Bottlefeeding: The use of a substitute for breast milk for feeding infants.

Pediatricians generally advise exclusively breastfeeding (that is, breastfeeding with no formula) for all full term, healthy infants for the first 6 months of life. However, many infants are formula-fed today, at least in part. For infants to achieve normal growth and maintain normal health, infant formulas must include proper amounts of water, carbohydrate, protein, fat, vitamins, and minerals.

The three major classes of infant formulas are:

1. Milk-based formulas are prepared from cow milk with added vegetable oils, vitamins, minerals, and iron. These formulas are suitable for most healthy full-term infants.
2. Soy-based formulas are made from soy protein with added vegetable oils (for fat calories) and corn syrup and/or sucrose (for carbohydrate). These formulas are suitable for infants who cannot tolerate the lactose in most milk-based formulas or who are allergic to the whole protein in cow milk and milk-based formulas.
3. Special formulas are for low birth weight (LBW) infants, low sodium formulas for infants that need to restrict salt intake, and "predigested" protein formulas for infants who cannot tolerate or are allergic to the whole proteins (casein and whey) in cow milk and milk-based formulas.

The use of infant formulas: Most infants and children thrive on a cow milk-based, lactose containing formula such as Similac (Ross Pharmaceuticals), Enfamil (Mead Johnson Pharmaceuticals), and Good Start (Carnation Food Corp).

Some infants are lactose intolerant (not allergic) and will better tolerate a lactose-free milk-based formula such as Enfamil Lactofree (Mead Johnson Pharmaceuticals) or Similac Lactose-Free (Ross Pharmaceuticals). For children who are recovering from infectious diarrhea and gastroenteritis, the short-term use of lactose-free formulas may help decrease cramps and diarrhea.

Some parents of lactose intolerant infants may prefer to use soy protein-based formulas such as Isomil (Ross Pharmaceuticals), Prosobee (Mead Johnson Pharmaceuticals), and Alsoy (Carnation Food Corp.). Infants who are allergic to cow milk protein can also use soy-based formulas.

For infants who are allergic to cow milk protein and soy protein (approximately 35% of infants allergic to cow milk protein are also allergic to soy proteins), the "predigested" protein formulas including Pregestimil, Nutramigen, and Alimentum can be used.

Unique medical conditions may require a specific formula recommendation by the pediatrician, as for example Lofenalac for patients with PKU (phenylketonuria).

Reasons for formula feeding: Some common reasons for choosing formula-feeding include the following:

• An inadequate supply of maternal breast milk.
• Inefficient sucking by the baby.
• Inability to quantitate the precise amount of breast-milk received by the baby.
• Concern about transferring drugs the mother may be taking for a medical problem through the breast milk to the infant. (Examples of medications that are considered unsafe for the baby include cimetidine, cyclophosphamide, lithium, gold salts, methotrexate, metronidazole, cyclosporine, and bromocriptine.)
• Mother needs to work outside of the home shortly after the baby's delivery. Formula-feeding offers a practical alternative to trying to be in two places at once! (Formula-fed babies also need to eat less frequently than do breastfed babies because breast milk digests and leaves the stomach more quickly. Thus, breastfed babies become hungry more frequently.)
• A side benefit of bottlefeeding is that the entire family can immediately become intimately involved in all aspects of the baby's care, including feedings. The mother can therefore get more rest, which can be critically important, especially if the pregnancy and/or delivery were especially difficult.