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The calorie, protein, mineral, and vitamin needs of the infant are very high in proportion to his body size. The infant under 6 months requires 115 kcal per kg (50 to 55 kcal per lb) and for the remainder of the first year 105 kcal per kg (48 kcal per lb). At these caloric levels the relatively high protein and calcium needs are met by the formula.

To take care of the rapid rate of growth and the expanding blood circulation the infant’s iron allowance is 10 mg up to 6 months of age, and 15 mg for the second half of the first year. Particular attention is also called to the need for 35 mg ascorbic acid since this is not always supplied by the formula.

Human and cow’s milk compared

There are many important differences in the composition of human and cow’s milk. Cow’s milk contains almost three times as much protein, more than three times as much calcium and over six times as much phosphorus. Most of the protein in cow’s milk is casein, while that in human milk is, for the most part, lactalbumin. Cow’s milk furnishes slightly less fat and lactose. Ounce for ounce, both milks supply about 20 kcal.

Proprietary pre-modified milk formulas comprise about 90 per cent of all formulas used in infant feeding. These formulas have been developed to resemble the composition of human milk. Cow’s milk is the usual base for these formulas, but it has been modified in some or all of the following ways: to lower the protein and calcium concentration; to increase the lactose content; to substitute vegetable oil for butterfat, thus furnishing a higher intake of linoleic acid and minimizing the spitting up associated with the butyric acid of butterfat; to adjust the mineral and vitamin levels to meet recommended allowances; and to heat denature the protein so that a soft, flocculent curd results.

Pre-modified formulas are available (1) as single strength, ready to feed, in quart cans or in 4 oz or 8 oz disposable nursing bottles, (2) as concentrated liquid which is measured into sterilized bottles and diluted with boiled water, and (3) as powdered formula, now seldom used.

Special formulas are also available for therapeutic purposes. For infants who are allergic to milk, nutritionally adequate formulas of soybean or meat base are substituted. Enzyme deficiency such as galactosemia or lactose intolerance requires meat base or amino acid formulas. A low-phenylalanine formula (Lofenalac) is used for phenylketonuria, an inborn error of metabolism.

Home-prepared formulas are made with fresh whole milk or evaporated milk. To make such formulas comparable to human milk, these changes are required: (1) the milk is diluted with water; (2) cane sugar, corn syrup, or dextrimaltose is added to increase the carbohydrate level; and (3) the formulas are heated to reduce the size of the protein curd and to assure safety from bacterial contamination. Each formula must be calculated to meet the individual infant’s needs. Although these formulas may be slightly less expensive than proprietary formulas, their preparation entails precautions in sanitation that may not be adequately observed by mothers who lack education.

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GENERAL HEALTH