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Nutrition for Infants

Breast milk is universally recommended as the preferred source of infant nutrition, in part because of its superior nutrient and immunologic properties. Successful breast feeding requires nursing on demand, prevention of sore nipples and convenient access to medical advice. For mothers relying on bottle feeding, cow's-milk-based formula is the preferred choice. Because soy-based formulas are lactose-free, they may be tolerated by infants who are allergic to cow's-milk protein.

Benefits of Breast Feeding

Breast milk is universally recognized as the preferred source of infant nutrition, and the nutritional advantages of breast milk.

Human milk also protects against infection by providing cellular immunity through macrophages and humoral factors, such as antibodies. Numerous studies have verified that breast-fed infants have a lower incidence of bacterial infection.

Recognizing these as well as other advantages, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have identified breast milk as the preferred source of infant nutrition.

To successfully promote breast feeding, family physicians should consider the influence of marketing campaigns aimed at expectant and new mothers by the manufacturers of infant formulas. Historically, their dogged marketing efforts have included the distribution of free cases of infant formula to expectant mothers, as well.

Counseling Strategies

Breast feeding should be initiated as soon after delivery as possible.

Mothers who choose to bottle feed also need counseling about infant nutrition. Although all commercial formulas use human milk as their model, none reproduce the immunologic and digestive properties of human milk. Formulas are available in three forms: ready-to-feed, liquid concentrates and powders. While ready-to-feed formula needs no preparation, it is the most expensive.

Protein hydrolysate formulas are used for infants who cannot tolerate cow's-milk-based formulas or soy-based formulas.


Major Nutrients in Infant Formulas Compared with Human Milk


Nutrient human milk Similac with iron Enfamil with iron Isomil with iron Prosobee with iron

Fat (g per L) 39 36.5 38.0 36.9 36.0

Oil mixture Soy, coconut Coconut, soy Soy, coconut Soy, coconut

Protein (g per L) 10.5 14.5 15.2 18.0 20.0

Whey:casein 70:30 18:82 100:0 * *

Carbohydrate (g per L) 72 72.3 70.0 68.3 68.0

Source Lactose Lactose Lactose Sucrose, corn syrup Corn syrup

Selected minerals

Calcium (rag per L) 280 493 470 710 640

Phosphorus (mg per L) 140 380 320 510 500

Iron (mg per L) 0.3 12.0 12.8 12.0 12.0

Sodium (mEq per L) 7.8 8.0 8.0 13.0 10.4

Selected vitamins

Vitamin D (IU per L) 20 410 430 410 430

Vitamin K (ug per L) 2.1 54 58 100 106

Vitamin C (mg) 40 60 55 60 60

Whole Cows Milk

In the past, whole cow's milk was considered an adequate replacement for iron-fortified formula in infants more than six months of age who were getting at least one-third of their calories from supplemental food. Recently, this recommendation has been re-examined. Infants fed whole cow's milk after six months of age have been found to have poorer iron status than infants who are fed iron-fortified formula.


Vitamin K is effective prophylaxis against hemorrhagic diseases of the newborn because it minimizes the postnatal decline of vitamin K-dependent coagulation factors. Therefore, regardless of the method of feeding, all infants should receive 0.5 to 1.0 mg of intramuscular vitamin K or 1.0 to 2.0 mg orally in the immediate newborn period?


Although human milk contains only 0.3 mg iron per L, it is approximately 50 percent absorbed. Iron from breast milk helps delay depletion of neonatal iron stores; however, breast-fed infants need iron supplementation at six months of age, usually in the


Fluoride supplements for children have recently been reassessed because of an increasing incidence of dental fluorosis. Dental fluorosis is caused by excess fluoride


Recommended Daily Doses of Fluoride Supplementation

Fluoride in water (ppm)