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What's the Best Water to Use for Baby Formula

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Manufactured food designed for feeding infants

Babe formula, infant formula or simply formula (American English) or infant milk, infant milk, faux milk, or commencement milk (British English), is a manufactured nutrient designed and marketed for feeding to babies and infants under 12 months of historic period, ordinarily prepared for bottle-feeding or cup-feeding from powder (mixed with water) or liquid (with or without boosted h2o). The U.S. Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human being milk".[1]

Manufacturers state that the composition of baby formula is designed to be roughly based on a human being mother'south milk at approximately one to three months postpartum; however, there are significant differences in the nutrient content of these products.[2] The most commonly used infant formulas contain purified cow's milk whey and casein as a protein source, a blend of vegetable oils every bit a fatty source[annotation 1], lactose as a carbohydrate source, a vitamin-mineral mix, and other ingredients depending on the manufacturer.[three] In addition, there are infant formulas using soybean as a protein source in place of cow'southward milk (by and large in the Us and Great United kingdom of great britain and northern ireland) and formulas using poly peptide hydrolysed into its component amino acids for infants who are allergic to other proteins. An upswing in breastfeeding in many countries has been accompanied by a deferment in the average age of introduction of baby foods (including cow'due south milk), resulting in both increased breastfeeding and increased use of infant formula between the ages of 3- and 12-months.[4] [5]

A 2001 World Health System (WHO) written report found that baby formula prepared in accordance with applicable Codex Alimentarius standards was a safe complementary food and a suitable breast milk substitute. In 2003, the WHO and UNICEF published their Global Strategy for Infant and Young Child Feeding, which restated that "processed-nutrient products for...young children should, when sold or otherwise distributed, meet applicable standards recommended by the Codex Alimentarius Commission", and also warned that "lack of breastfeeding—and especially lack of exclusive breastfeeding during the first half-year of life—are important take a chance factors for baby and childhood morbidity and mortality".

In particular, the use of infant formula in less economically developed countries is linked to poorer health outcomes because of the prevalence of unsanitary preparation conditions, including lack of clean water and lack of sanitizing equipment.[6] A formula-fed child living in unclean weather is between 6 and 25 times more likely to die of diarrhea and four times more than likely to die of pneumonia than a breastfed child.[7] Rarely, employ of powdered infant formula (PIF) has been associated with serious disease, and even expiry, due to infection with Cronobacter sakazakii and other microorganisms that tin be introduced to PIF during its production. Although C. sakazakii tin crusade illness in all historic period groups, infants are believed to be at greatest gamble of infection. Betwixt 1958 and 2006, there accept been several dozen reported cases of E. sakazakii infection worldwide. The WHO believes that such infections are nether-reported.[8]

Uses, risks and controversies [edit]

The utilize and marketing of infant formula has come under scrutiny. Breastfeeding, including exclusive breastfeeding for the showtime six months of life, is widely advocated equally "platonic" for babies and infants, both by wellness authorities[6] [nine] — and accordingly in ethical advertising of infant formula manufacturers.[x]

Despite the recommendation that babies be exclusively breastfed for the outset 6 months, less than twoscore% of infants below this age are exclusively breastfed worldwide.[xi] The overwhelming majority of American babies are not exclusively breastfed for this period – in 2005 under 12% of babies were breastfed exclusively for the first 6 months,[ix] with over 60% of babies of 2 months of age being fed formula,[12] and approximately one in 4 breastfed infants having baby formula feeding within 2 days of nativity.[13]

Some studies accept shown that utilize of formula can vary according to the parents' socio-economic status, ethnicity or other characteristics. For example, according to a research conducted in Vancouver, Canada, 82.9% of mothers breastfeed their babies at nascence, but the number differed between Caucasians (91.vi%) and not-Caucasians (56.8%), with the divergence essentially attributed to marital status, pedagogy and family income.[14] In the United States, mothers of lower socio-economic status have been constitute less probable to breastfeed, although this may be partly related to adverse effects of government nutrition supplementation programs that provide subsidies for babe formula.[xv]

The use of hydrolysed cow milk baby formula versus standard milk babe formula does not announced to modify the risk of allergies or autoimmune diseases.[xvi]

Utilize of infant formula [edit]

In some cases, breastfeeding is medically contraindicated. These include:

  • Female parent's health: The female parent is infected with HIV or has agile tuberculosis.[17] She is extremely ill or has had certain kinds of chest surgery, which may have removed or disconnected all milk-producing parts of the breast. She is taking whatever kind of drug that could harm the baby, including both prescription drugs such as cytotoxic chemotherapy for cancer treatments every bit well every bit illicit drugs.[17]
    • One of the primary global risks posed by chest milk specifically is the transmission of HIV and other infectious diseases. Breastfeeding by an HIV-infected female parent poses a 5–20% chance of transmitting HIV to the babe.[18] [19] [20] Nonetheless, if a female parent has HIV, she is more likely to transmit it to her child during the pregnancy or birth than during breastfeeding. A 2012 study conducted by researchers from the University of North Carolina School of Medicine showed reduced HIV-one transmission in humanized mice, due to components in the breast milk.[21] Cytomegalovirus infection poses potentially dangerous consequences for pre-term babies.[19] [22] Other risks include mother'due south infection with HTLV-one or HTLV-2 (viruses that could cause T-cell leukemia in the baby),[19] [xx] herpes simplex when lesions are present on the breasts,[xx] and chickenpox in the newborn when the disease manifested in the mother inside a few days of birth.[20] In some cases these risks can be mitigated by using heat-treated milk and nursing for a briefer time (east.g. half-dozen months, rather than 18–24 months), and tin can be avoided past using an uninfected adult female's milk, as via a wet-nurse or milk bank, or by using infant formula and/or treated milk.[23]
    • In balancing the risks, such as cases where the mother is infected with HIV, a decision to use infant formula versus exclusive breastfeeding may exist made based on alternatives that satisfy the "AFASS" (Adequate, Feasible, Affordable, Sustainable and Prophylactic) principles.[23] [24]
  • Baby is unable to breastfeed: The child has a birth defect or inborn error of metabolism such every bit galactosemia that makes breastfeeding difficult or impossible.[25]
  • Babe is considered at risk for malnutrition: In certain circumstances infants may exist at risk for malnutrition, such as due to iron deficiency, vitamin deficiencies (e.g. vitamin D which may be less nowadays in breast milk than needed at loftier latitudes where there is less sun exposure), or inadequate nutrition during transition to solid foods.[26] Risks can often exist mitigated with improved diet and education of mothers and caregivers, including availability of macro and micronutrients. For example, in Canada, marketed infant formulas are fortified with vitamin D, but Health Canada besides recommends breastfed infants receive extra vitamin D in the form of a supplement.[27]
  • Personal preferences, behavior, and experiences: The mother may dislike breast-feeding or think it is inconvenient.[28] In improver, breastfeeding can be difficult for victims of rape or sexual corruption; for example, it may be a trigger for posttraumatic stress disorder.[29] [30] Many families canteen feed to increase the father's role in parenting his child.[31]
  • Mental Wellness: The pressure level to breastfeed in many cultures can be so much that the mother's mental wellness may take a sharp decline. This can take physical furnishings such as poor latching as well as milk depletion and a lack of connection to the child. In some cases it is better for the child to be formula fed so that a better bond can exist made between mother and child rather than the 'special bond' that comes from breastfeeding being tainted by negative breastfeeding experiences. The force per unit area to breastfeed in many cultures can increase the likelihood of postpartum depression[32]
  • Absence of the female parent: The child is adopted, orphaned, abandoned, or in the sole custody of a man or male same-sex activity couple. The mother is separated from her child by being in prison house or a mental infirmary. The mother has left the child in the care of another person for an extended period of fourth dimension, such every bit while traveling or working abroad.
  • Nutrient allergies: The mother eats foods that may provoke an allergic reaction in the infant.[ citation needed ]
  • Financial pressures: Maternity go out is unpaid, bereft, or lacking. The mother's employment interferes with breastfeeding.[33] Mothers who breastfeed may experience a loss of earning power.[34]
  • Societal structure: Breastfeeding may exist forbidden at the female parent'south task, school, identify of worship or in other public places, or the mother may feel that breastfeeding in these places or effectually other people is immodest, unsanitary, or inappropriate.[33]
  • Social pressures: Family members, such every bit mother'south husband or young man, or friends or other members of society may encourage the use of babe formula. For case, they may believe that breastfeeding volition decrease the mother'due south energy, wellness, or attractiveness.[ citation needed ] [35] Conversely, societal pressures to breastfeed can also atomic number 82 to mental health issues. A sense of shame from not beingness able to or struggling to do then equalling being a failure has a connexion to Postpartum Low[32] The widely used phrase "Breast is Best" makes those who are struggling feel extra pressure level and shame for non giving their child "the best". The phrase "Fed is Best" is starting to exist used in replacement to relieve some of that pressure level and non let women who may be struggling fall into the trap of feeling similar bad mothers.
  • Lack of training and education: The female parent lacks educational activity and training from medical providers or community members.[ citation needed ] [36]
  • Lactation insufficiency: The mother is unable to produce sufficient milk. In studies that do not account for lactation failure with obvious causes (such as use of formula and/or breast pumps), this affects around two to v% of women.[37] Alternatively, despite a good for you supply, the woman or her family may incorrectly believe that her breast milk is of low quality or in low supply. These women may cull infant formula either exclusively or as a supplement to breastfeeding.[ commendation needed ]
  • Fearfulness of exposure to environmental contaminants: Certain environmental pollutants, such equally polychlorinated biphenyls, can bioaccumulate in the food chain and may be found in humans including mothers' breast milk.[38]
    • Withal studies have shown that the greatest risk period for adverse effects from environmental exposures is prenatally.[38] Other studies have further found that the levels of most persistent organohalogen compounds in homo milk decreased significantly over the past three decades and equally did their exposure through breastfeeding.[39]
    • Inquiry on risks from chemical pollution is generally inconclusive in terms of outweighing the benefits of breastfeeding.[twoscore] [41] Studies supported past the WHO and others have found that neurological benefits of chest milk remain, regardless of dioxin exposure.[41] [42]
    • In developing countries, environmental contaminants associated with increased health risks from use of infant formula, specially diarrhea due to unclean water and lack of sterile conditions – both prerequisites to the condom use of formula – often outweigh any risks from breastfeeding.
  • Lack of other sources of breast milk:
    • Lack of wet nurses: Wet nursing is illegal and stigmatized in some countries, and may not be available.[43] It may likewise be socially unsupported, expensive, or health screening of moisture nurses may not be available. The mother, her dr.,[44] or family may not know that moisture nursing is possible, or may believe that nursing past a relative or paid moisture-nurse is unhygienic.
    • Lack of milk banks: Human-milk banks may not be available, as few exist, and many countries cannot provide the necessary screening for diseases and refrigeration.

Health risks [edit]

Utilise of baby formula has been cited for numerous increased wellness risks. Studies have found infants in developed countries who consume formula are at increased risk for astute otitis media, gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma, obesity,[45] type one and ii diabetes, sudden infant decease syndrome (SIDS), eczema and necrotizing enterocolitis when compared to infants who are breastfed.[46] [47] [48] [49] Some studies have found an clan between infant formula and lower cognitive development, including iron supplementation in babe formula being linked to lowered I.Q. and other neurodevelopmental delays;[50] [51] however other studies take institute no correlation.[46]

Melamine contamination [edit]

In 2008, a instance of melamine poisoning of infant formula was discovered in Red china, where milk was deliberately adulterated with the chemical, leading to the decease of half dozen babies, and illnesses in more than 300,000 infants, including cases of acute kidney failure. Large quantities of melamine were added to watered-downwardly milk to give it the appearance of having adequate protein levels. Some of those responsible for the poisoning were sentenced to expiry.[52]

In November 2008, traces of melamine were reported to accept been institute by the U.S. Food and Drug Administration in baby formula sold in the United States made past the three main American firms[53] [54] — Abbott Laboratories, Nestlé and Mead Johnson — responsible for ninety–99% of the infant formula market in that country.[15] [53] The levels were much less than those reported in China, where levels of melamine contamination had reached as much equally 2,500 parts per 1000000, about 10,000 times higher than the recorded U.s. levels. The safety data sheet for melamine (CAS registry number 108-78-1; C3-H6-N6) recorded the acute oral toxicity (median lethal dose) at 3161 mg/kg for a rat.

Wellness Canada conducted a split up test and also detected traces of melamine in infant formula available in Canada. The melamine levels were well beneath Health Canada's condom limits,[55] although concerns remain virtually the prophylactic of manufactured food for infants and monitoring of potentially unsafe substances.[52]

Other wellness controversies [edit]

  • In 1985, Syntex Corporation was ordered to pay $27 meg in compensation for the deaths of two American infants who suffered encephalon damage subsequently drinking the company's baby formula, called Neo-mull-soy.[56] Formulas produced past Syntex had previously been subject to a major recall as they were found to have insufficient chloride to support normal infant growth and evolution.[57]
  • In 2003, baby plant-based formula manufactured by the German visitor Humana and sold in Israel under the brand Remedia caused severe vitamin deficiencies in babies. Babies who consumed the formula were hospitalized with cardiac and neurological symptoms. Three of them died, and at to the lowest degree twenty others were left with severe disabilities. An investigation revealed that the formula independent a much lower quantity of Thiamine than is needed for healthy babe evolution because of a manufacturing error. Humana's chief food technologist received a 30-calendar month prison house sentence for negligent manslaughter in Feb 2013 over the case.[58]
  • In 2010, Abbott Laboratories issued a voluntary recall of about v million Similac brand powder infant formulas that were sold in the United States, Guam, Puerto Rico and some Caribbean countries. The recall was issued later on the presence of a 'small common protrude' was detected in the product.[59]
  • In Canada, New Zealand and elsewhere, public concerns have been raised over the continued sale and marketing of soy-based formulae potentially containing loftier levels of phytoestrogens,[sixty] [61] linked to aberrant child evolution[62] including damage to babies' thyroid glands.
  • In December 2011 Wal-Mart recalled a quantity of infant formula after a baby died in Missouri. "Nosotros extend our deepest condolences to this baby boy's family unit as they effort to come to grips with their loss," said Dianna Gee, a Wal-Mart spokeswoman. "As soon as we heard what happened, we immediately reached out to the manufacturer of the formula and to the Department of Health and Senior Services to provide any information nosotros may have to help with the investigation." Wal-Mart said it pulled a batch of Enfamil from its stores nationwide that matched the size and lot number ZP1k7G of the formula that may have sickened the baby in Missouri, Gee said. The baby formula was purchased from a Wal-Mart in Lebanon, Missouri. After the purchase, a x-day-old infant died from a rare bacterial infection, CNN affiliate KYTV reported. Authorities ran tests to determine if the death came from the formula, the water to make the formula or any other factor, said Mead Johnson Nutrition, the company that makes Enfamil. "Nosotros are highly confident in the safety and quality of our products – and the rigorous testing we put them through," said Chris Perille, a Mead Johnson Nutrition spokesman.[Source CNN]

Preparation and content [edit]

Variations [edit]

Baby formulas come in pulverization, liquid concentrate, and ready-to-feed forms. They are designed to exist prepared by the parent or caregiver in modest batches and fed to the infant, commonly with either a cup or a infant bottle.[half dozen]

Infant formulas come in a multifariousness of types:

  • Cow's milk formula is the about commonly used type. The milk has been contradistinct to resemble chest milk.
  • Soy protein based formulas are frequently used for infants allergic to cow's milk or lactose. Soy-based formulas can also exist useful if the parent wants to exclude beast proteins from the child'southward diet.
  • Protein hydrolysate formulas comprise poly peptide that's been broken down into smaller sizes than are those in cow'southward milk and soy-based formulas. Protein hydrolysate formulas are meant for babies who do not tolerate cow's milk or soy-based formulas.
  • Specialized formulas are also available for premature infants and those with specific medical conditions.[63]

Manufacturers and health officials suggest it is very important to measure powders or concentrates accurately to accomplish the intended last product concentration; otherwise, the child will exist malnourished. Information technology is advisable that all equipment that comes into contact with the infant formula be cleaned and sterilized earlier each use. Proper refrigeration is essential for any baby formula which is prepared in advance.

In developing countries, formula is oftentimes prepared improperly, resulting in high infant mortality due to malnutrition and diseases such as diarrhea and pneumonia. This is due to lack of clean water, lack of sterile conditions, lack of refrigeration, illiteracy (so written instructions cannot be followed), poverty (diluting formula so that it lasts longer), and lack of education of mothers by formula distributors. These problems and resulting disease and death are a key gene in opposition to the marketing and distribution of infant formula in developing countries by numerous public health agencies and NGOs (discussed in more detail at Nestlé cold-shoulder and International Code of Marketing of Breast-milk Substitutes).

Nutritional content [edit]

Besides chest milk, infant formula is the only other milk product which the medical customs considers nutritionally acceptable for infants under the age of ane year (as opposed to cow's milk, goat's milk, or follow-on formula). Supplementing with solid nutrient in addition to breast milk or formula begins during weaning, and most babies brainstorm supplementing about the time their beginning teeth appear, normally around the age of half-dozen months.

Although cow'due south milk is the ground of almost all baby formula, evidently cow's milk is unsuited for infants because of its high casein content and low whey content, and untreated moo-cow's milk is not recommended before the age of 12 months. The infant intestine is non properly equipped to digest non-human being milk, and this may frequently result in diarrhea, abdominal bleeding and malnutrition.[64] To reduce the negative effect on the infant's digestive arrangement, moo-cow's milk used for formula undergoes processing to be made into infant formula. This includes steps to make protein more hands digestible and alter the whey-to-casein protein balance to ane closer to human milk, the addition of several essential ingredients (often called "fortification", see below), the partial or total replacement of dairy fat with fats of vegetable or marine origin, etc.

The nutrient content of baby formula for sale in the U.s. is regulated past the Food and Drug Administration (FDA) based on recommendations by the American Academy of Pediatrics Committee on Nutrition. The following must be included in all formulas produced in the U.S.:[65]

  • Protein
  • Fatty
  • Linoleic acid
  • Vitamins: A, C, D, Eastward, K, thiamin (Bone), riboflavin (Bii), B6, B12
  • Niacin
  • Folic acid
  • Pantothenic acrid
  • Calcium
  • Minerals: magnesium, iron, zinc, manganese, copper
  • Phosphorus
  • Iodine
  • Sodium chloride
  • Potassium chloride
  • Carbohydrates
    • Carbohydrates are an important source of free energy for growing infants, equally they account for 35 to 42% of their daily free energy intake. In most cow's milk-based formulas, lactose is the primary source of carbohydrates present, but lactose is not present in cow's milk-based lactose-free formulas nor specialized not-milk poly peptide formulas or hydrolyzed protein formulas for infants with milk protein sensitivity. Lactose is also not nowadays in soy-based formulas. Therefore, those formulas without lactose volition apply other sources of carbohydrates, such as sucrose and glucose, dextrins, and natural and modified starches. Lactose is not only a good source of energy, it also aids in the absorption of the minerals magnesium, calcium, zinc and iron.[66]
  • Homo milk oligosaccharides (HMOs)
    • HMOs are naturally occurring sugars establish in human breast milk, they improve the immune arrangement and act as nutrients to beneficial gut leaner.[67] Some manufacturers also use human milk oligosaccharides equally a modern infant formula supplement to requite additional wellness benefits to their products, notwithstanding they are not establish all types of formula.[68]
  • Nucleotides
    • Nucleotides are compounds found naturally in human breast milk. They are involved in disquisitional metabolic processes, such as energy metabolism and enzymatic reactions. As well, as the building blocks of deoxyribonucleic acrid (Deoxyribonucleic acid) and ribonucleic acid (RNA), they are essential for normal body functions. Compared to human breast milk, moo-cow's milk has lower levels of the nucleotides uridine, inosine, and cytidine. Therefore, several companies that produce babe formula accept added nucleotides to their babe formulas.[66]

Other commonly used ingredients:

  • Emulsifiers and stabilizers: Ingredients added to preclude the separation of the oil from the water (and its soluble components) in the babe formula. Some usually used emulsifiers include monoglycerides, diglycerides, and gums.[65]
  • Diluents: Skim milk is unremarkably used every bit the main diluent in milk-based liquid formula to provide the bulk of the book. In dissimilarity, purified water is the most normally used diluent in milk-gratuitous formulations.[65]

Policy, industry and marketing [edit]

The policy, regulatory and industry environments surrounding the infant formula market vary tremendously between countries.

International [edit]

The International Code of Marketing of Breast-milk Substitutes is an international wellness policy framework adopted by the World Health Associates of the WHO in 1981 regarding baby formula marketing, including strict restrictions on ad.[69] Its implementation depends on the laws of different countries and the behavior of babe formula manufacturers – the lawmaking has no power itself. Legislation and corporate behavior vary significantly betwixt countries: at least 84 countries have enacted national legislation implementing all or many of the provisions of the Code and 14 countries have draft laws pending adoption;[70] whereas elsewhere neither the Code nor its principles are followed past governments or formula manufacturers.

Practices that are banned in the Code include nearly advertising, challenge health benefits for formula, and giving free samples to women able to breastfeed – this latter practice is especially criticized because it can interfere with lactation, creating dependence on formula. In many countries free samples of infant formula take been provided to hospitals for decades; baby formula is oft the only product routinely provided free of accuse to hospitals.[71] The Infant Friendly Infirmary Initiative aims to reduce and eliminate this controversial do.

By country [edit]

Philippines [edit]

Infant formula is one of the tiptop three consumer commodities in the Philippines, and among the virtually imported products.[72] Annual sales amount to some United states$469 million annually. U.s.a.$88 million is spent on advert the product.[73]

Infant formula marketing has been regulated since the 1987 Executive Order 51 or "Milk Code",[74] which regulated, but did not ban, practices such equally advertizement and providing free samples. Shortly after information technology was enacted, Wyeth introduced "follow-on formula", which was not in the purview of the Milk Code which predated its market entry.

In 2006, the Department of Health banned the advertising of infant formula and the practice of providing gratis samples, regardless of intended historic period grouping (in the Revised Implementing Rules and Regulations of Executive Order 51, or RIRR).[75] The new regulation was challenged by the infant formula industry in the Supreme Court. Initially the claiming was dismissed, but this determination was reversed following industry pressure and a controversial letter by American business leader Thomas Donahue,[76] then President and CEO of the United states Sleeping accommodation of Commerce, resulting in the regulation being suspended and advertising continuing.[72] [74] [75] [77]

The Guardian paper reports widespread illegal ad and marketing of formula milk contrary to Earth Health System guidelines. Doctors and midwives are encouraged to promote feeding babies formula milk, advertizement as well targets mothers directly. Babies become sick and sometimes dice because poor mothers cannot sterilize bottles.[78]

South Africa [edit]

In South Africa, in that location is a move towards plainly packaging of infant formula[79] under R 991 of the Foodstuffs, Cosmetics and Disinfectants Act; as of 6 December 2013, Regulation 7 (Auction and Promotion) is strength, whereas Regulations two-half-dozen (primarily with respect to labelling) are scheduled to come into force on 6 December 2014. One of the primal requirements as per Regulation 3.1.A.iii is a conspicuous message stating "[t]his product shall only be used on the advice of a health professional".

United kingdom of great britain and northern ireland [edit]

In the United Kingdom, infant formula advert has been allowed since 1995;[80] advertising for "follow-on formula" is legal, which has been cited every bit a loophole allowing advertising of similarly packaged formula.[81]

U.s. [edit]

In the United States, baby formula is both heavily marketed – the country has not adopted the Code, nor is information technology being systematically implemented past manufacturers for domestic marketing[82] – and even heavily subsidized by the regime: at to the lowest degree 1 third of the American market is supported by the regime,[83] with over one-half of infant formula sold in the country provided through the Special Supplemental Nutrition Programme for Women, Infants, and Children (known equally WIC).[15]

According to surveys, over 70% of large U.S. hospitals dispense infant formula to all infants, a exercise opposed by the American Academy of Pediatrics and in violation of the Code.[84] The Gerber Products Company began marketing its brand of infant formula directly to the public in October 1989, while the Carnation Company began marketing Good Start baby formula straight to the public in January 1991.[84]

Infant formula costs are a significant fraction of the WIC program costs: 21% post-rebate and 46% pre-rebate.[15] Formula manufacturers are granted a WIC monopoly in individual states.[15] Meanwhile, breastfeeding rates are substantially lower for WIC recipients;[85] this is partly attributed to formula existence free of charge to mothers in the WIC program, who are of lower socio-economical condition.[15] Violations of federal policy have also been found in terms of infant formula company advertising using the WIC trademark, to reach both WIC and not-WIC participants.[85] In recent years WIC has been expanding its breastfeeding promotion strategies, including providing subsidies for clients who employ milk banks.[86]

History [edit]

The Wabanaki and other Native American tribal nations of Due north America did make an baby formula from nuts and cornmeal.[87] Elizabeth Hanson was captured by Wabanaki in 1725 and a Native American woman showed Hanson how to make this infant formula and this she did include in her captivity narrative.

Early babe foods [edit]

In 1865, the outset infant food was invented.[88]

Throughout history, mothers who could not breastfeed their babies either employed a wet nurse[89] or, less oft, prepared food for their babies, a procedure known as "dry nursing".[89] [90] Baby food composition varied according to region and economic condition.[xc] In Europe and North America during the early 19th century, the prevalence of wet nursing began to subtract, while the exercise of feeding babies mixtures based on animal milk rose in popularity.[91] [92]

Affiche advertisement for Nestle'due south Milk by Théophile Alexandre Steinlen, 1895

This trend was driven past cultural changes as well as increased sanitation measures,[93] and information technology continued throughout the 19th and much of the 20th century, with a notable increase subsequently Elijah Pratt invented and patented the India-rubber nipple in 1845.[89] [94] Every bit early as 1846, scientists and nutritionists noted an increase in medical bug and infant mortality was associated with dry nursing.[91] [95] In an attempt to amend the quality of manufactured baby foods, in 1867, Justus von Liebig developed the globe's offset commercial infant formula, Liebig's Soluble Nutrient for Babies.[96] The success of this product quickly gave ascent to competitors such as Mellin's Food, Ridge's Food for Infants and Nestlé'south Milk.[97]

Raw milk formulas [edit]

As physicians became increasingly concerned about the quality of such foods, medical recommendations such as Thomas Morgan Rotch'due south "per centum method" (published in 1890) began to be distributed, and gained widespread popularity by 1907.[89] These circuitous formulas recommended that parents mix moo-cow's milk, water, cream, and sugar or honey in specific ratios to achieve the nutritional balance believed to approximate human milk reformulated in such a way as to conform the believed digestive capability of the infant.[4]

A 1915 advertisement for "Nestlé's Food"

At the dawn of the 20th century in the United states of america, most infants were breastfed, although many received some formula feeding every bit well. Abode-fabricated "per centum method" formulas were more than usually used than commercial formulas in both Europe and the United States.[98] They were less expensive and were widely believed to be healthier. However, formula-fed babies exhibited more than nutrition-associated medical problems, such equally scurvy, rickets and bacterial infections than breastfed babies. By 1920, the incidence of scurvy and rickets in formula-fed babies had greatly decreased through the addition of orange juice and cod liver oil to home-made formulas. Bacterial infections associated with formula remained a problem more prevalent in the Usa than in Europe, where milk was usually boiled prior to use in formulas.[98]

Evaporated milk formulas [edit]

In the 1920s and 1930s, evaporated milk began to exist widely commercially bachelor at low prices, and several clinical studies in the period suggested that babies fed evaporated milk formula thrived equally well as breastfed babies.[89] [99]

These studies, accompanied past the affordable price of evaporated milk and the availability of the home icebox initiated a tremendous rise in the apply of evaporated milk formulas.[4] By the belatedly 1930s, the use of evaporated milk formulas in the United states surpassed all commercial formulas, and by 1950 over half of all babies in the United states were reared on such formulas.[89]

Commercial formulas [edit]

In parallel with the enormous shift (in industrialized nations) away from breastfeeding to home-made formulas, nutrition scientists continued to analyze human being milk and attempted to make baby formulas that more closely matched its composition.[4] Maltose and dextrins were believed nutritionally of import, and in 1912, the Mead Johnson Company released a milk additive called Dextri-Maltose. This formula was made available to mothers simply past physicians. In 1919, milkfats were replaced with a blend of animal and vegetable fats every bit role of the continued drive to closer simulate human milk. This formula was called SMA for "faux milk adjusted."[89]

In the late 1920s, Alfred Bosworth released Similac (for "similar to lactation"), and Mead Johnson released Sobee.[89] Several other formulas were released over the next few decades, but commercial formulas did not begin to seriously compete with evaporated milk formulas until the 1950s. The reformulation and concentration of Similac in 1951, and the introduction (by Mead Johnson) of Enfamil (for "infant milk") in 1959 were accompanied past marketing campaigns that provided inexpensive formula to hospitals and pediatricians.[89] By the early 1960s, commercial formulas were more commonly used than evaporated milk formulas in the United States, which all but vanished in the 1970s. Past the early 1970s, over 75% of American babies were fed on formulas, almost entirely commercially produced.[4]

When nascence rates in industrial nations tapered off during the 1960s, baby formula companies heightened marketing campaigns in not-industrialized countries. Unfortunately, poor sanitation led to steeply increased mortality rates among infants fed formula prepared with contaminated water.[100] Additionally, a WHO has cited over-diluting formula preparations every bit resulting in baby malnourishment.[101] Organized protests, the most famous of which was the Nestlé boycott of 1977, called for an end to unethical marketing. This boycott is ongoing, as the current coordinators maintain that Nestlé engages in marketing practices which violate the International Code of Marketing of Breast-milk Substitutes.

Generic brand formulas [edit]

In addition to commercially marketed brands, generic brands (or store brands) of infant formula were introduced in the United States in 1997, first by PBM Products. These private label formulas are sold by many leading nutrient and drug retailers such as Wal-Mart, Target, Kroger, Loblaws, and Walgreens. All infant formula brands in the United States are required to attach to the Nutrient and Drug Administration (FDA) guidelines. As reported by the Mayo Clinic: "as with most consumer products, brand-name babe formulas cost more than generic brands. But that doesn't mean that brand-name [Similac, Nestle, Enfamil] formulas are better. Although manufacturers may vary somewhat in their formula recipes, the FDA requires that all formulas contain the same nutrient density."[102]

Similarly, in Canada all infant formulas regardless of brand are required to meet standards set by Health Canada.[103]

Follow-on and toddler formulas [edit]

Follow-on or toddler formulas are sold for ages six months to 3 years (when infants are typically breastfed). In the US, a transition formula is marketed for children from age 9 to 24 months, and a toddler milk is sold for children historic period 12 to 26 months.[104] In both cases, the ingredients are powdered milk, corn syrup and other added sugars, vegetable oil, and common salt.[105] [106]

Toddler formulas are not nutritionally complete, nor are they subject to the same regulations or nutrient labeling laws every bit infant formula.[104] Critics accept argued that follow-on and toddler formulas were introduced to circumvent the regulations regarding baby formula and have resulted in disruptive advertising.[81]

An early example of follow-on formula was introduced by Wyeth in the Philippines in 1987, following the introduction in this country of regulations on infant formula advertising, but which did not address follow-on formulas (products that did not exist at the time of their drafting).[74] Similarly, while infant formula advertizement is illegal in the United Kingdom, follow-on formula advertizing is legal, and the similar packaging and market place results in follow-on advertisements frequently beingness interpreted as advertisements for formula.[81] (See also industry and marketing, below.)

These products have also recently fallen under criticism for contributing to the childhood obesity epidemic in some developed countries due to their marketing and flavoring practices.[107] The drinks are also expensive.[106] Although usually not quite equally expensive every bit infant formula,[105] they can toll iv times the cost of cow's milk.[106]

Usage since 1970s [edit]

Since the early 1970s, industrial countries take witnessed a resurgence in breastfeeding amid newborns and infants to six months of age.[five] This upswing in breastfeeding has been accompanied by a deferment in the boilerplate historic period of introduction of other foods (such as cow'due south milk), resulting in increased use of both breastfeeding and baby formula betwixt the ages of 3–12 months.[4] [5]

The global infant formula market place has been estimated at $7.ix billion,[83] with North America and Western Europe accounting for 33% of the market place and considered largely saturated, and Asia representing 53% of the market.[108] South East Asia is a particularly big fraction of the world market place relative to its population.[108] Infant formula is the largest segment of the baby nutrient market,[108] with the fraction given equally between 40%[108] and 70%.[83]

Leading health organizations (e.g. WHO, U.S. Centers for Affliction Control and Department of Wellness and Human Services) are attempting to reduce the use of infant formula and increase the prevalence of breastfeeding from nascency through 12 to 24 months of age through public health awareness campaigns.[9] [109] [110] [111] The specific goals and approaches of these breastfeeding promotion programs, and the policy environment surrounding their implementation, vary by land. Every bit a policy basic framework, the International Code of Marketing of Breast-milk Substitutes, adopted by the WHO's World Health Assembly in 1981, requires infant formula companies to preface their product data with statements that breastfeeding is the best style of feeding babies and that a substitute should only be used after consultation with wellness professionals.[69] The Infant Friendly Hospital Initiative also restricts apply past hospitals of costless formula or other infant care aids provided by formula companies. (See also Policy section below.)

Infant formula processing [edit]

History [edit]

Dates Events
1867 A formula containing wheat flour, moo-cow'southward milk, malt flour, and potassium bicarbonate was adult.[112]
1915 A pulverisation class of infant formula was introduced, containing cow'south milk, lactose, oleo oils, and vegetable oils.[112]
1929 Soy formula was introduced.[112]
1935 Protein was added because it was believed cow's milk poly peptide content was lower than man milk protein content; protein at 3.3–4.0 1000/100 kcal was added.[112]
1959 Iron fortification was introduced because a large amount of fe (~80%) is used to expand the ruby blood cell mass in a growing infant. Infants with nascency weights between 1500 and 2500g require 2 mg/kg of atomic number 26 per day. Infants with weights of less than 1500g require 4 mg/kg per day.[112] [113]
1962 The whey:casein ratio was made similar to human being milk considering producers were aware that human milk contains a higher ratio of whey poly peptide, and cow's milk contains a higher ratio of casein.[112]
1984 Taurine fortification was introduced because newborn infants lack the enzymes needed to catechumen and grade taurine.[112] [114]
Tardily 1990 Nucleotide fortification was introduced into infant formula because nucleotides can human activity as growth factors and may heighten the infant immune system.[112]
Early 2000 Polyunsaturated fatty acid fortification was introduced. Polyunsaturated fatty acids, such equally docosahexaenoic acrid (DHA) and arachidonic acrid (ARA), were added because those fatty acids play an important role in babe brain evolution.[112]

Current general procedure [edit]

The manufacturing procedure may differ for different types of formula made; therefore the following is the general procedure for liquid-milk based formulas:[65]

Mixing ingredients [edit]

Master ingredients are blended in large stainless steel tanks and skim milk is added and adjusted to 60 °C. Then, fats, oils and emulsifiers are added. Additional heating and mixing may exist required to get proper consistency. Next, minerals, vitamins, and stabilizing gums are added at various points, depending on their sensitivity to oestrus. The batch is temporarily stored and so transported by pipelines to pasteurization equipment when mixing is consummate.[65]

Pasteurization [edit]

This is a process that protects against spoilage past eliminating leaner, yeasts and molds. It involves chop-chop heating and so cooling of the product nether controlled conditions which micro-organisms cannot survive. The batch is held at around 85–94 °C for approximately 30 seconds which is necessary to adequately reduce micro-organisms and prepare the formula for filling.[65]

Homogenization [edit]

This is a process which increases emulsion uniformity and stability by reducing size of fat and oil particles in the formula. It is done with a diversity of mixing equipment that applies shear to the product and this mixing breaks fatty and oil particles into very small aerosol.[65]

Standardization [edit]

Standardization is used to ensure that the key parameters like pH, fat concentration and vitamins and mineral content are right. If insufficient levels of these are found, the batch is reworked to attain appropriate levels. Later on this step, the batch is ready to exist packaged.[65]

Packaging [edit]

Packaging depends on manufacturer and type of equipment used, but in general, liquid formula is filled into metallic cans with lids crimped into place.[65]

Heat treatment or sterilization [edit]

Finally, infant formulas are rut treated to maintain the bacteriologic quality of the production. This tin can be done traditionally by either retort sterilization or high-temperature short-time (HTST) treatment. Recently, ultrahigh-temperature treated formula has go more normally used. If powdered formula is made, then spray drying would be required in addition.[115] Retort sterilization is a traditional retort sterilization method that uses ten-15mins treatment at 118 °C.[115] Ultrahigh-temperature (UHT) is a method that uses a brief (2–iii seconds) handling at 142 °C. Because of the short time used, at that place is little protein denaturation, merely the process still ensures sterility of the final product.[115]

Recent and future potential new ingredients [edit]

Probiotics [edit]

Randomized, controlled trials completed in the 2000s accept shown limited and short term clinical benefits for the use of probiotics in infants' diet.[116] The safety of probiotics in full general and in infants, particularly preterm infants, has been investigated in a express number of controlled trials. The findings thus far suggest probiotics are by and large condom, though the research is preliminary and has yet to provide definitive conclusions.[116]

Prebiotics [edit]

Prebiotics are undigestible carbohydrates that promote the growth of probiotic leaner in the gut. Human milk contains a diverseness of oligosaccharides believed to exist an important factor in the pattern of microflora colonization of breastfed infants. Because of variety, variability, complication and polymorphism of the oligosaccharide limerick and construction, it is currently not viable to reproduce the oligosaccharide components of human milk in a strictly structural manner.[117]

The European Club of Pediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition establish evidence to support short term effects of ingesting prebiotics on stool microflora of infants with increased in the number of bifidobacteria. Babies can be at hazard of dehydration with the induction of softer stools, if they accept the kidney immaturity and/or a poor ability to concentrate urine.[117] A reduction of pathogens has been associated with the consumption of prebiotics.[117] However, there was no prove to support major clinical or long-term benefits.[116] Therefore, there is little testify of beneficial furnishings of prebiotics in dietary products.[116]

Lysozyme and lactoferrin [edit]

Lysozyme is an enzyme that is responsible for protecting the body by dissentious bacterial cell walls. Lactoferrin is a globular, multifunctional poly peptide that has antimicrobial activity. Compared to human milk, cow'south milk has a signifactly lower levels of lysozyme and lactoferrin; therefore, the manufacture has an increasing involvement in adding them into infant formulas.[112]

Long chain polyunsaturated fat acrid supplementation [edit]

Some manufacturers take begun supplementing formula milk with long-chain polyunsaturated fatty acids (LCPUFA). The current evidence suggests that there may be little or no divergence between formula milk with and without LCPUFA supplementation in terms of babies' visual role, physical growth or neurodevelopment.[118]

See also [edit]

  • 2008 Chinese milk scandal
  • Baby nutrient
  • Baby bottle
  • Breastfeeding
  • Breast milk
  • Child development
  • Daigou
  • Dairy allergy
  • List of dairy products
  • Baby Food Market Forecast to 2028 - Covid-19 Impact

Notes [edit]

  1. ^ Equally of 1915.[3]

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External links [edit]

  • Isadora B. Stehlin. "Babe Formula: Second Best but Good Plenty". U.S. FDA. Archived from the original on December 26, 2007.
  • FDA 101: Baby Formula
  • "Breast-feeding and Guilt: Interview with a Mayo Dispensary Specialist"
  • Babe and Toddler Nutrition
  • Breastfeeding VS Formula Feeding

What's the Best Water to Use for Baby Formula

Source: https://en.wikipedia.org/wiki/Infant_formula

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