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Got Milk, Baby?

by Dr Rebecca Nelson - November 8, 2017

An introduction to baby formula Vs breast milkAbout a year ago, I received a sobbing call from a good friend. She was standing in front of the formula shelf at her local all-night supermarket and she had no idea which tin to buy.

My friend had done her best to breastfeed, but her month-old baby was ravenous and she herself was stressed and exhausted. She was feeling guilty, but it was time to supplement feeds. 

The first thing to do was reassure my friend. The 'Breast is Best' message is great; breast milk is nutritionally balanced and strengthens the immune system. Nevertheless some parents DO need to formula feed or combine formula and breast.

Two hundred years ago, my friend could have hired a wet-nurse to breastfeed her baby. My 100 year old neighbour remembers expressing all the women in her maternity ward and mixing the milk in one big pan! It's fair to say these options are out of fashion; these days we have formula!

No parent should be made to feel guilty about nourishing their child, and no baby should starve - and especially fail to grow - because breast-milk is unavailable. 

So which formula should my friend buy?

Hospitals refuse to recommend a brand of formula. This can stress parents who want to buy the 'right' or 'best' formula. The reason the hospitals refuse to recommend a brand is that, despite what the ads would have you believe, no one brand is better than another.

For a healthy baby, it is quite reasonable to ignore the ads and go for whatever tin of cows milk formula is cheapest. (Never use powdered milk or carton milk that is not designed for babies). After a while some babies may develop a flavour preference for one brand, and that's fine! But when buying your first tin, the reality is that all cows-milk baby formulas must meet certain industry standards and differences beyond this are minor.

Should my baby have Cows-milk formula?

Most babies are fine with cow's milk ('normal') formula, which is also generally the cheapest kind. However, some around 2% of Australian/New Zealand babies are allergic to the proteins in cows milk. Also, about 15-20% of babies with cows-milk allergy will also be allergic to soy. These babies may have vomiting, blood or mucus in diarrhoea, poor weight gain, family history of eczema/wheezing, and feeding problems that get worse with time. Goat, soy, sheep, and rice cereal is often advertised as 'gentler' on tummies.... in fact changing to these formulas is unlikely to make a difference unless the baby truly has a cows-milk protein allergy. 

Be cautious when changing to rice, sheep or goats milk formulas. These have different balance in the types of protein they contain (caesin and whey) and are often heavily supplemented to make them suitable for babies. If you think your baby may be reacting to cows milk, it is worth talking to your doctor before changing formula. 

Prescription formulas

A small percentage of babies have trouble with digesting proteins from several types of milk. These babies may need formula where the protein has been broken down already (hydrolysed or HA formula). These are only used where absolutely necessary, with the supervision of a doctor and dietician. They generally taste awful and can be very expensive. 

Lactose free?

Often parents have been told an irritable, 'colicky' baby is lactose intolerant, and find themselves buying expensive lactose-free formulas to 'try' (soy formula is also lactose-free but not the first choice in this case). Lactose intolerance is not actually an allergy. It occurs when babies don’t digest all of the lactose sugar in milk. This is caused by not having enough of the lactase enzyme. Babies are not only irritable but may have foamy, frothy, acidic poo that burns their bottoms. Often babies make more lactase enzyme as they get older, and grow out of this problem. Lactose-free cows-milk formula should make a difference for these babies, but it is best to speak to your doctor before making a change.

AR (anti reflux) formulas?

Reflux is a topic all by itself! Reflux is when milk in a baby's stomach comes back up the 'food-pipe' (oesophagus). It may come a little way and go back down ('silent reflux'), up into the mouth, or all the way out (vomits). All babies have some reflux until their stomach valves strengthen up, and it's usually only a problem if the oesophagus gets irritated and sore... or if they vomit so much they don’t grow. Anti-reflux formulae contain thickeners that make it a little harder for the milk to come back up. The downside is the thickened milk may be harder work to suck and swallow. If thickener helps, you may need a bottle teat with a slightly larger hole. Other simple strategies for reflux can be to keep baby upright (cuddle time!) for 15 to 20 minutes after a feed. 

Switching Formulas

If you are trying different formulas you may need to use them for a week or so before you see an improvement; 'chopping and changing'  too often may confuse the issue. If you are changing brands, always remember to check that the number of scoops to water is the same!

If formula is not made up according to the instructions it may be too 'rich' or too ‘weak'. If you have concerns that your baby is allergic to milk protein, lactose intolerant, or isn't gaining enough weight, talk to your GP or paediatrician. They may enlist the help of dieticians and lactation consultants to help you and your baby. You can also find more advice on the CYH website.


Dr Rebecca Nelson - Paediatrician

Rebecca graduated from Flinders University in 2004, and received her Fellowship with the Royal Australian College of Physicians (Paediatrics) in 2015. 

Rebecca currently splits her time between private outpatient clinics and her work in paediatric and neonatal retrieval with MEDSTAR. This allows her to maintain a broad knowledge base and skills across all facets of paediatric medicine.