While exclusive breastfeeding is recommended up to 6 months of age, it’s reported that only 19% of American mothers exclusively breastfeed at this time. The majority of US families will use formula sometime in the first year of life. Here we break down the necessary components of infant formula and de-mystify some of the most commonly found ingredients.
The Gold Standard for Infant Formula
Human milk is the optimal source of nutrition for infants in their first year of life. Research confirms that breast milk is a complex and dynamic fluid: it contains macronutrients (carbohydrates, proteins, and fats), micronutrients (vitamins and minerals), as well as bioactive factors with health-promoting qualities (such as immunoglobulins, hormones, and growth factors to name a few). Many unique components of breast milk are still being identified!
Commercial Infant Formula is the Only Regulated Breast Milk Alternative
Infant formula is patterned after the carbohydrates, fats, and proteins found in human milk. And, as no animal or soy milk alone is able to supply the appropriate levels of nutrients found in breast milk all formulas are adapted and fortified to meet the health and developmental needs of babies.
Protein is a critical macronutrient that supports a wide range of body functions, including structural support, healthy growth and development, and a robust immune system.
Cow milk protein has been the standard protein source used in formula for many years. Cow milk has a whey to casein ratio (the major types of protein in milk) of 20:80. This protein ratio is adapted in many formulas to more closely match the 60:40 ratio found in breast milk by adding additional whey.
In hydrolyzed cow milk formula, the protein is either partially or fully (extensively) broken down. Extensively hydrolyzed formula is the first line choice for the majority of children with cow milk protein allergy (CMPA). CMPA affects about 2-3% of infants.
Soy is an alternative protein source to cow milk protein. It may be recommended for infants with rare conditions such as galactosemia or hereditary lactase deficiency.
For some children, cow milk protein may be difficult to digest and may cause mild to moderate symptoms such as spit-up, constipation, and eczema. In 2012, goat milk protein was approved for use in infant formula in the EU, and in 2014 goat milk toddler formula became available in the US market. Goat milk protein is naturally easy to digest and may alleviate the symptoms often associated with cow milk sensitivity. Goat milk, like cow milk, has a whey to casein ratio of 20:80, which is adapted in some formulas with additional whey. Like whole cow milk, whole goat milk is not suitable for infants; in addition to lacking nutrients (most notably folate), it contains too much protein for tiny kidneys. Goat milk is also not appropriate for children with a confirmed cow milk protein allergy.
Lactose is the Primary Carbohydrate in Breast Milk
All babies need carbohydrates for energy. Lactose is the primary carbohydrate source in breast milk. Contrary to popular opinion, lactose intolerance is uncommon in young children – babies are ‘programmed’ to break down the lactose in their mother’s milk. In many populations, lactase (the enzyme that breaks down lactose) does not begin to decrease until after 4 or 5 years of age.
Companies may use one or a combination of several carbohydrate sources to meet babies’ needs. Lactose (which is molecularly identical regardless of the source), corn syrup, maltodextrin, brown rice syrup, and sucrose are examples of carbohydrate sources found in many formulas.
According to the American Academy of Pediatrics, low-lactose and lactose-free formulas have no clinical advantages compared with standard lactose-containing formulas (except in severely under-nourished children).
For babies with the rare conditions of galactosemia or hereditary lactase deficiency, soy formula is recommended as the lactose is replaced with glucose or sucrose.
Fat is a critical macronutrient for babies and young children. It is essential for the rapid growth phase following birth, to help in the delivery of fat-soluble vitamins (such as A, D, E and K), and to support neurological development and brain function.
Breast milk fat is composed of fatty acids, and about 20-25% of the fat in breast milk is palmitic acid, The fat in formula should match, as best possible, the fatty acid profile found in human milk.
As the FDA does not permit the use of animal fat in formula, fatty acids in commercially prepared formula must come from vegetable oils. And, as no one vegetable oil has a comparable fatty acid profile to that of breast milk, all commercially prepared formulas contain a vegetable oil blend.
Infant Formula is One of the Most Highly Regulated Foods
Formulas vary, in terms of ingredients, or whether they are organic or non-GMO, but all infant formulas in the United States meet FDA regulations. The FDA provides guidelines that specify minimum amounts for 29 nutrients and maximum amounts for 9 of those nutrients.
The FDA also plays a significant regulatory role in the evaluation and safety of infant formula. Unlike many other countries, including the European Union, the US requires that each new infant formula participate in a clinical trial to demonstrate safety and tolerance before being marketed.
Parents can rest assured that from the list of FDA approved ingredients, manufacturers create their own recipes drawing on different protein, fat and carbohydrate sources, to meet the unique nutritional and digestive needs of the child the product is intended for. By understanding the necessary and critical components of formula, and the options available to manufacturers, parents can make an informed choice when it comes to formula ingredients.