Unpacking the nutrients required in your baby’s diet Part 1

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Formula feeding Breast milk naturally contains vitamins and minerals, but what if you can’t breastfeed? How do you know that your precious gift is getting all the nutrients he/she needs? As a new parent it can be quite daunting unpacking the labels at the back of the formula tin, let alone understand nutritional information out there. We don’t really know what nutrients baby is supposed to get and we trust that our formula providers are making sure that everything our little one requires is in the formula.

If you are anything like me, 1000 questions ran through my head when I had a newborn…are the nutrients in formula enough for baby…do I need to supplement the formula with other vitamins… how many kilojoules must my baby have in a day…the questions in my head were endless…

So we interviewed a nutritionist and over the next two blogs we will help demystify some of the information.

Choosing a formula can be quite overwhelming especially since brands are not allowed to advertise or market to you to provide you with the information you need to make a decision. The major difference between formula milks that are produced by different companies is the variance in taste, since the compositional differences (in terms of the nutrient contents) are often minor. However, some brands tend to provide more options within a range to address specific solutions such as constipation, Caesar born babies, regurgitation etc., whereas other brands take the “all-in-one solution” approach.

At the end of the day, the most important questions to ask are: whether your baby is tolerating the formula you have selected and whether your baby is thriving. If you are able to answer yes to these questions, you have made the right decision for your baby.

In the event that you cannot answer yes to these questions, there might be an underlying cause to this and therefore it would be wise to consult your health care professional on the options available for the particular problem at hand.

To get a general idea of the various infant formulas available on the South African market, you could refer to the URL link provided: http://www.tandfonline.com/doi/pdf/10.1080/20786204.2012.10874170 which is an article published in 2012 by the Nutrition Information Centre form the Stellenbosch University, summarising the jist of the infant formulae available in South Africa.

In the paragraphs to follow, a brief summary is given on the essentials one needs to know regarding the macronutrient and fluid requirements of your baby. We will try to address the most common questions moms tend to ask about the protein, carbohydrate (starch) and fat content of infant formulas.

Fluid requirements for baby

Water is the most important nutrient for infants since the younger the infant is, the greater the percentage of body weight is water. Your baby needs 150-180 ml/kg from the age of 0-6 months. Breast milk or infant formula usually provides enough water to healthy babies to replace fluid losses during early infancy (usually between 0-6 months of age). Even in hot and dry climates breastfed or formula fed babies don’t need supplemental water. Even though breastfed babies do not need any additional water when complementary foods are introduced, formula-fed babies need at least 400-600 ml/day of extra fluid in addition to the 200-700ml/ day of water estimated to come from the milk and other foods in a moderate climate and 800-1200 ml/day in a hot climate.

There are conditions that could cause rapid fluid loss such as vomiting or diarrhoea, which would require treatment with an electrolyte solution designed for infants. An anti-diarrhoea formula could be used as a treatment during the acute phase of diarrhoea since this product provides the nutrients and electrolytes the baby would need to rehydrate.

Often moms wonder whether and when it is necessary to supplement formulas with juices or tea, so this will be discussed in the following sub-section.

Supplementing formulas with juice or tea

It is not recommended to supplement your current formula regime with any fruit juices or teas. Feeding your baby low nutrient density liquids such as tea and coffee as well as high energy-dense (often sugar sweetened) drinks such as excessive fruit juice and high fat and salty snacks may displace other nutrient-dense foods (if the baby has been introduced to solid foods yet) or breast milk/ infant formula (if the baby has not been introduced to solid foods), which could ultimately worsen poor nutrient intake. In actual fact, these practices contribute to micronutrient deficiencies as well as the growing concern of overweight and obesity (Du Plessis et al., 2013).

To ensure that the baby’s thirst is satisfied in such a case; clean, boiled (if necessary) water should be offered from a cup a number of times during the day (World Health Organisation, 2005). In the event that fruit juice (including unsweetened juice) is given to babies between six and twelve months, the intake thereof should be limited to approximately 10 ml/kg of body weight or 120 – 180 ml per day (Marshall et al., 2003).

Casein and Whey explained

If the product says it contains Casein or Whey then it is a cow’s milk formula. Cow’s milk contains two types of proteins: casein which is the heavier protein and whey, which is the watery part when curd is removed.

In some formulas the protein is primarily whey and in others the protein is primarily casein, but the question is which is best for my baby. The whey-based formulas are highly adapted and result in a softer curd, closely mimicking breast milk. These formulas are usually recommended in the first 4-6 months of life, however, if the baby is satisfied and growing well according to the road to wellness growth chart it can be continued longer.

Casein-based formulas resemble cow’s milk, but are modified and fortified with vitamins and minerals. The higher casein content is more filling and satisfying for the “hungry” baby and is usually recommended from birth to twelve months. However, it is important to know that these casein predominant formulas form indigestible curds in the stomach, which might result in constipation and are not recommended for younger babies (< 4 months).

The role of omega fatty acids

Breast milk contains generous amounts of alpha-linolenic acid (ALA), which is the precursor for docosahexaenoic acid (DHA), more commonly referred to as omega-3 fatty acids as well as linoleic acid (LA), the precursor of arachidonic acid (AA), also known as omega-6 fatty acids.

For quite some time infant formulas only provided the linoleic acid and linolenic acid, but now DHA and AA (omega3 & 6s) are also included in infant formula. These essential fatty acids are important for neurological, cognitive, and visual development in the rapidly growing new born. However, there is a lot of controversial data on whether the supplementation of these omega fatty acids to infant formula milk result in the same beneficial effect these fatty acids has shown to play in mental and visual development of breastfed infants.

Things to consider around the carbohydrate profile of formulas:

Formulas that contain “sugars”

Reading the food labels of formula milks is key in determining the amount of sugar that is added to formula milk. The total carbohydrate content will mainly be listed in the nutritional information table. There it would be further divided into the amount of fibre and/ or sugars the product contains per 100 grams and possible per serving size. In order to know the specifics such as whether the product contains sucrose or lactose in particular, one would often need to refer to the ingredients list, which should also be provided on the label of the formula and would merely list the ingredient.

It is important to realise that both formula milk and even breast milk contain “sugars”. However, it is not about whether the milk contains simple carbohydrates (or sugars), but the type of simple carbohydrates it contains and whether a product naturally contains these sugars or whether they are added to a product.

There are six sugars (simple carbohydrates), which are important in nutrition. The three monosaccharides, of which mono means one and saccharides means sugar, are: glucose, fructose and galactose which all have the same chemical formula, but different structures. The three disaccharides, di meaning two, are: maltose, sucrose and lactose and are pairs of monosaccharides. All of these sugars are primarily derived from plants, except for lactose and its component galactose, which come from milk and milk products.

These sugars all occur naturally in food and are not the “sugars” we should be concerned about. Those that are added to foods/ formulas are the ones that cause concern. Unfortunately, many formulas on the market do contain added sugars (sucrose), some as much as 5 grams in order to make the formula more palatable. Remember, that the ingredient list will tell you which sugars have been added.

The main reasons why sugars (sucrose in particular) should not be added to the diet of babies nor toddlers are, because of its adverse role it has to play in the development of tooth decay, obesity and malnutrition. Fortunately, there are sucrose-free formulas such as the Novalac range also available on the market, where vanilla extract is used instead of sucrose to make the formula more tasty and acceptable.

Lactose intolerance

When baby is unable to digest the milk sugar (lactose), then they are lactose intolerant. The predominant carbohydrate in breast milk and formula milk is lactose, which plays a critical role in enhancing mineral (especially calcium) absorption which in turn is vital for a growing and developing baby. However, some babies might be lactose intolerant, which means that they do not have the ability to digest the milk sugar, lactose and often causes bloating, gas, abdominal discomfort and diarrhoea.

Even among the lactose sensitive babies, clinical symptoms of colic can be observed. It has been found that these lactose sensitive babies only digest and absorb 30% of lactose, of which the rest ends up in the colon where this undigested lactose gets fermented, producing gas and ultimately leading to the clinical symptoms of colic such as flatulence, cramping and crying.

Even though the incidence of lactose intolerance is very low, in the event that lactose intolerance is suspected a lactose free formula should be used. However, more often than not a baby is merely lactose sensitive and with lactose playing such a vital role in enhancing mineral absorption one would not want to remove this nutrient from the babies diet completely.

A product that takes both of these concerns into account, but still provides a solution to the typical colic problem is Novalac AC, which has an approximate lactose concentration of 40% as opposed to 80% in standard formulas or breast milk.

If you found this information useful please let us know or send us any of your burning questions via our Facebook page.

Disclaimer: This post is based on personal experience and personal brand preference of the content author and has in no way been paid for or sponsored. BabyYumYum reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines http://www.who.int/topics/infant_nutrition/en/ Breast milk is the best food for infants. Good maternal nutrition is recommended to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to health professionals’ advice. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.

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