Cow’s milk–based formulas are the vast majority of commercial formulas. Most milk-based formulas have added iron, which the AAP recommends, and parents should use only iron-fortified formula unless advised otherwise by theprimary health care provider. Infant formula manufacturershave begun to examine the benefits of adding a variety ofnutrients and biological factors to infant formula to mimicthe composition and quality of breast milk. These includelong-chain polyunsaturated fatty acids, nucleotides, prebiotics, and probiotics. Soy-based formulas, which sometimes have added iron, may be used for newborns who maybe allergic to cow’s milk. However, some newborns allergicto cow’s milk are also allergic to the protein in soy formulas. There are hypoallergenic formulas for infants who can’ttolerate the basic formulas, such as those with allergies tomilk or soy proteins. The proteins in these hypoallergenicformulas are broken down to their basic components andare therefore easier to digest (Table 27-2). Specialized formulas are designed for premature, low birth weight babies.The carbohydrate is generally lactose, although lactose-freecow’s milk–based formulas are available. The caloric density of formulas is 20 kcal/oz (0.67 kcal/mL), similar to thatof human milk. A relatively high-fat and calorically densediet (human milk or formula) is needed to deliver adequate
Table 27-2 Composition of Breast Milk, Breast Milk after Freezing and Pasteurization, and Representative Infant Formulas COMPONENT BREAST MILK BREAST MILK AFTER FREEZING AND PASTEURIZING STANDARD FORMULA SOY FORMULA HYPOALLERGENIC FORMULA
Protein 1.1 per dL Reduced 1.5 per dL 1.7 per dL 1.9 per d/L
Fat 4.0 per dL 4.0 per dL 3.6 per dL 3.6 per dL 3.8–3.3 per d/L
Carbohydrate 7.2 per dL 7.2 per dL 6.9–7.2 per dL 6.8 per dL 6.9–7.3 per d/L
Sodium 8.0 mg/L 8.0 mg/L 6.5–8.3 mg/L 13 mg/L 14 mg/L
Monoglycerides Present Present Added to some Added to some Added to some formulas formulas formulas
Free fatty acids Present Present Added to some Added to some Added to some formulas formulas formulas
Linoleic acid Present Present Added to some Added to some Added to some formulas formulas formulas
Alpha-linoleic acid Present Present Added to some Added to some Added to some formulas formulas formulas calories (around 18 to 30 oz per day). Formula-fed infants are at higher risk for obesity later in childhood; this may berelated to self regulation of volumes ingested by the newbornsand infants.
By approximately 6 months, complementary feeding ofsemisolid foods is suggested. By this age, an exclusivelybreastfed infant requires additional sources of severalnutrients, including protein, iron, and zinc. Cereals commonly are mixed with breast milk, formula, or water andlater with fruits. To help identify possible allergies or foodintolerances that may arise when new foods are added tothe diet, single-grain cereals (rice, oatmeal, barley) are recommended as starting cereals. If juice is given, it shouldbe started only after 6 months of age, be given in a cup (asopposed to a bottle), and limited to 4 oz daily of 100% natural unsweetened juice. An infant should never be put tosleep with a bottle or cup filled with milk, formula, or juicebecause this can result in Early Childhood Caries (ECC)(see Chapter 127).