Special Milk Formulas. How to Use Them Wisely?

Breastfeeding is the natural means of infant nutrition. Human milk composition is optimally suited to the needs of the infant and provides also many immunologically active components with anti-infectious and anti-inflammatory properties. Breastfeeding lowers the risk of different infectious diseases and other diseases (1). Due to the multiple benefits of breastfeeding for both mother and child paediatricians should enthusiastically promote, support and protect breastfeeding. Infants that are not (exclusively) breast-fed need infant formula. Follow-on formulae is only given after introduction of complementary feeding. Standard infant formulae are based on cows’ milk protein. Soybean protein–based infant formulae is not equivalent with an inferior protein quality and concerns regarding phytoestrogen, phytate, and high aluminum contents. Soybean-based formulae should not be given in the first six months. About 10% of infants that are allergic to cows’ milk protein may also develop a soybean protein allergy. Indications for soybean-based formula include galactosemia, religious or other convictions barring the use of cow’s milk, and the feeding of older infants with food allergy who persistently refuse therapeutic hydrolyzed protein formula. Home-made baby milks based on cow’s milk, other animal milks, or other substances are discouraged: hygienic and nutritional inadequacy risks are significant. Because of cross-reactions, the milk of animals other than cows is generally not suitable for the prevention or treatment of allergy to cow’s milk. Non–breast-fed or not exclusively breast-fed infants whose siblings or parents suffer from allergies should be given a hypoallergenic infant formula based on hydrolysed protein. The German Infant Nutrition Intervention (GINI) trial showed that children with a family history of allergies were 18% less likely to develop atopic dermatitis up to the age of 10 years if given a suitable HA formula in their first few months of life (after adjustment for other factors). Infant foods for special medical purposes will also be discussed.

Acknowledgments: The author’s work is financially supported in part by the Commission of the European Community (Projects EarlyNutrition, FP7/2007-13, DYNAHEALTH (H2020-633595) and LIFECYCLE (H2020-SC1-2016-RTD), the European Research Council Advanced Grant META-GROWTH (ERC-2012-AdG 322605), the German Ministry of Education and Research (Grant Nr. 01 GI 0825), and the German Research Council (Ko 912/12-1).

References:

1. Prell C, Koletzko B. Breastfeeding and complementary feeding - recommendations on infant nutrition. Dtsch Arztebl Int. 2016;113(25):435-344.