Infants presenting with specific symptoms, such as diarrhea and colic, are often switched formulas based on the assumption that the symptoms are caused by the formula. For most of these infants, said Bhatia, switching formulas is needed only temporarily to help a transient problem or is not needed at all.
For example, infants may present with diarrhea caused by a transient intolerance to sugar. For these infants, it is reasonable to switch to another formula with reduced lactose until the symptoms resolve and then switch them back to the original formula.
“Most babies can be managed like this,” said Bhatia. However, he emphasized that babies with other symptoms, such as blood in their stools, will need specialty formulas.
For infants with an infection, such as HIV or active tuberculosis, switching to a formula is also warranted until the infection clears. Once cleared, the infant can be switched back to breast milk.
Bhatia cautions, however, that symptoms of diarrhea and colic often are only temporary and not due to the formula used. “For most babies with transient diarrhea and colic, switching formulas is not needed,” he said, encouraging pediatricians and parents to “wait it out.”
He urges pediatricians and parents to do some “homework” to understand better why an infant may have diarrhea or colic. One major cause of these symptoms in infants, he said, is the introduction of new foods into the diet. This occurs often between the ages of 4 to 12 months when infants are transitioning to solid foods while still using breast milk or formula as complementary nutrition.
“Just by switching formulas, the pediatrician and parent may miss something easy that is going on that is responsible for the symptom like diarrhea or colic,” he said.
Figure 1 provides an algorithm developed by Bhatia to help guide pediatricians on the feeding of term infants and the transition to solid food.
Breast milk is recommended as providing the best nutrition for most term infants. For infants for whom breast milk is not tolerated or in situations where formula is preferred, a variety of formulas are commercially available based on specific need. Most infants are fed cow’s milk-based formulas, all of which meet the energy and nutrient requirements for healthy term infants during the first 4 to 6 months of life. For the relatively few infants who require specialty formulas, soy-based and hydrolyzed formulas are available, each indicated for specific situations only and not recommended as a routine feeding alternative for otherwise healthy term infants. Amino acid-based formulas are also available for specific indications.
For infants who experience transient intolerance to breast milk or cow’s milk-based formula, switching to a different formula until symptoms such as diarrhea or colic clear is a reasonable option. For many situations, switching is not needed as the symptoms may be due to something other than the formula (ie, introduction of new foods). Pediatricians and parents can take a wait-and-see approach to better understand what may underlie a symptom such as diarrhea or colic to ensure the underlying cause is accurately identified and not simply masked over by switching formulas.
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