What to look for when choosing formula milk

I’m not ashamed to admit that I am completely pro-breastfeeding, including breastfeeding to full term, which the World Health Organisation advises is 2 years and beyond.  I myself fed my own son to term, and am glad that I did.  But that doesn’t mean I’m “anti-formula” either.  So what happens when a mother can’t breastfeed or chooses not to? These days there are exclusive support groups available for breastfeeding mothers, but little or none that are exclusively for formula feeding mothers.  So how do they then decide what formula to choose? From my own personal research, it seems mothers don’t really know what exactly to look for in formula milks.  No one helps them to make this decision, it is either based on what the hospital gave them, what other friends have used, the marketing or price point of the formula or which the baby took to best.  But in reality, there are other factors that really should be considered but don’t seem to be discussed.  So I’ll try my best to help.

In the umbrella of “formula milks”, there are three different types – the most common is cow milk based made from altered cow’s milk, soy based for vegans or babies who are lactose intolerant and protein hydrolysate formulas for babies who can’t tolerate cow or soy milk or who have a protein allergy.  For the purposes of this article, I’m only going to point out what to look for when choosing a cow milk based formula, as this is the most widely used type of formula.

So when choosing a formula based on cow’s milk, one of the most important factors to consider is the protein content of the formula.  There is evidence to suggest that a lower protein content may be more beneficial to an infant in the long term, and prospective studies in the area show that high protein intakes during infancy can result in increased weight gain and a higher risk of obesity in childhood.  In the simplest terms, it is proposed that this induced weight gain happens when metabolic protein requirements are exceeded, leading to increased levels of insulin-releasing amino acids, and subsequently encouraging insulin and insulin-like growth factor 1 secretion.  Whilst the protein content in breastmilk naturally diminishes over time, from 2.09g/100kcal initially to 1.24g/100 kcal by 9 to 12 months, EU regulations set a minimum level of 1.8g/100kcal for formula and most manufacturers actually exceed this. 

Along with the protein content, the other element of formula milk to look out for is whether it is supplemented with prebiotics or oligosaccharides.  Breastmilk has the ability to promote the growth of beneficial bacteria in the infant gut and some infant formulas try to mimic this effect using prebiotic supplementation which can decrease the pH of faeces and bring the consistency closer to that of breast fed infants.  The different types of prebiotics used include galacto-oligsaccharide, fructo-oligosaccharide, polydextrose and a combination of these.  They are not digested by the small intestine but are primarily used as a fuel source by the healthy gut bacteria.    As little as 4 g/L of oligosaccharides can increase the abundance and proportion of Bifidobacterium (the microbiota that dominates the human milk fed infants) and 08g/dL fructo-oligosaccharides has been found to promote a gut microbiota closer to that of breastfeeding.  Furthermore, a trial in 2012 with formula containing prebiotics found that this guaranteed a similar growth to breastfed infants, that it was better tolerated and had a protective effect against the development of atopic dermatitis.   The gut environment in early life may have consequences for the metabolic, immunologic, and even neurologic development of the child.

The reality of formula feeding is that it will not and cannot ever replicate human milk.  Breast milk is complex and variable, and some bioactive components simply wouldn’t survive a shelf life and so cannot be included in formula milk.  But research is progressive and continuous, and manufacturers are constantly updating and improving their formulas.  For the moment, however, keep in mind the above two factors when making your choice and most importantly, just cherish every single moment of life with your baby – time passes and they grow so quickly.  As a mother to a five year old, I am certain of that much!