Sunday, July 25, 2021

Formula Feeding

This is an INFORMATION page, verified by physician

Paediatricians recommend breastfeeding wherever possible as the best start for your baby. But we also recognise that for some mums, breastfeeding may not be possible or desirable. Or perhaps they would feel happier with a backup if things don’t go according to plan.

Choosing a formula can be overwhelming. Each milk contains different “goodies” for example for brain and immune development. There seems to be a wide range of milk advertised:

  • Organic
  • For fussy babies
  • For babies with spit-ups
  • For hungrier babies.

This choice can feel difficult to navigate. That’s not to mention the combined lack of availability that comes with living on an island. Or the astronomical cost of some of the baby formulas. All this makes the choice even more difficult.

First Milks

First milks usually have the number 1 somewhere on the tin. These milks have been designed to most closely resemble breast milk. This is because of their ease of digestibility. All standard first milks are cow’s milk protein-based (CMP). They contain basic vitamins e.g. vitamin D which keeps your bones strong.

Each manufacturer has tried to match some of their products to breast milk. Many first milks will for example:

  • Match the number of omega acids,
  • Of pre and probiotics
  • Brain development vitamins
  • And vision development enhancing products

The more of these supporting additives the milk contains the more expensive the formula will be.

A baby can stay on a first milk throughout the first year of life, regardless of what all the adverts might suggest. Remember these milks most resemble breast milk and so are the best for your baby.

Milks for Fussy Babies

These milks contain (CMP). This has been partially digested so it is easier for baby to digest. It may produce less colic, gas and general fussiness. Babies who are on these formulas often pass green mucousy stools. These products are not suitable for babies who are intolerant of CMP.

Milks for Spit Ups

These milks contain a thickening agent so that it is harder for the baby to spit up. As a result, they may cause constipation.

Milks for Hungrier Babies, Keeping them Full for Longer

Cow’s milk protein consists of curds (the thick solid part) and whey (the watery part). First milks which resemble breast milk have 40% curds and 60% whey. In milk for hungrier babies this ratio is changed to 80:20. As a result it takes longer for a baby to digest their milk and theoretically at least, keeps them full for longer.

If you are trying to give a formula that is most like breast milk then a first formula is better. Babies do not routinely need to go onto formula for hungrier babies.

You may be advised by elderly relatives to add cereal to your baby’s milk to keep then fuller. Adding cereal to milk puts your baby at risk of obesity. It can program them (even if they lose the weight later) to long term health problems. Such as diabetes and heart disease.

In the first 6 months of life, babies will grow well on milk alone.

Lactose Free Formula

These are best reserved for babies who have secondary lactose intolerance. This usually occurs after having had a bout of gastroenteritis. Before using these formulas, it is best to discuss with your paediatrician.

Soya Milk

In many countries of the world, for example UK, soya formula can only be prescribed by a doctor. It cannot be bought in a supermarket or pharmacy.

Some babies, because of very specific health problems, will be advised by their paediatrician to take soya milk formula. Babies who are CMP tolerant may respond well to soya milk formula. But up to 60% of these babies will also be intolerant to the soya protein.

Soya induces oestrogens. Perimenopausal women are encouraged to drink it to increase their oestrogen levels. The effect of soya on oestrogens in babies is not well known. But theoretically, it could be harmful, especially to boys.

Glucose syrup included in soya milk is a sweetener. Babies are more at risk of tooth decay on these formulas. If a baby is on soya formula you must use fluoride toothpaste to clean teeth for babies from zero to two years of age.

Goat’s Milk

Some parents are now giving their children goats milk formulas. There is no evidence that these are better than cow’s milk formula.

It is imperative that you do not give a goat’s milk formula to a child diagnosed with CMP intolerance. Or cows milk allergy.
The proteins in the two types of milk are very similar.

Milks for Babies with Cow’s Milk Protein Intolerance

You should only use these milks if recommended to do so by your paediatrician.

22 Calorie Milks

These are milks designed for preterm babies. Your paediatrician may recommend these milks because your baby was born preterm. Do not use these milks unless recommended by your baby’s doctor.

Follow On Milks, Growing Up Milks, Toddler Formulas

Many milk companies recommend a follow-on milk either at 6, 9 or 12 months. These milks are more expensive. And there is no evidence that they are better than a first formula which resemble breast milk.

Assuming your baby is moving onto solid foods and a variety of foods at appropriate times (see articles on weaning onto solids) they can remain on their initial formula. At one year of age, a baby can move onto regular supermarket full fat cow’s milk.

What Water for Feeds

Tap water in Cayman is safe. The cheapest and easiest way to make formulas is by using boiled and then cooled, tap water i.e. sterile water.

Some parents prefer to buy baby water. Note this is distilled water and is not sterilised water and could put your baby at risk of infection. Bottled baby water can also contain fluoride. If you are using fluoridated water for your baby, they will not need baby fluoride toothpaste when you clean their teeth.

How Do I Make a Formula Feed?

It is important that you follow the instructions on the tin of formula you buy. You need to use the formula scoop that comes with the tin that you are using.

This is especially important in Cayman when we cannot always find the same product.

Make sure all baby bottles are properly washed and then sterilised. This can be done either in a microwave steriliser. Or by using an electric steam steriliser. Or by boiling and submerging bottles in water for 10 minutes. Or by using a sterilising solution. Pouring boiling water over bottles or just washing in the sink is not sterilisation.

Keep an eye out for bottle deterioration or signs of wear and replace if needed.
Continue to sterilise your baby’s bottles until they are 1 year of age as milk is a good growth medium for bacteria.

Have questions about formula feeding? Chat to your paediatrician. They will be able to guide you on what to do in your baby’s specific circumstances.

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about the author

Dr Sara Watkin

MB ChB, MRCP (paeds), FRCPCH, MD

SPECIALIST PAEDIATRICIAN & NEONATOLOGIST

Dr Sara Watkin is a highly experienced, tertiary trained paediatric and neonatal (newborn) specialist, based out of Grand Pavilion on West Bay Road, with paediatric & neonatal admitting rights at George Town. She has 25+ years experience as a consultant in the United Kingdom, including as Chief of Service at the world-renowned University College London Hospitals.



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