When was formula made

More specifically, the foundation works to identify critical gaps in current breastfeeding protocols, guidelines and education programs. Families and health professionals are provided with the most up-to-date scientific research, education and resources to practice safe infant feeding with breast milk, formula or a combination of both. For quite some time, parents were left without an organic baby formula option. Liebig's formula—consisting of cow's milk, wheat and malt flour, and potassium bicarbonate—was considered the perfect infant food.

Mead Johnson introduced first soy-based formula, Sobee. This set maximum and minimum standards for many nutrients in formulas and mandated testing and manufacturing standards. The formula industry was accused of interfering with breast-feeding in lesser industrialized countries by its aggressive marketing of infant formulas Joseph , McComas Likely in response to this new climate, the infant formula manufacturers increased their efforts to promote breast-feeding. The change from breast- or formula feeding to feeding of cow's milk occurred at progressively later ages.

The women, infants and children WIC program included a larger and larger percentage of infants from low income families and contributed to increased breast-feeding and use of iron-fortified formulas in this group. The American Academy of Pediatrics AAP Committee on Nutrition provided guidance to the Food and Drug Administration FDA on the nutrient content of infant formulas and issued policy statements on infant feeding, including one that contributed to the later introduction of cow's milk.

Federal regulations on infant formulas included the Infant Formula Act of and a new regulation in on nutrient content of infant formulas. Just as new regulations had been developed after the outbreak of vitamin B-6 deficiency in formula-fed infants in the early s, the occurrence of chloride deficiency in formula-fed infants in the s Fomon resulted in new regulations regarding infant formulas.

In , the Committee on Nutrition revised and extended its recommendations regarding nutrient content of infant formulas Committee on Nutrition a. An amendment PL to the Food, Drug and Cosmetic Act, referred to as the Infant Formula Act of , gave the FDA authority to establish quality-control procedures for infant formula manufacturing, to establish recall procedures, to establish and subsequently to revise, if necessary, nutrient levels and to regulate labeling.

The final rule, published 2 years later FDA , specified minimum concentrations of 29 nutrients and maximum concentrations of 9 of these nutrients.

In , an Expert Panel made recommendations for revision of the Code of Federal Regulations CFR as it applied to the nutrient content of infant formulas Raiton et al. This Expert Panel suggested a number of revisions of the upper and lower limits for nutrients already specified in the CFR, recommended an upper limit for potential renal solute load, a change in the assessment of protein quality and the addition of upper limits for most nutrients.

As the 20th century ended, the FDA had taken no action on these recommendations. Included were pregnant and lactating women, other women during the first 6 mo postpartum, and infants and children to age 4 y later, to age 5 y. By the end of , WIC was in operation in all but a few states, and in it was established as a permanent national health and nutrition program. The program served only a modest fraction of infants in , infants , but the number increased to 0.

From the beginning, the food package for formula-fed infants included iron-fortified infant formula and iron-fortified cereal. By the late s, the WIC program exerted a major influence on improvements in infant feeding. The trend toward increased breast-feeding beginning in was associated with a decrease in formula feeding of infants during the first 2 or 3 mo of life; however, there was a concurrent deferment in the age of introduction of cow's milk and the percentage of infants fed formulas after 4 mo of age increased.

Formula-fed infants including infants also breast-fed as a percentage of all infants in , , and Until the s, only Wyeth Laboratories marketed a whey-predominant, milk-based formula in the United States. Whey-predominant formulas were introduced by other companies in the s and s and by the mid s, nearly all milk-based formulas contained added whey proteins. From the time of introduction of isolated soy protein—based formulas in the mids until the end of the 20th century, these formulas were much more widely used in the United States than in most other countries.

More recent data are not available. The speculation that generous intakes of isoflavones from soy-based products might exert adverse effects on infant development Setchell et al. Iron deficiency in infancy in the United States has always been most prevalent among infants in low income families, presumably at least in part because these infants are inclined to be of lower birth weight and therefore, as a group, begin life with lower iron stores than infants from higher income families.

In the s and s, as already mentioned, most infants were fed cow's milk beginning at 4—6 mo of age and this practice extended into the early s. Although national survey data for infants are not available, three surveys of to mo-old children conducted between and Owen et al.

I concluded in Fomon b and still believe it most likely that the origin of the iron deficiency in these children was during y 1 of life, when absorption of dietary iron was insufficient to meet the infant's needs. Figure 9 presents data on the percentage of formula-fed infants receiving iron-fortified formulas at various ages in , and I have been unsuccessful in obtaining data for or , but there is little question that the percentage of infants fed iron-fortified formulas was quite high in the last few years of the 20th century.

Much of the increase in number of infants fed iron-fortified formulas from to can be accounted for by the increased enrollment in WIC, because it is evident that many of these infants would otherwise have been fed cow's milk.

In , the Committee on Nutrition published a forthright recommendation that all nonbreast-fed infants be fed iron-fortified formulas until 12 mo of age, and this statement probably exerted a major influence on pediatricians caring for infants not enrolled in WIC.

Infants fed iron-fortified formulas as percentage of formula-fed infants in , and Data for and based on personal communication from Martinez, G. Beginning about , use of concentrated liquid formulas declined, whereas use of powdered and ready-to-feed formulas increased Fig. By the early s, the physical properties of formula powders had been improved to the extent that they were much more readily suspended in water. The increased use of powdered formulas after coincided with the increase in breast-feeding.

Powdered formulas are commonly used to make up an occasional formula feeding for breast-fed infants and many mothers may have continued to use powdered formulas after cessation of breast-feeding. The trend away from early introduction of cow's milk was steady and impressive from through Fig. As already mentioned, the resurgence of breast-feeding that began in was associated with deferment of the age of introduction of cow's milk.

Initially, it seemed that the change was probably more related to inclinations of parents rather than a reflection of recommendations by pediatricians. My speculation is that a mother who elected to breast-feed her infant initially was convinced that it would be better to feed formula than cow's milk when she discontinued breast-feeding. The explosion of information about components of human milk and about the many probable nutritional and nonnutritional benefits of breast-feeding accelerated in the s.

As summarized elsewhere Fomon et al. Moreover, as already mentioned, the iron of infant cereals was believed to be able to meet the infant's needs. Thus, it was generally recommended Committee on Nutrition b , Fomon et al. Although one might have inferred from several reports Berenberg et al. In the s and early s, a number of physicians recommended the feeding of skim milk to infants beginning at 4—6 mo of age, presumably motivated by the desire to treat real or imagined obesity or to prevent development of obesity or atherosclerosis Fomon We carried out a study Fomon et al.

Most impressive was the loss of skinfold thickness, suggesting that the infants were using body fat stores to make up for the energy deficit of the diet. We speculated that persistence with such a diet was likely to be seriously detrimental to the infants. The Maternal and Child Health Service distributed reprints of our report widely to child health clinics but whether this had any effect on the practice is difficult to determine.

In any case, with the increase in breast-feeding and associated changes in attitude toward infant feeding in the s, the practice of feeding milk with decreased fat content became uncommon. In , we found evidence that fresh pasteurized cow's milk provoked blood loss in apparently normal infants Fomon et al. Actually, provocation of gastrointestinal blood loss may not be as important in the development of iron deficiency in infants fed fresh cow's milk as is the presence in cow's milk of large amounts of bovine proteins and calcium, which are known to be potent inhibitors of nonheme iron absorption Cook et al.

As early as , a question had been raised about the bioavailability of electrolytic iron powder of intermediate particle size Elwood et al. In the early s, most infants in the United States were fed beikost by 6 wk of age Brown and Hughes , Fomon , Jerome et al. The increase in breast-feeding during the s and early s in the United States was accompanied by a somewhat later introduction of beikost.

Beikost was introduced into the diet later for breast-fed than for formula-fed infants Fomon , Sarrett et al. Infant cereal is generally the first beikost item offered to infants, and the age at which it is introduced is therefore an indication of the age of introduction of beikost. Changes in the age of introduction of cereal from to are shown in Figure 10 , which is based on a survey carried out from to Sarrett et al.

The unpublished data also include age of introduction of cereal in , and these values are remarkably similar to those for Thus, by the end of the century, fewer infants were being fed beikost at 1—2 mo of age than had been the case in the mid s, but even at the end of the century, most infants were being fed beikost before 4 mo of age. Age of introduction of infant cereal in , based on Sarrett et al. An unfortunate development in infant feeding in the last 20 y has been the increase in use of fruit juices.

Sales of juices increased from 9. As a source of nutrients, juices provide primarily simple carbohydrates. Because human milk and infant formulas are rich in ascorbic acid, feeding of fruit juices cannot be justified on the basis of their contribution of ascorbic acid. Adverse reactions to consumption of juices appear to be common Bock and regular consumption of juices by infants with erupted teeth may contribute to development of dental caries, a threat that is exaggerated because juices are marketed in bottles that accept a nipple assembly.

In , my colleagues and I speculated that early introduction of beikost might contribute to establishing habits of overeating Fomon et al. The argument may be summarized as follows: Among the more important goals of nutritional management during infancy is the establishment of sound eating habits, including the habit of eating in moderation.

Establishment of such habits may require that the infant be encouraged to discontinue eating at the earliest sign of willingness to do so. The infant's willingness to discontinue eating can be readily detected by an alert individual who is feeding the infant by breast or bottle and can also be readily detected during feeding by spoon, but only after the infant is able to sit with support and has fairly good control of head and neck muscles.

In the s and s, quite a number of reports were published on nutritional imprinting in rodents, and there was speculation that malnutrition per se, rather than the circumstances leading to and following it, might be the basis for subsequent cognitive impairment Fomon In the s and thereafter, an association was established between iron-deficiency anemia during the first few years of life and delayed cognitive development de Andraca et al.

Nevertheless, interest in later consequences of malnutrition and iron-deficiency anemia undoubtedly stimulated interest in the field of nutritional imprinting during early life.

During the last 20 y of the 20th century, there was lively debate about the possible advantages of adding to infant formulas various substances found in human milk because of their possible effects on various aspects of development.

Prominent among these debates have been the possibility that dietary intake of nucleotides might affect aspects of infant development Raiten et al. Recent advances in these areas are likely to serve as prologue to developments in infant nutrition and feeding in the 21st century. Abt , I. Abt-Garrison History of Pediatrics : — W. Saunders Philadelphia, PA. Google Scholar. Google Preview. Adams , S. Andelman , M. Anderson , T. Ballabriga , A. Rey , J. Weaning: Why, What, and When?

Bain , K. Pediatrics 2 : — Beal , V. Pediatrics 20 : — Berenberg , W. Pediatrics 44 : — Bock , S. Pediatrics 79 : — Bracken , F. Brennemann , J.

Brown , M. Infant and childhood feeding practices among low-income families in urban Hawaii. Fomon , S. Bruck , E. Butler , A. Colle , E. Pediatrics 22 : 5 — Committee on Nutrition, American Academy of Pediatrics Water requirement in relation to osmolar load as it applies to infant feeding.

Pediatrics 19 : — Pediatrics 29 : — Committee on Nutrition, American Academy of Pediatrics Prepared infant formulas and commercial formula services. Pediatrics 36 : — Committee on Nutrition, American Academy of Pediatrics Proposed changes in food and drug administration regulations concerning formula products and vitamin-mineral dietary supplements for infants.

Pediatrics 40 : — Pediatrics 47 : Committee on Nutrition, American Academy of Pediatrics a Commentary on breast-feeding and infant formulas, including proposed standards for formulas. Pediatrics 57 : — Pediatrics 58 : — Committee on Nutrition, American Academy of Pediatrics On the feeding of supplemental foods to infants.

Pediatrics 65 : — Pediatrics 89 : — Cook , J. Cooke , R. It was not until the s that commercial formulas began to slowly gain acceptance Figure 1 in the print edition, Adapted from Fomon SJ: Infant feeding in the 20th century: Formula and beikost. J Nutr ;S. In the decades that followed, a variety of new formulas came on the market.

Nutramigen, introduced in , was the first protein hydrolysate infant formula. Ross Laboratories' Similac concentrate became available in , and Mead Johnson's Enfamil for "infant milk" was introduced in In that year, Ross first marketed Similac with iron.

Iron-fortified formula was poorly accepted initially because of the widespread belief that iron fortification caused gastrointestinal disturbances such as diarrhea and constipation. During the s, commercial formulas grew in popularity, and by the mids they had all but replaced evaporated milk formulas as the "standard" for infant nutrition. A major factor in the acceptance of commercial formulas was their use in hospitals to feed newborn infants during the s and s.

To encourage acceptance, formula companies began to provide inexpensive or free formula to hospitals in ready-to-feed bottles, enabling the phasing out of hospital formula preparation rooms. Mothers who witnessed how well their newborns accepted these easily prepared formulas were often convinced to continue this practice at home. Moreover, although pediatricians did not dissuade mothers from nursing, it was not strongly encouraged, as it is today.

The American Academy of Pediatrics Committee on Nutrition first made recommendations for vitamins and mineral levels for infant formulas in These recommendations have been revised periodically. In , the committee endorsed iron fortification of infant formula; in the years that followed, the incidence of iron deficiency anemia dropped strikingly. In and , cases of hypochloremic metabolic alkalosis in infants, resulting from consumption of two soy formulas, Neo-Mull-Soy and Cho Free produced by Syntex, Inc.

This prompted the passage of the Infant Formula Act of , which set maximum and minimum standards for many nutrients in formulas and mandated testing and manufacturing standards as well. Perhaps the greatest achievement of nutrition research over the past several decades has been the introduction of specialty formulas and human milk modifiers used to feed premature and very low-birthweight infants. For term and near-term infants, formula manufacturers have continued to improve their "standard" formulas to more closely resemble breast milk.

Both Mead Johnson's and Ross's formulas contain added nucleotides in amounts similar to those in breast milk, and this year both companies have introduced formulas that contain long-chain polyunsaturated fatty acids. Over the past few years, these two companies also have begun marketing "niche" formulas, including lactose-free formulas both companies , a soy formula with dietary fiber to hasten recovery from gastroenteritis Ross , and a formula with rice starch for babies with reflux Mead Johnson.

Today's young infants are the beneficiaries of a long and complicated history of infant formula. While we continue to encourage mothers to breastfeed their infants, babies who are fed formula from birth or are weaned to formula from breast milk receive the best nutrition medical science has to offer. The author thanks Virginia A. Mason for her assistance in preparing the manuscript of this article. Philadelphia, BC Decker, Madison, Wis. Marriot WM, Schoenthal L: An experimental study of the use of unsweetened evaporated milk for the preparation of infant feeding formulas.

Arch Pediatr ; American Academy of Pediatrics, Committee on Nutrition: Proposed changes in food and drug administration regulations concerning formula products and vitamin-mineral dietary supplements for infants. Pediatrics ; Answer: b. Answer: c. According to the Ross Mothers' Survey, Answer: a. Powder is the most economical formula preparation.

Infants with diarrhea are often given Pedialyte Ross before they resume regular formula. A little bit of digging revealed there were a whole bunch of makeshift alternatives to breastmilk, before formula and bottles arrived on the scene. Some of them make lots of sense, while others point to a time when people were much less fortunate than we are.

Let me take you through a few …. Wet nursing was undertaken as early as BC and continued right through to the 20th century and perhaps beyond, as some news stories and YouTube videos can attest!

This was a widely used alternative to breastfeeding because women sadly often died in childbirth or could not breastfeed due to health reasons. In some parts of society, breastfeeding was not the done thing. This meant wet nursing was very common in well-to-do families who often used servants or — sadly — slaves to breastfeed their babies. Again, babies would drink animal milk from the hollow horn.

Sometimes carved wooden vessels were crafted and used to feed babies even more of that milk from the local beasts. Others were fed cereal cooked in bone broth.