Nutrition

If breast milk is not available, either from the breast or as expressed milk, a commercially prepared formula should be chosen.

All formulas are classified based on three parameters: caloric density, carbohydrate source, and protein composition.

• Pre-term & enriched formula
• Term formula
• Specialised term formula

Term formula

These formulas are modeled after breast milk and contain 20 kcal per ounce. Their carbohydrate source is lactose, and they contain cow’s-milk protein.

All infants should receive iron-fortified formula to prevent iron deficiency anemia.

Recently, formulas with long-chain polyunsaturated fatty acids have been heavily marketed to promote eye and brain development. Clinical trials of the effects of AA and DHA on cognitive, social, and motor development have been inconsistent. Although no harm has been demonstrated, most well-conducted randomized trials show no benefit.

Preterm and Enriched Formulas

Preterm infants have higher protein and calorie requirements. It is currently the standard of care to prescribe these formulas for preterm infants.

There are no studies to guide timing for the discontinuation of enriched formula. Although preterm and enriched formulas may improve shortterm growth parameters, they do not appear to affect longer-term growth or development at 18 months of age.

Specialized Term Formulas

SOY FORMULAS - for infants with galactosemia or congenital lactase deficiency.

LACTOSE-FREE FORMULAS - for infants with galactosemia or congenital lactase deficiency. It is an alternative to soy formula in lactose intolerance.

HYPOALLERGENIC AND NONALLERGENIC FORMULAS - for milk protein allergy.

• IgE medicated milk protein allergy can present with any combination of cutaneous, respiratory, and gastrointestinal complaints; blood in the stool is a classic symptom. It is usually diagnosed in the setting of a strong family history of allergies or atopic disease. Referral to an allergist may be helpful because skin prick tests and IgE levels.
• Non-IgE-mediated milk protein allergy can manifest as enteropathy and enterocolitis.

Because most infants with milk-induced enteropathy will be equally sensitive to soy protein, hypoallergenic and nonallergenic formulas are the preferred alternatives.

ANTIREFLUX FORMULAS - Reflux may be considered physiologic and does not require treatment unless it is accompanied by poor weight gain or significant infant discomfort.

Infant Formula and Colic

Soy and lactose-free formulas are heavily marketed for colic without a formal diagnosis of lactose intolerance.

Most colic improves spontaneously between four and six months of age; new formulas tried during this time may be credited with the improvement.

Evidence for soy formula in the treatment of colic is limited and based on poor-quality trials, and so there is no proven role for soy in the management or prevention of colic.

There is no evidence to support lactose-free formula either, but a short trial may be reasonable in infants with colic who also have gastrointestinal symptoms.

Two systematic reviews have found some benefit with hypoallergenic formula; this potential benefit must be weighed against substantially greater cost.