Infant formula

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Image:Infant.jpg Infant formula is a breastmilk substitute: an industrially produced milk product designed for infant consumption. Usually based on either cow or soy milk, infant formula strives to be an adequate artificial substitute for natural human breast milk. Infant formula is necessarily an imperfect approximation since:

  • The exact chemical properties of breast milk are still unknown.
  • Breastmilk is bioactive, with live cells, hormones, enzymes, and growth factors that are impossible to offer in processed animal milk or soybeans.
  • A mother's breastmilk changes in response to the feeding habits of her baby and over time, thus adjusting to the infant's individual growth and development.
  • Breastmilk includes a mother's immunoglobulins, specifically IgA, that help the baby fight infections. These antibodies help the baby's immature immune system by helping the baby recognize illness to which the mother has been exposed, but which the baby has not.
  • Breastmilk includes a wide diversity of passive immune protection in addition to immunoglobulins. Formula cannot include either active or passive immune protection.

Its use, particularly in the developing world, is somewhat contentious.

Besides breast milk, infant formula is the only other infant milk which the medical community considers nutritionally acceptable for infants under the age of one year. Cow's milk is not recommended because of its high protein and electrolyte (salt) content which may put a strain on an infant's immature kidneys. Evaporated milk, although perhaps easier to digest due to the processing of the protein, is still nutritionally inadequate.

Contents

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Nutrient content

Most of the world's supply of infant formula is produced in the United States. The nutrient content is regulated by the American Food and Drug Administration (FDA) based on recommendations by the American Academy of Pediatrics Committee on Nutrition. The following must be included in all formulas produced in the U.S.:

In addition, formulas not made with cow's milk must include:

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Variations

Infant formula is available in powder, liquid concentrate and ready-to-feed forms, which are prepared by the caregiver or parent in small batches and fed to the infant, usually with either a baby bottle or cup. It is very important to measure powders or concentrates accurately to achieve the intended final product. It is advisable that all equipment that comes into contact with the infant formula be cleaned and sterilized before each use. Proper refrigeration is essential for any infant formula which is prepared in advance, since infant formula is especially susceptible to bacterial growth. Powdered, cow's milk-based infant formulas are not recommended for premature or sick infants, or for infants under one month of age. Powdered infant formulas are not sterile and may be contaminated with Enterobacter sakazakii, bacteria that may lead to neonatal meningitis, sepsis and necrotizing entercolitis in infants with weak or compromised immune systems.

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History

For centuries, attempts to create a breastmilk substitute resulted in high infant mortality. The first formula to significantly lower the artificial feeding death rate was developed by Henri Nestlé in the 1860s in response to the high mortality rate among infants in Switzerland in foundling homes (orphanages). It was a combination of cow's milk and cereals and was called Farine Lactee. Although the mortality and morbidity (illness) rates remained much higher in infants who did not received breastmilk, infant formula became increasingly popular during the 20th century as advertising entered its golden age. The medical community supported the use of infant formula because it was promoted as being more "scientific"--more easily measured and the nutrient content of the milk supposedly ensured. The medical community, as part of the larger culture, was subject to the same influences and trends then popular.

The post World War II "baby boom" provided a market for the expanding infant formula industry. Between the years of 1946 and 1956, the already diminishing incidence of breastfeeding was halved in the United States, leaving only 25% of infants still being breastfed at the time of hospital discharge. During the 1960s, when birth rates tapered off, infant formula companies began marketing campaigns in non-industrialized countries. Unfortunately, poor sanitation led to steeply increased mortality rates among infants fed formula prepared with contaminated (drinking) water. Organized protests, the most famous of which was the Nestlé boycott of 1977, called for an end to unethical marketing. The boycott is ongoing, due to marketing practices which violate the International Code of Marketing of Breast-Milk Substitutes, in the U.S. and worldwide.

Since the 1980s, the US and many other governments have made increasing breastfeeding rates a priority in improving the lifelong health of their citizens.

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Controversy and Science

The use of infant formula itself has come under scrutiny. Many scientists believe that infant formula exposure increases the risk of several conditions including insulin dependent diabetes mellitus[1] asthma, and eczema. It is well-established that non-breastfed infants suffer significantly more middle ear infections, respiratory, intestinal and other bacterial infections[2]. An association with lower cognitive development has also been shown in several studies[3]. The U.S. government has identified breastfeeding as an important measure of infant and maternal health.

Breastfeeding experts and the American Academy of Pediatrics contend that feeding anything (even breastmilk) to a child with a bottle can interfere with successful establishment of breastfeeding in the first two months. Supplementing with formula also decreases breastmilk supply in proportion to the amount of substitute offered. Bottlefeeding is much less successful than breastfeeding in promoting the natural bonding process of mother and child. (See The Womanly Art of Breastfeeding below). Infant formulas, like other processed food products, are the subject of occasional recalls, usually due to bacterial or foreign object contamination. Recently, infant formula has been recalled in several countries other than the U.S. for nutrient deficiencies leading to infant illness and death. Though infant formula is available without a prescription, it is generally recommended that its use be under the supervision of a medical professional. The health professionals most knowledgeable about breastfeeding are IBCLCs: International Board Certified Lactation Consultants (see IBLCE, below).

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Recent trends

Initiatives have begun to encourage a resurgence of breastfeeding mothers. As a result of the International Code of Marketing of Breast-milk Substitutes, infant formula companies are now required to preface their product information with statements that breastfeeding is the best way of feeding babies and that a substitute should only be used after consultation with health professionals.

Infant formula remains the least risky substitute when breastmilk is not available or is withheld, although numerous studies have shown that infant formula provides inferior nutritional value when compared to breastmilk. Not breastfeeding one's infant also increases the risk of infection and disease, both immediately and later in life, for infants and for their mothers. Infant formulas cannot come close to reproducing the bioactivity and immune protection of human breastmilk. Nonetheless, the baby bottle has become a very visible part of Western culture, and increasingly, of other developed and developing nations. This ubiquitous image leads some people to believe that bottles and infant formula are necessary to parenting an infant, whether or not this is true in an individual case.

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Manufacturers

Major infant formula manufacturers include:

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See also

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References

  • Benn, C. S., Wohlfahrt, J., Aaby, P., Westergaard, T., Benfeldt, E., Michaelsen, K. F., Bjorksten, B., and M. Melbye. 2004. "Breastfeeding and risk of atopic dermatitis, by parental history of allergy, during the first 18 months of life," American Journal of Epidemiology, 160(3): 217-223.
  • McCann, J. C., and B. N. Ames. 2005. "Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals," American Journal of Clinical Nutrition, 82(2): 281-295.
  • Riordan, J. M. 1997. "The cost of not breastfeeding: A commentary," Journal of Human Lactation, 13(2): 93-97.
  • Sadauskaite-Kuehne, V., Ludvigsson, J., Padaiga, Z., Jasinskiene, E., and U. Samuelsson. 2004. Diabetes/Metabolism Research Reviews, 20(2): 150-157.
  • La Leche League International. The Womanly Art of Breastfeeding. Several editions 1958 to 2005 (which is ISBN 0-452-28580-1).
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External links

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