The ideal food for babies under six months is exclusively breast milk , and this is recommended by the WHO and the main scientific societies. From six months to two years of life (or more) it is also the most appropriate liquid, accompanied by other foods.
However, mothers are sometimes unable or unwilling to breastfeed their babies, or some have to do mixed breastfeeding. For these cases, we have multiple preparations on the market, which seek to be as similar as possible to breast milk, both in their composition and in their functional effects. How do we know which is the most appropriate formula milk for our baby?
Types of preparations based on age
Basically we can distinguish three types of preparations based on age:
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Starter formula (type 1) : it is the milk that can be offered from birth. exclusively up to 6 months, and can be used up to one year together with complementary feeding .
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Continuation formula (type 2) : can be offered from 6 months. The WHO states that these formulas are not necessary, as they contain more protein. The advantage they offer is their lower price, so they can be an option for families with fewer resources.
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Growth formulas (type 3) : from 12 months to 3 years. Unlike the 2 previous types, regulated by the European Union, there is no specific regulation on them. Therefore, the composition varies greatly between formulas and some of them contain high amounts of protein and carbohydrates, even sugars. Healthy children do not need to take growth formula and this is stated by the main pediatric scientific societies; from 12 months they can drink cow’s milk without problem.
Composition of the different formulas
As we have previously commented, the composition of the starter and follow-on formulas is regulated by the European Union and they seek to resemble breast milk as much as possible; For this reason, there are no great differences between the preparations in terms of the major components, but they may vary in terms of other additional substances.
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Carbohydrates: lactose is the fundamental disaccharide in artificial formulas (and it is also the majority carbohydrate in breast milk) except, as we will see later, in lactose-free formulas.
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Proteins: a high consumption of protein during the first months of life has been linked to obesity later on. Therefore, the trend has been to reduce the protein content of the formulas (currently between 1.8-2.5g / 100Kcal). Alpha lactalbumin is a fundamental protein in breast milk (it accounts for 20-25% of all proteins): it has an immune function, is involved in the cognitive development of infants, modifies the microbiota and promotes satiety. In contrast, beta-lactolobulin predominates in artificial formulas, which does not exist in breast milk and has no immunological properties. However, many formulas are additionally supplemented with alpha lactalbumin .
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Fats: The fat in breast milk is absorbed much better than that of cow’s milk. It is because the fatty acids in breast milk are in the form of globules covered by a triple layer called the fat globule membrane . In addition to promoting absorption, this membrane plays a role in brain and immune development. That is why there are more and more formulas supplemented with fat globule membrane. Decosahexaenoic acid or DHA (also known as omega 3) is present in breast milk and plays a fundamental role in the brain and visual function of the baby, which is why its addition to all formulas is mandatory, according to the latest update of the regulation. of the European Union.
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Vitamins and minerals . Both iron and calcium in breast milk are absorbed much better than in formula. Therefore, the amount in these milks of both minerals is greater.
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Prebiotics and probiotics . Breast milk is not sterile; on the contrary, it contains a large quantity of bacteria and oligosaccharides (which have anti-infective activity and favor the growth of bifidobacteria and lactobacilli). Prebiotics are oligosaccharides that stimulate the growth of other bacteria; within them we have fructooligosaccharides (FOS) and galactooligosaccharides (GOS). Probiotics are living microorganisms that balance the intestinal microflora. Many formulas are supplemented with pre and probiotics, which have been shown to be safe and well tolerated.
Goat’s milk-based formulas
Most infant formulas are made from cow’s milk. There are also soy formulas, but they should not be used in children under six months. The marketing of infant formulas made from goat’s milk has recently been authorized.
This milk has a lower protein content than cow’s milk, higher concentrations of some minerals (such as magnesium, zinc, calcium and phosphorus) and a different composition and structure of fats that would facilitate its absorption . Thus, formulas made from goat’s milk are a valid alternative to milks made from cow’s milk.
What about palm oil?
Years ago, an alert from the European Food Safety Agency was raised about palm oil, not so much because of its nutritional characteristics but because of the contaminants that are generated in its production. This oil is rich in saturated fat, mainly palmitic acid.
This acid is also present in human milk (in fact, it is the most abundant fatty acid) and therefore in infant formulas; palmitic acid has important functions and is essential . The difference is that in breast milk most of the palmitic acid is in the beta position (the 2 position of the triglyceride) while in the formulas it is in the 1 and 3 position of the triglyceride. This is important since beta palmitate favors the absorption of fats and calcium as well as the development of bifidobacteria . Therefore, more and more formulas contain a higher percentage of palmitic acid in the beta position in their composition.
On the other hand, although the regulations on infant milk do not make any reference to palm oil ( only sesame and cotton oils are prohibited ), many commercial houses have eliminated palm oil from their formulas and use other oils. I also add that fats are essential at these ages and should not be restricted . In breast milk, 50 percent of calories come from fat. In fact, low-fat diets at these ages have been shown to have negative effects on the development and growth of these babies.
Special formulas
Some infants have digestive problems that lead them to need special formulas. It is important that these formulas are recommended by a pediatrician after evaluating the infant.
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Lactose-free formula: We have commented that lactose is the main carbohydrate in both breast milk and artificial formulas. However, some babies may have congenital (birth) intolerance to lactose, and others may have transient or secondary intolerance (for example, after very long gastroenteritis). For these particular cases, there are formulas without lactose, in which they substitute this carbohydrate for another.
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Hydrolyzed formulas : in these formulas the proteins are “chopped up”, giving rise to very small pieces that facilitate absorption and reduce their allergic capacity; They are therefore used in infants with an allergy to cow’s milk proteins and in patients with severe intestinal disorders. Depending on how small those chunks are, we have extensively hydrolyzed formulas and elemental formulas (even smaller chunks). There are no scientific studies showing long-term efficacy of partially hydrolyzed formulas designed for infants at risk of developing an allergy.
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Premature formulas : premature infants have different nutritional needs than term infants. The milk of a mother who has given birth to a premature baby is different from the milk of a mother who has given birth to a full-term baby. Thus, formula milks for premature babies will also be different: they provide more calories, more protein and more calcium and phosphorus .
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Anti-regurgitation formula : they contain thickeners, a lower proportion of lactose and different proportions of proteins and fatty acids to promote absorption and accelerate stomach emptying. Like other special formulas, they must be used under medical supervision.
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Anti-colic formula : the cause of infant colic is not yet established so we do not have adequate treatment. We do know, however, that infant colic improves with age, disappearing in most babies between 3 and 4 months of age. These so-called anti-colic formulas try to facilitate the infant’s digestion, reducing the lactose content, partially hydrolyzing the proteins and / or adding probiotics.
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Anti-constipation formula: these formulas usually contain a greater amount of beta palmitic (a fatty acid present in breast milk), probiotics and oligosaccharides (which act as prebiotics), as well as more magnesium that acts as a laxative.
In short … what should we look for when choosing a formula for our baby?
As we have seen, the composition of the starter and follow-on formulas is strictly regulated , so the main components vary little.
We can use the starter or type 1 formula from birth to six months exclusively and from 6 to 12 months together with other foods. The continuation or type 2 formulas are not strictly necessary, but they are cheaper and can be used from six months. From the year of life, healthy children can drink cow’s milk. Growth formulas are not necessary or recommended in healthy children.
The amounts of protein, fat and carbohydrates in the formulas are very similar. The trend is to decrease the amount of protein , since a high protein content in the first months of life has been associated with long-term obesity. A greater amount of palmitic acid in beta position is desirable to promote fat absorption. All formulas must be supplemented with DHA . In addition, some have a fat globule membrane , which favors the absorption of fats. They can also be supplemented with pre and probiotics.
In the event that our baby has a digestive problem (constipation, regurgitation, infant colic …) we must contact our pediatrician to assess him before changing formula.
