Breastfed Babies: Choosing Infant Formula for Supplementation

Breastfed Babies: Choosing Infant Formula for Supplementation or weaning

In breastfed infants, situations may arise where infant formula supplements are necessary at the maternity ward or upon returning home if weight gain is slow. Depending on the breastfeeding goal, if the aim is exclusive breastfeeding, the mother will be advised to express her milk so that supplements are breast milk, thereby maximizing lactation. (Specific consultations are available for this situation: you can book here).

However, if this is not sufficient and mixed feeding (combination feeding) becomes necessary, or if you decide to wean your baby: which formula should you choose?

Young parents face enormous commercial pressure regarding formula choices: organic, pesticide-free, enriched with various elements, etc. It is important to know that all infant formulas meet a standard formula that is scientifically validated for adequate infant nutrition. Ingredients added to "mimic breast milk" have not proven their benefit; otherwise, they would be included in the standard formula.

Preventing Cow's Milk Protein Allergy (CMPA)

Recently, it has even been suggested to give "allergy-specific formulas" to breastfed babies to prevent Cow's Milk Protein Allergy (CMPA).

For more information on suspected CMPA, you can consult this article.

CMPA prevention has been the subject of controversy among scientists in recent years. Some suggested that early introduction and exposure to formula could prevent allergies in "at-risk" infants (those with a family history).

However, because this could compromise lactation and the establishment of exclusive breastfeeding, the Nutrition Committee of the French Society of Pediatrics ruled as follows: "Regarding the introduction of cow's milk protein (CMP), current recommendations suggest avoiding any cow's milk-based supplementation for breastfed infants in the maternity ward."

Consequently, some professionals suggest "allergy-specific" (CMP-free) formulas during the maternity stay or upon returning home if weight gain is slow. These may be protein hydrolysates (e.g., Nutramigen), where proteins are broken down so they are no longer allergenic, or rice-protein-based formulas.

In February 2024, ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) published a position paper concluding: "Overall, the effects of brief early exposure (...) are not consistent. It remains unclear whether avoiding regular consumption of CMP-based formulas in early life reduces the risk of CMPA in children." The authors also noted that protein hydrolysates cannot be recommended for CMPA prevention due to a lack of evidence.

Furthermore, these special allergy formulas:

• Often have a poor taste: Some babies categorically refuse them.

• Are expensive: A tin of hydrolysate costs about four times more than standard formula. Using them without evidence of efficacy raises economic concerns, especially regarding public health resources.

  
  

Mixed Feeding or Weaning: What About "Follow-on" or "Toddler" Milk?

"Follow-on" Formulas (Stage 2 / Relay)

If your baby is 4 months old and you decide to wean or start mixed feeding, you might be offered "relay" milk (designed to transition from breastfeeding). These contain prebiotics and probiotics but have no demonstrated nutritional benefit and are not recommended by the French Association of Ambulatory Pediatrics or the American Academy of Pediatrics (AAP). You can use standard infant formula, which is typically more affordable.

"Growth" or "Toddler" Milks (Stage 3)

When your baby turns one, you might wonder what to give instead of breast milk. In France, "toddler milks" are often recommended from 10 months to 3 years, mainly for their iron content. However:

• The AAP (October 2023) stated that toddler milks offer no nutritional benefit and are subject to questionable marketing. They noted the high sugar content may lead to a preference for sweets and an increased risk of obesity.

• The NHS (UK) provides identical recommendations: no benefit for growth or relay milks.

• The WHO (2022) denounced the abusive marketing of these formulas, noting they fall outside the "International Code of Marketing of Breast-milk Substitutes," making them a loophole for industry advertising.

  
  

From age one, the AAP and NHS recommend pasteurized whole cow's milk as part of a diversified diet. If a child is iron deficient, a doctor can prescribe iron syrup with the same biological value as that added to industrial milks.

The WHO also classifies these products as ultra-processed foods. In a 2023 report, the WHO even stated that breast milk can be replaced by animal milk (pasteurized, boiled, or fermented) starting at 6 months if weaning is complete or partial, provided the child consumes iron-rich solid foods. Given current economic pressures, this may be a viable option for some families.

Contact for advice or questions: "My Baby Moon" by Elise Armoiry, IBCLC Lactation Consultant & Founder. Over 2,000 families supported since 2014. Doctor of Pharmacy, specializing in breastfeeding and infant sleep.

Email: info@mybabymoonibclc.com

Tel: 07.49.50.67.82

Website: www.mybabymoonibclc.com