Scientific Article

Breast Milk and Baby Formula: The Development of Infant Nutrition

Prof. Dr Karl Zwiauer


Paediatricians and other medical professionals agree that breastfeeding is best for babies. They also agree that there are safe alternatives to providing optimal nutrition in cases where it is not possible to breastfeed. When used as a supplement to breastfeeding, or if breastfeeding is contraindicated, formula feeding can provide many benefits. Strict regulations governing the manufacture of formulas control macro nutrients, such as protein sources, content and composition of carbohydrates as well as micro-nutrients and additives.

A variety of baby formulas are available to meet practically every need. Starter formulas designed to be used during the first 4 months of life can be fed in amounts and frequencies simulating breastfeeding. It is recommended to continue using these starter formulas throughout the entire first year of life instead of switching to follow-up formula. Hypoallergenic (HA) formulas are available if there is a family history of allergies. These can be used until the baby starts eating supplemental foods in addition to liquid formula, at about the 5th or 6th month. Most commercially available formulas also contain long-chain polyunsaturated fatty acids (LC-PUFAs). The addition of LC-PUFAs such as DHA benefits the child’s vision development and there are indications that they may provide other benefits to child development.

In recent years, more and more so-called “special formulas” have come on the market to be used for various medical conditions. It is important to note that for many of these foods, there are very few studies on their effectiveness for the indicated areas of application. They should only be used if there are clear indications determined by a physician.

The Right Bottle And More

In general, baby formula should be prepared with fresh drinking water. If the water contains high levels of nitrates or lead, bottled (mineral) water should be used. Special precautions may be necessary in areas with substandard or questionable water quality.

Whether feeding expressed milk or formula, it is important to choose the right bottle and accessories. Bottles which minimize the amount of air swallowed have been shown to reduce symptoms of colic and increase oxygen saturation levels (SPO2). With adequate SPO2 babies can better control their behaviour and coordinate between breathing and sucking while feeding. It is also important that the teat design is as close as possible to the breast in feel and function to allow the baby to properly use the muscles needed for feeding.

When bottle feeding, parents should mimic the technique used when breastfeeding. Close personal contact, good eye contact and alternate between left and right positions.

Whether using expressed milk or formula, proper hygiene is very important. Bottles, teats, storage containers, breast pumps; all of these items should be easy to clean properly. When freezing breast milk for longer storage, containers should be marked by date so older ones can be used first.

Beyond the Bottle

At some point, usually between the ages of 5 and 6 months, parents can introduce supplemental foods to the baby’s diet. Progressing from breast or bottle feeding to independent eating is an important step in child development. Nutrition and eating habits are established and new social skills are learned. Home cooking offers more variety and flavours while letting parents control undesirable ingredients like sugars and salt. Commercially available baby foods offer safe and convenient options for busy parents.

We have learned much about infant nutrition over the years. We have also made important advances in the safety, quality and developmental compatibility for the products we use to feed our babies. Even though we have increased our knowledge in this field, there is still much research needed concerning the ingredients, composition and effects of breast milk. It can be expected that as our knowledge in this field increases, it will also influence the development of infant nutrition.

Prof. Dr. Karl Zwiauer

Paediatrician

Prof. Dr. Karl Zwiauer, former head of the Department of Paediatrics at the St. Pölten University Hospital (Austria), is one of the leading paediatric specialists in the area of nutrition, metabolic diseases, social paediatrics, haemophilia and vaccinology. His scientific activities in Europe and America are also of note in this regard. Dr. Zwiauer is a member of the executive board of the Austrian Society for Paediatrics as well as member of the Nutrition Committee of the Austrian Society for Paediatrics and Children’s Medicine. He also acts as organiser and chairman for various congresses and continuing medical education events. Through his ambitious scientific activities, his work has been published in more than 150 national and international journals. Dr. Zwiauer is also active as a reviewer of international professional journals.