Why Formula Feeding Matters

Shel Banks

• Publisher: Pinter & Martin
• Year: 2022
• eBook ISBN: 9781780665962
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Making infant feeding decisions relies on parents having access to evidence-based information – but when it comes to formula feeding that can be hard to come by. Commercial interests and misunderstandings about the way breastfeeding is promoted can mean that important knowledge about formula feeding is not communicated to parents.

Why Formula Feeding Matters aims to address this situation so that parents can make fully informed choices about how they feed their babies. All infants should be fed as safely and effectively as possible, and benefit from the best evidence we have about feeding practices. If you are formula feeding your baby, or thinking about doing so, this book is for you.

1

Choosing and buying formula

Choosing infant formula

The array of infant feeding products on the supermarket shelves can be overwhelming. Many parents wonder what all the products are for and some are interested to know what research and evidence supports them. Often families get in touch with me, or with their midwife, health visitor or GP, to ask which milk might be best for a particular baby or circumstance. Unfortunately there is no easy answer to this question. The ingredients of formula milks (apart from the ones controlled by legislation), and the claims for health benefits of different brands and formulations, change frequently. The best we can do is to say that since all formula must by law contain certain ingredients, you can choose based on price, availability, and what your baby seems to prefer. This can seem as though we are saying: ‘it’s your baby, your decision, and you are on your own!’ when the reality is that we all deserve better information about formula.

When there seems to be so much evidence-based information available about breastfeeding, and breastfeeding mothers can access local peer supporters or even specialists to get breastfeeding working, parents can feel very lonely and unsupported when making choices about infant formula and bottles. It’s no wonder so many new parents seek advice from their family and friends, or from online parenting groups.

Reading the packaging leaves us not much the wiser. Phrases such as ‘unique blend of ingredients’, ‘inspiration taken from nature’, ‘delivering hard-to-get nutrients’, ‘contains nucleotides’, ‘can be used for combination feeding’, ‘makes bottle feeding easier’, ‘unique blend of oligosaccharides similar to those found in nature’, ‘LCPs and antioxidants’, ‘complete nutrition’, ‘the next generation of formula milk’, ‘certified organic’, ‘gentle’, ‘contains everything your baby needs for healthy development’, ‘tailored nutrient profile’, and ‘easy to digest’ do not give us factual information that might be useful in decision-making.

Luckily there are some reliable and unbiased resources out there to help to demystify the products, their appropriate uses, and the evidence for their effectiveness. First Steps Nutrition Trust (www.firststepsnutrition.org) provides evidence-based information about all the main infant milks on the market in the UK, and updates the information whenever there’s something new or the manufacturers make a substantial change to a product. Unfortunately this information is hard to come by, as the companies don’t tend to let anyone know unless it’s being used as a driver for marketing, and are often reluctant to provide the research studies which they claim have prompted the changes to their products. Where they do cite particular evidence it’s possible to appraise the papers independently, which is ably done by First Steps Nutrition and to a lesser extent by bodies such as www.lifib.org.uk, which produces information, updates and training for health professionals, but has some consumer information too.

You might imagine that there would be a central requirement for the manufacturers of such important foodstuffs, essential to the survival and growth of so many of our nation’s babies, to tell the public what is in their products, or to at least provide this information to a government department; but because it is classed as ‘food’, there is not. The standard infant milks have the same requirements for reporting contents on the packaging as any other processed or packaged food you can buy in the UK – a list of ingredients and a nutritional values table. Formula does have to conform to the maximum and minimum amounts of nutritional ingredients which are laid out in the European Food Standards Authority paper ‘Scientific Opinion on the Essential Composition of Infant and Follow-on Formula’ – more on that later in this chapter.

In the UK there are also rules about the guidance that must appear on the product’s packaging about making up the milk. So standard infant milks in the UK carry guidance about using recently boiled water, because we know that the powder may be contaminated with bacteria and very hot water is needed to neutralise them. Alarmingly, the rules for specialist infant milks have less regulation – not more, as you might expect – because they are termed ‘foods for special medical purposes’. They therefore do not carry the safer preparation information, although this is still very much applicable.

How is infant formula regulated?

The regulation that covers infant formula on sale in the UK is Regulation 2.16 of the Infant Formula and Follow-on Formula Regulations 2007, which you can find here: www.legislation.gov.uk/uksi/2007/3521/contents/made.

If you read it, you will immediately notice that manufacturers of formula in the UK are either actively infringing the regulation, or skating very close to the edge of it.

For example, the regulations prohibit the use of ‘idealising images’ on the packaging. Yet much of the infant formula available in the UK at the time of writing has representations of cute baby animals or cuddly toys on the label, or a representation of a parent holding their infant. Similarly, the regulations prohibit advertising that makes the brand the focus of the advert, rather than specific products, and that includes pictures or text which directly or indirectly relate or compare products to breastmilk. There have been many instances of advertising where these regulations have been ignored, and organisations including The Baby Feeding Law Group, First Steps Nutrition and Baby Milk Action collect examples and try to have the regulations enforced.

How do parents really make choices?

If we listen to parents describing how they chose the brand of infant formula they used, we can see that in many cases they did not have access to any of the information we have just discussed, either due to circumstances or because they did not realise that the information existed or might be important.

‘When I had my first baby I knew I was going to formula feed and so I got some SMA in before she was born. I was fed on SMA, so were my brother and sisters – it’s what my Mum said was best.’ Jemma, mum of four

‘With my firstborn I wasn’t given any choice! I woke from theatre to find he’d already been given Cow & Gate by bottle... when I had P I chose Cow & Gate because of previously having used that and not knowing any different! I honestly don’t recall being given any advice by anyone... Cow & Gate seemed to be advertised everywhere so I naïvely thought it was the best!’ Lucy, mum of three

‘I tried expressing for the first time at 9pm one night and only got 30ml. I panicked and rushed to Asda for formula, thinking I mustn’t have enough milk and that’s why he cried every evening (never mind that he’d gained a pound above his birth weight in the first 10 days on breastmilk alone!). I was so anxious, sleep-deprived and generally (uncharacteristically) stupid that for a brief while I actually believed that “immunofortis” or whatever Aptamil claimed to contain, was a real thing’. Sarah, mum of two

‘When I was told needed to top up, I was so disappointed – I had always planned to breastfeed. I felt really guilty like I had let my little boy down, so I chose the best on the market, the most expensive. When the nurse at the weighing clinic asked which one I had chosen she responded “Oh Aptamil, that’s supposed to be the closest to breastmilk” so I thought I had done the right thing, made a good choice. She also told me I needn’t feel guilty, that plenty of mothers chose to formula feed – but I hadn’t asked to be excused, I had asked for help with getting breastfeeding established. I went home feeling angry, not reassured’. Stevie, first-time mum

‘Ashamed now to say, I chose SMA mainly because that’s what the hospital had in stock and then because the packaging looked the most “professional” when I was panicking. At hospital, I was told all formulas are the same and was put under a lot of pressure to make a decision immediately, when it wasn’t something I’d ever looked into as I was so sure I’d be breastfeeding.’ Anna, mum of one

In Jemma’s story on page 17, she made a decision based on a product her mother had used perhaps 20–30 years earlier. We know that the ingredients and composition of formula change all the time – so the product her mother used was actually a completely different type of milk with the same name.

If you have ever purchased infant formula, can you recall why you initially chose that brand and type? If you’re thinking about choosing formula now, it can be worthwhile to look at some of your assumptions about branding, quality and health claims – at the very least, it might save you some money.

What are the different types of milks?

The baby aisle in any supermarket offers a baffling array of products. There are tubs of powder which need making up with recently boiled water, and bottles of ‘ready to feed’ milks. There are milks for different age groups, milks for babies who are ‘hungrier’ and there are milks which make claims about health benefits or are aimed at babies with health issues.

Most infant formulas are based on cows’ milk, with lots of additional ingredients (just look at the list on a random tub!), but goats’ milk and soy milk options are also available. Some of the products are labelled as suitable ‘from birth’, but these include products called ‘first infant milk’, ‘comfort milk’, ‘hungry baby milk’, ‘partially hydrolysed’, and ‘lactose free’. We will cover these below.

Most standard milks in the UK are ...

Table of contents

• Cover
• About the Author
• Title Page
• Copyright
• Contents
• Author’s Note
• Introduction
• 1. Choosing and buying formula
• 2. How to make up formula safely
• 3. Responsive feeding – how often and how much?
• 4. Night-time parenting
• 5. Troubleshooting common problems
• 6. Rarer problems
• 7. Alternatives to formula
• 8. Where to find support with formula feeding
• 9. Evaluating the research into formula feeding
• Conclusion
• Appendix: A brief history of formula feeding
• Further reading
• Acknowledgements
• Index