Mothers who choose to bottle feed also need counselling about infant nutrition. Although all commercial formulas use human milk as their model, none reproduce the immunologic and digestive properties of human milk. Formulas are available in three forms: ready-tofeed, liquid concentrates and powders. While ready-to-feed formula needs no preparation, it is the most expensive. Concentrates must be diluted with water and are intermediate in price. The most economical option is the powdered form, which is prepared by thoroughly
dissolving one scoop of powder in 2 oz of water? All three forms of the same brand are nearly identical nutritionally, although slight differences may exist.
The need for sterilization of bottles, nip-pies and water used in preparing formula is currently a matter of debate. Formula manufacturers recommend sterilization. Others argue that if the water is sanitized and bottles are prepared one at a time, sterilization is not needed. Unsensitised water, such as well water, should be boiled for 5 minutes. When tap water is used, cold water should be allowed to run for approximately 2 minutes, to clear standing water from the pipes and minimize possible lead contamination. Partially consumed formula should always be discarded.
The most common types of formulas are cow’s-milk-based, soy-based and protein hydrolysate. Cow’s-milk-based formula is the preferred Choice, since it has been tested extensively to provide nutritional support for the healthy infant when used exclusively. Differences in composition between cow’s-milk-based formula and human milk are summarized in Table . 2 Lactose is the major carbohydrate source in cow’s-milk-based formula. The calorie content is 20 kcal per oz, which is identical to that of breast milk. Soy-based formulas contain soy protein and are lactose-free. They comprise approximately 20 percent of infant formulas and represent a nutritionally sound alternative to cow’s-milk-based formula? Soy formulas may be used by vegetarians and infants with lactose deficiency or galactosemia. Soy formulas also may be used in the postdiar-rheal period although, in a recent meta-analysis, routine use of lactose-free formula was not found to be justified, especially when oral rehydration therapy and early feeding with solid foods are employed? Infants with an IgE reaction to cow’s-milk protein often do well on soy formula; however, some infants who are allergic to cow’s-milk protein also have allergies to soy formulas.23 Minor signs of intolerance to cow’s-milk-based formula, such as colic, loose stools and spitting up, may occasionally lessen or disappear after a switch to soy formula, although most of these problems are unrelated to the type of formula used. Protein hydrolysate formulas are used for infants who cannot tolerate cow’s-milk-based formulas or soy-based formula
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