Someday we’ll have enough milk banks for every baby to have human milk
regardless of circumstances. The reality right now is that some babies need formula.
What’s the best kind to use? It depends.
Milk-based formulas are cow milk-based and are a much better choice than soybean-based formulas. However, cow milk proteins are one of the most common allergens for infants and small children. A compromise is “predigested” formulas or hydrolisate formulas, which are widely available – especially if there is a family history of allergy. The hydrolisate formulas are expensive, they smell and taste terrible, and they are still a health risk. They also, unfortunately, use corn syrup instead of lactose, and that’s a significant drawback for longterm use. But your baby probably won’t take more of this formula than he needs, and you may a bit less likely to cause allergies or other long-term problems this way. Consider starting with a hydrolisate formula, and after the first month or so of life diluting it with standard cow milk formula, a little more each day, so that the baby eventually takes standard cow milk formula with lactose in it.
Low-iron formulas may make sense for a baby who is mostly breastfed. Her iron needs – especially if her umbilical cord was not cut until it stopped pulsing – are well-met through breastmilk. Mostly formula-fed babies are a different story. Since iron is poorly absorbed from formula, quite a bit must be added, which can be hard on a baby’s system, but iron is necessary. If your baby is mostly formula-fed, it probably makes sense to start with the higher-iron version unless your baby has obvious problems with it.
Powdered formulas are never sterile, and formula-fed babies lack the breastfed baby’s immune system. A few life-threatening cases of bacterial infection in babies up to a year old have resulted from powder that was contaminated at the factory. For at least the first month or so, it may be a good idea to use a concentrate or ready-to-feed, especially if your baby is completely formula-fed. However, the lining of both powder and liquid cans typically contains BPA right now. Less of the harmful chemical transfers to powder than to liquid, which may mean that, for now, overall risk is lower with powder. We won't know for a long time.
ADA/ARA-enriched formulas are increasingly popular, but there’s no solid research to say that they do anything more than increase the cost and perhaps the risk of digestive upsets. The ADA and ARA in these formulas are extracted from algae or fungi, which may mean they don’t function the way they do in breastmilk. No formula is a truly complete food, and no two are identical, though all meet the same minimum standards of calories and basic ingredients. There may be some advantage to using an assortment of different cow milk formulas to help “cover the bases”; there is certainly no reason not to.“Lactose-free formula” is a marketing gimmick that can be ignored. Lactose – milk sugar – is present in both human and cow milk, and is important in brain and nervous system development. Only about one baby in 75,000 is born unable to digest it. Babies can become temporarily lactose intolerant because of digestive upsets, but lactose remains an important ingredient in infant milk and should not be absent from a formula without good reason. If your baby is labeled “lactose intolerant,” you can modify standard formula by simply adding lactase, an enzyme that will help him digest lactose. Your baby can receive all the benefits of lactose without having to do all the digesting himself during his intestinal upset. Lactase capsules are available at most drugstores. Crush one-third to one-half capsule in each bottle and refrigerate for a few hours. If you buy lactose-free formula, return your baby to a lactose-containing formula as soon as you can.
Soy formulas are not milk and should never be a first choice. They lack lactose, and contain high levels of “phyto-estrogens”. The long-term effects of these early estrogens on baby boys and girls are unstudied. It is known that the thymus (an important part of our childhood immune system) is significantly smaller in infants raised on soy-based formula.
Homemade formulas are not a good idea. Remember, a baby can eat only what we feed him. If it isn’t a complete food, he loses out. If it has too many minerals, his kidneys can suffer damage. It’s a delicate balancing act that can’t be done in a home kitchen. While cow milk formula isn’t ideal, it’s a far better choice than, say, goat’s milk. The formula company did at least try to mimic human milk. The goat didn’t try.
Organic formulas may focus more on being organic than on their list and balance of ingredients, and there is some question as to whether the ingredients meet the true definition of “organic”. Until we know more, if you choose organic formula it may be better to stick with a mainstream company while you work on your own milk supply.
This is not an encouraging list. There is no formula that does a good job of approximating the many functions of human milk. However, milk banks are scarce and milk from them is, for now, both expensive and not often covered by insurance. Some mothers compromise by offering some donor milk along with formula. Formula risks are always reduced by providing at least a little mother’s milk, preferably your own. Most mothers are able to increase their own milk supply at least a little with skilled help.
Pumping isn’t fun, but it’s a life-long gift of health to the baby who receives it. The less the formula used, the less the risk. But remember Rule Number One: Babies Need to Eat. If you must use formula, think of it as a medication – not a good idea to take if you don’t need it and never without side effects, but good to have if you really do need it… at least it is until we have more milk banks around!
©2008 Diane Wiessinger, MS, IBCLC www.normalfed.com