Infant milks
First Steps Nutrition Trust
Department of Health, WHO and First Steps Nutrition Trust recommend:
Exclusive breastfeeding from birth to age 6m
Breastfeeding with complementary foods from age 6m to age 1yr and beyond.
Types
Breast milk
First infant formula – milks which are the sole food for infants from birth (dry powder that is mixed with water OR ready-to-feed liquid formula)
*Follow-on formula – milks only to be used after 6 months of age, contain more protein, micronutrients and iron than first milks
Milks for children over the age of 1 year
Pasteurised whole cows' milk or sheep's or goats' milk
Growing-up milk (toddler milk): contain more sugar than animal milk and less of some important nutrients such as riboflavin, calcium and iodine
Unsweetened calcium-fortified soya milk alternative
Nut based milk alternatives, hemp milk alternative or oat milk alternative
Do not give rice milk alternative (also called rice milk drink) to infants or children under 5Milks which are called foods for special medical purposes:
Thickened (anti-reflux) infant formula suitable from birth, made up at 70C
Lactose-free infant formula suitable from birth (cows’ milk formula)
Hungry baby milk- no evidence of benefit
Partially hydrolysed (comfort milk) are 100% whey protein and supposed to be easier to digest causing less colic and constipation-evidence in support is limited
Extensively hydrolysed (hypoallergenic formula) if diagnosed with Cows’ milk protein allergy
Amino Acid based formula if diagnosed with severe Cows’ milk protein allergy
Vitamin and Mineral Supplements
Department of Health advises
All pregnant women take vitamin D supplements in pregnancy and when breastfeeding
Breastfed babies receive 8.5-10μg vitamin D supplement from birth
All children aged 6 months to 5 years have supplemental vitamin drops (vitamins A, C and D) every day if they are not on at least 500ml formula daily.
Babies on more than 500ml infant formula daily do not need additional vitamin/mineral supplementation
Vitamin D is added to infant milks in the form of vitamin D3 (cholecalciferol).
The proposed minimum (target) vitamin D content for infant and follow-on formula is 2μg/100kcal (EFSA, 2014).
Depending on the milk being used (for example lactose-free milk), consider additional infant calcium and vitamin D supplements.
Giving Additional Water
Gastroenteritis: regular milk feeds + oral rehydration solution or water
Hot weather: additional water between regular milk feeds
Breast-fed infant: extra water is not needed
Complementary foods
Learning Early About Peanut (LEAP) study showed early exposure to peanut containing snacks in high risk infants (severe eczema and/or egg allergy) reduced the risk of being diagnosed with peanut allergy at age 5y.
No babies should be fed whole peanuts (risk of choking).
Avoid foods with added salt.
Starting peanut-products at 6m and other allergens as early as 3m (for breastfed babies) may reduce development of subsequent allergies.
Breast feeding
Infant benefits
Reduced risk of diarrhoea and vomiting and other infections
Reduced risk of Sudden Infant Death Syndrome
No risk of overfeeding (overfeeding in infancy is associated with later obesity)
Maternal benefits
Reduced risk of breast and ovarian cancer
Reduced risk of cardiovascular disease, obesity and osteoporosis
Contraception (Lactational Amenorrhoea method)
Timeline for majority of infants
Birth - 6 months Breast milk OR First infant formula
Infant 6-12 months Breast milk OR *First infant formula PLUS complementary foods (weaning)
Toddler 1yr-2yr Breast milk OR Pasteurised whole full-fat cows’/goats’/sheep’s milk PLUS solid foods
2 - 5yr Semi-skimmed cows’ milk (if they are growing well) PLUS solid foods
>5yr Can use skimmed milk if appropriate to reduce calorie intake PLUS solid foods
* The Department of Health does not recommend that babies move on to follow-on formula at 6 months of age.
*The World Health Organisation has made a clear statement that follow-on milks are not needed.
Whey protein is easier to digest
Mature human breast milk contains protein which is whey-dominant (60% whey and 40% casein)
First infant milk (whey-based) will provide the best alternative if babies are not being breastfed.
Whey-based infant formula is the only breastmilk substitute needed throughout the first year of life.
Hungry baby milks have more ‘casein’ than ‘whey’ in the protein mix; casein is harder for babies to digest so the baby feels ‘full’ for longer.
Lactose intolerance (non-immune mechanism)
Symptoms of lactose intolerance (due to enzyme deficiency, made in villi of the small bowel) may overlap with symptoms of Cows milk protein allergy (IgE and non-IgE mediated).
Lactose intolerance is rare in babies.
In the UK, lactose intolerance is more common in people of Asian or African-Caribbean descent.
Symptoms include excessive flatus, diarrhoea, abdominal bloatedness and abdominal pain.
Some babies might have a temporary secondary lactose intolerance after a bout of gastrointestinal illness.
Option is to use Lactose-free cows’ milk formula (but only under medical supervision).
Other lactose-free products include:
soya milks, yoghurts and some cheeses
rice, oat, almond, hazelnut, coconut, quinoa and potato milks
How to bottle-feed
UNICEF advises responsive bottle feeding (‘on demand’) and avoiding overfeeding:
Hold the baby close and look into their eyes during feeds.
Respond to cues that baby is hungry.
Invite the baby to draw in the teat rather than forcing the teat into the mouth.
Pace the feed so that the baby is not forced to feed more than they want to.
Recognise the baby’s cues that they have had enough milk.
Recommended feed volume
Calculate feed volumes by baby weight not age
A total feed volume of 150-200 mL/kg body weight over 24 hours [6–8 times a day] is usually recommended.Baby should be producing around 6 wet nappies and 2 dirty nappies a day
After 1 year of age, children should be consuming three meals, two ‘mini-meals’ and 350ml-400ml whole full-fat animal milk (or a suitable alternative) a day.
Children from age 1y-3y need about 350mg of calcium per day, which will be provided by 300ml (around half a pint ) of milk.
Milk Additives
Cows’ milk contains all 9 essential amino acids required by humans, and therefore can be used as the only milk drink from the age of 1yr.
Limited evidence suggests prebiotics are associated with lower rate of atopy at 5yr follow up.
Long chain polyunsaturated fatty acid (Docosahexaenoic acid DHA) will be compulsory in first milks and follow-on formula from 2020 as there is some evidence it benefits the development of vision.