Both the World Health Organisation and the Australian National Health and Medical Research Council (NHMRC) recommends that infants be exclusively breastfed for the first 6 months of life.1,2 Contemporary Australian data reveals that whilst breastfeeding initiation rates are high, at around 96%, by 6 months of age only about 63% of infants are still being breastfed.3-5 The NHMRC infant feeding guidelines and Australian Medical Association (AMA) Infant Feeding Position statement also makes it clear that when infants are not breastfed, infant formula is the only suitable and safe alternative.2, 3 Moreover, these bodies also state that if infant formula is needed health workers should respect a mother’s informed decision not to breastfeed and should be able to educate and support parents about formula feeding. Parents seeking to bottle feed their infants should receive appropriate support and guidance around formula feeding, including volume, frequency of feeds, feeding cues and sterilisation and preparation of formula.3
In Australia, the composition of infant formula is strictly controlled by Food Standards Australia and New Zealand (FSANZ). This statutory authority provides data on the minimum and/or maximum amounts of macronutrients as well as vitamins, minerals and other ingredients that must be found in infant formula. For example, FSANZ Standard 2.9.1 states that an infant formula must have a protein content of no less than 0.45g/100kJ and no more than 0.70g/100kJ. While these requirements allow infant formula manufacturers some latitude in designing their own individual product they also ensure that such formulas meet the nutritional needs of infants.
Any additional ingredients requested by infant formula manufacturers are considered and reviewed by FSANZ and through this mechanism, new ingredients have been allowed over recent years, such as lutein, L-histidine and most recently in 2021 two human milk oligosaccharides, 2’ -FL and LNnT.
There are a huge array of cow’s milk-based infant formulas available in Australia, as well as non-cow’s milk-based formulas, for example, that use goat’s milk or soy and there are also formulas based on organic milk. So-called specialty formulas also exist some of which require medical prescription. These include, for example, formulas designed to be potentially beneficial in infants with reflux, or formulas that are lactose-free, or hypoallergenic formulas.
Mothers who had intended to breastfeed, but were unable to, may feel a sense of guilt or failure for adopting formula feeds. With so many choices and options, parents can easily become confused and so it is important to remember that healthcare professionals working in this area, should promote breastfeeding first, but if infant formula is needed, as stated earlier, they should be able to provide appropriate reassurance about the efficacy of infant formula and educate and support parents about formula feeding.