Demystifying Infant Formula


Welcome to Contemporary Pediatrics podcast series: Demystifying Infant Formula. Our host Scott Kober is joined by Dr. Steven Abrams, professor in the department of pediatrics at the University of Texas at Austin Dell Medical School. Together, they discuss Infant Formula 101, looking at the origins and latest innovations in the development of infant formula.


Welcome to Contemporary Pediatrics Podcast series, Demystifying Infant Formula. This episode is brought to you by Perrigo, makers of all US store-brand infant formula.

Thank you, and welcome to this podcast. My name is Scott Kober with Contemporary Pediatrics, and today we’ll be talking about Infant Formula 101, looking at the origins and latest innovations in the development of infant formula. I’m happy to be joined today by Dr. Steven Abrams, professor in the department of pediatrics at the University of Texas at Austin Dell Medical School. Welcome Dr. Abrams and thank you so much for joining me today.

Thank you for having me. Glad to be here.

Dr. Abrams, let’s start by giving our listening audience a little bit of historical background. How has infant formula evolved over time?

Well, infant formula as we know it now, really began wide use in the 1950s. It was around before then. But over a period of time for example, iron fortification has become routine in infant formula. And then beginning in the 80s and 90s we began to really add sophistication in infant formula. With addition of our called bio-actives, such as DHA, and a variety of components designed to include components that are found in breast milk to make it a little more like what might be found in a breast-fed infant. So we see a continual evolution of formula over the last 20 to 30 years into what we currently have.

What are the current FDA nutritional and quality guidelines that manufacturers of infant formula need to follow?

Well, due to a problem that occurred in the 1970s, in the year 1980, the US Congress passed something called the Infant Formula Act. The IFA, this law very specifically regulates the manufacturer and the content of infant formulas in the United States. So to be registered with the FDA all infant formulas must meet that act. Which includes specifics for example, how much calcium is in the formula, how much protein. And then the FDA has developed a large series of rules, which cover how formula is to be manufactured, how it's to be tested, etc. All infant formula sold in the United States must meet these criteria.

Does that mean that all infant formula regardless of whether it's a brand name, generic, or store brand is required to provide the same complete nutrition?

It's all required to meet the requirements and the statements of value in the Infant Formula Act. And including all the testing and safety. Now formula companies may add additional components to the human milk beyond what was in the Infant Formula Act but all infant formula meets the needs of infants.

Let’s talk a little more specifically about the many variations of infant formula that are currently available in the marketplace. Why are there so many options, and more importantly, from the perspective of the practicing pediatrician, how can you determine which ones would be best options for a given baby?

Well, there are formulas that are based on cowmilk, and they can differ based on how many bio-actives are in them. Things like oligosaccharides, DHA, and things of that sort. But then there are different formulas that are based on whether or not the protein is broken down, called hydrolysis. And whether or not that's partly broken down or completely broken down. Whether or not the formula has components in it that helped keep babies from spitting up. Or whether or not the formula is broken down so completely that it helps babies with severe allergies. So most pediatricians will choose a routine formula that has regular cowmilk adapted protein in it, that hasn't been broken down. And it has the routine nutrients that are required by the Infant Formula Act in it. But for babies who have health problems, such as severe allergies, then they'll gradually move on to these more specialized formulas.

So then how can a pediatrician determine when a family might want to consider switching their child from one brand of formula to another?

Well, we generally encourage patients, that if some babies may have a little upset stomach, or may have a little colic, and a formula switch may not do anything for it. Furthermore, many babies have reflux and spit up, again, changing formulas doesn't often do much for that, except in severe forms. Also, routine formulas have, the sugar is lactose, what's in human milk, and some of the formulas have gone to reduce lactose formulas, aren't really any better, even though they may have names that make it sound like it's better. So if a baby has severe symptoms of allergy, like bloody stools, continuously throwing up, then a formula switch and a medical evaluation is necessary. And we encourage patients with formula switches and not making a lot of them for relatively minor symptoms.

As with everything else in the marketplace, there are always new innovations being introduced in the infant formula category. Can you talk about some of the most impactful and important recent innovations and how they may impact families’ choice of infant formula?

Well the big areas I've mentioned is what we call bio-actives. Bio-actives are ingredients that're based on the ingredients found in breast milk that may impact the immune system or development. So these include what they are called oligosaccharides, which may have a significant immune function. It includes fat fractions, something called MFGM, which may enhance development. It includes a variety of variations in the fat blends. So formula companies are always trying to improve their formula. And pediatricians have to kind of evaluate which of these are the ones that they like the best. Other formulas may be organic, they may be GMO free. They may have [INAUDIBLE] are called cleaned label. And now with imported formulas we are even seeing goat milk protein based formulas. So lots of innovations and novel formulas, especially in the US marketplace.

Cost is obviously a significant issue for a lot of families who are hit with many new expenses after the birth of a child. How much does cost impact your personal recommendation of infant formula? And how significant are the long-term cost differences between some of these newer infant formulas and some of the older variations?

Well, the cost differences among infant formulas can be huge. It can literally be a factor of two to three, so it may, for example for an entirely formula fed infant have the difference between a monthly cost of $100 a month, a monthly cost of $200 to $250 dollars a month. So for many families that difference is large. Recognizing that these bio-actives and other ingredients increase the cost, including organic. May not have any particular benefits. I think the pediatrician has to talk to each family and evaluate that situation for them and have them understand that all the formulas are legally approved for use in the United States will lead to good outcomes for babies. And if they have challenges in paying for the more expensive ones, they don't need to be concerned that their baby would not get adequate nutrition.

While there are government nutritional support programs such as WIC and SNAP, these are only supplemental, and there are many needy families who don’t even qualify for these programs. How can pediatricians provide support to families who struggle with the cost of infant formula in the wake of all of the other expenses that are associated with a newborn?

Well, it is important to recognize that WIC is a supplemental program. It provides for about 75% or so of the needs of infant formula or for a fully formula fed baby. So even families- and that's as many as almost half of all US families who receive WIC, do need to purchase their formula. So again, pediatricians need to be sensitive to cost issues, and not specifically recommend the most expensive formulas just because it may have some bio-active in it that they've read about. Again, all infant formulas will meet the baby's nutritional requirements. And the most expensive formulas may not have specific benefits for an individual baby.

Great. I think this has really been a terrific discussion about some of the current issues surrounding infant formula. Thank you so much for joining me today, Dr. Abrams.

My pleasure.

You’ve been listening to Contemporary Pediatrics Podcast series, Demystifying Infant Formula. Special thanks to Perrigo, makers of all store-brand infant formula for making this episode possible

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