BABY FORMULA AND INFANT REFLUX

RMacLean
January 2005

Many mothers choose not to breastfeed, or are unable to breastfeed their infants for many different reasons.  Infant formulas are designed to meet the nutritional needs of these infants for the first year of life.  Babies and children requiring tube feedings may also require formula for their sole nutrition.  The following information regarding infant formulas will apply to babies requiring tube feeds as well.  Older children (1-10) will require a follow-up formula, or one specifically designed for their age group.

There are several categories of infant formulas for meeting different needs of formula fed infants.  The main categories are standard-milk based, soy based, and hypoallergenic. Follow up formulas are available for older infants and toddlers consuming solid food.  Nutrient rich formulas for premature babies and formulas for metabolic problems are also available but they are less common.

1. STANDARD MILK BASED formulas are made from cow's milk.  Because cow's milk was not designed for people, it needs some adjustments before being suitable for infants.  The amount of some of the milk's nutrients is adjusted, the protein is changed making it more easily digestible, the butterfat is decreased or removed and vegetable fats are added providing more essential fatty acids.  Extra nutrients are added, such as vitamin c, iron and zinc.  These are the most common formulas and are adequate for most babies.  These formulas contain twenty calories per ounce.  Cow's milk contains thirty two different proteins with high allergic potency, causing many infants to have allergies, or sensitivities to cow's milk formula.

2. SOY BASED formulas are useful for babies with cow's milk allergies or sensitivities.  Greater amounts of vitamins and minerals are added to soy formulas because soy formulas contain compounds that may decrease the amount of nutrients absorbed.  Soy formulas also contain twenty calories per ounce.

3. HYPOALLERGENIC formulas are designed for babies with digestive problems, allergies and/or sensitivities to both milk and soy.  They contain twenty calories per ounce as well.  The idea behind this class of infant formula is to break down the protein (from whatever the source) into small enough units (process is called hydrolysis*) that the body's immune system does not recognize it as a foreign body and defend against it, causing the unwelcome symptoms that accompany such reactions.  Because the proteins in these formulas have been broken down, they are easier to digest and move through the digestive system faster than the standard formulas.

4. FOLLOW UP or follow on formulas are designed for older babies and toddlers.  Generally iron-fortified and cow milk based or soy protein based these formulas typically have higher levels of calcium and phosphorus than those for younger infants.

5. NUTRIENT RICH formulas for premature babies are made for low birth weight babies to help them grow quickly.  These formulas are all milk based and range in calories from twenty to twenty-four per ounce.  They have more nutrients than standard formulas.

6. METABOLIC infant formulas are for infants with disorders of amino acid metabolism.  These have a selected balance of amino acids.  Each of these formulas are created without the primary offending amino acid(s) for the specific disorder they are intended.

Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine