Figure 56.1 Examples of specialized milks Figure 56.2 Safe preparation of powdered infant formula
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Bottle feeding
Balanced nutrition is critical for the normal growth and development of the infant. Breastfeeding is the recommended method of infant feeding. However, by choice or necessity, some mothers may formula feed their infant. Formula companies must comply with legislation that governs the production, composition, marketing and distribution of formula milk. In particular, the composition of formula milk is adjusted to increase its similarity to breast milk. Protein, carbohydrate and fat content is modified, and important vitamins, minerals and trace elements are added. Despite such modifications formula milk continues to differ in the source and amounts of its constituents and does not contain the biologically active ingredients contained in breast milk. The nutritional composition of both breast and formula milk should satisfy the complete nutritional requirements of an infant until the introduction of complementary foods, around 6 months of age, and continue to contribute to nutritional intake for the first year.
Types of infant formula
Infant formula milk is commonly made from modified cow’s milk which is either dominant in whey or casein protein. Choosing an infant formula milk is based on the infant’s age and nutritional requirements, and in some circumstances an infant’s medical condition.
Standard infant formula
First infant formulas should be based on the whey protein in cow’s milk as whey is similar, although not identical, to the protein in breast milk. Whey-dominant formulas are suitable from birth to 1 year. Casein-dominant formula is marketed for hungrier infants. Casein is a more difficult protein to digest and it is thought, although not scientifically proven, that casein provides feelings of increased fullness and satiety. Casein-dominant formula has the same calorie and nutritional content as whey-dominant formula but the casein protein is less similar to the protein found in breast milk. A range of whey and casein-based formula milks are available for term infants (Table 56.1).
Follow-on formula is suitable for infants from 6 months of age. It contains additional iron and protein for growth and development. Infants do not have to switch from a first infant milk to a follow-on formula as the introduction of complementary foods will generally provide an adequate source of extra nutrients.
Daily fluid or feed requirements differ depending on the infant’s age and weight (Food Safety Authority of Ireland 2011) (Table 56.2).
Specialized infant formula
A range of specialized infant formula milks are available for infants with specific nutritional requirements that cannot be met by standard formula. These specialized formulas should only be used on the advice of a health care professional. Examples are shown in Figure 56.1.
Partial or completely hydrolysed formula is recommended for infants with cow’s milk allergy rather than using sheep, goat or soya-based formula.
Preparing infant formula
Infant formula is available as ready to feed (RTF) or powdered. RTF is a sterile formula that does not require refrigeration and is stored at room temperature. It is ready to feed to the infant and warming the feed is dependent on infant preference. Powdered infant formula is non-sterile and can be contaminated with a number of harmful bacteria including the Cronobacter species and Salmonella. It is therefore imperative that strict safety guidelines are followed in the preparation of powdered infant formula to ensure that the prepared feed is not contaminated by harmful bacteria. Key safety statements in relation to the safe preparation of formula feeds are presented in Figure 56.2 and the following guidelines.
Table 56.1 Whey and casein-based formulas
| Examples | Protein/g/100 mL | Energy/100mL | |
| Whey-dominant | Aptamil
Cow & Gate
SMA
| 1.3 (whey : casein = 0.8–0.9 : 0.4–0.5) | 66–67 |
| Casein-dominant | Aptamil
Cow & Gate
SMA
| 1.6 (whey : casein = 0.3 : 1.3) | 66–67 |
Table 56.2 Daily fluid or feed requirements
| Age (months) | Approximate number of feeds in 24 hours | Daily fluid intake (mL/kg) |
| 0–3 | 6–8, every 3–4 hours | 150 |
| 4–6 | 4–6, every 4–6 hours | 150 |
| 7–9 | 4 | 120 |
| 10–12 | 3 | 110 |
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