FORMULA FEEDING

Prof. EKRAM M. HELMY

 WHEN ?
WHAT ?
HOW MUCH ?
HOW ?
Breast feeding for all infants is
the BEST
But if it is impossible,
A formula, as compositionally
close to breast milk as possible
is desirable
 WHEN ?
1- SUBSTITUTIVE : NO BREAST MILK
• Mother absent or unwilling to breast-feed

• Failure of lactation : no or very little milk

• Nurseries and institutes

2- BREAST + FORMULA TOGETHER

• Complementary: if amount is not sufficient

• Supplementary : for working mothers, twins

WHAT
WHAT Animal
Animal Milks
Milks
SHE
DOES NOT
BELONG
TO HERE
 Cow’s Versus Breast Milk
8
7
6 7

5 Protein
Fat
4
3.8 3.8 4 Lactose
3
3.3 Mineral
2
0.8
1
1 0.2
0
BREAST COW
Difference
Difference in
in Proteins
Proteins

1% Breast Milk

3.3 % Cow’s Milk

 Difference in Proteins

COW 20 80
Whey
Casein

BREAST 70 30

0 20 40 60 80 100 120
Quality of Protein

100% Immunoglobulins
7
30 13 Lactalb, Lactoferrin,
80%
etc
60% B-lactoglobulin

40%
40
Casein

20%
30 80
0%
Breast Cow
 Difference
Difference inin Proteins
Proteins
PROTEIN BREAST COW
Lactalbumin 0.4 0.2
Serum globulin 0.15 0.05
Lactoferrin 0.15 Trace
B-lactoglobulin Absent 0.4
 Difference
Difference in
in Fats
Fats

3.8 % Breast Milk

3.8 % Cow’s Milk

 Differences
Differences in
in Fats
Fats
Hindmilk

COW
Midmilk
BREAST

Foremilk

0 2 4 6 8
 Differences
Differences in
in Fats
Fats
 According to stage of lactation:
Amount is MORE in early months of lactation

 According to time of day:

Amount is 2.5 times more in mid-day

 According to stage of suckling:

Amount is 3 times more in hind milk
 Differences
Differences in
in Fats
Fats
Breast milk contains
 Lipase (digests 92 % of triglycerides)
 Higher cholesterol
 Higher Essential fatty acids:
 Linoleic ( 8 times more)
 Arachidonic

 Less volatile fatty acids

Difference
Difference in
in Carbohydrates
Carbohydrates

7% Breast Milk

4.5 % Cow’s Milk

 Differences
Differences in
in Carbohydrates
Carbohydrates
 Breast Milk: DOUBLE lactose ( 7 : 4 )
 Helps Calcium absorption
 Constituent of Brain

cerebrosides
 Helps growth of lactobacilli

 Breast milk contains BIFIDUS factor

 Breast milk contains L-fucose
Difference
Difference in
in Minerals
Minerals (Ash)
(Ash)

0.2 % Breast Milk

0.8 % Cow’s Milk

 Differences
Differences in
in Minerals
Minerals
140
120
100 118

80 100 Sodium
Calcium
60
Posphate
60
40
20 34 Na Ca P
15 16
0
BREAST COW
 Differences in IRON
In Breast milk: 0.05 mg/dl
In Cow's milk: 0.045 mg/dl In Breast-Fed: Less risk of
Iron Deficiency
100% anemia in 1st 6 months:
80% 50
 Better Iron absorption
60% 90
 Acidic medium
40%
50  More Vit. C, E
20%
10  More Copper
0%
Breast Milk Cow's Milk
 No Iron loss in stools
Absorbed Unabsorbed
Differences
Differences in
in Vitamins
Vitamins
C,E
5 times

COW
D 2 times
BREAST

Nia

B,K 1/3 times?

0 2 4 6 8 10 12
Forms
Forms of
of Animal
Animal Milks
Milks

LIQUID DRIED
Liquid
Liquid Animal
Animal Milks
Milks

‫لبن‬

RAW EVAPORATED PASTEURIZED

FRESH CONDENSED& & ULTRAPAST.
 Liquid
Liquid Animal
Animal Milks
Milks
NOT SUITABLE
For young (<1year)
infant feeding
Unless Modified
(Humanized)
Modification
Modification of
of Buffalo
Buffalo Milk
Milk

M + + =

100 ml
50 ml 50 ml 5 g (spoon) Modified
MILK WATER SUGAR Milk
Modification
Modification of
of Buffalo
Buffalo Milk
Milk
BUFFALO MODIFIED BREAST
MILK BUFFALO MILK
Protein 4 2 1
Fat 7 3.5 3.8
Carboh. 4 lactose 7: 2 lactose. 7 lactose
+ 5 Sucrose
Ash 0.8 0.4 0.2
Calories 100 67 67
 Advantages
Advantages of
of Dried
Dried Milks
Milks

 Sterile and highly soluble

 Composition is constant
 Can be stored for long time
 Heat makes protein more digestible
 Heat makes protein less allergenic
 Many forms are available to suit all children
and situations.
 Types
Types of
of Dried
Dried Milks
Milks
 Whole milk
 Humanized “adapted” milks
 Follow-on milks
 Modified special formulas:
 For low birth weight infants
 For certain diseases
 Adapted
Adapted Formulas
Formulas
COW’S ADAPTED BREAST
MILK FORMULA MILK
Protein 3.3 1.5 1
Whey:Casein 20:80 60:40 70:30
Fat 3.8 3.8 3.8
Sat:Unsat. 40:60 45:55 40:60
Carboh. 4.5 7.2 7
lactose lactose lactose
Ash 0.8 0.3-0.4 0.2
Calories 67 67 67
Humanized
Humanized “Adapted”Formulas
“Adapted”Formulas

European Formulas
Humanized
Humanized “Adapted”Formulas
“Adapted”Formulas

American Formulas
Follow-on
Follow-on Milk
Milk Formulas
Formulas
Lactose-free
Lactose-free Milk-based
Milk-based Formulas
Formulas
Lactose-free
Lactose-free Soy-based
Soy-based Formulas
Formulas
Other
Other Special
Special Formulas
Formulas
HOW
HOW MUCH
MUCH ??
Daily needs: 150 ml / kg / day

150 ml X Body Weight in Kg

Number of feeds per day
Example: For a 4 kg Baby
150 X 4 = 600 = 100 ml /Feed
6 6
HOW
HOW TO
TO FEED
FEED ??
X 
Eructation
Eructation (burping,
(burping, driving
driving off
off air)
air)