Breastmilk vs. Formula

Breastfeeding or bottle feeding your newborn baby is a personal decision. If you are undecided at birth time, consider a one month trial of nursing your baby – it is usually easy to go from breastfeeding to bottle feeding at this time. The first month of breastfeeding is usually the most difficult – so if you can get through that period – the rest will be easier. Breast milk has nutrients that change over time to match your baby’s changing nutritional needs. The research about breast milk – reducing risk of acute and chronic disease is well founded. Ingredients in breast milk are in perfect balance for your rapidly developing baby. Cholesterol is one of these ingredients – promoting proper brain growth. Cholesterol is high in human milk, lower in cow’s milk, and very low in formula. Human milk contains the right kinds of fats along with an enzyme (lipase) that helps digest the fat. Around 6 months of age, the baby’s digestive system begins to mature and becomes less open to proteins that may harm the body as allergenic proteins. Giving only human milk until the intestines mature is the best way to keep potentially allergy-causing proteins out of your baby’s bloodstream. Vitamins and minerals have a higher bioavailability in human milk – this means that the body uses most of the vitamins and minerals that are present. The germs in the baby’s environment (i.e. illnesses and infections in the household) to which the mother has been exposed, causes the mother to produce antibodies to that germ which are passed on to the infant. This property of breast milk enables the infant to develop immunity to these germs. Human milk contains more lactose (sugar) that cow’s milk/formula – formulas add sucrose/glucose (other types of sugars).

Comparison with Formula Feeding
The ideal food for human infants is human milk. Human milk contains all the right ingredients in just the right balance – protein, carbohydrates, fats, vitamins, minerals and water. No formula can make that assertion. Formula feeding is a practice that is relatively recent – about 60 years – before that, humans were relying on breast milk alone for feeding their infants. Breast milk has immune properties, disease fighting factors and digestive enzymes that are not found in formula. Some infants can display an intolerance or allergy to some formulas. These symptoms include but are not limited to significant vomiting after most/all feedings, persistent diarrhea or constipation, irritable behavior, red rash around the face and anus, and/or blood in the stool. Do not offer low iron formula! For a direct comparison of human milk and formula – visit www.askdrsears.com/html/2/T021600.asp.

According to the U.S. Food and Drug Administration (FDA), what is the definition of infant formula?
Infant formulas are liquids or reconstituted powders fed to infants and young children. They serve as substitutes for human milk. Infant formulas have a special role to play in the diets of infants because they are often the only source of nutrients for infants. For this reason the composition of commercial formulas is carefully controlled and FDA requires that these products meet very strict standards (Psst... even generic formulas).

How does FDA regulate infant formula ?
The safety and nutritional quality of infant formula are ensured by requiring that manufacturers follow specific procedures in manufacturing infant formulas. There is a law known as the Infant Formula Act – which gives FDA special authority to create and enforce standards for commercial infant formulas. Manufacturers must analyze each batch of formula to check nutrient levels and make safety checks. They must then test samples to make sure the product remains in good condition while it is on the market shelf. Infant formulas must also have codes on their containers to identify each batch and the manufacturer must keep very detailed records of production and analysis.

Does the FDA regulate generic formulas as well?
All formulas are subject to the same Infant Formula Act whether they be a name brand like Enfamil ®, Similac ®, or Nestle ® or a generic equivalent from Walgreens, Costco-Kirkland, Albertson’s, Walmart Parent’s Choice, etc.

If I choose to feed formula, which is the right one?
If the mother cannot or chooses not to breast-feed, normal full-term infants should get a conventional cow’s milk based formula. However, adverse reactions to the protein in cow’s milk formula or symptoms of lactose intolerance (lactose is the carbohydrate in cow’s milk) may require switching to another type of formula. Symptoms that may indicate an adverse reaction to cow’s milk protein include vomiting, diarrhea, colicky abdominal pain, blood in the stool or hives on the face and body. With lactose intolerance, the most common symptoms are excessive gas, abdominal distension and diarrhea. Examples of cow’s milk based formulas include: Enfamil Lipil ®, Similac Advance®, Nestle Good Start ®, etc.

The main alternative to cow’s milk formula is soy formula. Some infants may have an intolerance or an allergy to cow’s milk. Although there is a chance that a child who is allergic to cow’s milk is also allergic to soy – these formulas may still present an option for a formula-fed infant. The carbohydrates in most soy formulas are sucrose and corn syrup – which are easily digested by infants. However soy is not as good a protein source as cow’s milk. Also babies don’t absorb some minerals such as calcium as efficiently with soy than with cow’s milk formula. Some name brands include: Prosobee Lipil®, Isomil Advance ®, Nestle Alsoy® and of course their generic equivalents are also acceptable alternatives.

For a child who cannot tolerate cow’s milk protein, the AAP recommends the use of hydrolyzed protein formula – although these formulas are made from cow’s milk, the protein has been broken up into its component parts or predigested (protein hydrolysate). Examples of these formulas include Nutramigen Lipil® or Alimentum Advance®.

Lactose free formulas such as Enfamil Lactofree ® or Similac Lactose Free® are formulated without lactose. Infants are usually not born with lactose intolerance, but may display a sensitivity to lactose in cow’s milk based formula – if this is the case, your provided may recommend this type of formula.
Even the American Academy of Pediatrics has never taken a stand on one brand over another, just to say that breastmilk is best and that a low iron formula should not be used.

To access a chart comparing the nutrients of Enfamil®, Similac® and a generic equivalent from Walmart Parent’s Choice® check out this informative website – www.parentschoiceformula.com/compare.html.

What about low iron formulas? Won’t my child get constipated from iron fortified formula?
The infant formulas currently marketed in the U.S. are either “iron fortified” with approximately 12 mg/iron per liter or “low iron” with approximately 2 mg/iron per liter. A low iron formula is a nutritionally deficient formula – it does not provide enough iron to maintain proper hemoglobin counts. Hemoglobin is a blood protein that delivers oxygen from the lungs to the body tissues and the waste, carbon dioxide from the tissues to the lungs. These formulas were formulated in a time when parents thought that iron causes abdominal discomfort and constipation. Human milk does contain low amounts of iron – however much of the iron – nearly 100% of the iron is absorbed. To ensure that an exclusively breast fed infant is taking in enough iron, Town and Country recommends that your infant be given 1 ml/daily of a multivitamin with iron like Tri Vi Sol with Iron®.

Why must I wait until 12 months to start whole milk (But it is okay to start foods like cheese and yogurt before)?
Cow’s milk alone is not an appropriate diet for babies because the baby’s kidneys may not work as efficiently as an adult’s just yet – cow’s milk has too much protein ( in the form of casein) for the kidneys to digest. The minerals are not as easily absorbed and there is increased chance of milk protein sensitization (see first section). Foods made from milk products like cheese and yogurt become a very component of your child’s diet-breast milk or formula is still the primary source of nutrition.

Breastfeeding Resources

Websites
American Academy of Pediatrics-Breastfeeding Policy – www.aap.org/policy/re9729.html
Baby-Friendly Hospital Initiative USA – www.aboutus.com/a100/bfusa/
Breastfeeding Basics (Case Western Reserve University) – www.breastfeedingbasics.org
Breastfeeding Legislative Updates – www.house.gov/malone/issues/breastfedding/index.html
Breastfeeding or ursing Mothers – www.breastfeeding.com
Bright Future Lactation Resource Centre – www.bflrc.com
Hollister/Ameda-Egnell Breast Pump Company – www.hollister/products/breast.htm
Medela Breast Pump Company – www.medela.com

Literature
"The Complete Book of Breastfeeding" – Eiger and Olds
"Breastfeeding: Pure and Simple" – Gotsch
"The Nursing Mother’s Companion" – Huggins
"The Nursing Mother’s Guide to Weaning" – Huggins
"The Womanly Art of Breastfeeding" – La Leche League International
"Breastfeeding and the Working Mother" – Mason and Ingersoll
"That’s What They’re For! Breastfeeding Basics" – Tamaro