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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
--Breastfeeding – Advantages and Disadvantages
--Breastfeeding: Resources and Frequently Asked Questions |
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Formulas – Which Gets Used When?
Contemporary Peds, August 2001
Introduction. The bane of the pediatrician’s existence are
parents who never can find exactly the right formula for their baby. Many
myths exist in our society about formulas. Formula intolerance varies from
10-30% depending on the definition of intolerance.
Classification of formulas:
1. Iron – supplemented (10-12 mg Fe/liter): vs. “low-iron” (now 4-5 mg
Fe/liter):
- No indication for low iron formula: AAP has asked to have taken off
the market.
- Harmful effects of switching: risk neurodevelopment problems.
2. Cow’s Milk vs the others: Cow’s milk made up of:
- a. 43% calories as carbohydrate (lactose)
- b. 50% calories as fat (vegetable oil)
- c. Protein (nonhydrolyzed cow-milk protein)
3. Premature Discharge Formulas: for babies born before 34 weeks
gestation.
- (e.g. Neosure) Contain a higher caloric density, protein content and
calcium and
- phosphorus content than standard formulas. Helps promote catch-up
growth by 9 months of age. Also used to supplement (up to two feedings a
day) breastfeeding.
4. Formulas for protein allergy: actual percentage is less than 6%:
hypoallergenic formulas:
- a. casein hydrolysate (Alimentum, Pregestimil, Nutramigen) or
- b. Amino Acid formula (Neocate)
- c. Whey hydrolysate (Carnation good start); this contains some lactose
5. Lactose-free formula: (Lactofree): not indicated except possibly for
those recovering from transient lactase deficiency after gastroenteritis.
Not indicated galactosemia because trace amounts of lactose are in this type
of formula.
6. Soy formulas. Contains sucrose, not lactose. They are supplemented now
with iron, zinc and calcium. Not indicated for preterm infants in a special
care nursery since use in this group has exacerbated demineralized skeletal
status. Soy formulas also appropriate for those that want their children to
be on a vegetarian diet. Also not as allergenic as cow-milk protein
formulas.
7. Follow-up Formulas. No clear-cut advantage to using these; AAP – no
role in toddler.
Switching Formulas. How we can minimize this tendency:
- Talk about this in prenatal examination as well as
when visiting the nursery. Always state that breast milk is the best
choice.
- If switch indicated (parent insists, true
intolerance), suggest a one-month trial of whichever formula parent
requests. Reassure about irritability
- If after a month, family wants another formula
switch, colic is present, etc., then tell them to try hydrolysate formula
– but warn them it is expensive and probably won’t help.
Unanswerable situations: Partner suggested switching, other
child needed to switch, nurse in your office told to switch, grandmother
told parent to switch, etc.
Written 9/2001
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