Following the Infant Formula Act of and backed by nutritional research, formula options continue to more closely try to resemble breast milk. A few examples, courtesy of Contemporary Pediatrics :. DNA is in our cells, and it contains our genes, or the codes that make us unique.
The same way that protein is made of chains of amino acids, DNA and RNA are both made from long chains of nucleotides nucleotides do not contain protein, nor are they the same as amino acids.
Nucleotides are in breastmilk and can be added to formulas. Nucleotides are found in human milk, along with a lot of other helpful components. Scientists realized that nucleotides might provide some benefits to breast-fed infants, including to the immune system. One of the possible benefits of adding nucleotides to formula is that they may help to support growth in some formula-fed infants. You can read more about the evidence of how nucleotides may support growth in this publication.
Nucleotides may also help to reduce how often formula-fed infants get diarrhea and how long the diarrhea lasts. There is evidence that adding nucleotides to infant formula may minimize diarrhea.
There are a few key points:. Replication : There are some things that are hard to replicate and therefore, not found in formula. Wet nursing is when a woman breastfeeds another woman's child.
Initially these bottles were made of glass. Shortly after, the first rubber nipple was patented. In evaporated milk was developed. The use of evaporated milk allowed food to be transported and stored without spoiling.
It was a huge breakthrough for food sterilization and allowed several baby formula brands to emerge. Ruth M. Moskop and Melissa M. Modern, scientifically produced formulas in clean bottles, however, now offer another safe choice for babies in North Carolina and elsewhere. Few records exist about infant feeding during the Middle Ages, but we know that between and the late s it was not fashionable for wealthier women in the West to nurse their babies.
Often, families hired another woman, called a wet nurse , to feed the baby. Pap was a very unwholesome, thin mixture of bread and liquid boiled to a pulpy texture.
Cleaning infant cups and pap feeders was almost impossible. They exposed hand-fed babies to harmful bacteria, and the food lacked important nutrients.
Around , things began changing. People recognized that glass was a better material for baby bottles. Because glass is clear, it can be cleaned more easily. Still, many more artificially fed babies died young, compared to naturally fed babies.
Medical writers insisted that human milk was best for babies. During the second half of the s, doctors realized two important things about feeding infants. First, human milk stays almost germ-free as it passes from mother to child. Prepared formula—especially from animal milk —in a bottle, cup, or spoon can be contaminated.
Use of cod liver oil as a prophylactic measure against rickets became widespread in the United States by the mids. By the mids, when it was known that infantile scurvy could be prevented by daily feeding of fruit juices, the prejudice against use of boiled milk in infant formulas disappeared and formula feeding became much more successful. To modify curd tension, lactic acid was commonly used.
The use of lactic acid rather than lime water for modifying curd tension may have occurred because of the advantage of acidified over alkalinized formulas in inhibiting bacterial growth.
Evaporated milk was first marketed by Gail Borden in Wharton ; beginning in , it was sold in hermetically sealed cans sterilized by heat. However, because of fear of producing scurvy, it was not used in infant feeding until the s, when its use was promoted by several of the leading pediatricians of the time Brenneman , Marriott , Marriott and Schoenthal Evaporated milk was relatively inexpensive, could be stored at room temperature and was free of bacterial contamination until the can was opened.
The processes of evaporation, homogenization and heat treatment resulted in physical changes in the milk, with an increased percentage of casein adsorbed to the surface of the fat globules Council on Foods a , thus contributing to the reduction in curd tension.
Although cereal was commonly included as a constituent of infant formulas in the early s, the purpose of its inclusion was the reduction of curd tension, not as an energy source. With the use of evaporated milk for infant formulas, cereal was no longer needed.
She pointed out that in Holt's The Diseases of Infancy and Childhood , the recommended age for introduction of green vegetables in the edition was 36 mo, but that by the edition, the age had decreased to 9 mo.
However, it is evident that earlier introduction of beikost was common at least in some areas. Infants under the care of the Infant Welfare Society of Chicago between and received cereal at 5 mo of age and a vegetable at 6 mo of age Grulee et al.
Various developments in infant feeding and nutrition from — are indicated in Figure 2. Although data on the percentage of infants who were breast-fed in the United States from to are less satisfactory than later data, there is no question that the trend was downward. The data of Bain regarding percentage of infants initially breast-fed are based on a review of discharge records and therefore are likely to be more accurate than the recall data of Hirschman and co-workers Hirschman and Hendershot , Hirschman and Butler Changes in infant feeding and nutrition from to breast feeding declined, whereas beikost and fresh cow's milk were introduced at earlier and earlier ages.
The first federal regulations concerning infant formulas went into effect in and, beginning in , commercially prepared formulas began to replace home-prepared formulas. Iron-fortified formulas were introduced in Exclusively and partially breast-fed infants as percentage of all infants in , and A smoothed curve is presented for based on data from personal communications from Boettcher, J. From the s or early s, most formulas fed to infants in the United States were prepared by mixing evaporated milk or fresh cow's milk with water and adding carbohydrate.
Home-prepared formulas were sometimes made with cow's milk usually pasteurized and homogenized rather than with evaporated milk. These formulas provided about the same distribution of energy from protein, fat and carbohydrate as did the evaporated milk formulas. Most evaporated milk and most pasteurized, homogenized whole cow's milk were fortified with vitamin D. Orange juice was given as a source of vitamin C.
Improved general sanitation, safe supplies of water and milk, and better understanding of both microbiology and nutrient requirements resulted in a high degree of success with formula feeding, and it was the opinion of most physicians and the general public that formula feeding was about as safe and satisfactory as breast-feeding.
However, the infant formulas in general use in the s were associated with a number of problems unappreciated by physicians and parents, including the following: 1 the high potential renal solute load placed the infants, especially young infants, at risk of developing hypernatremic dehydration during illness Fomon and Ziegler ; 2 the low content of iron in the formulas together with the high intake of inhibitors of iron absorption Fomon were responsible for a high prevalence of iron deficiency and, in the case of whole-milk formulas, probably with the added problem in some infants of increased intestinal blood loss Ziegler et al.
In addition, scurvy continued to be seen. A survey of teaching hospitals in the United States indicated that during the years —, infants and children were admitted to these hospitals because of scurvy Committee on Nutrition From the late s, a number of commercially prepared formulas were available in the form of powders that merely required the addition of water before being ready to feed to infants.
Many of these formulas had been developed in an attempt to mimic the chemical composition of human milk, and several researchers had focused their attention on the greater percentages of low-molecular-weight fatty acids in cow's milk than in human milk, believing that these were responsible for the poor tolerance of infants to butterfat Gerstenberger et al. Thus, even in the early s, formulas free of butterfat had been marketed.
The cost of powdered formulas was appreciably greater than that of formulas made from evaporated milk or whole cow's milk, and usage of commercially prepared formulas was rather low.
By , concentrated liquid formulas had largely replaced powdered formulas Fig. The change from home-prepared formulas to commercially prepared formulas was accelerated by the introduction in of iron-fortified formulas and the vigorous promotion of these formulas by the formula industry and by pediatricians Andelman and Sered , Committee on Nutrition Percentage of 2- to 3-mo-old infants receiving various forms of feeding from to feeding of commercially prepared formulas prepared increased and feeding of formulas based on evaporated milk EM decreased.
Relatively few infants were breast-fed and few young infants were fed cow's milk CM. From at least the s Powers until the s, the protein concentration of human milk was believed to be greater than is now known to be the case, and many pediatricians believed that cow's milk protein was so inferior to human milk protein for meeting the needs of infants that infants fed formulas required a considerably greater intake of protein than did breast-fed infants.
Protein content of a number of widely used formulas ranged from 3. During the late s and early s, most of the leading commercially prepared formulas fell into one of two classes. One class e. The gradual takeover of the market by the latter formulas seems not to have been based on considerations of nutrient requirements or renal solute load, but on the unpleasant odor of regurgitated butterfat after its partial digestion and on the impression that formulas similar to the home-prepared evaporated milk formulas led to constipation.
As early as , James Gamble had gained at least some understanding of renal excretion of solutes Abt , but it was not until the s that the relation of renal solute load to water balance in infants received serious consideration Cooke et al. However, even at the end of the century, infant formula regulations permitted the marketing of formulas with undesirably high potential renal solute load.
However, most of the formulas fed in the first half of the 20th century exceeded this maximum and undoubtedly contributed to the prevalence of hypernatremic dehydration. An iron-fortified formula was introduced in the United States in ; by the mid s, most manufacturers offered the same base formula with or without substantial iron fortification Fomon Many parents and physicians were reluctant to use iron-fortified formulas because they believed that feeding such formulas was responsible for constipation, fussiness and intestinal disturbances in the infants.
Studies that failed to confirm such adverse effects Nelson et al. Nevertheless, the whey proteins of cow's milk are quite different from those of human milk; even today, rather meager evidence exists that a milk-based formula with added whey proteins results in a product that is superior to a milk-based formula without the additional whey proteins.
A formula based on soy flour was developed by Hill as a feeding for infants allergic to cow's milk and became commercially available in Abt Formulas prepared from soy flour were pale tan in color and had a nutty odor. Parents complained that the formulas produced loose, somewhat malodorous stools, and resulted in staining of the reusable cloth diapers that were in general use.
Excoriation of the diaper area was common. The stool characteristics resulted primarily from the presence of considerable amounts of fiber in the soy flour.
In addition to soy-based formulas, a meat-based formula and a casein hydrolysate formula were marketed. Several of these special formulas were not fortified with vitamins when initially marketed, apparently because pediatric allergists believed that the vitamin mixes used for vitamin fortification of formulas might include allergens. In the s and s, a number of vitamin deficiencies were described Fomon In addition, goitrogens present in soy flour were responsible for development of goiters in infants fed a soy flour—based formula unfortified with iodine.
A few cases of vitamin K deficiency were reported in the s in infants fed a meat-base infant formula protein from beef heart or a casein hydrolysate formula before these formulas were fortified with vitamin K Fomon Formulas prepared with isolated soy protein became commercially available in the United States in the mids and within 10 y almost completely replaced soy flour—based formulas. Isolated soy protein—based formulas are similar in color to milk-based formulas and are nearly odorless.
Because most of the fiber is removed during the protein isolation process, the infant's stools are generally similar to those of infants fed milk-based formulas. However, the process employed in isolation of the protein resulted in elimination of most of the vitamin K that had been naturally present in the soy flour—based products, and a few cases of vitamin K deficiency were reported before the products were fortified with vitamin K Fomon Development of nutrient deficiencies in infants fed milk-free formulas was responsible in part for the development of a series of federal regulatory actions on nutrient content of infant formulas.
The United States was among the last of the major industrialized countries to implement federal regulations concerning safety of infant formulas Miller It was not until that the new Food and Drug Act included reference to foods for special dietary purposes, including infant formulas.
In , the FDA declared that a food sold for use by infants should include a label declaration for moisture, energy, protein, fat, available carbohydrates, fiber, calcium, phosphorus, iron and vitamins A, B-1, C and D.
In and , an alteration in the method of heat treatment of concentrated liquid SMA resulted in a decrease in vitamin B-6 content, and clinical manifestations of vitamin B-6 deficiency developed in a number of infants Fomon As a result of this experience, the FDA in published a proposed revision of the regulations. A revised final regulation published in included the requirement for minimal levels of 11 vitamins and minerals; because of controversy over the regulations, however, it was not put into effect Miller The report of the Committee on Nutrition was used as a basis for public hearings in —, and the final regulation, published in FDA included minimum requirements for protein, fat, linoleic acid and 17 vitamins and minerals.
Throughout the first half of the 20th century, hospitals maintained formula laboratories to prepare formulas for newborns and other formula-fed infants. This activity required special equipment, was labor intensive and presented formidable problems in quality control. In the early s, commercial formula services began operating in a number of metropolitan areas in the United States Committee on Nutrition and many hospitals elected to use these services rather than to continue their own activities in formula preparation.
By the early s, considerable discussion centered about the cost effectiveness of purchasing ready-to-use formulas from outside sources rather than preparing them intramurally Fomon It was evident that use of a commercial formula service influenced the choice of stock formula selected by a hospital. Manufacturers of various prepared formulas were therefore motivated to develop competing feeding systems. In , the Mead Johnson Company introduced the Beneflex system of feeding in which bulk quantities of any infant formula manufactured by that company could be transferred aseptically to feeders suitable to the needs of individual infants Fomon Soon afterward, the formula manufacturers were able to offer sterile ready-to-feed formulas in disposable bottles with disposable or reusable nipples.
These were first used in hospitals but were subsequently made available to the general public. An indication of the rapid rise in sales of ready-to-feed formulas during the late s and early s may be seen from Figure 5. The data in the figure apply to consumer sales and do not include hospital usage. Early in , approximately equal numbers of hospitals in the United States used ready-to-feed formulas supplied by manufacturers and formulas supplied by locally operated commercial formula services.
By , nearly all of the locally based commercial formula services had ceased to exist, few hospitals prepared their own formulas intramurally and most newborn nurseries used commercially prepared, ready-to-feed formulas.
The percentage may not have been quite as high for the entire country. Infants fed cow's milk no breast-feeding, no formula feeding as percentage of all infants in , and Data for and from Martinez et al. Because it was not yet appreciated that feeding of homogenized, pasteurized cow's milk to young infants could predispose to dehydration during illness and to development of iron deficiency, there seemed therefore little reason not to change at an early age from feeding formula to feeding fresh cow's milk.
Cow's milk was considerably less expensive than infant formula, required no mixing and was a staple item in the home. Moreover, many parents probably considered that the ability of an infant to tolerate at a young age a diet more closely approaching that of older children was an index of infant development and maturity. Following the trend of the previous two decades, the recommended age for introduction of beikost continued to decrease from to the early s.
Beal reported that in an upper socioeconomic group in Denver, strained foods were offered to the infant at increasingly early ages during the years through , and this seemed to be a general trend. Most extreme were the recommendations of Sackett , who promoted feeding of cereal at 2—3 d of age, strained vegetables at 10 d and strained fruits at 17 d. Such a diet can be calculated to be generous in protein and carbohydrate and relatively low in fat Fomon et al.
Because few infants were fed iron-fortified formulas or any formulas after 5 or 6 mo of age, beikost contributed most of the dietary iron for most infants, and dry powdered cereals fortified with iron were the major contributors.
In the s and s, infant cereals were fortified with sodium iron pyrophosphate or other insoluble iron compounds of low bioavailability; beginning in , the cereals were fortified with electrolytic iron powder Committee on Nutrition b.
On the basis of a report by Rios et al. Therefore, most physicians saw no objection to feeding cow's milk. Throughout the s, salt, monosodium glutamate, sugar and modified food starches were included in the preparation of many commercially available strained and junior foods.
Salt, monosodium glutamate and sugar were presumably added to satisfy the preferences of adult taste panels, and the modified food starches were used to achieve and maintain the desired physical appearance, consistency and texture of the products. The manufacturers voluntarily discontinued the use of monosodium glutamate in Over the next few years, the manufacturers adjusted their formulations to decrease the concentration of salt in infant foods. The downward trend in addition of salt was accompanied by a downward trend in addition of sugar.
By , the addition of salt had been discontinued, and sugar was added to fewer products and in smaller amounts than previously. The decrease in addition of sugar resulted in a considerable decrease in the energy density of some products, e.
By the late s, all manufacturers had reduced the number of beikost items to which modified food starches were added, and had discontinued use of all but a few types of modified starches.
In , soon after I arrived in Iowa as an assistant professor in the Department of Pediatrics, the chairman of the department, Charles D. May, was asked by the executive director of the AAP to serve as chairman of a new committee of the Academy, the Committee on Nutrition, which had been established by the Executive Board of the Academy on April 1, Executive Board In those days, the AAP operated in a much less formal mode than was to be the case in later years, and May was given complete freedom in choosing members, mostly from pediatric departments, to serve on the committee.
A liaison group of scientists and administrators was also established with individuals from governmental agencies, including the FDA and the infant food industry. Fortunately, the report did not acknowledge that I was the author because I had included calcium and magnesium as components of the renal osmolar load. It was the first of a series of gradually improving statements that I, and later Ziegler and I, published on the topic.
The second chairman of the Committee was Charles U. Lowe — and I was the third chairman — During those early years, the reports of the Committee were primarily educational and did not include policy statements.
It was not until the mid s that the Committee finally gained nutritional prominence through its assistance to the FDA in defining nutritional requirements for infant formulas and in setting policy for nutritional practices relating to infants, children and adolescents.
During the last quarter of the 20th century, the Committee on Nutrition exerted an enormous influence on child nutrition, most notably on aspects of infant feeding. Infant feeding in the United States during the last 30 y of the 20th century was marked by increases in breast-feeding and formula feeding and a decrease in feeding of cow's milk Fig.
The increase in breast-feeding in industrialized countries in the s was worldwide, and the reasons for the increase after several decades of decline are not easy to identify. The movement toward increased breast-feeding seemed to arise from the general public rather than from health professionals, and may have been in part associated with negative publicity directed against the formula industry.
The formula industry was accused of interfering with breast-feeding in lesser industrialized countries by its aggressive marketing of infant formulas Joseph , McComas Likely in response to this new climate, the infant formula manufacturers increased their efforts to promote breast-feeding.
The change from breast- or formula feeding to feeding of cow's milk occurred at progressively later ages.
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