When it Has to be Formula: Optimizing the Health Of Your Formula-fed Baby

There are occasions when a mother is unable to provide any human milk for her baby, or where serious supply challenges require artificial supplementation. 

What can you do to optimize the health of your formula-fed infant?

By Dr. Linda Folden Palmer

Modified August, 2013

 

First off, know that infant formulas are constantly improving. Research on breastmilk substitutes is growing every day, with a few bumps in the road. There are fewer drawbacks to these formulas than those seen historically. Additionally, some very recent fortification attempts hold the promise of partly buffering the greater risks of diabetes, heart disease, obesity and cancer found among children and adults who were formula-fed as infants.

Formula feeding poses immune and neurological drawbacks but there are strategies you can take now to improve your formula-fed baby’s health. Thesefactors can have a life-long impact on your child’s overall health.

Consider hydrolyzed milk formula 
The best choice for a first formula may be a hydrolyzed milk formula, especially if any kind of allergies exist in the family. Cow’s milk proteins are large and difficult for young babies to digest, and are highly allergenic. In hydrolyzed formulas, the proteins are broken down into smaller, more tolerable pieces.
Many of the potential problems with milk intolerance can be avoided by using one of these hypoallergenic formulas from the beginning. Often, small but regular intestinal bleeding occurs in formula-fed infants (or breastfed infants not tolerating cow’s milk proteins in mother’s diet), even when dairy intolerance is not suspected. This common occurrence is usually undetected but can lead to anemia. It may be preventable by simply beginning with hydrolyzed formula for the first months of life, when formula is necessary.

Hydrolyzed formulas do not taste as good to infants who have tasted other formulas. Therefore, it’s sometimes difficult to switch to a hydrolyzed formula once you’ve begun with regular formula.

Some babies still react to the traces of intact proteins in these. There are alternative formulas made with only amino acids (the protein building blocks), but they’re very expensive. These formulas (Neocate AA, Nutramigen AA) are even more hypoallergenic and are good choices for the very allergic, formula-fed baby (although they still contain trace corn proteins).

Some mothers are erroneously told they should feed hydrolyzed or amino acid formula to their infant who is breastfeeding and is intolerant of dietary proteins in mother’s milk. This advice is sad and absolutely wrong. A food-intolerant baby will fare far better on mother’s milk while mother avoids dairy and any other problematic foods in her own diet.

Don’t avoid lactose
Many are mistaken about lactose tolerance when it comes to babies. Lactose is baby sugar. It’s available only in the milks of mammals to provide for their offspring and it provides valuable immune-protective properties. Many older children and adults develop lactose intolerance, as adults are not intended to be nursing; drinking milk.

A baby born with the extremely rare defect causing total inability to digest lactose quickly suffers brain damage and would not survive prior the rather recent development of lactose-free infant feeds. It is, however, common for an infant reacting to cow’s milk proteins or recovering from some other intestinal irritation to suffer a temporary reduction in lactase enzyme, needed for lactose digestion. This may cause some babies to test positively for lactose intolerance via laboratory tests. While these babies may appear to fare slightly better with lactose-free formula, this condition will reverse as soon as a child recovers from illness or is given a feed without cow’s milk proteins or other problematic proteins in it.

Use acidophilus 
Formula-fed infants develop adult-type flora in their intestines. These flora are part of the cause of formula-fed babies’ increased incidence of intestinal illnesses. Providing a daily dose of friendly bacteria (the kind found in yogurt) may help to maintain a gentler flora for baby.

Don’t give your young infant yogurt though. Instead, provide a twice-daily dose of a good quality powdered or liquid combination of Lactobacillus acidophilus, Bifidobacterium, and some other good bacteria. You can add the powder directly to the formula when preparing it (after warming), or place drops of the liquid directly in baby’s mouth. Store these friendly bacteria, known as probiotics, in the refrigerator.

Formula companies are currently studying the addition of probiotics to store formulas. They have been found to be safe for infants and to possibly reduce colic and diarrhea, although occasional constipation has been reported with probiotic-fortified formulas. Daily use of probiotics may reduce your baby’s potential for developing allergies, as formula-fed babies have a greater risk.

Consider DHA and ARA
There has been much research lately in regards to certain fatty acids known as DHA (docosahexaenoic acid) and ARA (arachidonic acid), important nutrients for brain and vision development. These long-chain polyunsaturated fatty acids found in breast milk have traditionally been very low in infant formulas. It is known that babies are able to make their own DHA and ARA, but it has been found that they are unable to create optimal amounts.

This discrepancy explains in part the slight neurological and visual deficits linked with formula feeding. Studies show some possible visual and cognitive benefits when these fatty acids are supplemented in formula-fed infants. Several recently released studies and ongoing studies are working to find the optimal levels and forms of these to add to infant formulas. 

Study results so far are mixed but mostly positive. Oxidation of these fatty acids during storage may be a problem and may account for some of the mixed results. Some infants experience diarrhea from these formulas. The chemicals used in the distraction process are under scrutiny today. Fresh forms of these fatty acids might be more beneficial to infants. Some consultants are recommending adding these directly to infants’ diets.

Cod liver oil is an excellent source of DHA and ARA, as well as EPA, another important fatty acid. An eighth to a quarter teaspoon per day may be appropriate for a small infant. Vegan DHA supplements are available as well.

ARA, DHA and EPA are found only in animal sources. Egg yolk is an excellent source for babies, but it’s not something to give newborns. Some nutrition consultants suggest providing one rinsed yolk plus a teaspoon of cod liver oil daily after 4 months. Since egg white is the part of eggs that can cause allergy, you should avoid using them with infants. Cod liver oil may loosen the stools.

“Nurse” your bottle-fed baby
The term “to nurse” means to provide gentle nurturing care. Nursing your baby during feeding provides face-to-face contact and rich non-verbal and verbal conversation — all extremely valuable for your baby’s social and neurological development. Skin-to-skin contact is shown in studies to provide an additional advantage and can be included in a cozy bottle feeding.

Reduce cortisol releases
When babies are allowed to cry without receiving a nurturing response, they release a large amount of the stress hormone cortisol into their systems. When this is allowed to happen regularly, their brains develop permanent, life-long patterns of increased cortisol release in response to stress. These excess stress responses are coupled with abnormally low base levels of cortisol. This abnormal cortisol-release pattern is strongly associated with depression, heart disease, and autoimmune diseases in later life.

In addition to the permanent modeling of brain receptor responses, chronic cortisol elevation makes babies more susceptible to illness. Incidentally, mothers release cortisol when their babies cry, too, increasing their own susceptibility to frequent illness, heart disease and depression.

In contrast, affectionate, responsive care induces the release of positive bonding and health-promoting hormones such as oxytocin in both mother and child.

Sleep with your baby in your bedroom
Sudden Infant Death Syndrome (SIDS) happens more often in formula-fed babies but studies show that the incidence of SIDS is greatly reduced when your baby sleeps in the same room as you do, compared to sleeping in a crib in another part of the house. When neither parent smokes and proper safety measures are taken, cosleeping in the parental bed provides the same safety as crib sleeping in the same room, especially after the first few weeks of life.

Take great caution with homemade formulas 
Concerns over formula difficulties and trends toward organic and raw products have created increasing interest in making infant formulas at home. While “organic” and “natural” are wonderful concepts, unmodified raw, organic, or standard cow’s and goat’s milk are dangerous infant feeds. The levels of many components are far too high in these milks, and the levels of other components are far too low. The number of problems that could arise is too high to mention.

Recipes are available using goat or other milk and simply adding sugar and water. The dilution of animal milks for babies is very important for the kidneys, and the sugar is extremely important for the brain, but other nutrients are far out of balance in this concoction. Companies developing breast milk substitutes have devoted over a century of research to create optimal formulas, and professionally made organic formulas have now hit the American shelves.

The only recipes I have seen that appear nutritionally adequate are those presented by the Weston-Price Foundation (though manganese seems low in the milk formula to me). Every ingredient in their recipes is there for a reason. I’ve heard of parents trying to use this formula leaving out the lactose (or replacing it with stevia) because they think less sugar is better or they are mistaken about lactose tolerance. The right amount of sugar (almost 50% of calories) is essential to proper brain development and lactose is the healthiest sugar for all babies. Others parents try to reduce the amount of fats. Again, adequate fats (almost 45% of calories) and a full spectrum of fatty acids are very important to developing babies.

Consider starting solids sooner
Studies show that delaying the introduction of solid foods is highly beneficial when a baby is exclusively breastfed — but the same does not always ring true for formula-fed or formula-supplemented infants. It is difficult for some formula-fed infants to gain enough iron from their formula, no matter how much is in it, and babies’ own iron stores may begin running out after several months. Dark-colored vegetables also have valuable antioxidants and fiber that have been missing in the formula diet.

Earlier solids are not for every formula-fed baby, but babies who have been experiencing a slight intolerance to their formula may robustly respond to the introduction of non-dairy, healthy solid foods. Some formula-fed babies fare better with introductions of strained vegetables, meats or a little fortified brown rice cereal as early as 4 months. Sugary foods, juice, or plain white-flour snacks have much less nutritional value than formula and are not appropriate for babies. Delay the introduction of fruit, which teaches babies to acquire a taste for sweet foods, unless you are trying prunes for constipation.

Keep formula in the diet for 18 months 
Studies show that children fare even better when infant formula is continued in the diet for 18 months or more, rather than switching to straight cow’s or goat’s milk, or other drinks at one year. “Follow-on” formulas are just cheaper versions of infant formulas. They have more calcium only because they have not replaced as many cow’s milk ingredients with the more-balanced nutrients put into infant formulas.

Consider avoiding the vitamin K injection
Babies are purposely born with low levels of vitamin K, which is meant to increase gradually through feedings of breast milk, which is deliberately “low” in vitamin K. This tightly managed vitamin K level controls the rate of cellular reproduction. When infants are injected with the huge amount of vitamin K routinely given at birth, cellular reproduction may be allowed to get out of hand. Some very slight increase in leukemia cases is associated with these injections, and there are other very rare complications as well.

On the other hand, serious damage from a rare bleeding problem may be prevented by vitamin K injections at birth. A baby born with an undetected liver disorder can suffer damaging or fatal bleeding into the brain, and the clotting action of added vitamin K can reduce this bleeding.

Studies have shown that breastfed babies can be supplemented in smaller oral doses spread out over the first weeks of life and still safely avoid this rare but dangerous bleeding complication. Formulas are already supplemented with much higher levels of vitamin K than are natural. Studies suggest that this gradually supplemented amount of vitamin K is adequate to prevent bleeding problems, negating the need for routine injection at birth in formula-fed babies. All babies need to be watched for signs of liver disorders, including advanced jaundice, or pale colored stools.

Take immune-protective measures
Because formula-fed infants miss out on the daily provisions of immunities and chemical defenses from mother’s milk, you should do all you can to assure your baby gets the best possible dose of antibodies from your body before birth. The greatest portion of these immunoglobulins are pumped into the newborn’s body during labor. A child born via scheduled cesarean section misses out on labor and its last-minute provisions. Even when a C-section is recommended, natural labor can often be allowed to happen first, giving your baby a big, important immunity boost.

A maternal diet high in antioxidants from fruits, vegetables, and nuts, can provide baby with good stores of antioxidants before birth. These stores can help for a while with some of the oxidizing effects of infant formula. A little liquid vitamin C may be added to formula to provide some extra antioxidant protection to formula-fed babies.

Newborns are more susceptible to illness when not receiving an exclusively breastmilk diet. The first weeks of life are the most dangerous. Simply keeping your baby close to home and screening visitors for any illnesses can help a great deal. Visitors should wear a snug mask if they’ve recovered from a virus less than 3 days prior to their visit.

Try just a little bit
When physical limitations or lifestyle circumstances may not allow for continued breastfeeding, supplying breast milk in the first few weeks of life can provide your baby with a large edge on health and survival, especially if he was born early or tiny. The first milk, called colostrum, is especially full of immune-providing, protective factors.

If you plan to formula feed by a certain date, your baby can benefit greatly if you avoid using formula supplements at all until it is nearly time for the switch. Any amount of formula supplementation weakens the advantages of the breast milk. American infants who are fed formula from birth enjoy more than a 99.3% survival rate; that rate is even higher when some early breast milk is received, growing proportionally with the amount of breast milk received to over 99.5% for fully breastfed infants.

If you cannot produce milk, you may be able to obtain donor milk from milk banks and occasionally directly from donating mothers. Long-term use of donor milk can be expensive and complicated, but short-term use could be a powerful investment in the future of your child. Donor human milk should be considered the first option when mother’s milk is unavailable.

You can go back
There are occasions when a parent feels that formula is just not working well for a particular child. Intolerance to all forms of formula is usually the dilemma involved. Re-lactation is a viable yet seldom-mentioned consideration in these situations. I saw one occasion in which a child developed an illness that could respond much better to breast milk feedings, so the mother decided to give re-lactation a try. With the assistance of a lactation consultant, re-lactation works fairly well or very well for most mothers who are determined to succeed.

Find resources for Relactation and Adoptive Nursing at KellyMom.com.