Which is the Best Formula for My Infant?

I support breast feeding. I support parents who breast feed. Your breast milk is the best for your own baby.

Having said that, I have also met parents who decided to stop breast feeding for various reasons. As a dietitian, a counsellor, and/or a supportive friend, I stood by their choice.

Breast feeding moms, new or experienced, may go through stages of stress and are not comfortable to breast milk. They are in dire needs to "supplement" feed their growing infants, or to replace breast milk completely. We also know that human milk bank is not culturally acceptable for Muslim moms, and not readily available for other moms of other races, these parents need an alternative, at that juncture.  

I am sharing this post on how to choose infant formula or follow up milk for babies who have to stop taking breast milk and for parents who are worried about the choices they are about to make. I wish new parents are empowered, guided and can carry on with life. It would be extra jolly to me, if they come back to breast feed after the initial hurdle.

The Safety to Use Infant Formula in Malaysia

The content of infant food (below 1 year old) and follow up formula (6 to 12 month old) are tightly regulated by the Malaysia Ministry of Health (MOH). We can rest assured the formula bought from a reliable source is safe (halal) for our babies. 

The marketing or claims on the formula for children below 1 year old is by far tightly regulated by law. Soon, the regulation will also cover a wider scope, beyond 1  year old. That also means, if the label says it's not suitable for your child age, you shall then consult your pediatrician or dietitian on what other choices you have.

The Special Ingredients 

A growing numbers of findings have suggested the importance of various groups of nutrients for fetus or infant development. These are good science and those that are needed have been fortified in our formula recently. For some others which fortifications remain debatable, they might have been added into the formula at safety and presumed effective levels. It's then  expected of the parents to make informed choices.

Parents who could afford nutrients fortified formula or babies who can’t tolerate regular baby formula, are keen for an alternative or specialized formula, by choice or by need. So, let's learn a little about these additives that differentiate the formula.

1. Sufficient intakes of omega 3 fatty acids, namely Docosahaexaenoic Acid (DHA) and Arachidonic acid (ARA) have been linked to visual acuity and cognitive performance in babies. Babies absorb these nutrients either through the placenta or the breast milk, accumulate these nutrients in their eye and brain in the 3rd trimester (as a fetus) and during the first 2 year of life.

For baby formula, the recommended doses for infant below six month are established in Europe, US and adopted by the WHO. They are to mimic the human milk contents of parents with good intake of such fatty acids. The minimum effective doses have generally been added into the formulation that is globally known.

For these nutrients, more doesn’t equate better. Parents don’t have to worry about getting the product with the highest (and often more expensive) content.

During the second 6 month of life, a diet rich in DHA and AA should be continued, but experts do not have enough information to recommend exact amounts of those fatty acids so far. Giving your child a daily diet rich in seaweed or seafood, can increase his DHA and AA intakes. If this target for dietary intake can be achieved, the amount of DHA and AA in formula will be less concerning.

2. Hypoallergenic (HA) formula shall be used for the prevention of food allergy for infant below 6 months, before any sign of allergy. If either one parent or a sibling of a child has a history of allergic reaction, this baby is at a greater risk to develope allergy. They shall be given HA formula before starting any other form of milk. However the benefit to continue HA formula after the baby is 6month old is not convincing yet.

A family ought to know that for a baby who has been diagnosed with allergy by a pediatrician,HA formula won’t help to stop the allergy reaction activated earlier. An extensively hydrolyzed or amino-acid based formula, depending on the severity shall be used.

3.       Prebiotic and probiotic fortification creates a gut environment that is similar to healthy breastfed babies. It may help to reduce infections and risk of allergy. Early studies are encouraging, but again the need to provide them in infant formula and follow-on formula is uncertain yet. 

You may also have heard of neucleotides, Sialic Acid (SA), Selenium, Choline, or carotenoids fortified formula. There has been some evidence to fortify formula with them. However, the evidence is not strong and not conclusive yet, especially for a baby who is growing up well.

Nutrient discoveries won’t stop here and I believe it is for our benefits. However, whenever any new information comes out, parents do not have to rush to get the newest formulation. Usually medical institution or local authorities of developed countries would come out with guidelines in time to regulate the content in all formula.

Your own breast milk remains the best food for your child. It is the gold standard of all infant nutrition. When formula information is generally overhwelming, may be parents shall give breast milk another try, switch the focus onto the nutrition for herself.