Other specialty infant formula

What other special infant formulas are available?

Specialty infant formulas are for babies with specific health problems. They should only be used on the recommendation of a health-care provider. One of these infant formulas is for premature babies, who have unique needs. It may contain specialized fats and added calcium and phosphorus. It may also have more calories than regular infant formula. Thickened infant formula is for babies with major swallowing problemsThere are other infant formulas designed for children with specific medical challenges. These include carbohydrate-free infant formula, reduced- and modified-fat infant formula, and low-mineral infant formula. Some infant formulas are not fortified with iron. They can lead to low iron levels in the blood and are not recommended.

A) Describing specialty infant formula

Specialty infant formulas (formula) are for babies with specific health problems and should not be used unless recommended by your health-care providers.

B) Premature infant formula

Premature babies have unique needs. Premature formula is aimed primarily at very small babies (born at less than 1,500 grams, or about 3 pounds 5 ounces). The formulas are based on cow’s milk. They may contain specialized fats and more calcium and phosphorus for bone growth. They may also have more calories and vitamins than regular formula.

Post-discharge formula, used after discharge from hospital, is also sometimes used by small premature babies and has slightly more slightly calories than regular formula. However, some researchers report there is not enough evidence that it has any more benefits than regular formula (Young 2016).

C) Thickened infant formula

Thickened formula may be given to babies who have major swallowing problems.

D) Lactose-free infant formula

1) Describing lactose-free infant formula

Lactose is the main sugar in breast milk, cow’s milk, and many formulas. Lactose-free formula contains cow’s milk protein, but nearly all of the lactose has been replaced by another sugar such as corn syrup solids or brown rice syrup. Formula can also have reduced amounts of lactose. 

2) The use of lactose-free infant formula

Lactose-free infant formula was previously recommended for infants with diarrhea and other gut problems. It was thought even mild gut illness caused damage to the lining of the gut and resulted in low levels of the enzyme lactase, needed to digest lactose. It was even used instead of breast milk.

Research has since shown that for most babies, lactose-free formula did not have any advantages over regular formula and was inferior to breast milk.

Infant formula-fed babies with persistent diarrhea or who have major health problems that can reduce the amount of lactase enzyme may benefit from a short trial of lactose-free infant formula.

There are very few conditions in which babies cannot tolerate lactose. Two conditions are congenital lactase deficiency, caused by the baby's bowel not making the lactase enzyme, and galactosemia, a disorder that prevents the body from processing the milk sugar component galactoseLactose-free infant formula is not suitable for these babies as it may contain residual lactose.

Both lactose-reduced and lactose-free formula are often marketed as decreasing stomach gas and cryingThere is very little evidence to support this (Sherman 2015).

3) The risks of using lactose-free infant formula  

There are drawbacks to using lactose-reduced or lactose-free formula. These formulas are generally more expensive than regular formula. 

Lactose itself has beneficial effects (Romero-Velarde 2019):

  • Compared to glucose or sucrose, it is less likely to stimulate the reward centre of the brain.
  • Formula with corn sugar has been shown to raise the insulin level higher than lactose-containing formula.
  • Lactose helps the body absorb calcium from milk.

Brown rice syrup, which is sometimes used to replace lactose, may contain arsenic

E) Other specialty infant formula

Other formulas are designed to meet the needs of children with specific medical challenges. Examples are:

  • Carbohydrate-free formula
  • Reduced- and modified-fat formula
  • Low-mineral formula
  • Low-phenylalanine formula

F) Non-iron-fortified infant formula

Some formulas are not fortified with iron, but these can result in a baby having low levels of iron in the blood (anemia). Their use is not recommended (O’Connor 2009). 

Some parents use non-iron-fortified formula to treat constipation, but there are other approaches to constipation that are safer.

References

O'Connor NR. Infant formula. Am Fam Physician. 2009 Apr 1;79(7):565-70

Romero-Velarde E, Delgado-Franco D, García-Gutiérrez M, et al. The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting. Nutrients. 2019;11(11):E2737
 
Sherman AL, Anderson J, Rudolph CD, et al. Lactose-Free Milk or Soy-Based Formulas Do Not Improve Caregivers' Distress or Perceptions of Difficult Infant Behavior. J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):119-24

Young L, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Cochrane Database Syst Rev. 2016 Dec 13;12:CD004696