Which to Pick for Baby? Pricy Elemental Vs. Cow’s Milk Formula

I get this question a lot: Is there a difference between different types of infant formulas?

A recent study on infant formula (aka ‘artificial milk’),  asked that question in terms of how babies gain weight when taking different recipes of the stuff.  The answer was sufficiently dramatic, I thought, that I expected the nation to be temporarily deafened by the collective ping of thousands of cow’s milk formula cans being tossed into the trash bin.

Cow’s milk formula comprises about 80% of all infant formula consumed in the US. By the time the cow’s milk formula–be it powder, concentrated liquid, or the ‘ready to eat’ variety–makes it to the baby, it has been substantially modified, through heat and processing, to approximate the more digestible and nutritious balance of sugars, proteins and fat in breastmilk. In addition, other vitamins and supplements may be added, including iron and other nutrients (e.g. omega 3 fatty acids).  Most newborns that are given cow’s milk formula do just fine, and have no issues with the ingredients therein. For most, it is merely a matter of picking a brand (e.g. Similac, Enfamil, Earth’s Best, etc) and going with it. Cost? About 15 bucks a can, which can last 2-3 days.

Some children, though, develop sensitivity to the cow’s milk protein. These babies may display an unhappy intolerance for the cow’s milk-based product, and let their parents know this with persistent bouts of barfing, diarrhea, bloating, or fussiness.

Enter the so-called hydrolysate, hydrolyzed or elemental formulas. Manufacturers prepare these artificial milk products by breaking down the proteins and amino acids that may spur sensitivity reactions in some infants. They can be an excellent choice for families needing a hypoallergenic option. With their ‘predigested’ or ‘gentle proteins’, the nutrition profile of the elemental formulas more closely approximates breastmilk. That has instant appeal, I’d think, to someone weighing a purchase in the supermarket, looking at one can of formula versus another. The elemental formulas also contain similar amounts of key nutrients to their cow’s milk counterparts, including iron, vitamin D, and essential fatty acids, etc.

Customarily, the elemental/hydrolysate formula option is chosen with a clinician’s input and guidance, presumably due to formula intolerance, or suspicion of a protein sensitivity. Put plainly, these are not formulas that we routinely recommend out of the gate for healthy infants whose families are mulling supplementing a breastfed infant or exclusively using formula.   The elemental formulas aren’t cheap: they run around 30 dollars for a standard can. You can do the math, but you might spit up.

In a recent study in the journal Pediatrics, two groups of infants were identified whose parents had opted to exclusively formula feed at two weeks of age. In all, they followed 35 infants on cow’s milk formula versus 24 infants on a hydrolysate formula. Both formulas used contained the same amount of calories, but differed principally in their protein makeup as noted above. The babies underwent monthly weight checks, and were even taped while feeding, to see if they behaved differently on the different formula. The results were interesting.

Both groups of babies grew in a similar fashion in terms of their linear growth, or height. Those infants on the elemental formula not only ate less per meal, but their weight gain more closely resembled that of children who were exclusively breastfed. The cow’s milk formula-fed infants ate more, and gained more: up to two pounds more by the end of the first year. The implication: some babies on cow’s milk formula may gain too much weight.

So, should new parents, or those currently using cow’s milk bail, for the hydrolysate formula option for optimal baby growth?

I say no…Or, not yet. Cow’s milk-based formula  works for the majority of babies who take it. Routine visits with a primary care provider allow each family to check in about their baby’s growth and development. We do this kind of troubleshooting all the time.

For those pondering a formula change (e.g. fussiness or feeding problems), I think a new formula trial is done best when done with a clinician’s input. I advise against parents doing a willynilly buffet approach of formula trials (Alimentum on Monday, Neutramigen on Tuesday), for it may be confusing or costly.

Sure, breast milk is best milk (and a whole lot cheaper!) for the newborn or infant. While I wholeheartedly support breastfeeding whenever possible, it is also my job to help inform parents who supplement or turn to infant formulas.

In my estimation, the cost of the elemental/hydrolysate formulas is prohibitive for the typical family with a healthy, trouble-free little feeder and grower. And, for those of you who still have questions, run it by your infant’s primary care provider(hey, look savvy by quoting this study). Everyone may learn something.

In my next post, I’ll look at the many myths and concerns of the overweight infant. When does cherubic plumpness stop being cute and start being a problem?

Bon appetit!

Link to study overview

http://www.monell.org/news/news_releases/hydrolysate

Photo above by SweetSuzy

Cartoon below by me

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