-Feeding: How Much, How Often, How Long

Infant formula: 7 steps to prepare it safely1 .Check the expiration date and condition of the container .

.2 .Wash your hands

:3 .Prepare your bottle Sterilize bottles, nipples, caps and rings before using them for the first time: Boil the bottle and accessories in water for five minutes. Use a pot that's large

enough to hold all of the pieces and cover them completely with water. Remove the pieces from the water using a clean set of tongs. Allow the pieces to air-dry. After the first use, there's no need to sterilize your bottle and accessories.

Simply wash these items with soap and water and allow them to air-dry. Bottle and nipple brushes can help you clean nooks and crannies.

Infant formula: 7 steps to prepare it safely

4 .Add water to liquid-concentrate or powdered formula.

.5 .Measure the formula

6 .Warm the formula, if needed.

.7 .Store formula safely