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Changing partners: the dance of infant formula changes
F P Polack1, N Khan, M J Maisels
1Department of Pediatrics, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Insights
One in three infants experience formula changes, often for colic or regurgitation. While formula changes frequently resolve symptoms, they may lead to excessive use of nonstandard formulas and impact infant development.
Area of Science:
- Pediatrics
- Infant Nutrition
- Gastroenterology
Background:
- Formula changes are common in infants.
- Published estimates of formula intolerance vary.
- The frequency, reasons, and outcomes of formula changes require further investigation.
Purpose of the Study:
- To determine the frequency, reasons, and outcomes of formula changes in infants.
- To assess the impact of formula changes on infant health and parental perception.
Main Methods:
- A survey was conducted with 175 parents in pediatric outpatient clinics and private practices.
- Data collected included infant's initial formula, changes made, age at change, reasons, initiator, and outcomes.
- Infants ranged from 30 to 210 days old.
Main Results:
- 9% of infants started on nonstandard formulas; 36% were later switched to them.
- Colic and regurgitation were primary reasons for formula changes.
- 80% of infants showed symptom improvement or resolution after formula changes, with 4% later challenged with regular formula.
Conclusions:
- One in three infants experience formula changes, suggesting potential overuse of nonstandard formulas.
- While formula changes often improve symptoms, they may lead to unnecessary use of specialized formulas.
- Excessive formula changes can foster beliefs of infant abnormality and potentially impact development.
Abstract:
The purpose of the study was to establish the frequency of, reasons for, and outcome of formula changes in infants. In this survey, we interviewed a convenience sample of 100 parents in our pediatric outpatient clinic and 75 parents in private pediatric office practices regarding their baby's initial formula, changes in formula, age at change, reason for change, initiator of the change, and outcome. The infants were 30-210 days old. Sixteen of the 175 infants (9%) were started on nonstandard formulas at birth. Fifty-eight of the remaining 159 infants (36%) were changed from regular to nonstandard formulas. After using nonstandard formulas, only seven infants (4%) were ever challenged subsequently with regular formula and all did well. Colic and regurgitation were the main reasons for switching formulas. In 47% the decision to change the formula was made by the mother and in 44% by the pediatrician. Following the formula change, mothers reported improvement or complete resolution of symptoms in 80% of infants. Although published estimates of formula intolerance range from 2% to 7.5%, one in three infants experiences a formula change, suggesting that nonstandard formulas are used excessively by both mothers and physicians. Nevertheless, in the vast majority of cases, parents report that the changes result in improvement or resolution of symptoms. Thus, while this practice appears to be a simple and effective intervention, it produces a significant population of soy and other nonstandard formula-fed babies who should be drinking regular formulas. Such changes encourage a belief by parents that their infants are allergic or otherwise abnormal and could have a negative impact on subsequent child development.