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ParentsNovember 24, 2016

Choosing baby formula: A guide for New Zealand parents

shares of A2 Milk Corporation sharply dropped.
shares of A2 Milk Corporation sharply dropped.

Following a column from a bottle-feeding mum wondering why there was so little information available for those parents whose babies don’t breastfeed, we asked trained dietician and kids food expert Stacy Kemeys to share some pointers.

First things first, this article is not aimed at debating the for and against of breast feeding and formula feeding. There are plenty of articles written on that topic. It’s written for the parent who needs to buy infant formula. The parent who is standing in the supermarket or pharmacy looking at the vast selection of formula, worrying that they could make a bad choice. This article will not tell you which specific formula to choose, but it will hopefully give you the information you need to decide and feel confident about it – Emily Writes.

Which is the best baby formula?

In New Zealand, infant formula manufacture is governed by Food Standards Australia and New Zealand (FSANZ). Based on the robustness of the infant formula code I believe you can rest assured that all infant formula available for purchase from reputable New Zealand retailers is of excellent quality and will contain all the nutrients in the right amounts to ensure babies will thrive. In fact, the food standard code for infant formula is so prescriptive about what it can and cannot contain, and the amounts of nutrients they MUST contain, that there is very little wriggle room for manufacturers. The standards are so prescriptive that from a pure nutrients perspective, all infant formula have a pretty similar nutritional profile. I can almost hear you asking the question: well, if you say they are all the same then why on earth are there so many different types?

What is the best type of baby formula?

There are many different types of baby formula for sale in New Zealand. The first thing you need to know is that ALL OF THEM ARE GOOD. Different types of formulas may suit different babies and parents, but no matter which formula you select from the supermarket or pharmacy shelf, all baby formulas for sale in New Zealand from reputable retailers are good. They are all great alternatives to breast milk when breast milk is not an option for your baby. One of the biggest differences between the various types of formula is the protein source used. Cow’s milk infant formula is the most commonly used and widely available infant formula within New Zealand. Most babies tolerate a cow’s milk formula.

Casein vs whey protein – what’s the difference?

Cow’s milk formula is usually labelled as either casein dominant to whey dominant. This means that the formula either has more casein or more whey. Let me explain the difference in what I hope is a simple way. Cow’s milk is made up of two different types of protein: casein and whey. If you have ever added an acid such as lemon juice to cow’s milk you will have seen these two protein types. Casein is the curd, or the lumpy part, while whey is the watery bit. Whey protein is more easily and quickly digested, while casein takes a bit longer. This makes sense when you look at the physical difference between curds and whey.

The proteins in breast milk are also casein or whey. Breast milk has what we call a dynamic nutrient profile; it changes over time. It can be different from mum to mum, and even varies depending on the time of day. It is generally considered that the protein ratio of breast milk starts off as very whey dominant in the first few days, then settles to approximately 40% casein and 60% whey when your mature milk comes in. Then over time the casein content gradually increases so an older baby might be having breast milk that may have a ratio of 50:50, or 60:40 casein to whey.

As well as listing whether cow’s milk formula is either casein or whey dominant, the label will state the percentage of protein that is casein or whey. Often stage one formulas are whey dominant, and stage two formulas are casein dominant (mimicking the changes that happen with breast milk) but this is not always the case. However the percentage will always be clearly labelled.

Goat’s milk formula

Goat’s milk is an alternative to cow’s milk formula. I hear many people say “goat’s milk is gentler on little tummies”. Understanding what this means involves a bit of biochemistry. As I mentioned above, cow’s milk and breast milk contain casein and whey proteins. The story gets a little more complicated when you bring goat’s milk into the mix. There are in fact two different types of casein, alpha and beta. Breast milk contains beta casein, while cow’s milk contains alpha casein. Beta casein is more easily digested than alpha casein. Goat’s milk contains predominately beta casein like breast milk. Whey remains the most easily digested protein overall. And as with cow’s milk formula, the label on the goat’s milk formula tin will let you know the casein/whey ratio.

Allergy and goats milk formula

According to most health care professionals and the latest clinical guidelines, goat’s milk is not a suitable alternative for babies with cow’s milk protein allergy. Many children who react to cow’s milk protein will also react to goat’s milk protein. In fact, I remember listening to a presentation one day by a leading paediatric allergist Dr Jan Sinclair, whose comment about goat’s milk and cow’s milk in terms of allergy has always stuck with me. She said basically all mammalian milks are so similar in composition/allergenicity that none of them would be acceptable as an alternative for a child with cow’s milk allergy. Her only exception was camel milk. Unfortunately, however, camel milk infant formula is not readily available, or at least not in New Zealand. A new business opportunity for someone perhaps?

If you are looking for information about formula for babies with cow’s milk allergy you can find it here. As with all formula for sale in New Zealand, goat’s milk formula will be of good quality, and will have all the nutrients your baby requires to thrive. If goat’s milk formula works for your baby and you, then it is a good formula choice.

Soy infant formula

Soy formulas use soya bean as a protein source, offering a vegetarian alternative to milk which may suit some families. In addition, as soy is naturally lactose free it offers a lactose free option for parents and babies if needed.

Allergy and soy formula

Although soy formula is cow’s milk protein free, some guidelines on the management of cow’s milk protein allergy do not recommend soy as first choice alternative to cow’s milk allergy in babies under six months of age. If you suspect cow’s milk protein allergy in your child it is generally best to seek advice from a health care professional before making decisions regarding which formula to use. As with all formula for sale in New Zealand, soy formula will be of good quality, and will have all the nutrients your baby will require to thrive. If soy formula works for your baby and you, then it is a good formula choice.

Reflux infant formula

Formulas designed to help with reflux are often labelled A.R (Anti Reflux). They are essentially formulas which contain thickeners and are designed to stay in the stomach, reducing regurgitation. Different A.R formulas on the market contain different thickeners. The more modern thickeners are designed to be slightly thick in the mouth and then thicken further in the stomach. If you suspect your baby has reflux, I would strongly suggest you seek medical advice for diagnosis and a management plan before starting to use a thickened formula on your own. There can be underlying reasons for reflux that require more treatment than a thickened formula. I often hear mums who are using A.R. formula complain that this has led to constipation in their babies. There have been some small studies on this, but they showed no conclusive link. However, based on the number of mums I have heard mention the problem, I would keep a track of your baby’s bowel habits when you start. It may depend on what type of thickener is used in the formula as to whether it leads to constipation or a reduction in bowel movements.

Lactose free infant formula

Lactose is the naturally occurring carbohydrate found in both breast milk and cow’s milk. Lactose free formulas are typically cow’s milk formula that have had the lactose removed and replaced with an alternative carbohydrate source. Lactose free formula is an option for formula-fed infants with lactose intolerance. As mentioned above, soy formula is another lactose free option. If you suspect your baby has lactose intolerance, please seek a medical diagnosis before starting a lactose free formula. A lactose free formula is not an appropriate treatment for cow’s milk protein allergy. For this reason, if you suspect either cow’s milk or lactose intolerance in your baby, please seek medical advice before starting specialised formula. There can be some cross over with the presenting symptoms so an accurate diagnosis is best.

Hydrolysed formula

This formula is often labelled as AF. Hydrolysed formula refers to a group of baby formulas where the protein source (most often cow’s milk protein) has been broken down to make the protein chains shorter. This is done for reasons relating to both allergy and digestion. If you imagine protein chains as being like long necklaces made up of beads (the amino acids), hydrolysed formulas have protein chains which are shorter than the original long necklace.

There are two categories of hydrolysed formula, partially hydrolysed and extensively hydrolysed (The degree of hydrolysation will be described on the label). If we think back to our long necklace analogy, then Partially Hydrolysed Formula (PHF) have protein chains which are a bit shorter than the original. So instead of a full-length necklace the protein chains may be equivalent to a short choker style necklace. Hydrolysed infant formula PHF is marketed to be gentler on your baby’s digestive system as the protein chains are shorter and therefore require less digestion. PHF was also designed to be used as a protective measure for children at high risk of developing cow’s milk protein allergy, for example, where there is a strong family history of cow’s milk protein allergy. If your baby already has developed an allergy to cow’s milk protein, then a PHF is not considered to be a suitable treatment option. The protein chain lengths are still long enough to cause a reaction.

Extensively Hydrolysed Formula (EHF) has protein chains that are broken down to shorter chain lengths than partially hydrolysed formula: think bracelets and rings. EHF formulas were until relatively recently only available through pharmacies, but are now available online and in supermarkets. EHF is used as a treatment option for babies with cow’s milk protein allergy. The protein chains are much shorter than standard cow’s milk formula they are generally tolerated by babies with a cow’s milk protein allergy. Although EHF is now more easily accessible, I would urge parents to seek advice from a healthcare professional if they suspect cow’s milk protein allergy in their baby.

Amino acid infant formula

Amino acid formula (AAF) is not available within supermarkets; it’s a pharmacy-only product. Amino acids are the building blocks of protein chains. If I go back to my necklace analogy, then amino acids are the individual beads that make up the necklace.

Should I be using gold or standard infant formula?

As I have said, due to the robustness of the infant formula regulations in New Zealand, all infant formula available is good formula. Standard infant formula contains all the nutrients in the amounts that the infant formula regulations specify. Therefore, standard infant formula will be nutritionally complete and balanced.

Gold infant formula contains all of the nutrients in the amounts that the infant formula regulations specify, and contain extra ingredients that the regulations state may be added. Therefore, gold infant formula will be nutritionally complete and balanced but may provide additional benefits. Information on the additional nutrients and ingredients that gold infant formula contains can be found here.

What isn’t necessarily the best formula for your baby

The most expensive formula on the shelf

Price has no bearing on whether a formula is good or not. All formulas must meet the same regulations to be sold in New Zealand and will be good choices if breast milk is not an option. Choose a formula that fits your budget.

The formula your best friend swears by

It may have suited her and her baby, but it may not suit you, and your baby.

The formula you think smells and or tastes the best

Have you ever smelt a bottle of multi vitamins? It has a very distinctive odour. Infant formula is packed full of all sort of vitamins and minerals; it is these nutrients that give infant formula its distinctive smell. This is not a bad thing and your baby will more than likely find it completely acceptable. Your baby also very different taste perception to you – just because you don’t find it delicious does not mean your baby will not be completely happy to drink it.

A can of formula past its use-by date or that has been open for too long

Infant formula have use-by dates for a reason. Please follow them and discard any formula that is past its use-by date. Infant formula will have a guideline on the can telling you how long after the can has been opened that it will remain safe for use. Please follow this guideline. Over time the nutrients in infant formula can degrade. Infant formula is sterile until opened; after this point it is at risk of contamination. Every time you open and close the lid and use the scoop there is a chance the formula could pick up contaminants. It is for this reason formula should be discarded after a certain amount of time. When you open the can, write the date on the lid so you know how long it has been open for.

The formula your hospital stocks

These are usually on rotation as many hospitals do not wish to show preference to one brand over another, so one week they may have one formula on hand, the next week it may be a different brand.

A non-commercial infant formula

If it has not been through rigorous testing and does not meet the nutritional parameters set out by the infant formula regulations, it is not going to be a good choice as a sole source of nutrition for your baby.

In conclusion: you should feel secure in the knowledge that all formula sold within New Zealand will be of good quality and will contain the nutrients your baby needs. You will find different types which will suit different families and different babies, but you will not find a bad formula for sale at a reputable retailer in New Zealand.

Keep going!