- educate parents on the importance of correctly preparing infant formula and following the instructions carefully, including using the correct scoop and not overfilling or underfilling the scoop.
- check that infant formula is being prepared according to instructions (i.e. to the correct concentration).
I'm going to look at the legalities of infant feeding and the context us midwives and nurses are working in partnership with families, in relation to infant feeding. And holy moly it is a minefield. Must be careful where I step. I'm looking at the NHMRC, WHO (World Health Organisation) and the Australian midwives rules. I think as a parent it's useful to know what a health professional is duty bound to inform you about and we as health professionals have a duty of care to give parents correct, up to date info on formula feeding as well as on breast feeding.
As a midwife I support the WHO stance on breast feeding but I also support mothers/parents choice.
This is what the Australian midwives code of ethics and guidelines says:
"A midwife’s primary responsibility is to the woman and her infant(s)...midwives recognise the validity of the woman’s knowledge of self during pregnancy, labour, birth and early parenting; and the need for each woman to have freedom to make choices about her care, informed decision making, and a trusting, supportive and protective environment. Midwives also strive to ensure that the infant’s health needs are met, including promoting a safe birth and the establishment of breastfeeding."
"Health workers have a responsibility to promote breastfeeding first but, where it is needed, to educate and support parents about formula feeding. Some mothers may experience feelings of grief or loss if they decide not to breastfeed. A mother’s informed decision not to breastfeed should be respected and support from a health worker and/or other members of the multidisciplinary team provided."
Under the WHO code
- feeding with infant formula should only be demonstrated by health workers, or other community workers if necessary, and only to the mothers or family members who need to use it
- the information given should include a clear explanation of the hazards of improper use. Labels of infant formula products must contain a statement that a doctor or health worker should be consulted before deciding to use the product. Health workers are seen by the public as the main source of advice on infant feeding and are well placed to advise mothers and carers, regardless of the feeding option they have chosen for their infant.
- that a suitable infant formula should be used until the infant is 12 months of age
- the cost of formula feeding
- the hazards of improper formula preparation and storage.
All infant formulas available in Australia are regulated by the Australia new Zealand Food standards code and contain adequate nutrients for infants. The constituents of human milk are used as a reference in developing infant formula. However, infant formula lacks many factors present in human milk, including numerous types of living cells, cholesterol, polyamines, free amino acids, enzymes and a wide range of other bioactive substances. Furthermore, the sterilisation (pasteurisation) processes used in manufacturing formula slightly modify the structure of the cow’s milk proteins, with a consequent loss of any cross-species protection against infection.
We know that it is unlikely that these products could ever duplicate the variety of nutrient and active factors present in human milk or the changing nature of the milk during the course of a feed.
Recently infant formula manufacturers have examined protein levels in infant formula in relation to childhood obesity. The protein in infant formula is either casein or whey dominated. Casein is harder to digest, stays in the stomach longer and is the curds. Whey is easier to digest and is the watery milk. Some formula's are a balance of casein and whey, others are whey dominant.
Amino acid content differs from breast milk and a higher protein level is required to meet minimum amounts of specified amino acids, especially tryptophan. Remember that blog I wrote recently on tryptophan and helping babies sleep?
Research into infant feeding and later growth has reported that infants breastfed more than 12 months were leaner at one year. A major well-conducted, randomised, controlled trial of lower protein formula undertaken in europe concluded that a ‘higher protein content of infant formula is associated with higher weight in the first 2 years of life but has no effect on length. Lower protein intake in infancy might diminish the later risk of childhood overweight and obesity. Since this study, the quality of the protein in many brands of infant formula in Europe has been improved, enabling the overall protein levels to be reduced.
"A review of links between protein levels of infant formula and cow’s milk and obesity and chronic disease in adulthood is now available. This is really interesting and new information. This evidence suggests that preferable levels of protein in formula to promote growth rates similar to breastfed infants are similar to the levels in human milk, subject to a minimum content of specific amino acids.
Human breast milk contains 1–1.1 g protein per 100 ml compared to cow’s milk with 3.3 g per 100 ml.
Protein content in infant formulas available in Australia is in the range of 1.3–2.0 g protein per 100 ml, with goat’s milk formula at the high end of this range.
Nan HA Gold has 1.3g per 100ml - the protein is 100% whey
S26 Newborn Gold has 1.3g protein per 100ml - the protein is 65% whey, 35% casein
Karicare Aptamil Gold has 1.44g per 100ml - the protein is 60% whey and 40% casein
A2 Platinum formula has 1.5g per 100mls - 60% whey and 40% casein
Bellamy's Organic Newborn has 1.7g per 100mls - the protein is 60% whey and 40% casein
I hope you found that interesting and I agree it was very long overdue!
I'm going to delve into the nitty gritty next of what is different about each formula. Each company has its' special ingredient and I think parents need to know what exactly is Gold or HA or the individual probiotics etc. Coming up next.