The Formula Behind Formulas

Neal LeLeiko, MD, PhD,  Pediatrics in Review Editorial Board

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May 17, 2017

This month’s PIR contains useful information on standard infant formulas and specialized infant formulas in two “In Brief” columns by Dr. Tracy P. Milbrandt.

Neal LeLeiko, MD, PhD, Pediatrics in Review Editorial Board

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Article type: Pediatrics in Review Blog

This month’s PIR contains useful information on standard infant formulas and specialized infant formulas in two “In Brief” columns by Dr. Tracy P. Milbrandt. I certainly mean no disrespect to the folks that I meet from the formula companies, but, it is rule number one that every mother should be encouraged to breastfeed her infant, and it is astonishing to me that our society and we ourselves frequently remain at best tolerant of nursing mothers and at worst we are hypocritical.

How many of us have readily available facilities (aka “a lactation room”) in our work area to meet the needs of mothers who are lactating. This goes for our own medical establishments that teach the virtue of nursing but as a matter of policy do little to make it easy for nursing mothers to nurse or pump their breasts and store their infant’s milk.

Commercial formulas are certainly important for mothers who are unable to nurse their babies, however, these formulas are simply not as good as mother’s milk. There is no compelling evidence that for otherwise well infants, any one formula is going to be better for any particular infant than any other available formula. Yet the costs of the various formulas are often burdensome for young families.

It is an axiom of nutrition that the best nutrition comes from a variety of sources, and for those infants not exclusively breastfeeding and enjoying the meal-to-meal variations of human milk, there is always the risk that for any individual baby the particular formula may be considerably less than ideal.

I look forward to the day that we will have a better grasp of personalized nutrition and feeding “guidelines” will seem archaic. Until such time, I feel that formula-fed babies could benefit from some form of variety in their diet.

With regard to specialized formula, the situation is somewhat different. The proper approach should be a rational generic prescription for those nutritional components of the formula necessary to meet the documented individual dietary needs of the infant. The least synthetic diet that meets the infant’s needs is always the preferable choice. With a rational generic prescription, the least expensive formula that fills that prescribed need is the goal. Infant formula composition is not readily discernable from the name of the formula, and the contents may change even without changes to the name. The time constraints placed on our parents and our pediatric practitioners make it very appealing to play around with different formulas.

Time is on everyone’s side, because most so-called feeding problems in well children resolve by themselves over time; switching formula and waiting 1-2 weeks eventually works. Unfortunately, it medicalizes and reinforces untested medical therapies for treating often nonexistent feeding maladies.

For infants truly in need of specialized formulas, a generic prescription seems to be the best way of assuring a well-thought-out plan.

Additional Resources for Pediatricians:

Standard Infant Formula and Formula Feeding – Cow’s Milk Protein Formulas

AAP Textbook of Pediatric Care, 2nd Edition