Infant Formula
Hetty Cunningham, MD
December 2007
Learning Objectives:
- Understand different types of formula their indications and usage
- Learn about formula use in infants with milk protein allergy.
Primary References:
1. Hall RT, Carroll RE. Infant feeding. Pediatrics in Review. 2000;21(6): 191-200.
2. Soy Protein-based Formulas: Recommendations for Use in Infant Feeding. Pediatrics 1998;101;148-153
Secondary References:
1. Hypoallergenic Infant Formulas. Pediatrics 2000;106;346-349
2. Ripkin Formula Intolerance, Pediatr. Rev. 1997;18;191
3. Garrison MM, Christakis, DA. A Systematic Review of Treatments for Infant Colic. Pediatrics. Vol. 106 No. 1 Supplement July 2000, pp. 184-190
Formula cases:
Case I
1a. The mother of a breastfeeding mother would like to supplement with formula and she is asking you which would be the best formula to use soy or cow’s milk based.
1b. Mother has heard about the lipil formulas and DHA supplementation in formula. She would like to know whether it is worth paying extra money for these formulas.
1c: Mom asks what are those other formulas on the shelves at Wal-Mart? They seem to go on and on…
1d: Mother reads only French, Woloff, and German and thus cannot read the instructions on the back of the formula container. How would you instruct mother to mix powdered formula? Concentrated liquid formula?
1e: What water should she use?
2. You are seeing a 6 month old premature baby who has been fed with Neosure. The baby is growing very well and the mother is wondering when she can switch to regular formula since her insurance company “Cheepie HMO” is giving her a hard time about paying for it.
Case II: Consider the following 3 cases: In which would you consider a formula change, to what and why?
1. A mother of a 2 month old presents to your office. She reports that the child is spitting up a lot (not projectile) and she would like to change the formula. The child otherwise seems to be thriving. Also the child has atopic dermatitis and constipation.
2. You are seeing a 2 month old in your office mother reports that the child is very fussy and cries in pain frequently throughout the day. Mother’s neighbor recommended changing the formula to soy and mom is now is asking you for a letter for WIC.
3. You are seeing a 2 month old who is cranky, spit up a lot, has flecks of blood in the stool and has dropped 2 percentiles in the past month.
i. Would you substitute with a soy formula?
ii. Could you substitute with a lactose-free formula?
Case III:
The mother of a 3 day old presents to your office with persistent vomiting and diarrhea. The child has lost 20% of her birth weight, and she has a weak cry and poor perfusion. What would you do?
CASE IV:
