Families For Life | Feeding Your Baby: Breast or Bottle?-Toddlers

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Breastfeeding is the best source of nutrition for your baby. However there are exceptional circumstances in which a mother is considered to be unable to breastfeed her baby.

The debate on breastfeeding or bottle-feeding your baby

Breastfeeding gives your baby the best start to his/her life. Breastfeeding is the most natural way of feeding and is also the best source of nutrition for your baby. The nutritional composition of breast milk changes according to your baby’s needs which can vary, from day to day, and during the day.

Colostrum — the first milk

Colostrum is the first milk, which is produced for the first few days after birth. Its composition is very different from mature breast milk. It is important for the baby’s long-term health and development.

Colostrum has a higher content of protein than mature breast milk. Much of the protein is present as immunoglobulins (antibodies), which help to protect your baby against infection. Also, colostrum has a lower fat content than mature milk and is rich in minerals and vitamins A, D and B12.

Energy

The energy requirements of infants reflect the amount needed to promote health, adequate growth, optimal body composition and levels of physical activity appropriate for their developmental age. On the per weight basis, infants require 3–4 times more energy than adults.

The energy in breast milk is provided by fats, carbohydrates and proteins in the following proportions:

Fats

Fat is a concentrated source of energy, which is needed for growth and development. Fat also provides the infant with a source of essential fatty acids and long chain polyunsaturated fatty acids (LCPs), DHA for brain, retina and nervous tissue development and is necessary for the absorption of the fat-soluble vitamins A, D, E and K.

The fat content of breast milk is highly variable. It varies during a feed (more fat in hind milk) and at different times of the day (lowest fat in early morning).

Carbohydrates

Carbohydrates provide infants with a major source of energy, freeing protein for growth. The main carbohydrate source in breast milk is lactose. Lactose is beneficial for the baby as it enhances calcium absorption.

Breast milk also contains a group of non-digestible carbohydrates called oligosaccharides. Oligosaccharides are not digested in the upper part of the gastro-intestinal tract, reaching the colon intact. Here, they are used as food for the beneficial bacteria (e.g. Bifidobacteria) present in the intestine and increasing their numbers. Bifidobacteria has been shown to have protective properties such as inhibition of pathogens (disease forming bacteria) as well as supporting the development of the immune system.

Protein

Protein provides infants with a source of essential amino acids for growth. Breast milk contains two types of protein, whey and casein.

However, excess protein may put unnecessary stress on the immature kidneys of baby.

Summary of the important roles of breast milk

Roles	Breast milk constituents (Examples only, not complete list)
Energy and growth	Fat, carbohydrates, protein, growth factors, nucleotides
Brain and eye	LCPs, taurine
Digestive system	Oligosaccharides, taurine, enzymes
Immune system, defence	Immunoglobulins, selenium, beta-carotene, nucleotides, oligosaccharides
Cardiovascular system and blood	Iron, lactoferrin, vitamin K
Bones	Calcium, phosphorus, vitamin D

Bottle-feeding your baby

While breast milk is superior for the newborn baby, infant milk formula plays an important role in infant nutrition when exclusive breastfeeding is not possible.

Many advances have been made to bring the composition of infant formula milk closer to breast milk. Important modifications have included reduction in protein content, addition of vitamins, trace elements and lactose and alteration of the whey:casein ratio. The final aim is not necessarily to mimic the composition of breast milk in every respect, but to achieve the functional benefits of breast milk.

All infant milk formulas that are available in the market today are formulated in accordance to the Codex Alimentarius standards. They are safe and nutritionally adequate for feeding your baby.

According to the World Health Organization, there are exceptional circumstances in which a mother can be considered to be unable to breastfeed her baby; for example, if the mother has a chronic illness (such as HIV infection or tuberculosis) or is under certain medication.

If you have decided to bottle feed your baby, you will have to start by selecting the right infant milk formula. Your doctor can help you pick one based on your baby’s needs.

Why infant milk formula instead of cow’s milk?

Many parents wonder why they cannot just feed their baby regular cow’s milk. The answer is simple: young babies cannot fully digest cow's milk as completely or easily as they digest formula.

Also, cow’s milk contains high concentrations of protein and minerals, which can stress a newborn’s immature kidneys and cause dehydration.

In addition, this feeding lacks the proper amounts of iron and vitamin C that infants need. It may even cause iron-deficiency anemia in some babies, since protein can irritate the lining of the stomach and intestines, leading to loss of blood into the stools.

For these reasons, your baby should not receive any regular cow’s milk for the first year of life.

Choosing an infant milk formula

When shopping for a manufactured infant formula, you will find three basic types:

Cow’s milk-based formulas account for about 80% of the formula sold today. Though cow’s milk is at its foundation, the milk has been changed dramatically to make it safe for infants. It is treated by heating and other methods to make the protein more digestible and less potentially allergenic. More milk sugar (lactose) is added to make the concentration equal to that of breast milk, and the fat (butterfat) is removed and replaced with vegetable oils that are more easily digested by infants. Cow’s milk infant formulas are fortified with iron. If your baby is full-term, he should have enough natural reserves of iron to meet his needs for his first four to six months. After six months, however, he needs some extra iron in his diet, and iron-fortified formula is one way to meet this requirement.
Soy formulas contain a different protein (soy) and different carbohydrate (glucose polymers or sucrose) from milk-based formulas. They are recommended as an alternative for babies who are unable to digest lactose, the main carbohydrate of cow’s milk formula. If you choose to use soy products, be sure to use a soy-based infant formula — not regular soymilk.
Specialized formulas are manufactured for infants with particular disorders or diseases. Protein hydrolysate formulas are meant for babies who have a family history of milk allergies. It is easier to digest and less likely to cause allergic reactions than standard cow’s milk formula because the proteins are broken down. There are other specialized formulas, such as those for infants with low birth weight, problem of regurgitation, inability to digest fat and other conditions. There are also formulas made specifically for premature babies. If your newborn has special needs, consult your pediatrician on which formula is best for your baby.

Preparation of infant formula

Infant formulas are available in ready-to-feed liquid forms or as powders. Powders are available either as pre-measured individual packets or in a can with a measuring scoop. To prepare it, each scoop of powdered formula must be mixed with the specified amount of water.

It is important to follow the manufacturer’s directions exactly. Do not pack the scoop with too much powder as this will increase the concentration of the feed.

Adding the right amount of water is also important. If you add too much water, your baby would not get the calories and nutrients he/she needs for proper growth. If you add too little water, the high concentration of formula could cause diarrhoea or dehydration and will give your baby more calories and nutrients than he needs.

Whichever type of infant formula you choose, proper preparation and refrigeration are essential.

Remember that no infant milk formula can surpass breast milk as the ideal and unique food for healthy term infants. Continuous research is still in progress to identify the role of different substances in breast milk so that the breast milk benefits can be integrated into infant milk formulas.

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By Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John,
KK Women's and Children's

Sources:

The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.