|
Are infant formulas appropriate substitutes for breast-milk?
Although infant formula cannot replicate all the qualities of breast-milk, it is the only safe alternative. If infant formula is not available, mothers may have to use inappropriate and potentially dangerous foods, such as gruel, or unmodified animal milks, to feed their babies. In contrast, infant formula products are manufactured using strict rules of hygiene and formulated according to recognized, international standards based on expert medical and nutritional opinion.
What does the World Health Organization (WHO) say about breast-milk substitutes?
Guidelines issued by WHO in 1986 state that, in general, commercially produced infant formula represents a considerable improvement over some common, nutritionally inferior substitutes. Many foods used as substitutes for breast-milk, including raw milk from cows, buffalo, goats and other animals or gruels made from cassava, rice, maize or other plants, are totally unsuitable and often dangerous to very young babies.
When should solid foods be introduced into the diet?
Introducing Solid Foods to Baby
Watching an infant grow and develop skills is a source of continuous wonder for parents, family, neighbours and friends. A newborn usually makes its first connection with mother, who normally breastfeeds the child for the first three to six months or longer. For mothers who cannot nurse, or choose not to do so, the infant formula industry offers mother's milk substitutes of unprecedented quality that take the worry out of feeding babies with formula milk during the first few months of life. Baby formula has been available for more than forty years, and yet this is a very short time considering that the evolution of mankind has taken two million years.
Breast milk is the ideal food choice for infants during the first four to six months. The nutrient composition of mother’s milk is superior to any artificially prepared substitute that the food industry will ever produce. Breast milk contains still-undiscovered substances and constituents such as immunoglobulins that are nearly impossible to reproduce. These natural proteins protect the very young infant from infectious diseases of all kinds. In addition, the emotional impact of breastfeeding will always be lacking with formula feeding.
During the second half-year of life, the energy and nutrient content of human milk will be inadequate as an exclusive food. During the second six-months, or the weaning phase, the baby’s growth rate accelerates rapidly and progressively more nutritious foods must be included in the feeding program.
Babies do not weigh the same at birth or grow at the same rate as others do during the first years. This is quite natural and due to both genetic and environmental influences. The quality and quantity of available food are the most important of all environmental factors. The variation in body weight and weight gain among infants can be large and must be taken into account when developing food type and amount standards that are to be applied to all infants universally.
When to Introduce Solid Foods
During its initial period, every mammal starts life with mother’s milk as its single liquid food. After a time, solid foods gradually become the predominant source of nutrients and human babies must switch from mother’s milk to formula and then to solid foods. If a baby who is one hundred percent breastfed or who is bottle fed with adapted mother's milk substitute shows signs of permanent hunger, it is time to introduce a more nutritious follow-up baby milk formula or to start offering home prepared or commercial semi-solid foods specially formulated for baby feeding. Under normal circumstances, this changeover should not begin before the age of four months. For heavier babies, this change may be acceptable at this age, but for smaller ones, it is better to start at five to six months of age. The U.S. Food and Drug Administration has developed these guidelines for introducing solids during baby feeding and they are recognized and promoted by most of the pediatric societies of the industrialized countries.
In the past, many mothers started feeding solid foods to babies too soon, before their digestive organs were adequately developed. Semi-solids are fed to babies with a small spoon; but before the age of four to six months, the baby’s nervous system is neither sufficiently developed to recognize this eating tool, nor can the baby coordinate swallowing with appetite control. As a result, overfeeding may easily occur. In addition, feeding common cereal products to babies too early may present some risk for developing food allergies. One in every 3000 children is born with an inherited trait called coeliac disease. Gliadin, a fraction of gluten, the predominant protein in wheat grains, damages the digestive cells in the small intestine of these individuals and they must avoid eating wheat, rye, barley and oats for their lifetime. Rice, corn, millet and potatoes contain no gliadin and are appropriate foods for people with coeliac disease.
The Benefits of Solid Food
Early in life, mother's milk or an adapted formula supplies all the necessary ingredients, including proteins, fats, lactose, vitamins, mineral salts and trace elements, required for a young human being. Once this food source is abandoned, follow-up foods take its place as a source of vitamins and trace elements. During the second six months of life, most babies still lack teeth and cannot chew or swallow solid pieces of food. To fill this gap, the food industry produces a great variety of finely blended, semi-solid, ready-to-eat baby foods as well as a series of precooked and dried cereal mixtures that can be easily prepared before each use. These modern "junior" foods are supplemented, if necessary, with all the known essential micronutrients, including iron and vitamin C, so that they meet the needs of growing infants at any age beyond six months. The formulas for these foods are continuously improved according to new scientific knowledge and technological progress. They are also of high quality in regard to microbiological safety. The composition and quality of manufactured foods are maintained at a constant level and their ingredients along with nutrient values are listed on their labels. Currently, the nutrient density (concentration per serving) of most commercial baby foods is consistent with the recommended dietary allowances of the National Academy of Sciences in the USA or the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in Europe.
When a mother’s milk supply gradually decreases, she should start to supplement it with special cereal mixtures. At the beginning, the baby may turn away from this food because of the distinct taste difference between the slightly sweet tasting mother's milk and the often less sweet cow's milk-cereal preparation. In the past, sugar was usually added to enhance the flavor, but today, pediatricians are critical of this outdated practice. It’s better to avoid developing a taste for over-sweetened foods in infants so the growing child will not be conditioned to sweet foods for the rest of his or her life. Eating sweets incurs such detrimental consequences as excessive tooth decay in pre-adolescence, overweight during adolescence, and possibly predisposition to later diabetes and atherosclerosis. After a period of adaptation during which the mother must be patient, the baby’s hunger will lead him or her to drink and eat foods that taste less sweet.
After the age of about six months, the mother should start to prepare her own baby foods and to gradually replace the bottle with semi-solid foods. Precooked, dehydrated cereal mixed with milk makes an excellent soft meal for babies who remain toothless. Carrots, potatoes and rice can be cooked together and then finely blended manually with a fork or in a blender. Small amounts of beef, an excellent source of iron, and egg yolk can be added to the mixture later. The tendency to overcook food is common at this stage and should be avoided to prevent destruction of heat sensitive vitamins. Mashed raw bananas and apples, which are much appreciated for their good taste and digestibility, are useful supplements. Such meals should be fed with a small spoon. The more a baby develops his or her manual abilities, the more frequently he or she will try to feed himself or herself with the spoon. At the beginning, some help and much patience are necessary for baby to progress through this important phase of development.
Fruit juices, especially orange and lemon juice, are very acidic and should not be offered in the bottle on a regular basis. The acid may erode newly emerging teeth even before they are fully developed. Apple, apricot, peach and pineapple juices are less acid and therefore more suitable. Currently, several manufacturers market different kinds of special fruit juices for babies in small containers. They are perfectly suited for babies, but in order to prevent tooth erosion, they should be served in a cup or with a spoon and not in the feeding bottle.
During the second year of life, the baby slowly becomes a child. Vision and movements become more accurate, the capacity for speech emerges, teeth grow and feeding habits totally change to be more in line with common adult diets. However, this change should not occur too abruptly, since problems with digestion, flatulence or diarrhea may arise. Individual preferences and intolerances will show up during this period. After any drastic change in food type, parents should pay attention to the general health of their child. When there is a reaction, a health professional should be consulted.
Growing children need more nutritious food than babies do. Cereals of all kinds are the most suitable foods for toddlers. They contain fiber, proteins, B-vitamins and minerals, and their high starch content represents a slow, steady source of glucose compared with white sugar, which peaks and then drops in a short time. The latter course of sugar metabolism favors fat formation in the liver.
Outlook
Parents’ behaviour during mealtime has a deep and lasting influence on the feeding habits of their children. Therefore, parents should not hesitate to obtain professional advice during their first baby’s early years, especially if extreme negative behaviours occur. Correct eating habits and the selection of healthy foods are perhaps the strongest determinants of well being in adulthood. These traits can be initiated best by feeding high quality foods in the first year of life.
Note: These feeding recommendations are general in nature. Be sure to check with your health care provider concerning any questions you may have about feeding your infant.
References related to infant feeding:
- J.T. Bond, L.J. Filer, G.A. Leveille, A.M. Thomson, W.B. Weil, Infant and Child Feeding, Academic Press, New York etc. 1981, ISBN 0-12-113350-8.
- C. Courpotin, J.P Girardet, S. Machinot, Alimentation du nourrisson, de la naissance à 18 mois, 4e édition, Flammarion, Paris 1986, ISBN 2-257-13240-8.
- D.E.M. Francis, Diets for Sick Children, Blackwell Scientific Publications, Oxford etc., 4th ed. 1987, ISBN 0-632-00505-X.
- C.W. Biermann, D.S. Pearlman, Allergic Diseases from Infancy to Adulthood, W.B. Sounders Co., Philadelphia etc., 2nd ed. 1988, ISBN 0-7216-1513-9.
- James Akre (editor), Infant Feeding, the Physiological Basis, Supplement to Vol. 67 of the Bull. of the WHO, WHO Geneva 1989, IX ISSN 0043-9686.
- Recommended Dietary Allowances, 10th edition, Food and Nutrition Board, National Research Council, National Academy of Sciences, Washington D.C. 1989, ISBN 0-309-04041-8.
- S.J. Fomon (editor), Nutrition of Normal Infants, Mosby, St.Louis 1993.
- R. Kleinman (editor), Pediatric Nutrition Handbook, American Academy of Pediatrics, Committee on Nutrition, 4th ed., Elk Grove, Illinois 1998.
What are some examples of recent innovations in infant formulas?
Examples of recent innovations in infant formulas:
- Fortification with nucleotides so formulas more closely resemble breast milk.
- Addition of taurine, a constituent of breast-milk.
- Improvements in the fatty acid profile.
- Adjustment of mineral levels to more closely achieve the absorption and retention levels seen in breast-fed babies.
- Development of formulas for special nutritional needs including low birth weight and such inborn errors of metabolism as phenylketonuria.
What is available for babies with special needs?
The infant food industry has collaborated with medical professionals, nutritionists and dietitians to develop a wide range of food products that are suitable for babies with special needs.
Examples:
- Special formulas for low birth weight babies.
- Special formulas for babies with inborn errors of metabolism including phenylketonuria and galactosaemia.
- Special formulas for babies with digestive problems or such other medical conditions as renal disease.
- Special formulas for babies with allergies to cow's milk protein or soya protein.
- Special formulas for babies with food intolerances such as lactose intolerance.
In addition, the baby food industry produces weaning foods suitable for older special needs babies (from 4-6 months of age) that are gluten-free, milk-free, or egg-free.
Updated October 2003
|
|
