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Infant Breast and Formula feeding

Infant and Children, Nutrition | November 1, 2018 | Author: Naturopath

infants

Infant Breast and Formula feeding

Ok so we know the best “formula” for feeding baby is the one that is perfectly matched in nutrition, probiotics and temperature, is that which comes from the breast. Unfortunately, there are situations where breast feeding baby is just not possible. So, what to do? There are formulas available to help resolve this issue, but which one is best for bub.

Whilst it is impossible to replicate breast milk composition, formula powders are designed to mimic breast milk as close as possible. This is done by starting with a base product such as cows, goats or soy milk and then adding missing nutrients, probiotics, nucleotides and fat blends including fatty acids of arachidonic acid (AA) and docosahexaenoic acid (DHA). These commercial products in Australia must follow a food standard as set by the Australian Government. http://www.foodstandards.gov.au/consumer/generalissues/Pages/Infant-formula-products.aspx

Breast Milk

Let’s start with what is in breast milk that make it best. Breast milk is complex with a general composition of water, fat, protein and lactose.

Breast MilkThis mixture of components changes overtime with the growth of the suckling baby. Health and nutrition of the mother and environment exposure also plays a role in the quality and quantity of the milk, although it has been noted that the breast milk is always adequate in essential nutrients for the growth and development of the full-term baby, even though the mother’s own nutrients might be lacking. 

The first milk consumed at a time of feeding is thinner and higher in lactose to satisfy a thirsty/hungry baby, whilst the later milk is higher in fat.

Along with the carbohydrate, protein and fat nutrients, breast milk also includes vitamins, minerals, digestive enzymes, hormones and immune building components. Oligosaccharides, small units carbohydrates, charge forth with an army to prevent pathogens infecting the infant’s immature gastrointestinal system and help develop the diverse and balanced microbiota, colonizing up to 90% of the infant microbiome. This is important for appropriate immune responses - known as innate and adaptive immunity.

Important considerations

Carbohydrates provides energy and fuel for immune system development in the gastrointestinal tract.

Protein found in breastmilk comes from two classes, casein and whey. Casein is the clotted milk often seen when baby regurgitates, whilst whey remains liquid and is easily digested. These two components fluctuate in ration through breastfeeding and is specific to the needs of the human infant as opposed to that of other mammals.  It is this ration that determines the digestibility of infant formula. A formula higher in casein is harder to digest for some babies. But casein has a higher amino acid profile (protein building block) and this is important depending on the stage of lactation.

Fats. It is the fat in breastmilk that gives it its taste and aroma. (maybe this is why we like eating fat when we are older). The fat component also provides energy and the development of the central nervous system. There are a variety of fats in breast milk with the main being triglycerides. Two essential fatty acids convert to AA, EPA and DHA which are important for regulating growth, inflammatory responses, immune function, vision, cognitive development and motor systems in newborns.

Which make it a tall order to match as a food source for baby.

Finding an alternativeFinding an alternative

Formula foods purchased should be approved by Foods standards Australia, and be age appropriate – as discussed breastmilk changes to the growing need of the baby, so should the formula used to be matched to the developmental needs of the baby, but also addressing any allergic or digestive concerns. Specialised formula is made for this purpose.

Formula is usually classed as:

  • Cow-milk based formula
  • Soy-based formula
  • Specialised formula

Formula vary in taste, nutritional content, extra content – such as added probiotics, and cost. Parents may choose a product from personal choice such as being organic or produced in a certain country.
In the development over the ages of suitable alternative to breast milk, it has been found that milk obtained from other animal sources, needs to be modified to be acceptable for human consumption.

Cow milk Formula

Cow based formula has been found to be the most acceptable – but with the need of modification or removing of hard to digest components. For example, removing animal fat and substituting vegetable oils, diluting the protein content for the newborn's relatively immature renal tubular system, adding iron to prevent anaemia and long-chain polyunsaturated fatty acids (LC-PUFAs) to support cognitive and visual development.
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Goat milk formula

Goat milk formula is a popular choice as an infant formula. Like other formulas, nutritional additives are necessary, but as the base product, goat milk may offer a better alternative for digestive heath.

Goat milk formulaWhilst the protein and lactate components of goat milk is similar to cow milk formula, compared to cow milk, goat milk contains much lower concentrations of alpha-s1 casein. Alpha-sl is not present in breastmilk, making goat milk a closer match to breast milk. An analysis of the microbiota in the stools of breastfed, cow milk-based formula and goat-milk formula showed more similarity in some bacterial components of the goat-formula fed stool to that of a breastfed baby microbiota.

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Cow/Goat

  • Growth of infants feeding using goat or cow milk infant formula is not different.
  • Goat, cow, and human milk differ in caseins proteins.
  • Protein digestibility of goat and cow milk infant formula is similar to that of human milk, with goat milk being more comparable to human milk than cows milk formula
  • Protein digestion of cow milk infant formula is delayed compared to goat milk infant formula and human milk.

Soy

Soy formula was first developed for perceived intolerance or allergy to cow milk formula. It is used by parents wanting to avoid cow-milk protein in the diet and thus wean directly to soy without any reported intolerance to cow-milk formulas.

Allergy

It should be noted that an allergic reaction can occur using any infant formula, cow, goat or soy. Formulas containing extensively hydrolysed protein (broken down into smaller components for easier digestibility) are available but consultation with doctor or paediatrician for recommendation is a must.

Please note Cow milk and Goat milk, not in a specific baby formula, are not suitable for feeding a baby under 6 months of age. There is a lack of the right nutrition and a possibility of allergy, as well as the potential of blocking the absorption of certain nutrients.

Added Probiotics

Human milk contains compounds to support immunity. These include oligosaccharides which serve as prebiotics to feed the gut microbiota. By adding specific probiotics to formula, studies and clinical trials show help with the prevention of atopic dermatitis, allergic asthma and food allergy.

Formula as a Food

Formulas are supplemented with all the necessary nutritional components for infant growth and development and should meet the standard set by Foods standards Australia and New Zealand -

 “All commercially produced infant formula products available in Australia and New Zealand must comply with the composition and safety requirements outlined in the Code. Standard 2.9.1 specifies the mandatory nutrient content for infant formula and follow-on formula to ensure that the nutrition requirements of infants aged up to 12 months are met and the Code controls food additives that can be added (Standard 1.3.1), as well as sets maximum limits to control food safety risks. Commercial infant formula manufacturers must also have processes and systems in place to minimise risks posed by microbiological pathogens like Salmonella (Standard 1.6.1).” 

The bottom line

Breast feeding is absolutely the best choice especially in the first 6 months of baby’s life. Breast milk is a biological formula best suited for growth, brain and digestive and immune health of the new baby.

The World Health Organisation (WHO), recommends breast feeding as a first choice in the first 6 months and supplementing with an age appropriate balanced formula if required. In situations when breast feeding is not possible, it is important to not feel bad. Talk to your health care provider as to the formula that best suits baby and enjoy close cuddle time whilst you bottle feed.

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References

Review of Infant Feeding: Key Features of Breast Milk and Infant Formula https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/

http://www.who.int/topics/breastfeeding/en/

Intestinal microbiology in early life: specific prebiotics can have similar functionalities as human-milk oligosaccharides. https://www.ncbi.nlm.nih.gov/pubmed/23824728/

Mechanisms underlying immune effects of dietary oligosaccharides https://www.ncbi.nlm.nih.gov/pubmed/23824724

http://www.foodstandards.gov.au/consumer/generalissues/Pages/Infant-formula-products.aspx

Comparison of the compositions of the stool microbiotas of infants fed goat milk formula, cow milk-based formula, or breast milk https://www.ncbi.nlm.nih.gov/pubmed/23455335

Protein Digestion and Quality of Goat and Cow Milk Infant Formula and Human Milk Under Simulated Infant Conditions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704675/

3Comparing Infant Formulas with Human Milk https://www.ncbi.nlm.nih.gov/books/NBK215837/

Protein Digestion and Quality of Goat and Cow Milk Infant Formula and Human Milk Under Simulated Infant Conditions https://journals.lww.com/jpgn/Fulltext/2017/12000/Protein_Digestion_and_Quality_of_Goat_and_Cow_Milk.15.aspx

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