“What to Feed Your Baby” — is the title of a recent, easy-to-read, practical book written by one of my colleagues, Stan Cohen. I had the opportunity to read it and recommend it as an excellent resource for parents. This book is not just for selecting formula and introducing foods, but it also reviews gastroesophageal reflux, colic, stooling problems, poor weight gain, overweight issues, prematurity, and allergies. In addition, the subtitle, “Cost-Conscious Nutrition for Your Infant,” is an important element throughout the book.
The first few chapters highlight the advantages of breastfeeding but acknowledge that formula-feeding is an acceptable alternative. Specific advantages that are outlined in Table 2.2 include decreased infections, decreased risk for several illnesses like sudden infant death syndrome (along with many others like diabetes and obesity), protection from allergies, and improved intelligence. Advantages for the mother, like weight loss and better emotional health, are discussed as well.
Almost any question that a new mother would ask about the logistics of breastfeeding are answered in the 3rd chapter: “How long should each feeding be?” “Should I wake the baby?” “Do I need to stop if I have a cold?” “How long can the breastmilk be stored?” The latter question has its own table 3.1 and the answer depends on the storage temperature. At room temperature, covered breastmilk should be durable for 6-8 hours. In addition, Dr. Cohen explains the need for vitamin D supplementation.
Chapters 4 and 5 help parents understand the highly marketed formulas and to understand a rationale for choosing one formula over another, including cost as a factor. Dr. Cohen provides data on mean docosahexaenoic acid (DHA) content in breastmilk throughout the world. In the U.S., the level is relatively low at 0.29 (as a percentage of fatty acids). The breastmilk DHA level is nearly three times higher in Japan and Artic Canada. These discrepancies account in part why formula companies may choose different target concentrations for some of their components when trying to mimic breastmilk.
While Dr. Cohen explains that some of the differences between formulas are akin to differences between Coke and Pepsi, he expresses a preference for the current Mead Johnson formula Enfamil Premium due to its higher DHA content –“though the research is not thoroughly established.” However, he states that the differences probably do not justify a much higher cost. For a generic brand, the Costco brand, “Kirkland Signature…are reasonable and less expensive, FDA-approved options.”
In addition, these chapters question whether infant organic formulas are truly organic (page 55), explain the issue of burping, and discuss the pragmatic advise regarding cleaning nipples/bottles; “kitchen clean” with soap and a washing with hot water should suffice and sterilization is not needed.
The most inciteful comments, in my opinion, are in chapter 5:
- Lactose-free formulas: “Mead Johnson pulled its product from the market because lactose sensitivity is rare, rare, rare in infants…Abbott, in a shrewd marketing move, renamed its formula, originally called Lactofree, to Similac Sensitive, and that labeling has convinced an enormous number of mothers that this formula makes a difference.” Similac Sensitive accounts for >10% of formula market. A similar product is Gerber (previously Nestle) Good Start Soothe.
- Elemental formulas: “cost as much as a monthly Porsche payment.” Monthly costs of each type of formula are detailed in Table 5.3. Routine cow’s milk based formula $149.88, soy-based $153.56, cow’s milk with rice starch $159.39, hydrolyzed (broken down protein) formula (e.g.. Alimentum, Nutramagen) $223.56, and elemental amino acid based $511.83.
- Among extensively hydrolyzed formulas, Dr. Cohen indicates a preference for Alimentum (from Abbott) over its competitors due to better acceptance by infants.
- The rationale for not switching from contracted WIC products is explained. When changing from a contracted product to a non-contract product, the costs are much greater and among the same type of formula there is not a scientific rationale.
- Reasons why goat’s milk are not a good choice and “dangerous” for infants are detailed. “The protein content is over three times higher than cow’s milk…additionally, goat’s milk is deficient in folate and vitamin B6.”
As noted above, the book covers a variety of pediatric gastroenterology problems in the newborn. As part of the chapter on undernutrition, additives to increase calories are detailed (pg 136). For example, a tablespoon of polycose adds 23 cal, a tablespoon of rice cereal 15 cal, and a tablespoon of vegetable oil 124 cal.
The last few chapters provide ample advice on transitioning to solid foods, reviews nutrients and mineral oils. In addition, he provides growth charts (for full term, premature infants, and infants with Down syndrome) as well as tables on infant formula contents.
Take-home message: this is a terrific resource for parents to help understand the what, why and when of feeding their infant. At the same time, the book provides advice on the most common pediatric gastroenterology problems of infancy like reflux, colic, stooling difficulties, allergies, and poor weight gain.
Book’s website and how to purchase:
To purchase the book:
Other favorable reviews (http://what2feedyourbaby.com/reviews/) have come from influential pediatricians like Jay Berkelhammer and pediatric gastroenterologists like Jeff Hyams and Allan Walker.
“In this book, Dr. Stanley Cohen, a pediatric gastroenterologist and nutritionist with longstanding interest in infant nutrition, provides a practical and pragmatic approach to a major concern for new mothers, namely What to Feed Your Baby. ”
— Allan Walker, M.D., director, Division of Nutrition, Conrad Taff professor of pediatrics and nutrition, Harvard Medical School
Related blog entries: