Infant feeding is a confusing topic for many parents. Here are answers to some of the most commonly asked questions

Q Why is breastfeeding best for my baby?

A The Department of Health and World Health Organization recommend exclusive breastfeeding for the first six months of a baby’s life. “Breast milk is the only natural food available for a baby and breastfeeding has many benefits for both the mother and the baby,” says Helena Gibson-Moore, nutrition scientist at the British Nutrition Foundation. These include:

• Providing the correct balance of nutrients in a form that is readily absorbed by an infant’s immature digestive system
• Changing its composition over time to correspond with the baby’s growth
• Containing antibodies and other immunological factors to prevent infection. These cannot be replicated in formula milk
• Containing enzymes to aid digestion
• Containing less protein and fewer electrolytes than cow’s milk, which reduces the burden on the baby’s immature kidneys
• Containing substances like long chain polyunsaturated fatty acids, which play a key role in the development of brain, vision and psychomotor functions
• Appearing to protect against gastrointestinal infection and Crohn’s disease
• Appearing to help prevent the development of allergies, childhood diabetes, respiratory tract infections and middle-ear infections.

Breastfeeding also ensures bodily contact between mother and baby, helping to strengthen their physical and emotional bond. It is by far the most convenient feeding method, as sterile milk is readily available free of charge, at the correct temperature. Breastfeeding also uses up around 500 calories a day and may even reduce mum’s risk of developing breast and ovarian cancer.

Q What’s the difference between infant and followon milk? Does it matter which one I use?

A First infant formula is based on modified cow’s milk and is the only accepted alternative to breast milk. “It is suitable from birth as it is thought to be easier to digest than other types of infant formula,” says Helena. Modifications include:

• Altering the whey:casein ratio from 20:80 in cow’s milk to 60:40 (the same as breast milk)
• Adjusting the carbohydrate concentration to increase the lactose content
• Removing fat and adding vegetable oils to increase fatty acid absorption
• Reducing the sodium content
• Adding vitamins, minerals and other key ingredients

Follow-on milks are suitable from six months alongside a healthy weaning diet. Also based on cow’s milk, follow-on milks contain a higher level of certain key nutrients than infant formula milks, such as iron and vitamin D, to help meet the needs of infants at this age. Helena adds: “Followon milk is casein-based and should never be fed to babies under six months old.”

Q I’ve only ever breastfed, but am returning to work and want to start bottle-feeding, but my baby refuses to take a bottle. What can I do?

A When introducing a bottle, start with expressed breast milk before giving formula. Try to establish a routine by offering a bottle at the same time each day. If feeding continues to be difficult, experiment with different types of teats and hold the baby in a different position to that used during breastfeeding. Someone other than the mother offering the bottle may also help.

Q I think my baby is allergic to milk. What should I do?

A Cow’s milk allergy (CMA) is the most common food allergy in infants, affecting two to seven per cent of babies under one year of age. It is more commonly seen in bottle-fed babies, but most grow out of it by three years of age.

Symptoms generally involve the skin and one or more body system, such as the gastrointestinal or respiratory system. Common symptoms include:

• Swelling of the face, hives and wheezing
• Diarrhoea and vomiting
• Constipation, bloating and abdominal pain
• Colic

If CMA is suspected, refer to a healthcare professional. Total avoidance of cow’s milk is usually the treatment. This may involve breastfeeding mothers cutting all cow’s milk products from their diet and compensating with supplements. A food-symptom diary should be kept, with cow’s milk being periodically reintroduced under the supervision of a healthcare professional.

For formula-fed babies, a healthcare professional may recommend an extensively hydrolysed formula (EHF), which is based on cow’s milk but the proteins have been broken down. Amino acid-based formulas are also available, where the protein is made up of individual amino acids and doesn’t trigger reactions. Soya-based formulas can elicit reactions and increase phytoestrogen exposure, so are only recommended if babies cannot tolerate EHFs, or for lifestyle reasons.

Q My baby is still hungry after her feed. I’m worried she’ll gain weight if I give her extra milk.

A Even babies of identical age and weight can vary in their appetites, while individual babies may vary week-to-week or day-today. “A breastfed baby should feed as often as they want,” explains Helena, as limiting feeding can inhibit growth and development.

Generally, babies fall asleep or let go of the teat when they’re full. Alternatively, if they’re awake and interested, they may need a larger feed. Bottle-fed babies can be given a casein-rich infant formula for hungry babies, which takes longer to digest and leaves them more satisfied.

Q My toddler is eating solid food. Does he still need milk?

A From 12 months of age, milk should begin to play a less important role in helping to meet an infant’s dietary requirements. However, infants aged one to three still need at least two to three daily servings of dairy, which can include cheese and yoghurt. At 12 months, toddlers shouldn’t drink more than 500ml of milk a day, including cow’s, formula or follow-on varieties. Too much milk can suppress their appetite for other foods and cause unhealthy weight gain. To help cut back:

• Offer water instead of milk
• Give milk in smaller cups
• Restrict milk to after meals

The Department of Health recommends introducing full-fat cow’s milk at one year of age, semi-skimmed from two years and skimmed from five years of age, providing the child’s diet is nutritious and balanced. Growingup/ toddler milks can be beneficial as they contain high levels of iron, essential fatty acids, and vitamins A, C and D.