Breast milk naturally contains vitamins and minerals, but what if you can’t breastfeed? If you are anything like me, you’ll have questions racing through your mind when you have a baby. Are the nutrients in formula enough for my baby? What do the labels on the tin mean? Do I need to supplement the formula with other vitamins? How many kilojoules must my baby have in a day?
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, c-section 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 or not your baby is tolerating the formula you have selected and if they are thriving. If your answer to both these questions is yes, you’ve made the right decision for your baby. In the event that you cannot answer yes to either or both these questions, there might be an underlying cause and you would be wise to consult your healthcare professional on the options available for the particular problem your baby seems to have.
“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.”
For a general idea of the various infant formulas available on the South African market, refer to the article published in 2012 by the Nutrition Information Centre form the Stellenbosch University, summarising the list of the infant formulae available in South Africa. In the paragraphs to follow, we provide a brief summary of the essentials you need to know regarding the macronutrient and fluid requirements of your baby. We also try to address the common concerns moms have about 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.
Although 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.
Supplementing formula 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 dense liquids such as tea and coffee, as well as high energy-dense (often sugar sweetened) drinks such as excessive fruit juice or high fat or salty snacks, may displace other nutrient-dense foods (breast milk, infant formula or solids when these are introduced). This could ultimately worsen poor nutrient intake. In 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 your baby’s thirst is satisfied in such a case, offer your baby clean, boiled (if necessary) water from a cup several times a day (World Health Organisation, 2005). In the event that fruit juice (including unsweetened juice) is given to babies between 6 and 12 months, this 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 (heavier protein) and whey (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 your 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 12 months. However, it is important to know that these casein-dominant 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) as well as linoleic acid (LA). ALA is the precursor of docosahexaenoic acid (DHA), more commonly referred to as omega-3 fatty acids, while LA is the precursor of arachidonic acid (AA), also known as omega-6 fatty acids. For quite some time, infant formulas only provided the ALA and LA, but now omega fatty acids are also included. These essential fatty acids are important for neurological, cognitive and visual development in the rapidly growing newborn. However, there is a lot of controversial data on whether or not the supplementation of these fatty acids to infant formula milk has the same benefits to mental and visual development as the natural fatty acids do in breastfed infants.
The simple carbohydrate (sugar) profile of formulas
Reading the food labels of formula milks is key in determining the amount of sugar that has been added. The total carbohydrate content will be listed in the nutritional information table, where it is also further divided into the amount of fibre and/or sugars the product contains per 100 grams and possible per serving size. Specifics such as whether the product contains sucrose or lactose in particular, are included in 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 breast milk contain “sugars”. However, it’s not about whether the milk contains simple carbohydrates (or sugars), but rather the type of simple carbohydrates it contains and whether these occur naturally or have been added. There are six sugars important in nutrition are:
- The three monosaccharides, of which “mono” means “one” and “saccharides” means “sugars”, 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. The ingredient list will tell you which sugars have been added. Sugars (sucrose in particular) should not be added to the diet of babies or toddlers because of the 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 on the market, where vanilla extract is used instead of sucrose to make the formula more palatable.
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 suffer bloating, gas, abdominal discomfort and diarrhoea. These lactose-sensitive babies only digest and absorb about 30% of lactose, the rest of which ends up in the colon where it ferments and produces gas 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 you do not want to completely remove this nutrient from the baby’s diet. 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 essential to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to the advice of healthcare professionals. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.