I recently stumbled across a lot of information on social media about homemade baby formulas and how “nasty” commercial formulas are. I wanted to give you my opinion as a mum, paediatric nutritionist and whole foodie to clear up some misinformation.
Obviously, breast is best. But if you’re a mum in a situation where things have not turned out the way you planned or you don’t fancy breast feeding, I understand. My first born had food protein induced enterocolitis and could only be breast fed. By the time ,y second Clementine came along (18 month later), I breastfed until I was fed up (pun intended!).
Breastmilk contains a range of beneficial properties including immune complexes, hormones, probiotics plus many other superpowers that food science simply cannot replicate. The discontinuation of breast feeding is not a decision that should or is taken lightly, if it is a choice at all.
Common reasons people discontinue breastfeeding include; supply issues, nipple damage, mental health reasons, allergies or other feeding issues, and work commitments. Also, some women just don’t enjoy breast feeding.
In regard to exposure to allergens, the current recommendation is to introduce potentially allergenic foods from 4-6 months (NHMRC, 2012). Repeated and frequent exposure of allergens is key, provided there is no reaction. Please don’t just give an allergen once and assume you’ve done your bit. Keep giving it to them, at least every week. Please don’t delay the introduction of allergenic foods. Research has shown that delaying introduction actually increase the risk of food allergies. The exception to this of course is when babies need formula before the age of 4-6 months. the most common type of formula given is a cows milk based, other people choose goats or plant based folks choose soy. There is no right or wrong. It's what works for your baby. Fed is best.
When cow’s milk allergy is an issue, I recommend (if mum cannot continue to breast feed) try a hypoallergenic formula, my favourite is NOVOLAC allergy. My only caution to this is it can be tricky to find Novolac and keep a constant supply of it.
As a whole foodie, I love the idea of homemade baby formula, though the reality it is far from safe. You or the person who wrote the homemade formula recipe is likely not a specialist in infant nutrition or food science, sorry. There are lots of things to consider when deciding which formula is best for your baby.
A few things to consider:
⁃ Contamination and shelf life. Raw milk and bone broth are not safe as a base for formula. Raw milk is a potential source of pathogenic bacteria, which can cause life threatening complications. Whole milk (raw or pasteurised) also contains too much protein and causes excessive renal load for infants and has the uncorrected micronutrient balance for HUMAN BABIES. Although baby formulas are “sterile”, they are a much safer choice when it comes to feeding you baby.
- You can add probiotics to formula to make it less "sterile". If adding probiotics to formula (something I recommended) make sure you are using an infant specific probiotic. There are many different strains for a variety of indictions. Eg. LGG for prevention of allergies, Lactobacilli rueteri for colic (Sung et al, 2018), bifidobacterium infantis the one most commonly found in “healthy’ infants. It’s best to speak to someone about what strains and species are best suited to you baby and what dose.
⁃ Most cow’s milk baby formulas use milk powders. These may be listed as demineralised whey protein or whey protein concentrate, skim milk powder, or whole milk powder. Generally, whey dominant formula is used for infant because it is gentler on the stomach. You’ll find that stage 2+ formulas will use either half whey + casein or just casein protein. If you think your baby has an issue with cow’s milk, you can try goats as people do report better digestibility, however the casein to whey ratio in goats is 80:20, the same as cows. Goats milk is not a suitable alternative for infants with cow’s milk protein allergy as majority of the infants also react to goats (and soy) formulas.
⁃ You'll notice most cows or goat milk formulas list lactose as an ingredient. Lactose is used as a sweetener, as this is what also makes breast milk sweet. Soy based, lactose free or hypoallergenic formulas will use corn syrup, brown rice syrup or glucose to sweeten. Lactose is the preferable in my opinion as the health consequences of early sugar intake in the form of glucose and fructose are unknown. However this may not be a choice in the case of lactose intolerance or allegories.
⁃ Can’t we just give our baby whole cows or goats milk? NO, infant formulas are used because they manipulate the proteins, fats and nutrient content to be as similar to breast milk as possible. Whole milk is not suitable for babies as a substitute for breast milk mainly because of the higher protein content which puts excessive strain on babies’ kidneys. The micronutrient balance is also not suitable for human babies.
⁃ Micronutrient balance: food scientists and manufacturers use average breast milk concentrations and government RDI’s to set amounts of micronutrients in formula. It’s incredibly difficult to measure amounts of micronutrients yourself in wholefood/ homemade formulas. Vitamin B12 deficiency can lead to permanent neurological damage and iodine deficiency if uncorrected can cause mental retardation. Other nutrients (especially fat-soluble vitamins and minerals) can be toxic in high doses. Homemade formulas cannot replicate the intricate micronutrient balance like food science can.
⁃ Choose a formula that contains added elongated fatty acids (DHA + AA). DHA is derived from omega 3 fatty acids and AA is derived from omega 6 fatty acids. I know omega 6 generally gets a bad wrap. It’s true the western diet contains an imbalance of omega 6 to omega 3, but its suggested in the literature that infants need both omega 3 and omega 6. AA is a precursor for over 100 eicosanoids, that have a broad range of physiological functions in humans. The vascular and immune functions of eicosanoids may play a preventative role in some common medical issues in premature infants including retinopathy, periventricular haemorrhage, necrotizing enterocolitis and general infections. DHA has a high affinity for the brain function, visual acuity and immune function. The ratio of AA: DHA in the breast milk of mothers varies across the continents. Western mothers have a ratio of 2:1, Asian 0.4:1 and European 1:1. It is impossible to mimic this precise ratio’s and dosages with homemade formula.
⁃ Prebiotics are great to stimulate the establishment of a healthy microbiome. HOS (human oligosaccharide) are naturally found in breast milk. They are undoubtedly the best probiotics on the planet! GOS (Galacto-oligosaccharides) stimulates bifidobacterium species which produce short chain fatty acids which maintain the health of the colon and for general gut health. FOS (Fructooligosaccharides) stimulates the growth more of lactobacilli species.
In summary….
Breast is best but also so is fed.
If you cannot breast feed,
1. Find a formula that you can have a reliable supply of. Babies often will find a formula they like and can be pretty averse to slight flavour changes.
2. If possible (affordable/ accessible), choose organic, and one with added long chain fatty acids, DHA + AA, especially if preterm.
3. For infants, a whey based is usually best tolerated. Once solids are introducing, transitioning to a casein and whey based is the nest step (usually termed step 2).
4. If allergies are present, discuss your options with your doctor, lactation consultant or paediatric dietician or nutritionist.
5. Know who you are getting your information from (is it well referenced, what is the writer qualifications etc) and what is driving your decision making (fear or facts).
6. Parents know best, follow your gut! It’s your baby after all.
If you don't want to read all the research papers, here are two fairly user friendly resources https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers and https://www.allergy.org.au/patients/fast-facts/cows-milk-dairy-allergy.
References
Nhmrc.gov.au. (2012). Infant Feeding Guidelines: information for health workers | NHMRC. [online] Available at: https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers [Accessed 3 Mar. 2020].
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